Friday, July 28, 2017

On Regret

I've taken many questionable risks in my life. I lean toward leading a life that's lived fully over a safe and secure existence. Most I bounced back from easily from typical childhood falling from trees when I've climbed too high to dropping out of high school and somehow ending up with a Masters. Sometimes it's gone extraordinarily well for me. When an elderly woman next door to me died, I went deep into debt to buy and flip her crumbling house only to find it packed with cash. People thought I was crazy for my efforts to save my school from the chopping block until it all worked, and I'm still there. People were adamant that I can't possibly hold my head high as a teacher and unwed mother back a few decades when premarital sex was shameful, but I ignored them all with the most delightful results. And when my third pregnancy was fraught with complications, and doctors strongly advised me to terminate because of a high risk of Edwards syndrome, I, still single, took a chance and have another healthy daughter to show for it. I've been very very lucky over the years.

But then there are the times that didn't go as well. That time I was convinced I was overinsured and cancelled the insurance on a property, then it promptly went up in flames. That time I got scared of my debt load and hastily sold the slightly charred land - 24 acres with 2000' of waterfront, then soon realized there's nothing else like it out there in my price range. And that time I was convinced by a couple doctors, in opposition to others doctors, equally educated, to get an auxiliary lymph node dissection (ALND), and only afterwards found out about, and succumbed to, the risks of lymphedema.

Like most people, I imagine, I have an easy time ignoring my luck and a really hard time coping when my decisions don't pan out as well. Regret is a bugger.

So I wrote to Stoic advice columnist, Massimo Pigliucci, explaining my surgery situation in very general terms so it could be applied to and/or understood by more people, and I made it sound worse than it is to get a response to the worst case scenario. In general I asked "How were the Stoics so able to get on top of these types of thoughts so well?"

His reply in a nutshell: practice.

He suggests the lesson for me here is that I should have waited to get a clear majority of opinions from the doctors, except, to avoid a long-winded question, I had suggested it was a toss-up. I hadn't fully explained the ins and outs of the many doctors involved: the original surgeon, against it, who I didn't really respect; the panel of doctors who thought it definitely necessary; the oncologist who was against it until she looked at it more closely and changed her mind with vehemence; the radiologist who had little to do with it all but was against it and thought the panel decision was a "political statement," followed by my second surgeon, who speaks eloquently, and shook his head at the "political" comment, insisting the surgery is very important and very low risk. The final tally: 2 against, 1 against but later for, 6-8 resolutely for (depending on the size of the panel). The respect for and involvement I had with each doctor made a difference in my decision-making, as well as their confidence in their own decision. At the time, the first surgeon seemed to have questionable ideas, but I later think he was the better of the two, and I only met the radiologist briefly, so the nay-sayers had their votes further watered down. But if I just look at the majority, then I did the right thing, which makes me feel a little less stupid. But it turned out regretfully regardless.

More importantly, Pigliucci suggests coping with the regret in the best stoic way, by looking at those who have managed with worse, and he recommended looking specifically at the life of Larry Becker (interviews here), in a wheelchair from polio. In Pigliucci's book, which I coincidentally took on my recent kicking ass trip, he spends a chapter on Becker's coping strategy. I'll quote the pertinent bit at length as Larry managed his disability, at first resisting a wheelchair in favour of simply avoiding going anywhere with even a few stairs:
"For Larry, the most devastating disabilities are precisely those that severely limit or entirely erase our agency. Yet he claims that even if polio paralyzes you completely, paralysis itself doesn't permanently rob you of your agency. Nevertheless, you may need to reclaim it, slowly and painfully, as he did. Indeed, he saw the whole question of dealing with his disability as coinciding with his need to reclaim his agency. 
After you have reclaimed your agency, Larry points out, you are in the same position as everyone else: you have to become good at being an agent.  This, he says, requires lining up the following elements: values, preferences, goals, deliberations, decisions, and actions. If these are incoherent, incomplete, or weak, then you are paralyzed no matter what your physical condition happens to be. You can also be paralyzed by indecision, because you are not committed to a particular course of action and wish to keep multiple possibilities open....To complicate things, there is the fact that the world itself changes, requiring constant adjustments to our goals, decisions, and actions. In other words, we need to learn how to maintain agency under changing circumstances.... 
We need to focus on abilities, not disabilities....We also need to practice the Socratic task: know thyself. Knowing our physical and psychological abilities includes knowing our limits. Ignorance, or worse, self-deception about our own abilities can be very dangerous....Larry also counsels us to train ourselves to recognize when we have lost a good fit between our abilities and our activities. We must develop what he calls an internal alarm system, which will tell us when it's time to stop suffering and begin (or resume) taking charge.... 
The problem is that we seem to have trouble figuring out which brick walls are worth worrying about and which ones we should try to tear down. The way Larry deals with this problem is by going back to basics. First he identifies his fundamental life goals and commitments: to his wife...professional objectives...Only when these commitments are at stake is he willing to stop if he encounters an actual brick wall, and only if he hits it pretty hard. Ramps, in Larry's estimation, don't qualify: "Doing without a wheelchair is not a basic life goal."
I like the clarity of the wording: reclaiming agency. Since sending the question, working out at WellFit surrounded by people in various stages of fighting cancer has been a godsend. It definitely helps to see how other people are able to manage to stay positive in times of adversity. And when it gets really bad, I think about 127 Hours and imagine how much worse it all could be.

In his response to my issue, Pigliucci wrote,
"Epictetus clearly recognizes that practice is much more difficult than theory, and that it requires years, because one has to undo the sort of bad habits of mind one develops during one’s upbringing as a non-Stoic. In your case, regret is considered by most to be a natural response to that sort of situation, so you have probably regretted all sorts of other things before, from very small and inconsequential ones to the one we are talking about now.  
 For you, then, “practice” may mean to start small, pick some minor regret you have, then analyze it — perhaps in writing, in a personal diary, or discoursing with a close friend about the issue. At the end of each round of analysis, tell yourself — loudly if it helps — that that was “nothing to me.” Then move to consider past events that are a bit more important to you, and finally come back to the surgery issue. Should this not be enough, then you may want to consider seeing a therapist (either REBT or CBT), focusing on this specific issue, and see whether that helps."
This is excellent advice. The thing is, I generally live without regret. I've done many, many stupid things that I've been really good at brushing off just like this. And I've helped my kids over their many hurdles the same way. More specifically, "Yup, that was humiliating or costly or whatever, but it'll make for a good story! It is what it is!" The loss of that beautiful piece of land and the effortless use of my arm, however, these are too big to easily convince myself are nothing to me, and I can't see the humour in them to make them remotely entertaining as a tale I might tell years from now, which is my typical strategy. There's no happy ending except that I've endured, and that acorn of regret just barely under the surface makes the telling uncomfortable to hear. I have to find the right spin and take on the right attitude in order to relax that weird little tightness in my throat.

So, apparently not enough, I already contacted a CBT therapist about a month ago, but our vacation schedules are ever in conflict. I look forward to a bit of one-on-one support to help get to the other side of this whenever we manage to finally connect.

In the meantime, I'll try practicing. When I had little ones, and I'd often have one or another wedged in my left arm all day while I played with the others or cooked or cleaned, I often commented that, once they no longer demand to be held, you could cut my left arm right off and I'd hardly notice. So there's that. And, while I'm irritated with the time I'm required to allot to caring for myself each day, I'm likely getting healthier than I've ever been as a side-effect.

And I'll keep immersing myself in philosophy, where, at the very least, thinking is a great escape from the corporeal self.

To be honest I think the real barrier for me is a concept related to practice and alluded to by Pigliucci: a lack of patience. I want to stop feeling this gnawing regret today! I feel like I've done all the learning and practicing, but clearly I'm still a novice, and it will take more time to get to where I'm okay with it all. The reality of the situation, the daily exercises and apparatus and limitations don't bother me nearly as much as the thought that it could all be so different - so much better - had I taken the other path. And that's all entirely in my head, an impression that's completely within my control to alter. Maybe I just have to want to alter it. I have to be willing to accept the situation fully rather than fantasize about what might have been. Once I completely close the door on that crazy illusion of hope that thinking about not having had the surgery will somehow make it so, then all that's left is accepting what is. Here I am with a bit of a wonky arm living with pigeons and cars instead of loons and canoes, and that's okay.

(Well, it's not quite okay, not yet, but the telling of it might help to make it so.)

And here are some random quotations that add to the consolation. David Foster Wallace in A Supposedly Fun Thing I'll Never Do Again, wrote this lovely bit:
"It feels like much time has passed and is passing faster and faster every day. Day to day I have to make all sorts of choices about what is good and important and fun, and then I have to live with the forfeiture of all the other options those choices foreclose. And I'm starting to see how as time gains momentum my choices will narrow and their foreclosures multiply exponentially until I arrive at some point on some branch of all life's sumptuous branching complexity at which I am finally locked in and stuck on one path and time speeds me through stages of stasis and atrophy and decay until I go down for the third time, all struggle for naught, drowned by time. It is dreadful. But since it's my own choices that'll lock me in, it seems unavoidable--if I want to be any kind of grownup, I have to make choices and regret foreclosures and try to live with them.
Bertrand Russell said, in The Conquest of Happiness,
"The wise man, though he will not sit down under preventable misfortunes, will not waste time and emotion upon such as are unavoidable, and even such as are in themselves avoidable he will submit to if the time and labour required to avoid them would interfere with the pursuit of some more important object. Many people get into fret or a fury over every little thing that goes wrong, and in this way waste a great deal of energy that might be more usefully employed. Even in the pursuit of really important objects it is unwise to become so deeply involved emotionally that the thought of possible failure becomes a constant menace to peace of mind."
Seneca said,
"No man has been shattered by the blows of Fortune unless he was first deceived by her favours. Those who loved her gifts as if they were their own for ever, who wanted to be admired on account of them, are laid low and grieve when the false and transient pleasures desert their vain and childish minds, ignorant of every stable pleasure. But the man who is not puffed up in good times does not collapse either when they change. His fortitude is already tested and he maintains a mind unconquered in the face of either condition: for in the midst of prosperity he has tried his own strength against adversity." -
The ridiculous expectation that my health would continue, unabated, forever, was the first problem.

Watching Fargo, season 3 also really helped in its own odd little way."There's a violence to knowing the world's not what you thought." Characters get the rug pulled from under them - they have a plan they work towards, things are going well, chugging on towards easily attainable goals, but then they lose everything randomly. Senselessly. That's what happens. One character suggests, like Schopenhauer, that all life is suffering. Unlike Schopenhauer, he continues: "The problem isn't that there's evil in the world. The problem is that there is good, because otherwise who would care?" And it's so much harder losing what you had then never having it to begin with.

There's a randomness to the universe, and sometimes you get lucky, and sometimes you don't. You can be a good person, and still fail, and you can break all the rules and do just fine. And it's really easy to take that reality and decide there's no point in trying to do the right thing. It seems an obvious route. Yet there still is. It's right to be hardworking, to keep trying to do right, not because it gets you anywhere, but because it's right. That's all we've got.

ETA: Another way to cope is through action. As one commenter suggested, advocating for different methods around this type of surgery can help relieve regret. I've already talked to the hospital's lymphedema specialist about giving pamphlets of information for surgeons to distribute, but apparently surgeons are a hard sell. The second option is going through family doctors. It's just a straight-forward set of risks and preventative measures that need to be clarified for patients. I can't imagine why it's been ignored so far.

ETA: I was just thinking about this again. Part of my problem is how I perceive those other possibilities that I've slammed the door on. My inner tumults are from the pain caused by imagining the other path to be glorious, lined with flowers and sunshine. I imagine choosing NOT to have the surgery and how perfect my life would be. So it helps to remind myself that, had I not done the surgery, I would be in store for the possibility of cancer spreading all through my body, and the possibility of having chemo and radiation, which can ALSO cause lymphedema. Life is a gamble. Ante up.

ETA: Also read this take on it.


Unknown said...

Thank you for writing this post. I needed to be reminded of my own obsession with the game "If only..."

Unknown said...

Thank you for writing this. I needed to read these words be reminded that I should stop playing the game of "If only..."
Regret is such an insidious and ridiculous thing. Ah well. This too shall pass. :)

Marie Snyder said...

Yes, "This too shall pass" is an excellent mantra!