Enough is enough:
The phenomenology of satisfaction.
Dr David Straton
The engravings
of the famous proverbs, "Know thyself" and "Nothing in
excess," are found on the walls of the most important building in the
sanctuary of the Temple of Apollo at Delphi. Western civilization, and
psychiatry in particular, has been more successful at promoting the first
proverb than the second.
Many psychiatric
disorders are concerned with these three states. For example, anorexia nervosa
involves too little food. The decision to end a relationship, or commit
suicide, follows the decision ‘enough is enough’. Substance abuse, bulimia,
obsessional cleaning in OCD, and behaviour in hypomanic or manic states
commonly involve ‘too much’.
The management
of patients frequently requires decisions involving quantities: enough
medication, frequency of visits, time to admit to hospital. Winnicott described
the concept of ‘good enough mothering’.
In everyone’s
life there are decisions that lie on the same continuum: enough money, enough
superannuation, enough holidays, where to ‘draw the line’ with children.
In national and
global affairs, the same pattern comes up and must be dealt with. Enough
population, enough economic growth, too much crime, too much inequality
When these
matters are discussed, they are invariably considered from an objective point
of view.
Eating disorders
are assessed in the light of the Body Mass Index.
Alcoholism is measured in
standard drinks, or occasionally a more flexible definition such as ‘anyone who
drinks more than their doctor!’
Traffic cops
measure speed and levels of alcohol in the breath.
Financial
planners calculate interest rates, tax, and future spending levels.
When considered
objectively, the key question is ‘Enough of What?’ Alcohol, Money, Weight,
Psychiatrists in the Bush, whatever.
I have recently
become interested in the subjective experience of ‘Enoughness’. The
phenomenology of the subject. Just as one can discuss the phenomenology of
hallucinations and delusions without getting overwhelmed by their content, one
should be able to consider the process of the appreciation of ‘Enough’ as
distinct from the content of the specific issue.
Perception.
From a cognitive
point of view, one can hypothesize that a subject, facing a quantitative
continuum requiring a judgement, could have a template representing their value
of ‘enough’ of whatever the quantity is. They then estimate the present state
in comparison to this template, and initiate a push towards More, or Less, if
there is a discrepancy.
A comparison can
be made with someone waiting for a passenger to arrive. They have a template in
their mind of the person they are waiting for, and they check each arriving
passenger against this until they get a ‘fit’.
In this model, a
failure of fit between the quantity and the ‘enoughness’ template can occur as
a result of either:
- the quantity
being too small,
- the template
being too large, or
- both.
The objective
school of thought traditionally concentrates on only the first of these
possibilities.
Transition.
The second issue
I want to raise is the transition between ‘Not enough’ and Enough’. This is the
interface between the zone in which ‘More’ is required, and it is not. The top
of the plane’s climb. The last drink. ‘Rock Bottom’. The time to retire. The
announcement of leaving home. The shift from dieting to eating, or vice versa.
This is the
shift from the quantitative response to a qualitative one. The end of the
‘More’ paradigm, and the beginning of the ‘Stable’, ‘Sustainable’, or just
‘Different’ one.
It seems to me
that the challenges of this transition sometimes lead to the template being
adjusted up. In other words, the achievement of the fit between the quantity
and the template requires a response. If that response is too difficult, the template
is changed to fit the quantity.
‘Just one more
drink’. ‘I’ll give you one more chance’. ‘Try increasing the pills’. ‘If the
natives don’t understand you, just shout at them!’
These are
quantitative responses to situations requiring a qualitative response.
The failure to
make a transition at the enough spot is a huge caterpillar, failing to
metamorphose into a chrysalis and butterfly.
The cancer cell,
reproducing when reproduction is not needed.
Enough is where
quantitative hits qualitative. Where the accelerator is released and the wheel
is turned.
Cognitively,
there are three aspects to this transition:
The recognition
that the threshold of enoughness has been reached.
The engagement
of the schemata of changing behaviour.
The
consolidation of the schemata of the novel behaviour.
In a therapeutic
context, this provides a framework for tackling the change cognitively.
Schema Deficit
theory
A schema is any
sequence of sensory, motor, cognitive, or emotional processes. A psychological
‘sub-program’. Schemas are much easier to create than to destroy.
If a subject has
several schemata in a particular area, they generally use the best one
available.
If they are
lacking a range of schemata in a particular area, they will use whatever they
have.
Increasing the
menu of available schemata is a better route to change than trying to eliminate
a dysfunctional schema.
We all have a
schema for putting on a lace-up shoe.
- Perceptual. Which
foot, which shoe?
- Gross motor.
Dock foot in shoe.
- Sensory. Check
for pebbles, laces, etc.
- Fine motor. Tie
bow.
- Pressure
sensation. Tight enough?
If this schema
was causing you trouble, and it couldn’t be modified, there are no psychiatric
treatments I know that would eliminate it. No medication, no ECT, no
neurosurgery, and no psychotherapy. Far easier, and far better, would be to
teach you schemata involved in using other types of footwear, such as:
Sandals
Thongs
Velcro shoes
Tooled Texan
boots
Gumboots
Slippers
The ‘Not enough
zone’ requires schemata like:
Initiating
Spontaneity
Saying ‘yes’
Demanding
Shopping
The ‘Enough zone’
requires schemata like:
Tolerating
boredom
Buffering
destabilizing inputs, either Up or Down.
The ‘Too much
zone’ requires schemata like:
Garage sales
Going to the tip
Coping with loss
Grieving
Saying ‘no’ to
invitations
EXAMPLES
Eating
disorders: The capacity to experience satiety may be disrupted. One theory
about the efficacy of fluoxetine in bulimics is that it assists neurological
pathways used in the experience of satiety. To resist the impulse to eat
requires the tolerance of the experience of hunger or emptiness. To maintain
sensible eating practices requires regular patterns of diet and eating. Each of
these can be tackled separately. The emphasis throughout should be on the
identification, development, rehearsal, and practice of new schemata, not on
the condemnation of old schemata.
Substance abuse.
As for over-eating, except that mind-altering substances may themselves disrupt
the capacity to experience satiety and also disrupt schemata of sobriety. The
phenomenon of state-dependant learning often complicates change.
Emancipation of
young adults. I frequently see teenagers and twenty-somethings who are living
at home in conflict with one or both parents. Hosing down family bush-fires is
generally a thankless task. The problems seem to improve only when some or all
of the participants decide that ‘enough is enough’ and the young person leaves
home, gets a job and a partner.
I recommend focussing on:
- the threshold
(‘how will you know when you have reached the point when it would be better for
you to leave?’),
- the process of
leaving, (‘could you leave home in anything other than uproar, in a way that
your parents actively help you without making you feel rejected?’),
- identifying the
various micro-skills of independent living and rehearsing them.
This seems to be
preferable to stabilizing the conflict, or urging good behaviour on all and
sundry.
Marital
dysfunction.
Pretty much any
situation involving dissatisfaction produces a choice plan with 3 options.
Useful questions
include:
- How will you
know when you have put up with enough?
- How will you
know when you have tried enough to improve things?
- If you decide to
leave, how can you do that in such a way as to minimize avoidable drama that
might rebound on you?
- What pitfalls
can you anticipate after separating that might be avoided?
