Upheaval

CHAPTER 1

PERSONAL CRISES

A personal crisis—Trajectories—Dealing with crises—Factors related to outcomes—National crises

At the age of 21, I experienced the most severe crisis of my professional life. I had grown up in Boston as the oldest child of educated parents, my father a Harvard professor and my mother a linguist and pianist and teacher, who encouraged my love of learning. I attended a great secondary school (Roxbury Latin School), then a great college (Harvard College). I thrived in school, did well in all of my courses, completed and published two laboratory research projects while still in college, and graduated at the top of my class. Influenced by the example of my physician father, and by my happy and successful experiences of undergraduate research, I decided to pursue a PhD in the laboratory science of physiology. For graduate study I moved in September 1958 to the University of Cambridge in England, at that time a world leader in physiology. Additional attractions of my moving to Cambridge included my first opportunities to live far from home, to travel in Europe, and to speak foreign languages, of which by then I had already learned six from books.

Graduate study in England soon proved far more difficult for me than had been my Roxbury Latin and Harvard courses, or even than my undergraduate research experience. My PhD mentor at Cambridge, whose laboratory and office I shared, was a great physiologist about to study electricity generation in electric eels. He wanted me to measure movements of charged particles (sodium and potassium ions) across the eels’ electricity-generating membranes. That required me to design the necessary equipment. But I had never been good with my hands. I hadn’t even been able to complete unassisted a high school assignment of building a simple radio. I certainly had no idea how to design a chamber to study eel membranes, no less to do anything remotely complicated involving electricity.

I had come to Cambridge highly recommended by my Harvard University research advisor. But it was now as obvious to me as it was to my Cambridge advisor that I was a disappointment to him. I was useless to him as a research collaborator. He transferred me to a separate lab of my own, where I could figure out a research project for myself.

In an effort to find a project better suited to my technological ineptitude, I latched onto the idea of studying sodium and water transport by the gallbladder, a simple sac-like organ. The required technology was elementary: just suspend a fluid-filled fish gallbladder every 10 minutes from an accurate scale, and weigh the water contained in the gallbladder. Even I could do that! The gallbladder itself isn’t so important, but it belongs to a class of tissues called epithelia that include much more important organs, such as the kidneys and intestines. At that time in 1959, all known epithelial tissues that transported ions and water, as did the gallbladder, developed voltages associated with their transport of the charged ions. But whenever I tried to measure a voltage across the gallbladder, I recorded zero. In those days that was considered strong evidence either that I hadn’t mastered even the simple technology that would have sufficed to detect a voltage across the gallbladder if there had been any, or that I had somehow killed the tissue and it wasn’t functioning. In either case, I was chalking up another failure as a laboratory physiologist.

My demoralization increased when I attended in June 1959 the first congress of the International Biophysical Society at Cambridge. Hundreds of scientists from around the world presented papers on their research; I had no results to present. I felt humiliated. I had been used to being always at the top of my class; now, I was a nobody.

I began to develop philosophical doubts about pursuing a career of scientific research at all. I read and re-read Thoreau’s famous book Walden. I felt shaken by what I saw as its message for me: that the real motive for pursuing science was the egotistical one of getting recognition from other scientists. (Yes, that really is a big motive for most scientists!) But Thoreau persuasively dismissed such motives as empty pretense. Walden’s core message was: I should figure out what I really want in my life, and not be seduced by the vanity of recognition. Thoreau reinforced my doubts about whether to continue in scientific research at Cambridge. But a moment of decision was approaching: my second year of graduate school would begin at the end of the summer, and I would have to re-enroll if I wanted to continue.

At the end of June I went off to spend a month’s vacation in Finland, a wonderful and profound experience that I’ll discuss in the next chapter. In Finland for the first time, I had the experience of learning a language, the difficult and beautiful Finnish language, not from books but just by listening and talking to people. I loved it. It was as satisfying and successful as my physiological research was depressing and unsuccessful.

By the end of my month in Finland, I was seriously considering abandoning a career in science, or indeed in any academic discipline. Instead, I thought of going to Switzerland, indulging my love for and ability in languages, and becoming a simultaneous translator of languages at the United Nations. That would mean turning my back on the life of research, creative thought, and academic fame that I had imagined for myself, and that my professor father exemplified. As a translator, I would not be well paid. But at least I would be doing something that I thought I’d enjoy and would be good at—so it seemed to me then.

My crisis came to a head on my return from Finland, when I met my parents (whom I hadn’t seen in a year) for a week in Paris. I told them of my practical and philosophical doubts about pursuing a research career, and my thoughts of becoming a translator. It must have been agonizing for my parents to witness my confusion and misery. Bless them, they listened, and they didn’t presume to tell me what to do.

The crisis reached resolution one morning while my parents and I were sitting together on a Paris park bench, once again thrashing out the question of whether I should give up on science now or should continue. Finally, my father gently made a suggestion, without pressuring me. Yes, he acknowledged, I had doubts about a scientific research career. But this had been only my first year of graduate school, and I had been trying to study the gallbladder for only a few months. Wasn’t it really too early to give up on a planned lifetime career? Why not return to Cambridge, give it another chance, and devote just another half-year to trying to solve gallbladder research problems? If that didn’t work out, I could still give it up in the spring of 1960; I didn’t have to make an irreversible big decision now.

My father’s suggestion felt to me like a life-preserver thrown to a drowning man. I could postpone the big decision for a good reason (to try for another half-year); there was nothing shameful about that. The decision didn’t commit me irrevocably to a scientific research career. I still had the option of becoming a simultaneous translator after half-a-year.

That settled it. I did return to Cambridge to begin my second year there. I resumed my gallbladder research. Two young physiology faculty members, to whom I’ll be eternally grateful, helped me to solve the technological problems of gallbladder research. In particular, one helped me to realize that my method of measuring voltages across the gallbladder was perfectly adequate; the gallbladder did develop voltages that I could measure (so-called “diffusion potentials” and “streaming potentials”) under appropriate conditions. It was just that the gallbladder didn’t develop voltages while transporting ions and water, for the remarkable reason that (uniquely among transporting epithelia known at the time) it transported positive and negative ions equally, and so transported no net charge and developed no transport voltage.

My gallbladder results began to interest other physiologists, and to excite even me. As my gallbladder experiments succeeded, my broad philosophical doubts about the vanity of recognition by other scientists faded away. I stayed at Cambridge for four years, completed my PhD, returned to the U.S., got good university jobs doing research and teaching in physiology (first at Harvard and then at UCLA), and became a very successful physiologist.

That was my first major professional crisis, a common type of personal crisis. Of course it wasn’t my last life crisis. I later had two much milder professional crises around 1980 and 2000, concerning changes in the direction of my research. Ahead of me still lay severe personal crises about getting married for the first time, and (seven-and-a-half years later) about getting divorced. That first professional crisis was in its specifics unique to me: I doubt that anyone else in world history has ever struggled with a decision about whether to abandon gallbladder physiological research in favor of becoming a simultaneous translator. But, as we’ll now see, the broad issues that my 1959 crisis posed were completely typical for personal crises in general.

Almost all readers of this book have experienced or will experience an upheaval constituting a personal “crisis,” as I did in 1959. When you’re in the middle of it, you don’t pause to think about academic questions of defining “crisis”; you know that you’re in one. Later, when the crisis has passed and you have the leisure to reflect on it, you may define it in retrospect as a situation in which you found yourself facing an important challenge that felt insurmountable by your usual methods of coping and problem-solving. You struggled to develop new coping methods. As did I, you questioned your identity, your values, and your view of the world.

Undoubtedly, you’ve seen how personal crises arise in different forms and from different causes, and follow different trajectories. Some take the form of a single unanticipated shock—such as the sudden death of a loved one, or being fired without warning from your job, or a serious accident, or a natural disaster. The resulting loss may precipitate a crisis not only because of the practical consequences of the loss itself (e.g., you no longer have a spouse), but also because of the emotional pain, and the blow to your belief that the world is fair. That was true for relatives and close friends of the victims of the Cocoanut Grove fire. Other crises instead take the form of a problem building up slowly until it explodes—such as the disintegration of a marriage, chronic serious illness in oneself or in a loved one, or a money-related or career-related problem. Still other crises are developmental ones that tend to unfold at certain major life transitions, such as adolescence, midlife, retirement, and old age. For instance, in a midlife crisis you may feel that the best years of your life are over, and you grapple to identify satisfying goals for the rest of your life.

Those are the different forms of personal crises. Among their commonest specific causes are relationship problems: a divorce, a break-up of a close relationship, or else deep dissatisfaction leading you or your partner to question continuing the relationship. Divorce often drives people to ask themselves: What did I do wrong? Why does he/she want to leave me? Why did I make such a bad choice? What can I do differently next time? Will there ever be a next time for me? If I can’t succeed in a relationship even with the person who is closest to me and whom I chose, what good am I at all?

Besides relationship problems, other frequent causes of personal crises include deaths and illnesses of loved ones, and setbacks to one’s health, career, or financial security. Still other crises involve religion: lifelong believers in a faith may find themselves plagued by doubt, or (conversely) non-believers may find themselves drawn to a religion. But, shared among all of those types of crisis, whatever their cause, is the sense that something important about one’s current approach to life isn’t working, and that one has to find a new approach.

My own interest in personal crises, like that of many other people, stemmed initially from the crises that I’ve experienced myself or that I’ve seen befalling friends and relatives. For me, that familiar personal motive has been further stimulated by the career of my wife Marie, a clinical psychologist. During the first year of our marriage, Marie trained at a community mental health center, in which a clinic offered short-term psychotherapy for clients in crisis. Clients visited or phoned that clinic in a state of crisis, because they felt overwhelmed by a big challenge that they couldn’t solve by themselves. When the door opened or the phone rang at the clinic reception, and the next client walked in or began talking, the counselor didn’t know in advance what type of issue that particular person faced. But the counselor knew that that client, like all the previous clients, would be in a state of acute personal crisis, precipitated by their having acknowledged to themselves that their established ways of coping were no longer sufficient.

The outcomes of consultation sessions at health centers offering crisis therapy vary widely. In the saddest cases, some clients attempt or commit suicide. Other clients can’t figure out a new coping method that works for them: they revert to their old ways, and may end up crippled by their grief, anger, or frustration. In the best cases, though, the client does discover a new and better way of coping, and emerges from the crisis stronger than before. That outcome is reflected in the Chinese written character translated as “crisis,” which is pronounced “wei-ji” and consists of two characters: the Chinese character “wei,” meaning “danger,” plus the Chinese character “ji,” meaning “crucial occasion, critical point, opportunity.” The German philosopher Friedrich Nietzsche expressed a similar idea by his quip “What doesn’t kill us makes us stronger.” Winston Churchill’s corresponding quip was “Never let a good crisis go to waste!”

A frequent observation by those helping others in an acute personal crisis is that something happens within a time span of about six weeks. During that short transitional period, we question our cherished beliefs, and we are much more receptive to personal change than during our previous long period of relative stability. We can’t live for much longer than that without some ways of coping, although we can grieve, suffer, or remain unemployed or angry for much longer. Within about six weeks, either we start to explore a new way of coping that will ultimately prove successful, or we embark on a new maladaptive way of coping, or we revert by default to our old maladaptive ways.

Of course, those observations about acute crises don’t imply that our lives conform to an oversimplified model of: (1) receive shock, set alarm clock for six weeks; (2) acknowledge failure of previous coping methods; (3) explore new coping methods; and (4) alarm clock goes off: either give up and revert, or else succeed / crisis solved / live happily ever after. No: many life changes instead unfold gradually, without an acute phase. We succeed in identifying and solving many impending or growing problems before they ever become crises and overwhelm us. Even crises with an acute phase may merge into a long phase of slow rebuilding. That’s especially true of midlife crises, when the initial burst of dissatisfaction and glimmerings of a solution may be acute, but putting a new solution into effect may take years. A crisis doesn’t necessarily stay solved forever. For instance, a couple that resolves a serious dispute and avoids divorce may outgrow their solution to the dispute and have to deal again with the same problem or a similar one. Someone who has dealt with one type of crisis may eventually encounter a new problem and face a new crisis, as did I. But even those caveats don’t change the fact that many of us do traverse crises with the approximate course that I described.

How does a therapist deal with someone in crisis? Obviously, the traditional methods of long-term psychotherapy, which often focus on childhood experiences in order to understand root causes of current problems, are inappropriate in a crisis because they are much too slow. Instead, crisis therapy focuses on the immediate crisis itself. The methods were initially worked out by the psychiatrist Dr. Erich Lindemann in the immediate aftermath of the Cocoanut Grove fire, when Boston hospitals were swamped not only by the medical challenge of trying to save the lives of hundreds of severely wounded and dying people, but also by the psychological challenge of dealing with the grief and the guilt feelings of the even larger numbers of survivors, relatives, and friends. Those distraught people were asking themselves why the world had permitted such a thing to happen, and why they were still alive when a loved one had just died a horrible death from burns, trampling, or asphyxiation. For example, one guilt-stricken husband, berating himself for having brought his now-dead wife to Cocoanut Grove, jumped out a window in order to join her in death. While surgeons were helping the fire’s burn victims, how could therapists help the fire’s psychological victims? That was the crisis that the Cocoanut Grove fire posed to psychotherapy itself. The fire proved to be the birth hour of crisis therapy.

Struggling to assist the huge number of traumatized people, Lindemann began to develop the approach that is now termed “crisis therapy,” and that expanded soon from the Cocoanut Grove disaster to the other types of acute crises that I mentioned above. Over the decades since 1942, other therapists have continued to explore methods of crisis therapy, which is now practiced and taught at many clinics such as the one at which Marie trained. Basic to crisis therapy as it has evolved is that it’s short-term, consisting of only about half-a-dozen sessions spaced out at weekly intervals, spanning the approximate time course of a crisis’s acute stage.

Typically when one is first plunged into a state of crisis, one feels overwhelmed by the sense that everything in one’s life has gone wrong. As long as one remains thus paralyzed, it’s difficult to make progress dealing with one thing at a time. Hence a therapist’s immediate goal in the first session—or else the first step if one is dealing with an acknowledged crisis by oneself or with the help of friends—is to overcome that paralysis by means of what is termed “building a fence.” That means identifying the specific things that really have gone wrong during the crisis, so that one can say, “Here, inside the fence, are the particular problems in my life, but everything else outside the fence is normal and OK.” Often, a person in crisis feels relieved as soon as he or she starts to formulate the problem and to build a fence around it. The therapist can then help the client to explore alternative ways of coping with the specific problem inside the fence. The client thereby embarks on a process of selective change, which is possible, rather than remaining paralyzed by the seeming necessity of total change, which would be impossible.

Besides that issue of building a fence that gets addressed in the first session, another issue is also often addressed then: the question “Why now?” That’s short-hand for: “Why did you decide to seek help in a crisis center today, and why do you feel a sense of crisis now, rather than some time earlier, or not at all?” In the case of a crisis arising from a single unanticipated shock, such as the Cocoanut Grove fire, that question needn’t be asked because the obvious answer is the shock itself. But the answer is not obvious for a crisis building up slowly until it explodes, or for a developmental crisis associated with an extended life phase such as the teen-age years or middle age.

A typical example is that a woman may say that she came to the crisis center because her husband is having an affair. But it then turns out that she has known for a long time that he has been having the affair. Why did the woman decide to seek help about the affair today, rather than a month ago or a year ago? The immediate impetus may have been a single sentence spoken, or else a detail of the affair that the client held to be the “last straw,” or a seemingly trivial event reminding the client of something significant in the client’s past. Often the client isn’t even conscious of the answer to that question “Why now?” But when the answer is discovered, it may prove helpful to the client, or to the therapist, or to both, in understanding the crisis. In the case of my 1959 career crisis, which had been building for half-a-year, the reason why the first week of August 1959 became “now” was the visit of my parents, and the practical necessity of telling them whether or not I would return next week to the Cambridge Physiological Laboratories for a second year.

Of course, short-term crisis therapy isn’t the only approach to dealing with personal crises. My reason for discussing it isn’t because of any parallels between the time-limited six-session course of crisis therapy and the course of dealing with national crises. The latter course never involves six national discussions within a short time frame. Instead, I focus on short-term crisis therapy because it’s a specialty practiced by therapists who have built up a large body of experience and shared their observations with one another. They spend much time discussing with one another and publishing articles and books about the factors influencing outcomes. I heard a lot about those discussions from Marie, almost every week during her year of training at the crisis therapy center. I found those discussions useful for suggesting factors worth examining as possible influences on outcomes of national crises.

Crisis therapists have identified at least a dozen factors that make it more or less likely that an individual will succeed in resolving a personal crisis (Table 1.1). Let’s consider those factors, starting with three or four that inevitably are critical at or before the beginning of the course of treatment:

1. Acknowledgment that one is in crisis. This is the factor that leads people to enter crisis therapy. Without such an acknowledgment, they would not even present themselves at a crisis therapy clinic, nor (if they didn’t go to a clinic) would they begin to deal with the crisis themselves. Until someone admits, “Yes, I do have a problem”—and that admission may take a long time—there can’t be any progress towards resolving the problem. My 1959 professional crisis began with my having to acknowledge that I was failing as a laboratory scientist, after a dozen years of uninterrupted successes in school.

2. Acceptance of personal responsibility. But it’s not enough just to acknowledge “I have a problem.” People often then go on to say, “Yes, but—my problem is someone else’s fault. Other people or outside forces are what’s making my life miserable.” Such self-pity, and the tendency to assume the role of victim, are among the commonest excuses that people offer to avoid addressing personal problems. Hence a second hurdle, after a person has acknowledged “I have a problem,” is for the person to assume responsibility for solving it. “Yes, there are those outside forces and those other people, but they aren’t me. I can’t change other people. I’m the only person whose actions I can fully control. If I want those other forces and other people to change, it’s my responsibility to do something about it, by changing my own behavior and responses. Those other people aren’t going to change spontaneously if I don’t do something myself.”

3. Building a fence. Once a person has acknowledged a crisis, accepted responsibility for doing something to resolve it, and presented himself at a crisis therapy center, the first therapy session can focus on the step of “building a fence,” i.e., identifying and delineating the problem to be solved. If a person in crisis doesn’t succeed in doing that, he sees himself as totally flawed and feels paralyzed. Hence a key question is: what is there of yourself that is already functioning well, and that doesn’t need changing, and that you could hold on to? What can and should you discard and replace with new ways? We shall see that that issue of selective change is key also to reappraisals by whole nations in crisis.

4. Help from others.