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Gaining insight to our own desires—and how they align with the lives we are considering—takes frequent assessment and the ability to overcome the anxiety to make a change.
It’s June—the time of year when people graduate from high school and college with plans to tackle the world and become an adult. There’s an expectation, whether self-imposed or imposed by others, to decide about what we want to do for the rest of our lives. How can we decide this? How can we really decide what we will want in six months? One year? Five years? 10 years?
We can’t. It’s the lucky few who even have an idea, and even then it is untested.
What we can decide is to take a chance. To take a step in some direction and with each step, trust that we gain knowledge about the careers, and futures, we want to pursue. Each bit of knowledge gained helps steer decisions about what next.
With each step along a path, we become more committed toward some specific goal. Eventually we arrive at a crossroad, where the next step we take is going to have a significant outcome, say leaving a job. For some that decision is daunting, impossible even. How do I know that’s what I want? Gaining insight to our own desires—and how they align with the lives we are considering—takes frequent assessment and the ability to overcome the anxiety to make a change.
For the past few years I have been working with a man in his 30’s who was referred to me by his primary care physician because of his frequent complaints of fatigue, stomach problems, and shortness of breath. Every medical workup turned out to be negative and his doctor suggested he meet with me to be evaluated for depression and anxiety.
Reluctantly, he came to see me for an evaluation. He conveyed that he is always tense, feels tired, and is often getting sick. He describes his sleep as not great and reports “I often feel worthless and not good enough.” Daily, he struggles with stomach discomfort. “I’m tired of going through all these tests and treatments and still feeling like crap, that’s why I took my doctor’s advice to see you. My mother’s a doctor and she also feels this is all in my head.”
His mother is a primary care doctor in a group practice. “She likes her work but she works all the time and my parents always complained about not having enough money. My father is an artist and was a stay at home dad.”
He admired how much his parents enjoyed their careers. “Other couples would fight about wanting the other parent to make more money so they can quit their job and do what they want to do. My parents never did that. My parents enjoyed what they were doing. The only time they would argue would be when my father got upset with my mother for working so many hours and not getting paid for it.”
Growing up my patient always thought he would have a career in healthcare. He started out pre-med in college and ended up getting a bachelor’s degree in business. After college he went on to get an MBA with a focus in healthcare. “I knew I liked healthcare but I wanted to make more money than my mother did. I didn’t want to go to school for all those years, work that hard, to end up not being able to buy or do whatever I wanted.”
He has been working as a hospital administrator and a few months ago he was up for a promotion but the job was given to another candidate:
“I shouldn’t care,” he said, “I really dislike my work. I don’t know how I ended up here, doing this as my career. My mother always emphasized that I should do what makes me happy. I just always thought that if I am going to work as hard as she did I am going to be paid enough for it. I also always wanted to do something where I have meaning and success in my career.”
We started a medication and I advised him to start psychotherapy:
“I don’t have time for that. I’ll just try the medication.”
When he came in for follow up it was apparent he was doing better. We probed a bit more:
“I’m not feeling as bad as I did but I don’t feel good. I thought these medications would make me feel better.”
“Well,” I said, “How bad is it? Did something good happen in your life that you weren’t able to enjoy or feel good about.”
“I thought the medication would do that,” he retorted. “I don’t think they are working!”
“Did you make any changes at work? Are you taking better care of yourself?” I said gently.
“I’m eating better and sleeping better but I still hate my job.”
“How much time do you spend at work each day?”
“About 10 hours, why?”
“I would find it very difficult to be happy when I spend 10 hours a day doing something I hate, probably another hour or so commuting to and from this job I hate, and then trying to sleep 7-8 hours a night so I can perform well at this job that I hate. I think the medication is helping but a large part of your treatment is missing. Don’t you think you should question why you spend so much time doing something you hate? Psychotherapy would help you do that.”
“I’ll think about it.”
The next time I met with him he seemed less stressed and happier:
“I was let go from work, the hospital merged with another medical center and my position was eliminated.”
“Umm, is that a good thing?”
“Well I got a severance package and have some savings so I’m not too worried. I’m happy to be out of that job but I’m worried about not having anything to do. I do think the medication finally kicked in.”
“I think the medication has already been working for a few months. I think you feel better because you are not going into a job you hate every day. I think this is a good time to start therapy and figure out what you want to do before getting yourself back in a position where you spend every day doing something you hate.”
He did start therapy and over the next few months decided he wanted to become a veterinarian. He had all his prerequisites and signed up for his GRE exam. He also started a job working with the veterinarian who treated his pets when he was growing up so he was able to gain the experience needed to apply to Veterinary School. He discovered an interest and took steps toward a new future. That took action, in his this case, medication and therapy.
Without noticing it, we develop into the people we become because of the interaction of our genetic predisposition, experiences we have, and the environment around us. In a perfect world we would all grow up in an environment that takes maximum advantage of our natural gifts. We would all feel good and have the drive to strongly create a satisfying future for ourselves.
The stress of constantly going against what feels good wears on your body, leading to depression, anxiety, and even a weakened immune system. It may also lead to other medical problems effecting your body’s ability to function optimally. Once this depression and anxiety have started it usually requires treatment with medication to relieve the symptoms but at that point it is important to explore, in psychotherapy, how has the life you’ve been align with your natural gifts and interests, or something innate in your genetic makeup.
This doesn’t mean you need to change your life, it may be that you need to understand it and examine what parts of your life are giving you the gratification you need. In the case of my patient, he took a chance, did the work of discovering what career might better align with his passions. He’ll continue his medication, continue to see his therapist and, most critically, remain attuned to what in life he finds satisfying, interesting, gives him a better shot at happiness. That’s normal.
