“And that’s okay”: accepting and owning reality

The Con­text

I was hav­ing a con­ver­sa­tion with Ruby a while back–the gist of it was that I was up­set be­cause of a night­mare I’d had the night be­fore, and mad at my­self for be­ing up­set about some­thing that hadn’t even re­ally hap­pened, and try­ing to figure out how to stop feel­ing ter­rible. He said a thing that turned out to be sur­pris­ingly helpful.

Life in­volves feel­ing bad, of­ten with good rea­son, of­ten, not. A lot of the time the best re­sponse is to say ‘Yes, I’m feel­ing shitty to­day, no, I’m not go­ing to able to fo­cus, and that’s crap, but that’s to­day.’

It’s differ­ent from tol­er­ance or res­ig­na­tion, it’s more ‘this is re­al­ity, this is my start­ing point and I’ve got to ac­cept this is what it is’.

Then if you can find a way to make it go away, great, if not, most things pass soon enough, and even if didn’t, you could ac­cept that too.”

I’m not good at this. I’m fre­quently us­ing Sys­tem 2 to fight Sys­tem 1: for ex­am­ple, when I’m feel­ing in­tro­verted and re­ally don’t want to be at work hav­ing face-to-face con­ver­sa­tions with pa­tients and co-work­ers, I ba­si­cally tell that part of my brain to suck it up and stop be­ing a baby. I get mad at my­self for want­ing things that I can’t rea­son­ably ask for, like praise from ran­dom other nurses I work with. I get mad at my­self for want­ing things for what I think are the wrong rea­sons: for ex­am­ple, want­ing to move to San Fran­cisco be­cause I’m friends with lots of peo­ple there, and re­luc­tantly ac­cept­ing that I would need to leave my cur­rent job to do that, is one thing, but want­ing to leave my job be­cause it’s stress­ful–not okay! And then I mis­trust my brain’s mo­ti­va­tions to move to San Fran­cisco at all–heaven for­bid I should be­have “like a groupie.” I ig­nore my de­sires for food that isn’t the same bean salad I’ve been eat­ing for four days, for an ex­tra evenings of sleep, or to can­cel on plans with a friend be­cause I just want an af­ter­noon alone at home.

And even though I’m pretty good at over­rid­ing all of my de­sires, the sub-agents that rep­re­sent those de­sires don’t go away. They just sit there, metaphor­i­cally, fum­ing at be­ing ig­nor­ing and plot­ting re­venge, which they usu­ally achieve by mak­ing the de­sires ten times stronger...and then I go out and buy hot dogs at mid­night, or stay in bed for thir­teen hours, or spend an en­tire stretch of days off hid­ing in my apart­ment read­ing fan­fic­tion. Or I just end up con­fused and con­flicted and not ca­pa­ble of want­ing any­thing. In other words, I’m a so­ciety of mind that’s fre­quently in a civil war with it­self.

I hadn’t thought of try­ing to ac­cept the civil war. Of say­ing “tonight, dur­ing this hos­pi­tal shift, I will not be able to solve the civil war. Rather than adding to the nega­tive af­fect by get­ting mad at my­self, I will ac­cept that to­day will sim­ply suck and I will feel shitty. Go­ing into the fu­ture I will work on peace talks, but to­day I must en­dure.”

“And that’s okay.”

There’s one area where I’ve suc­cess­fully taken a thing that I was con­fused and con­flicted and frus­trated about, and turned it into a thing that’s okay, even though the origi­nal con­flict hasn’t been solved. That thing is re­la­tion­ships. At some point, around the time that I started ap­ply­ing the term asex­ual to my­self and first read about tac­tile defen­sive­ness and sud­denly had words for the things that were ‘wrong’ with me, I stopped be­ing frus­trated about them. I haven’t solved all the prob­lems. I’m still con­fused about re­la­tion­ships, I still get su­per anx­ious and avoidant in the face of be­ing wanted too much, and that’s okay. Maybe it’ll change. I haven’t given up, and I’m try­ing things on pur­pose. It turned out that most of the suffer­ing from this prob­lem was meta-suffer­ing and now it’s gone.

Some­how, when it wasn’t okay, it was a lot harder to try things on pur­pose.

I hy­poth­e­sized that adding the men­tal phrase “and that’s okay” onto all your prob­lems would be a good gen­eral-pur­pose strat­egy.

Non-complacency

Ruby dis­agreed with me: “One of my strongest virtues, but I pay a cost for it, is how not-com­pla­cent I am. I’m not good enough, the world’s not good enough. And I just see it. It’s there. And I’m not okay with it.”

The prob­lem is, even though I don’t have the virtue of ac­cep­tance, I don’t have the virtue of non-com­pla­cency ei­ther–in the sense that see­ing the things that aren’t good enough, and not be­ing okay with them, rarely causes me to do some­thing to make the things bet­ter. It causes me to not think about them, un­less it’s some­thing as ob­ject-level as “my pa­tient is in pain and the doc­tor re­fuses to give me an or­der for more pain meds.” And some­times even then, I’ll re­treat into it no longer be­ing my prob­lem.

I think that I, and prob­a­bly oth­ers, need a cer­tain amount of ac­cep­tance, a cer­tain amount of “and that’s okay”, to let the wrong things into the cir­cle of our aware­ness–to ad­mit that yes, they re­ally do suck. It’s a bit like the Li­tany of Gendlin. What’s true is already true, and even though think­ing about it be­ing true makes me feel like I must be a bad per­son, it can’t cause me to be more of a bad per­son than I already am.

“You need to own it.”

Once, I had a fairly awful nurs­ing school place­ment at a very large, stress­ful ICU. I made mis­takes, de­spite the fact that ‘I knew bet­ter’ in the­ory. (I’ve since learned that nurs­ing is some­thing that takes place un­der av­er­age con­di­tions, not op­ti­mal con­di­tions, mean­ing that you will have good days and bad days and that on your bad days, you will make dumb mis­takes.)

As a perfec­tion­ist, I found this re­ally hard, even though I knew enough cogsci to rec­og­nize that my brain was be­hav­ing pre­dictably and un­der­stand­ably. My men­tor said a lot of things that weren’t helpful, but one of the things that she said is “you need to own your mis­takes.” At that time, those words left her mouth and reached my ears and then got pro­cessed and turned into “you should ad­mit that you’re hope­lessly in­com­pe­tent and a failure.” The only ob­vi­ous con­clu­sion to draw was that I ought to quit nurs­ing school right then. I didn’t want to quit, and the only other op­tion was to not think about the stupid mis­takes–or, rather, try not to, and then end up think­ing about them any­way and be­ing anx­ious all the time.

Nowa­days, when I pro­cess those words from a much bet­ter emo­tional place, they come through as “you need to let your mis­takes into your self-con­cept, so that you can learn not to make them again even if you’re put un­der those same awful con­di­tions again.” The fact that be­ing dis­tracted by an in­ter­rup­tion and then try­ing to put an un-primed, full-of-air IV tub­ing in the pump is un­der­stand­able and pre­dictable doesn’t make it less likely to kill some­one. The cor­rect re­sponse is to de­velop habits and rou­tines that cause you to pre­dictably not make that mis­take. But if think­ing about it means au­to­mat­i­cally bring­ing up the pos­si­bil­ity that you should just quit nurs­ing school now be­fore you ac­tu­ally kill some­one, it’s hard to think of good rou­tines or fo­cus on train­ing your brain to do them.

In this case, what even­tu­ally helped was let­ting my past mis­takes be just okay enough that I could ad­mit them into my men­tal au­to­bi­og­ra­phy, think about them, strate­gize, and learn from them–in short, own them.

On Hav­ing Priorities

When I brought this up to my friend Ben Hoff­man, he had an­other point to add.

The ob­vi­ous-to-me al­ter­na­tive here is the trick of putting EVERYTHING on a list, pri­ori­tiz­ing, and op­ti­miz­ing for work­ing on the “most im­por­tant thing” in­stead of for get­ting all the “im­por­tant things” done. (Or solv­ing the most im­por­tant prob­lem, how­ever you want to word it.) This is the strat­egy I’ve started us­ing, and when I’m dis­ci­plined about it I feel nearly no bad­ness above the baseline level from hav­ing some prob­lems un­re­solved.

This rings true with a part of my nurs­ing clini­cal ex­pe­rience, and a thing I found es­pe­cially frus­trat­ing about my in­ter­ac­tions with my men­tor. Once, I ac­ci­den­tally gave my pa­tient an ex­tra dose of di­goxin be­cause I mis­read the med­i­ca­tion sheet. Which ended up do­ing ba­si­cally noth­ing, but the gen­eral class of “med­i­ca­tion er­ror” con­tains a lot of harm­ful op­tions. (The most em­bar­rass­ing and po­ten­tially se­ri­ous med er­ror that I’ve made so far at my cur­rent job in­volved ac­ci­den­tally run­ning my pa­tient’s fen­tanyl in­fu­sion an or­der of mag­ni­tude too high.) There was also the IV-tub­ing-full-of-air in­ci­dent.

Then, there was the thing where I would leave plas­tic sy­ringe caps and bits of pa­per from wrap­pers in pa­tients’ beds. This in­curred ap­prox­i­mately equal wrath to the med er­rors–in prac­tice, a lot more, be­cause she would catch me do­ing it around once a shift. I agreed with her on the pos­si­ble bad con­se­quences. Pa­tients might get bed­sores, and that was bad. But there were other prob­lems I hadn’t solved, and they had worse con­se­quences. I had, cor­rectly I think, de­cided to fo­cus on those first.

That be­ing said, I wasn’t ac­tu­ally able to stop feel­ing bad about it enough to ac­tu­ally free up men­tal space for anti-med-er­ror strate­giz­ing. This is partly be­cause an adult in a po­si­tion of au­thor­ity was con­stantly mad at me, and I wasn’t able to make that stop feel­ing bad. But it’s partly be­cause I gen­uinely felt like a failure ev­ery time I caught my­self do­ing some­thing wrong, whether it mat­tered a lot or not.

Mak­ing lists and pri­ori­tiz­ing is a use­ful thing to do, but the phys­i­cal mo­tion of writ­ing down a list isn’t all that’s in­volved. There’s the “be­ing dis­ci­plined about it”, the abil­ity to ac­tu­ally take all the prob­lems se­ri­ously and then only work on the first and most im­por­tant. I think that’s non-triv­ial, and doesn’t au­to­mat­i­cally hap­pen when you make a list of Im­por­tant Prob­lems 1 through 5.

Conclusion

There are two closely re­lated con­cepts here. One is the idea that you can let go of strug­gling against un­pleas­ant feel­ings–you can just have the un­pleas­ant feel­ings and ac­cept them, for­go­ing the meta-suffer­ing and the use­less burn­ing of men­tal en­ergy that comes with fight­ing them. If you ap­ply this men­tal habit of not strug­gling against suffer­ing, the re­sult is that you have less over­all suffer­ing.

The sec­ond con­cept is re­lated to own­ing mis­takes you’ve made, or per­sonal flaws, or atroc­i­ties in the world. By de­fault, it seems like most peo­ple ei­ther ob­sess over these or don’t think about them–I ex­pect that this hap­pens be­cause the things are too awful. If you ap­ply the men­tal habit of ad­mit­ting that you made that mis­take and it re­ally was dumb, or that poverty re­ally is bad, but that that’s okay, the re­sult is that you can think about it sanely, set pri­ori­ties, and maybe ac­tu­ally fix it.

How­ever, when I go through these men­tal mo­tions, they feel like the same op­er­a­tion, ap­plied to a differ­ent sub­strate. It’s an habit that I would like to cul­ti­vate more.

Appendix

Ruby sourced much of his origi­nal thoughts on this from Ac­cep­tance and Com­mit­ment The­ory, and from Russ Har­ris’ book The Hap­piness Trap.

In stark con­trast to most Western psy­chother­apy, ACT does not have symp­tom re­duc­tion as a goal. This is based on the view that the on­go­ing at­tempt to get rid of ‘symp­toms’ ac­tu­ally cre­ates a clini­cal di­s­or­der in the first place. As soon as a pri­vate ex­pe­rience is la­beled a ‘symp­tom’, it im­me­di­ately sets up a strug­gle with it be­cause a ‘symp­tom’ is by defi­ni­tion some­thing ‘patholog­i­cal’; some­thing we should try to get rid of. In ACT, the aim is to trans­form our re­la­tion­ship with our difficult thoughts and feel­ings, so that we no longer per­ceive them as ‘symp­toms’. In­stead, we learn to per­ceive them as harm­less, even if un­com­fortable, tran­sient psy­cholog­i­cal events. Iron­i­cally, it is through this pro­cess that ACT ac­tu­ally achieves symp­tom re­duc­tion—but as a by-product and not the goal.