So, I write a little, but it’s not good enough, of course. So, I skip over to yoga and meditation, where my monkey-mind does a full gymnastics routine. I meditate for less than five minutes before I get lost in thoughts about an upcoming lecture, and about the writing I’m supposed to be doing. I go back to the computer and check my email. I am, again, failing. I always tell my students to just get to it: meditate, or write, or exercise, or whatever. Just take the first steps, and keep stepping. But I encourage and forgive myself much less. I must meditate for a long time with complete serenity, stretch and strengthen efficiently, and write really good stuff and a lot of it. That is, all or nothing.
In her book Devotion, Dani Shapiro writes: “This was the way it had always been for me: all or nothing, I realized, invariably led to nothing.” I’ve been re-reading two nonfiction books by Shapiro, who is one of my favorite novelists; her kind heart and wise counsel continue to reach out and inspire me. One of her nonfiction books is Devotion, in which she shares a great deal of wisdom about acceptance, and living in the present, and spiritual practice. The other book is Still Writing: the Perils and Pleasures of a Creative Life, and her counsel is the same as that of another of my favorite novelists, Ann Patchett, who advises in her essays on the process of writing. You need to sit yourself down in the chair and write, every day. Develop and nurture the habit. Invariably you will disappoint yourself because what you end up with won’t be perfect, and you will probably experience some feelings more acutely than you would like to, but accept that and keep writing.
Did I mention that one of the things I’m writing about is developing and maintaining habits? Health habits to be exact, but a habit is a habit. So I’m reading books about how to stick to the habit of writing so that I can write about developing and sticking to health habits. This reminds me that once when my daughter was in junior high school, she saw me reading a book about how to overcome procrastination. She pointed out the obvious in a way that only a junior high school student can --that this was an ingenious way to procrastinate.
But when I learn from Shapiro and Patchett about the habit of writing, I also learn more than I ever have about changing oneself, with all the depth that implies. I am trying to learn to focus, to write more about what I love and am passionate about (health and healthcare), and in the process learn to just “be” -- to calm down, accept, strive with joy, get stronger, create something of value, become more flexible, and stop scanning for stuff to worry about. My own struggle to do all of it right, and right away, offers me ample opportunity to generate some empathy for anyone who has tried to develop and maintain a habit.
Medical patients, for example, are told by their physicians to lose weight, exercise regularly, never go in the sun without sunscreen, and manage their stress. And this is for the basically healthy ones. People who have diabetes are also supposed to test their blood sugar levels (finger pricks for blood, anyone?) four times a day, measure out and self-inject various types of insulin in doses that can change depending upon eating and exercise. Patients who also have high blood pressure and heart disease (commonly co-occurring conditions) must also remember to take several different medications per day. [Take Drug A three times a day with food, Drug B twice a day on an empty stomach, Drug C once a day but not with the others….] Oh, and give up most sweets and starches, walk 30 minutes most days (before or after work?), and even on terrible-traffic-jam days, don’t forget to meditate!
People feel overwhelmed striving to get it “just right” and they just give up. Six months after diagnosis, more than 50% of patients with serious chronic diseases have given up trying and become “nonadherent.” Nonadherence to high blood pressure medicine leads to 89 thousand premature deaths a year in the United States. Nonadherence costs the U.S. healthcare system more than 300 billion dollars annually in preventable hospitalizations and emergency room visits, poor outcomes, and avoidable complications. Diabetics lose limbs and their eyesight. Roughly 600 thousand people die of heart disease in the United States every year; rough calculations suggest that perhaps 300 thousand of them die sooner than they might have if health behavior change were not so daunting. All or nothing, invariably leads to nothing.
There’s a wonderful classic book on habits by Karen Pryor; the catchy title is Don’t Shoot the Dog. In it, she describes in great detail the essential elements of training and maintaining behavior; the principles apply to a dolphin, the family dog, one’s spouse or children, and even oneself. A complex behavior is built upon the acquisition of individual smaller behaviors, each of which is reinforced. Meditate for five minutes, give yourself an “atta girl,” then work towards ten. Show up at the gym or walk around the block, put a gold star in your exercise diary, and the next day try for a 15 minute workout or a walk around two blocks. Test blood sugar levels once a day, feel good about accomplishing that, then try for twice and then for more. Reinforcement doesn’t have to be a big reward; a kind nod to oneself every day for moving in the right direction can work wonders. Something, reinforced, can lead, incrementally, to something more.