When Crisis Strikes

ONE OF THE WORST FEELINGS for many of us is the sense of losing control. Whether you’re about to go under general anesthesia for surgery or you’ve rested your case and are awaiting the jury’s ruling, your situation has drastically changed and you no longer have any input, any control over the next steps your life will take. For most of us, this feeling is unsettling; for some of us (control freaks in particular), it can be terrifying. Whatever life crisis or parade of horrible things has led you to this book, the feeling of helplessness will likely insert itself into your story at some point.

A few years ago, my friend—a California girl to her core—moved to Indiana. We marveled at all of the “firsts” this move would require of her: tornado insurance, a ginormous winter heating bill, and everything that comes with snow, from hats, boots, gloves, and coats to scheduling time for shoveling the driveway every time she leaves the house. What she wasn’t prepared for was the first time she hit black ice on a major thoroughfare with her young child in the backseat. She described what it felt like the moment she lost control of her car: the change she felt in her hands as they gripped the steering wheel, the oddness of moving in a diagonal trajectory. Despite her attempts to prepare for hitting ice, nothing prepared her for the shock of instant, unanticipated loss of control, that moment when her son’s life was no longer in her hands as she slid across the road toward another car.

For my patient Abe, this instant shock of helplessness arrived in an envelope left under his car’s windshield wiper while he was at work. When he picked it up, he felt an oddly shaped object inside. When he opened the envelope, he found a note and his fiancée’s gorgeous engagement ring. Eight months prior, he had left his dream job to move with his fiancée across the country so she could attend graduate school. He left his friends, his social and business networks, his neighborhood. The job he found wasn’t particularly fulfilling, but he was happy because it paid the bills and would pay for his dream bride’s dream wedding. He was so in love he optimistically sacrificed everything to create a life with his partner. He paid the hefty nonrefundable deposit for their wedding venue. He paid for the wedding dress hanging in the hall closet he was forbidden to open. He bought the decorative pillows for their couch, the special pot she wanted for cooking, the floral sheets he didn’t really like but she loved, the candlesticks for their table. He created a home with his fiancée. And now, on a Wednesday evening after work, he stood next to his car holding the ring he worked so hard to afford, the ring he went to a dozen shops to find, the ring of his partner’s dreams, and a note saying she had left that day and was transferring to another university out of state. In his hand, he held the end of their relationship. There was no fight, no discussion, no warning Abe had seen. In a moment, the life he knew, the life he had curated and cherished with his fiancée, ceased to exist. His hands were on the steering wheel, he was navigating his way peacefully, when suddenly Abe hit black ice. His opinion didn’t matter. His love didn’t matter. His actions wouldn’t matter. Her decision was out of his control, and he found himself suddenly veering in an unanticipated direction.

Scientific (but Interesting, I Promise) Theories About Control

Curiously, control doesn’t actually mean the same thing to everyone, but people tend to fall under one of two main worldviews: what we call an external locus of control or an internal locus of control. (Here we go with unnecessary medical Latin again: locus means “location.” Basically this means, do you believe control of your life resides outside of yourself or within yourself?) It’s really more like a personality continuum rather than a strict one or the other, but understanding how you view your problems will help you master Step Two.

Someone with an external locus of control tends to attribute outcomes to external circumstances. Several years ago, a couple I knew became pregnant. They repeatedly announced, “We’re in shock. We weren’t expecting this at all. This is definitely a miracle!” I happened to know that the wife had stopped her birth control months before and that despite saying they weren’t trying, they certainly (based on what she herself told me) weren’t doing anything to prevent pregnancy, so each time I heard them tell someone, “It’s a miracle!” I wanted to say, “Actually, it’s biology!” (I didn’t, by the way, because I’m only snarky in private with my best friend, but I really wanted to.) I had known this couple for years. I had heard the way each of them spoke about life events: meeting each other was “fate” (rather than his decision to walk over and talk to her), and not getting a highly competitive promotion was “discrimination” (rather than a result of the tantrum she had thrown at work). And despite publicly fighting like two coyotes over the world’s last remaining raccoon baby, seemingly at constant war with one another, they said things like “Destiny brought us together” and “Even though marriage is totally miserable, we’re sooooo meant to be.” For each of them, the ultimate decider of life’s events was external.

Someone with an internal locus of control tends to experience a sense of responsibility over outcomes. My neighbor has an incredible garden. She grows avocadoes, lemons, kale, eggplant, green beans, squash, and an array of gorgeous flowers and succulents. When her remarkable garden was invaded by the neighborhood opossum family one night and its contents plundered, her response was, “I better figure out a better system for protecting the vegetables.” She never said, “My garden is doomed! Fate won’t allow tomatoes to survive here!” She owned the challenge of creating a garden that could thrive despite nightly visits from these destructive bandits, of maintaining a garden that was not only beautiful but also safe for her dogs (without traps or poison). She assumed that she had reasonable control over the outcome. She did her research and engineered new opossum-proof coverings for her planting beds.

Having an internal versus external locus of control isn’t about a right way or wrong way of looking at things. Where we are on the continuum is based on personality, mindset, and experiences. However, studies have identified correlations between someone’s locus of control and factors such as mood, anxiety, and level of optimism. Step Two—identifying the things you can control—will likely be more challenging for someone with a more external locus of control. We’ll coach you with lots of examples, but if you find you are an extreme externalizer, you may benefit from some professional guidance in the form of counseling to help you learn ways to identify what you can control. It just comes more naturally to some than to others. Do not despair.

As you now know, Step One (the thumb of the hand, so to speak) involves getting a grip on your circumstances. It challenges you to stop self-medicating or escaping with alcohol or video games and to reach beyond simply acknowledging what your situation is, to identify what your life crisis is triggering from deep within you. It is the process of unearthing the past experiences that may in some way be amplifying your body’s physical and emotional response to your current situation. Step Two (the pointer finger) involves pinpointing what you can control.

Step Two explores three questions about your crisis:

1. What can’t I control?

2. What can I control?

3. What can I do about the things I can’t control?

In a moment of crisis, our brains are wired to focus only on the crisis. Think back to “The Science of Stress” chapter’s explanation of fight-or-flight: when suddenly faced with a bear, your entire system is focused on the split-second mechanisms of survival—blood pressure, oxygen delivery, muscle tension, reaction time. Your mind isn’t about to start an internal debate over whether you should select tennis shoes for running or steel-toed boots for kicking. It is this telescopic focus on imminent danger that keeps us alive. Since humans are wired for acute, not chronic, crisis, taking a step back to evaluate the situation often doesn’t come instinctively. Our brains are wired to be pulled to—and focused on—the threat. It is how we survive an acute crisis. We have to mentally override this system during times of chronic crisis, which takes some effort.

There’s another reason why exploring what we can control is often difficult under pressure. It has to do with attitude and outlook, which are often molded by our social circles and communities, and even our shared culture. Think about the different television sitcoms you may have loved over the years: Seinfeld, Friends, The Big Bang Theory, Schitt’s Creek. Every popular situation comedy shares a few common denominators: comedic timing, cast chemistry, and, oftentimes, sarcasm. Sarcasm is literally the backbone of much of our comedic entertainment. It’s why we love Elaine Benes, Chandler Bing, Sheldon Cooper, and David Rose. Alanis Morissette’s song “Ironic” is iconic because it hits that sarcastic button perfectly. Who hasn’t had a black fly in her chardonnay? In a sense, that song unites us in the shared experiences of life’s little miseries—ironically (pun intended), within the context of a catchy tune. (If you’re my age, I know you’re singing it in your head now.) It’s a song that celebrates catastrophe, and we loved it enough that it was nominated for two Grammy Awards and two MTV Video Music Awards. In a crisis, however, sarcasm can take on another life-form, morphing from twisted humor to perceived reality, resulting in pessimistic thinking. And too much pessimistic thinking can pull a vulnerable mind (we’re already focused on the crisis, right?) farther into the abyss. This also makes identifying what we can control more challenging, so it may be easiest if we start at the point of least resistance: identifying what we can’t control. These things are just more likely to be lurking at the surface of your consciousness than the things you can control. Plus, humans tend to want to complain before moving to problem-solving (no judgment, friends), so let’s just start here. We’ll use Nina as our example.

What Can’t Nina Control?

In Step One, you learned about Nina’s predicament. On the surface, there’s not much Nina can control about her situation. Already vulnerable from her own health problems, issues in her marriage, and the juggling of the joys and frustrations of raising teenagers, she’s now crushed by her father’s terminal cancer diagnosis. Digging deeper (in Step One), we found Nina has always relied on her father for emotional (and sometimes financial) support, to an extent that a somewhat codependent relationship evolved. She’s now swimming in the cauldron of her own life’s problems, suddenly faced with an enormous loss with meanings on so many levels beyond what an outsider would see and the task of figuring out how to take care of her father while living with her husband and teenagers in another city.

The first question Nina needs to consider is, what can’t I control in this situation?

WHAT NINA CAN’T CONTROL:

• Her own health issues

• Her husband’s “escaping into work”

• Teenagers

• Dad’s cancer diagnoses, prognosis, course, or outcome

• Where she lives

• The future—how she’ll cope down the line without her dad 4

• Dad’s diagnosis triggering her own worries about her future health and aging, questions about whether she will inherit this cancer.

What Can Nina Control in This Situation?

Sometimes what you can or can’t control is obvious. But it really pays to do a deeper dive here, past the obvious. It’s helpful to grab a pen and notebook for this step and to write down all the things you can control, even if you’re just going to throw the list away. It takes a lot of positive reinforcement to override a single negative event, and writing helps cement ideas into our brains. The purpose is to turn down the volume of—and eventually override—the internal alarm coursing through your veins by training your mind to look beyond the surface of the crisis. We’re challenging that feeling of helplessness to a duel.

Nina can’t control the cancer, but she can control her communication with her dad and his doctors. She can have her dad sign consent forms so she can communicate with his treatment team directly to help facilitate appointments and understand treatment options. She can open a dialog with her dad regarding his questions, his worries, and what he thinks about his situation. She can ask about his wishes and encourage him to make advanced health directives so his wishes can be followed even if he becomes unable to express them later. It isn’t easy, but now is the time to discuss end-of-life issues. Does he want to be in his own home with in-home care? Does his insurance cover this? Will he need to be in a care home? Will he benefit from hospice care? Can any of those things be done in Nina’s city? Nina can encourage her dad to make his own end-of-life decisions ahead of time so that when he is so ill he can’t contribute to medical discussions, she can rest assured she’s making decisions that would make him comfortable. If Nina’s dad is in a panic and doesn’t want to talk about any of it, Nina has done her part in bringing it up and can bring it up from time to time with help from his doctors and nurses. If he refuses to discuss any of these decisions, then his lack of a decision is his decision, and it is out of Nina’s hands, onto the list of things not within her control. But initiating communication is.

This is the time for Nina to call a family meeting. It’s an opportunity to talk to the kids about what is going on with their grandfather and what she’s going through (and what one day they, too, may face) and to try to bring the family together as a team. Nina can talk about having to travel to help with her dad’s care, about her stress and sorrow, and she can ask for support. This is a time when the family will be tested a little, and they’ll manage best if each of them can be flexible and contribute to the running of the household. Nina can ask her teens what they’re willing to do to help the family. Will one of them cook a few meals? Will they do their own laundry? Take out the trash? Feed the dog?

This is also a good time for Nina to talk to her husband about his tendency to escape into work and to ask him whether he’s willing to cut back to take care of the family. It’s also a time to identify the nonnegotiables that must be done and what can be put on hold for a while. Now isn’t the time to let the contractor start the renovation, no matter how prepared he says he is to finish the project or how smoothly he thinks it is going to go. Nina (and her family, by extension) will be faced with things she can’t even anticipate at this moment, so she needs to be kind to herself and put the nonessentials on hold, without feeling guilty about it.

Nina can take control of her schedule. (An old-fashioned paper calendar or weekly planner can be really helpful here, but so can a shared family digital calendar.) She can write out her teens’ weekly schedules and reach out to the parents of their friends and ask for help driving them to school, sports, and other activities. She can ask friends or neighbors to prepare a meal for the freezer so that as Nina comes and goes the family has some home-cooked food. She can meet with her human resources department at work and discuss the policy for emergency leave (under the Family and Medical Leave Act, or FMLA, in the United States). How much paid time off does she have? Can she use sick days? Would the company allow other employees to donate their sick days?

Nina has control of her body. She is in control of her sleep schedule (prioritizing eight or nine hours every night) and her quality of sleep. Stress impinges on sleep, but by cutting out any caffeine ten hours before her bedtime, sticking with her sleep/wake schedule every day of the week (10 P.M. to 7 A.M., for example), and not exercising, eating, or drinking late at night, she is making healthy decisions that will maximize her sleep quality.

She is also in control of her fuel—what she eats. Fast food and junk food often provide some sort of momentary comfort, but they can lead to mood swings and energy crashes. I practice in Southern California, where the streets are inundated with high-end performance cars, so I sometimes ask a patient, “What goes into the gas tank of a Porsche?” The answer is always the same: high-octane fuel. The car won’t function well if you put sludge into the tank. Why would a human be different? Fuel matters. With a little planning, Nina can ensure that she has access to healthy fuel during her crisis. She can stock up on nuts, fruits, and vegetables, and she can schedule a little time for advanced cooking. One hour on a quiet Sunday afternoon will give her a dozen servings of a hearty and healthy vegetable chicken soup to freeze and use in the coming weeks ahead. She can also cut down on alcohol.

LET’S HAVE A BRIEF DISCUSSION ABOUT WHY ALCOHOL IS A FAKE FRIEND

Some people turn to alcohol to relax, but alcohol is actually a “frenemy” of a life crisis. In the moment it can calm you down, but it can also disinhibit you. Someone with a happy demeanor is typically more happy with alcohol, but someone who is angry or irritable can become more so. Even when alcohol has a calming effect, it doesn’t last long. Alcohol is a central nervous system depressant. As the body metabolizes it, it has the opposite effect, and the nervous system becomes more stimulated. The effect tends to be proportional to the amount consumed, but even small amounts of alcohol to unwind can lead to a delayed stimulation of the central nervous system, resulting in restless sleep, waking during the night, and exaggerated anxiety responses the following day.

Nina can also control her access to fresh air and exercise. As stressed as she is, she can take two or three minutes to step outside, listen to the air blowing through the trees, and feel the sunshine on her skin. Or maybe she’ll smell rain and feel the crispness of the air or be wrapped in humidity. It is important to regularly take a few minutes and just be in the moment, focusing thoughts only on the sensations present, with worries intentionally put aside for a few minutes.

Nina can also choose movement over stagnation. As busy as she is, she can take the stairs, park far away, and walk a little more, or make a habit of going for a fifteen-minute walk as soon as she arrives home from work or while running errands at the mall. Exercise—and brief is better than none—is one of the best nonpharmaceutical treatments for stress, depression, impaired sleep, and poor focus. Even when it feels impossible to fit it in, adding a fifteen-minute walk sometime during the day is almost always possible.

Most importantly, Nina can control her thoughts. During times when nothing in life seems to be in control, the one thing we can always control is what and how we are thinking. It’s beautifully powerful. Let’s step away from Nina for a minute to discuss.

Thoughts, Flexibility, and Attitude

Our thoughts and feelings seem to be coupled by some sort of subconscious pinky-swear to always stick together. The human brain looks for external justification for the internal emotional state. Humans are wired for consistency, and our brains don’t like discrepancies. Studies show that people with depressed brains tend to slide into pessimistic outlooks, resulting in a perceived balance between the outside and inside environments. In other words, when we’re sad we prefer cloudy skies, so we feel the universe is gloomy, too. Sunny days often make depression worse because we feel disconnected from the surrounding environment. The psychological term for this is positivity-negativity bias. It is the brain’s tendency to enhance things that are positive in the environment (optimistic thinking) or magnify the negative.

Understanding this helps us take a step back. If my life situation has left me feeling angry, depressed, anxious, or helpless, what are my thoughts like? It’s important to pay attention to your running commentary of thoughts. Is the tone negative? Sarcastic? Angry? Resentful? What is your imagination conjuring up? My patient Ellen said this:

I was driving into the office today for our appointment, and a car cut in front of me. Nothing happened, but in my mind I started imagining he hit me, and for twenty minutes, I drove along like a zombie, lost in my imagining of all sorts of horrible outcomes—needing an ambulance, being in pain, having my car towed—and the consequences of those outcomes—being on crutches, not having a car to drive to work and school, the financial burdens it would cause. I literally spent the entire drive thinking of one horrible scenario after another. It was strange to arrive here and find myself... myself. Why do I do that? It feels awful.

Ellen’s stressed brain was looking for external reasons to be stressed. When it couldn’t find any on the gloriously sunny morning, it decided to create something, which magnified the intensity of her stressed emotional state further. Ellen’s brain felt justified, but the price she paid wasn’t worth it.

It is uncomfortable to challenge a thought pattern that is congruent with one’s internal emotional state. The brain doesn’t like the discrepancy. But changing what you think is an important step in changing how you feel. Now that Ellen has started recognizing and paying attention to the content of her imagination, she can choose whether she wishes to continue with a fantasy or cut it off, put on some music, roll down the window, and feel the sunshine and breeze on her skin as she drives.

One option is to create a mantra or a motto. A friend of mine encountered several threats at once—he lost his job, the unhealthy aspects of his long-term relationship were surfacing, and he and his boyfriend were going to have to move out of their home. He was faced with the possible loss of everything familiar, so I encouraged him to pick a “word of the year” to help shape his outlook. He texted a few ideas: hope, strength, patience, faith. “FAITH!!!!!” was my reply with that many exclamation points, followed by a series of GIFs of George Michael wiggling his bottom and the YouTube link to his “Faith” video. His word of the year came with its own built-in theme song. What could be more perfect? When he felt himself sliding into pessimism, he could choose to pull up the song on his phone, crank up the volume, and dance around his bedroom. If it sounds ridiculous, good. Ridiculous can teach the brain an important lesson: I can override that negativity bias you’re throwing at me with a little wiggle of my (or George Michael’s) bottom.

Another patient of mine came in for her first appointment and stated, “I can’t sleep. It’s the worst thing. I haven’t slept for years, and no one can help me.” Well, that’s not a loaded sentence, is it? She has just declared her belief that she is untreatable. Since mindset plays such a big role in life, if she believes it, she will own it and run with it. Thoughts like that can become a person’s identity. The truth is, every living thing (that I know of, anyway) sleeps. Birds, fish, bears, and baby goats are just like humans: we all sleep. Sleep may be disrupted, interrupted, or of poor quality due to external or internal circumstances (screaming babies, sleep apnea, etc.), but sleep happens. Unless this patient changes her mindset, even after sleeping a few hours, she will continue to feel the same emotional pain. The internal dialog needs to be updated. “Eventually, I’m going to sleep. Not sleeping isn’t the worst thing; it will just make me tired, and no one ever died of being tired.”

If you aren’t a “motto” kind of person, it can also help you to focus on the big picture. You may be suffering through a divorce that would top the list of the world’s most contentious divorces, but the heaviness can start lifting every time you remind yourself you’re willing to pay the price required to separate from the person who has so mistreated you. You can change your mindset from victim to master of your own fate. You can’t control your ex in a divorce, but you can focus on how glad you are that this person is no longer in your bed. You control the content of your thoughts and your attitude.

Back to Nina. Let’s summarize what she can control.

WHAT NINA CAN CONTROL

• Communication with her dad and his treatment team

• Encouragement of advanced health directives

• The simplification and organization of her schedule

• Reaching out to friends and neighbors for help

• Organizing ahead of time to make last-minute trips easier

• Talk to the human resources department at work about options for leave

• Her sleep schedule

• What she eats

• Whether she makes time for exercise, fresh air, and meditation

• Her thoughts, attitude, and flexibility

What Can I Do About the Things I Can’t Control?

The final component of Step Two involves asking this question: what can I do about the things I can’t control? The purpose of this component is to start chipping away at that pesky feeling of helplessness that sometimes creeps up. If I can’t control it, what are my options here? If you’re struggling to get started, ask a good friend to brainstorm with you. Some of her ideas may work and some may irritate you, but it’s a starting point to get your creative juices flowing at a time when your creativity may be hibernating. It’s like cowriting a book with a Norwegian. When I get stuck, I call or text him. He doesn’t have all the answers, but his brain works differently enough to get me out of my rut and help me start thinking with a fresh perspective. It’s sometimes helpful to have some input from someone who isn’t “in” your life crisis. It isn’t about having someone tell you what you should do; it’s about inviting a different perspective and possibly looking at your options from a new angle.

Earlier, we outlined the things that Nina can’t control in her situation, including her own health issues and her dad’s prognosis. What can she do about them? While Nina can’t change the course of some of her chronic health issues, she can certainly have regular appointments with her doctor and actually follow the medical advice she’s given. (That sounds so simple, but how many of us delay going in for bloodwork, getting a prostate exam, a colonoscopy, a mammogram, etc.?) She can ask her doctor whether her dad’s cancer tends to be hereditary and whether there are steps she can start taking now to improve her health. She certainly can’t control her teenagers, but she can open lines of communication with them and with her spouse, too, and she can encourage everyone to “hit the reset button” together moving forward. She can go to a grief support group or even a see a therapist to address the deeply rooted fears her father’s illness is unearthing. She can talk to the social worker at the hospital and inquire about resources, hospice care, and what his insurance will cover. Addressing each of these options chips away at Nina’s feelings of helplessness piece by piece.

As you start to think about your own Step Two and ask yourself the three questions, remember: this step involves pinpointing options, not committing to acting on them. You are not creating a ginormous to-do list. You are training your brain to step beyond reacting to your crisis. You are designing a measure of control over your circumstances, boldly challenging that sense of helplessness that creeps in. Inventing options. My favorite synonym for option is possibility. What is possible for you?