I recently finished reading a book by one of my favorite authors, Atul Gawande, M.D., entitled Being Mortal: Medicine and What Matters In The End. In his book, Dr. Gawande primarily discusses decisions related to end of life care and outlines the differences between the medical, information-providing model of addressing these issues and newly emerging, more humane ways of having hard conversations.
The kind of conversations Gawande encourages readers to have are not just applicable to end of life decisions. For many reasons, we tend to insulate ourselves from having real conversations about difficult topics. The result can be that we talk and talk around important details of our lives but rarely manage to reach the heart of an idea and it’s impact on how we live each day. The proverbial elephant in the room is more of a force in our lives than we often realize.
So, how can we broach essential but inelegant topics in productive, affirming ways? Gawande makes suggestions about this, which I have taken the liberty of breaking down into five essential questions we should be asking ourselves and discussing with those we love when times are tough. These questions include:
- What are your biggest fears and worries?
- What are your short-term goals?
- What are your long-term goals?
- What trade-offs are you willing to make to achieve your goals?
- What trade-offs are you unwilling to make to achieve your goals?
Answering these questions honestly requires courage. According to Gawande:
At least two kinds of courage are required…The first is courage to confront the reality of mortality – the courage to seek out the truth of what is to be feared and what is to be hoped. Such courage is difficult enough. We have many reasons to shirk from it. But even more daunting is the second kind of courage – the courage to act on the truth we find. The problem is that the wise courage is so frequently unclear. For a long time, I thought this was simply because of uncertainty. When it is hard to know what will happen it is hard to know what to do. But the challenge, I’ve come to see, is more fundamental than that. One has to decide whether one’s fears or one’s hopes should matter most (p.232, bold and italics added).
The statement that we must decide whether our fears or our hopes matter most resonates with one of the most basic tenets of the therapeutic process, which is that before we can develop skills to maintain resilient mental health we need to develop awareness around thought and behavior patterns that are keeping us unhealthy.