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Dr. Daniel Seidman Headshot

Sometimes, "Don't Just Do Something, Sit There!" Is a Good Idea

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The impulse to chain smoke, drink too much, overeat, overspend, or take too many prescription medications is part of a larger cultural problem. As a society, we are uncomfortable being uncomfortable. It is as if we have become so consumer-oriented that we believe we can switch our moods as easily as we click to change a TV station.

I see this dynamic often in my work helping smokers to quit. Experiencing discomfort rather than "acting" to eliminate it is an important part of overcoming smoking and other compulsive and addictive behaviors. As I describe in my book Smoke-Free in 30 Days, research shows that 2 out of 3 times a smoker relapses back to smoking, it is as an automated response to a negative emotional experience. I call this pattern the "Emotion-Triggered" smoker. Similarly, "emotion-triggered" spending, alcohol use, eating, and pill taking becomes a serious problem when they are employed as a "quick fix for anxiety". In other words, when they are used to avoid something which may be wrong in our lives and that we need to constructively address.

In contrast to acting impulsively, if we can expand our capacity to tune into our inner world and to fully live in the present moment, not in the future or the past, we can discover things in our nature that will enrich our sense of well-being over the long-term. Just "taking action" when you are unhappy, such as getting another prescription from a doctor for instance, may make you feel less helpless at that moment, but could end up causing a slew of other problems down the road. Sometimes the wise course of action for change and growth as a person is to experience a situation until a solution, however imperfect, emerges. It is also important for those we turn to for help to listen carefully to our concerns, and not just take quick action because they are also not comfortable with uncertainty and are not sure what else to do or offer.

Has pill taking become the new chain smoking?

In the TV series Mad Men, the early 1960's characters chain smoke in automatic reactions to anything that brings stress into their lives. At the same time, they are often struggling to avoid the experiences they are having inside on a deeper level. Ironically, the seeds of promoting a widespread addiction to cigarettes can be found in the advertisements created by admen of the 1920's and 1930's, when smoking was offered as a way to cope with "the stress of modern life". While these old ads are long gone, they myths they generated persist. In these ads people were encouraged to smoke to "soothe the nerves," to "let up--light up". These ads offered a seductive message which has become deeply rooted in our consumer culture: smoking helps give your "nerves a rest," to cope with "high-pressure," with the "fast-moving" and "high tension" of modern times. Mood modulation and stress relief were only a puff away. Nowadays, is it only another drink, another mouthful, another purchase or another pill away? What's the problem anyway if you can take a short-cut to happiness?

For cigarettes, in case a potential customer had any doubts about whether it was safe to smoke, the ads created by the real Mad Men of Madison Avenue, before the Surgeon General's 1964 report on Smoking and Health, showed doctors, dentists, teachers and scientists recommending their favorite brands in a very reassuring manner. Other ads recruited movie stars to make smoking seem like a normal and fun way to relax and socialize. We all know how well this shortcut to happiness worked out for the health of the nation. It caused skyrocketing rates of lung cancer and heart disease which years down the road created a public health crisis.

In an advertising strategy similar to that used in the early cigarette ads, starting in the 1950's, Hollywood celebrities were also used to promote the "anti-anxiety" pill Miltown. The rise and success of the pill Miltown in the mid 1950's was swift. At one point Miltown accounted for one out of three prescriptions in the US; by 1957 36 million prescriptions for it had been filled! The happiness train had left the station. In a recent New Yorker piece, Louis Menand makes the point that in an age of anxiety, Miltown was sold as "the cost of success in a competitive world". However, you would have to jump on board the happiness express fast while the pills still worked as advertised! By the mid 1960's, Miltown developed a bad reputation for physical and psychological dependence, and its use was severely restricted.

Medicines that effectively treat medical conditions, like major depression, are important contributions and should not be diminished. I myself am a great proponent of nicotine replacement therapy (NRT) for my smoking cessation patients who need it. When used properly, it can play a crucial role in making it as easy as possible to quit smoking. However, there is a line where addressing legitimate medical problems crosses over into selling stress relief and happiness at all costs. In 1966, the Rolling Stones picked up on the problem of the everyday use--and possible abuse--of prescription drugs in their popular song "Mother's Little Helper":

Kids are different today, I hear ev'ry mother say
Mother needs something today to calm her down
And though she's not really ill, there's a little yellow pill
She goes running for the shelter of a mother's little helper
And it helps her on her way, gets her through her busy day

While research upholds the crucial role of antidepressants in pulling a seriously depressed person out of the black pit of depression, it has not supported the use of these pills for moderate and mild symptoms of depression. Although it has been questioned in some quarters, this research provides evidence that, in the range of the more normal problems in living, we shouldn't just turn to those "little helpers" to get us through the day.

Has pill-taking really become a public health danger like chain smoking, too much drinking and overeating? According the Centers for Disease Control (CDC), yes.

"Recent work at CDC has focused on the short-term, severe problems of medicines taken by people outside of hospital settings. It is estimated that there are more than 700,000 visits to emergency departments for adverse drug events each year in the United States. Nearly 120,000 of these patients need to be hospitalized for further treatment. This is an important patient safety problem, but many of these adverse drug events are preventable."

Sometimes the easy magic of certain pills is oversold just as the purported stress-reducing qualities of cigarettes used to be. The difficulties of learning to cope with life stress through nonmedical means such as a shift in psychological perspective and behavior change is also exaggerated in favor of the "quick fix." At the same time, the benefits of learning to tune in and live with our experiences before taking action are often overlooked.

Fully 95 percent of physician visits now result in a prescription. How many prescriptions are too many? We've gotten to the point where almost every visit to a doctor ends by pulling out the prescription pad. If this goes on much longer it may be no more sustainable than our national debt. Taking multiple mood altering prescription medicines at once is a new frontier in medicine, one we have already crossed but with little research to guide the way. Doctors are very busy and can't or don't always access accurately all the other medications being prescribed to their patients. I've seen more and more patients taking multiple medicines who can no longer separate out what are side-effects from the medicines from what is an underlying physical complaint. Some of these medications interact in tricky ways, which requires careful listening to patients and time-consuming detective work to disentangle. Meanwhile, as patients are on more and more medicines, doctors in managed care have been required to schedule shorter visits. No wonder many cases end up in the emergency department!

Complex medical problems can require aggressive medication strategies and approaches. But let me provide two cautionary tales about this trend. One patient of mine complained of stomach pain and was worked up by a series of physicians. Each offered her a new prescription after the visit, but without eventual improvement. After a year of intense frustration, (she had never been sick in her life and never felt so debilitated before) she started to look into all the medications she was taking. She then discovered the problem was listed as a side-effect of a medication which she had been taking when she started to feel bad. She discussed this with the doctor who was prescribing it, discontinued the medicine and started to feel like herself again.

A colleague of mine, a physician with multiple medical problems, has taken periodic trips to the emergency room and had to endure multiple stays in the hospital some of which have been related to her medications. These experiences have demoralized and depressed her spirit, especially when her medical colleagues refused to listen to what she was telling them. Getting heard has been an important part of getting better for her.

Becoming a patient herself and struggling with chronic illnesses, has opened her eyes to the patient's side of the doctor-patient relationship. She is now more convinced than ever of the importance of giving a careful hearing to a patient's concerns. Listening to patients, and not just "taking action" and reaching for your prescription pad, she believes, is indispensible to proper diagnosis and treatment. The human side of medicine, the trusting patient-doctor relationship, is not just some minor part of the vocation of medicine. The art of listening, and not just shutting down the patient's experience to speed up the assembly line that is modern medicine, is at the heart of delivering the highest standard of care possible. During one of her darkest episodes of being overmedicated she wrote the following:

I wonder about the will to live. People who have illness (me too) grow weary of the attention which goes with disease----daily pain, dysfunction that they have, problems walking or what-
ever- The effort is great to overcome the most mundane of tasks. But they make the effort because they want to become human, like before. The joys of life, like reading, swallowing, eating, and walking are curtailed. When it is bad, you feel weary-tired-weary-tired, depressed-weary-tired-depressed. It eats at you, and impacts your drive to enjoy life.

Thankfully, after reducing some of her medications, she quickly got steady on her feet again, and her cognitive functioning, thinking, and energy also improved. Her spirits soon improved as well.

Doctors worry that patients would be disappointed to leave their office without a prescription, that the visit would be a "waste". But wouldn't it be more respectful to treat patients like adults and tell them when it is in their interest to not receive a prescription, and to adapt through non-medical means to some of the inevitable discomforts of life?

Dr. Seidman is author of the new book Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit with a foreword by Dr. Mehmet Oz (Fireside Trade Paperback Original, January 2010). An audio book is available from Random House. Dr. Seidman first introduced his own program to stop smoking as a featured expert on The Oprah Winfrey Show with Dr. Oz early in 2008. For more details about the book go to www.danielfseidman.com

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