What's going well?

Shifting difficult narratives

My doctor opens most visits by asking “What’s going well?” The question pleases me. I like the way it shifts our dialogue. I’m sure physicians spend a lot of time with people for whom things are going wrong, so she wants to adjust the focus a little.

I was reminded of this recently because Twin B’s illness has taken us to the Pediatric Pain Management Clinic at Children’s Hospital. One of the things they’re teaching us is how to live with pain, to get Twin B back to some of the activities she loves. This is cognitive behavioral therapy, aimed at managing the psychological aspects of long-term—we still hope it’s not chronic—pain. Right now we’re working on shifting the narrative away from everything Twin B can’t (won’t) do to more positive ways of viewing the situation, but without diminishing her real experience of pain and dizziness. Both/and. Going swimming increases dizziness and she gets joy from doing flips. Riding her bike feels unbalanced and she enjoys the freedom.

Talking about this with the provider, I connected it to my doctor’s “What’s going well?” So we’re working on this now as a family, looking for the good in the hard situations, to shift to a both/and way of looking at things. We can remind each other to think this way—all of us, not just Twin B. Because pain (and other difficulties) and happiness walk side by side sometimes.

As I said, the question pleases me. This shouldn’t be surprising coming from an optimist. At the same time, however, I’m wary of American happiness culture: the idea that there’s something wrong with us if we’re not happy, that it’s our fault if we’re not, because happiness is in our control and all we have to do is change our attitude. Put on a happy face and all is well. Call this the happiness thesis. I’ve often felt like such talk papers over real issues that need to be faced honestly. Moreover, it denigrates people’s real experience of mental illnesses like depression and anxiety, which can’t just be snapped out of. It also convinces us that happiness is an individual matter when it isn’t.¹

We need to be careful here. “Happiness” is a term that has a lot of different meanings. It can mean pleasurable feelings, being in a good mood—let’s call this the hedonistic interpretation. “Happiness” can also mean something deeper, a kind of flourishing (the ancient Greek term is eudaimonia, roughly “good spirit”), meaning your life is going well even if you’re not always in a cheerful state of mind. This kind of happiness is closely connected to meaningful activity.

Happiness culture focuses on the hedonistic version, and this is what I’m wary of. As the first Inside Out movie teaches us, emotions besides joy have important roles to play, and sometimes we need to attend to them, sit with them, and work with them.

But here we are with experts who are telling us to find the good within the things that are difficult, to break the pattern of being sucked under by (in this case) Twin B’s health issues. Twin B sometimes resists the question, in part (I think) because she doesn’t want to minimize her very real discomfort.² I get it: Is this another case of cheap platitudes patching over real problems?

Photo by Nick Fewings on Unsplash

Ultimately, I think not. The converse of the happiness thesis is also true: it’s possible to paper over and bury what’s good when we focus too much on the bad (our pain, our fears, our obstacles and setbacks). So the endeavor to seek the positive that coexists with the negative is just as important as the endeavor not to erase the negative that exists with the positive.

Mindfulness exercises and meditation have been shown to make real positive differences in mental health. Part of what mindfulness does is view the current moment from a somewhat detached point of view, taking a gently curious stance. The idea is to observe without judgment. There seems to be something important about attending to the here and now, both mentally and physically. And here and now can be many things at once.

We can be mindful on multiple levels. There’s the level of what is: physical and mental states. There’s also the level of what we’re making of it, that we’re interpreting those states in certain ways and are motivated toward various behaviors. We have little control over our physical and mental states, but we have more control of what we make of them. Again, we need to be careful: meaning isn’t as simple as what we make it. Mindfulness is an exercise in awareness of reality, and we can’t change reality just by looking at it differently. Nevertheless, we can make an effort to rebalance our perspective. Attending to what’s good in a difficult patch, and keeping sight of negative reality while attending to the good, are two sides of the same awareness coin.

I’ve mentioned before philosopher Susan Wolf’s claim that the pursuit of meaning in the form of engaging in activities of value is important because it harmonizes with the reality of our cosmically insignificant status. Perhaps something like the reverse is also true: attending to the complexity of reality and the mixture of pain and joy that it contains, accepting and harmonizing with it, leads us toward achieving meaning by enabling us to engage in activities of value even in the face of difficulty.

If that’s the case, then asking what’s going well isn’t a matter of papering over problems. It should help us shift difficult narratives toward meaning, and from there toward eudaimonia. (Now, how to get an 11-year-old to see this…)

1. Thanks to Carrie Jenkins for this point (in Sad Love).

2. She wouldn’t put it like that, but I’m pretty sure something like this is what’s behind her resistance.