Injunctive Messages 6
MOVING THE SET POINT AS AN INDICATION OF HEALING
If valid data from excellent research could change minds then most folks would believe that Type A Behavior (TAB) is the primary cause of coronary artery disease. Unfortunately, the most that his research got for Dr. Meyer Friedman was a rather cold shoulder from a majority of the medical establishment. He once commented on this quandary by wryly saying, “When we are mentioned (in the press), we are disagreed with and when we are agreed with, we are never mentioned.” He seemed to harbor no ill-will about the situation recognizing that for most medical people, “Nothing heals like cold steel,” and they were not crazy about the idea of a “talking cure” for coronary heart disease. **
His research was immaculate. I will share a short description here as it contains a helpful concept in thinking about Injunctive Messages (IM’s). With his colleagues, he painstakingly created a videotaped standardized interview process to assess the presence and amount of TAB. Using this interview, they were able to obtain a score on two measures: Time Urgency (TU) and Free Floating Hostility (FFH). These two scores added together gave the person their “Type A score.” The goal of the treatment intervention (a form of group counseling) was to decrease this score over time, indicating a decrease in the occurrence of TAB.
An individual’s initial score represented his or her “set point.” On a good day, there might be less TAB and on a stressful day more. The amount of TAB did not deviate greatly from the set point. In the treatment, as evidenced by subsequent interviews, many people were able to move their scores downward, creating a new set point. Because the treatment was done over a long period of time (four years), the new set points became as durable as the former set points. This is important because the people who lowered their scores significantly increased their protection from coronary heart disease.
Moving the set point created protection.
The idea of a set point is central to my concept of the three styles of intimate relationships: Destructive, Limp-along, and Healing. By the time a couple has decided that counseling would be helpful, if not a last resort, it is easy for them to recognize that their relationship is either in the Destructive or Limp-along category. It is not only vital for a couple to know where their relationship is on this spectrum, it is also most helpful to determine where their original models of relationship were located as well.
It is important to know our set point, the spot we start out from. This was a great source of power in the TAB work. We could say to people with scientific authority, “Here is your starting set point. You do have this malady and it will do you no good to believe you don’t.” This approach is also vital in couple’s work, to know where one is starting from, not where one wishes to be or believes themselves to be.
Those IM’s that are very powerful in a person’s life create a set point on the left-hand side of the IM Chart. When one has made a Despairing Decision in response to a particular IM, that will be followed at some point of empowerment by the Defiant Decision. There is a movement back and forth between the recurring feelings of despair and the alleviation of that despair by use of behaviors coming from the Defiant Decision. This recurring pattern morphs over time into the Coping Behavior. This Coping Behavior enshrines itself as the primary way to deal with stress and becomes codified. And it largely becomes invisible to the sufferer because it has all the hallmarks of, “That’s just me.”
The frequency and tenacity of the Coping Behaviors become the identifiable beacons of the set points in a person’s life. It is very difficult for a person to see these set points because the Coping Behaviors have become normalized. This is the same case with TAB. To a trained observer, it is quite easy to recognize and measure TAB. It is not easy for the individual to see it at all, or perhaps only in part. It brings to mind the old adage, “It’s hard to see the picture when you are standing in the frame.”
The presence of intense and unbending coping behaviors indicates that the set point is located on the left-hand side of the chart: revealing an ongoing state of struggle with one or more IM’s.
When my father was asked how he felt after the first definitive research was published linking cigarette smoking to a number of diseases, most notably lung cancer, he replied humorously, “It made me so nervous that now I smoke even more.” Smoking was embedded in my father’s life and represented the depth of his set point in relation to the IM, “Don’t Be Well.” Mere data was not about to be able to allow him to move that set point. Indeed, he was saying in reality, “The data made me feel a certain level of despair that is alleviated by defiantly smoking cigarettes and the relief is too great to give it up.”
Unfortunately, everyone at that dinner table laughed along with him and his chipper attitude. Two years later, he was dead of complications stemming from his smoking. He was fifty-seven. No one at that table, least of all the teenager who was myself and secretly smoking, realized the gravity of his comment. Here again, it is not hard to reframe his words, “I am revealing to all of you that I am actively involved in destroying myself and I am so wedded to this spot that I am not able to move. My illness and poor health have become part of my sense of identity and it is not possible for me to think that any or all of you might be impacted by my early death if I do not find a way to stop.”
Neither the specter of his possible death or the devastation it would cause his loved ones was powerful enough to deter him from his path. In order for him to have changed course, he would have had to embrace the “New Belief Based on What is Actually True” for the Don’t Be Well Injunctive Message: “I need more help than I can give myself.” This son of a country doctor had a long list of physicians in his life and spent his time defiantly refusing to take their advice to heart. Besides, his primary physician smoked.
Using smoking as an apt metaphor, it is well known that stopping addictive smoking has almost immediate short-term as well as long-term beneficial effects. The initial benefits are not particularly satisfying to a person craving a cigarette, but true nonetheless.
In just this same way, the pursuit of healing along with the willingness to be coached and counseled in that direction brings with it immediate benefit. It is possible to move our set points. It is possible to resolve all IM’s by discarding our belief in their multiple falsehoods and embrace what is true. Once we are fully ensconced on the right side of the diagram, our set point there is as durable as our previous one.
It would be a cynical person indeed who would claim that there is no difference to our wellbeing whether we live on the bitter side of the diagram with its struggle and pessimism, or if we live on the healing side with its warmth, wisdom, acceptance, and optimism.
Two years ago, I attended the ninetieth birthday party of a dear friend, a vital and perspicacious man. Somehow, we happened on the issue of smoking. He revealed that he had been a heavy smoker. “How long?” I asked. “Until I was sixty-two,” he said. “Just in time,” I said. “Just in time,” he repeated nodding his head. “Why did you quit?”, I asked. “Because my friends convinced me they would be shattered by my early and avoidable demise.”
He moved, with help, his set point. And he still is, moving his set point that is.
**I once asked Dr. Friedman what it took for a new scientific theory like his to be accepted. It was obvious that the data, no matter how good, often did not suffice. He replied, a bit humorously, “You outlive your enemies.” Wittingly or unwittingly, he was quoting the great physicist Max Planck, “A great scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die.”