Richard G. Petty, MD

Life Is About Choices


“One’s philosophy is not best expressed in words; it is expressed in the choices one makes. In the long run, we shape our lives and we shape ourselves. The process never ends until we die. And, the choices we make are ultimately our own responsibility.”

–Eleanor Roosevelt (American Diplomat, First Lady and Humanitarian, 1884-1962)

Choosing A Life of Magnitude

Marianne Williamson.jpg

“A life of magnitude does not just happen; it is consciously chosen. Living is an endlessly creative process in which we work on achieving the life we want through our willingness to be who we would like to be.”      

–Marianne Williamson (American Author, Unity Church Minister and Lecturer on Spirituality, 1952-)   

“Everyday Grace” (Marianne Williamson)

The Genetics of Wall Street

After seeing the recent ups and downs of Wall Street, I was fascinated to see a new study in the Proceedings of the National Academy of Sciences by an international team of researchers that has demonstrated for the first time that genes exert an influence on people’s behavior in a very common experimental economic game.

The Nobel Laureate Jim Watson once quipped that there were only molecules and everything else was sociology. I don’t think that he was being altogether serious, but he did highlight a yawning chasm between different ways of describing human experience.

Social scientists have been a bit reticent about acknowledging a role for genes in economic behavior. But a study by David Cesarini, from the Massachusetts Institute of Technology’s Department of Economics and colleagues in Sweden indicates that there is a genetic component to people’s perception of what is fair and what is unfair.

The researchers looked at the ultimatum game, in which a proposer makes an offer to a responder on how to divide a sum of money. This offer is an ultimatum; if the responder rejects it, both parties receive nothing.

Because rejections in the game entail a zero payoff for both parties, theories of narrow self-interest predict that any positive amount will be accepted by a responder. The intriguing finding in the laboratory is that responders routinely reject free money, presumably because they feel that they want to punish proposers for offers that they think are unfair.

To study genetic influence in the game, the researchers recruited twins from the Swedish Twin Registry, and had them play the game under controlled conditions. Because identical twins share the same genes but fraternal twins do not, the researchers were able to detect genetic influences by comparing the similarity with which identical and fraternal twins played the game.

The results suggest that genetic influences account for as much as 40 percent of the variation in how people respond to unfair offers. This is much larger than the effect of common environmental influences such as upbringing.

The research indicates that many of our preferences and personal economic choices are subject to substantial genetic influence, and it will be interesting to see how they interact with social and environmental factors.

Choosing To Be Happy?

For the last two decades, one of the central tenets of the self-help movement has been that we can choose to experience or to be whatever we want.

Many psychologists have also said that human happiness or subjective well-being is largely independent of our life circumstances. Therefore wealthy people are no happier than people of more limited means; married people aren’t much happier than single people and healthy people aren’t much happier than sick people. The keys to happiness are supposed to lie within us, in our attitudes and perceptions.

If these theories are correct – and they are theories – we would predict that changes in our life circumstances would not have long-term effects on our happiness. This has indeed been the dominant model of subjective well-being: people adapt to major life events, both positive and negative, and our happiness stays pretty much constant through our lives, even if it is occasionally perturbed by some big gain or loss. According to the theory, winning the lottery may make you happy for a little while, but it won’t make you happier in the long run.

Not unless you have made the choice to be happy.

Similarly, while a divorce or major illness might throw your life into turmoil for a while, your happiness level will eventually return to where it was before. The idea has been that of sense of subjective well-being has a set point, and that a change in beliefs or attitudes can change the set-point.

But is this true?

New research, and reexamination of old research, is challenging some of the claims of set-point theory.

In this month’s issue of Current Directions in Psychological Science, Richard E. Lucas of Michigan State University and the German Institute for Economic Research, reviews some recent studies suggesting that adaptation to changing life circumstances only goes so far. As he says, “Happiness levels do change, adaptation is not inevitable, and life events do matter.”

To study adaptation, Lucas and his colleagues used data from two large national prospective panel studies, one in Germany and the other in Great Britain. Unlike most previous studies of adaptation, these data were able to capture levels of life satisfaction both prior to and after major life events like marriage, divorce, unemployment, and illness or disability.

Lucas found that not all of life events are created equal. For example, most people adapt quickly to marriage. They have peak in subjective well-being at the time of getting married, but within about two years, their happiness levels return to their previous levels.

People usually adapt to losing a spouse, but it takes a lot longer: on average about seven years. People who get divorced and people who become unemployed, however, do not usually return to the level of happiness that they experienced before. The same can be said about physical debilitation. Numerous recent studies have demonstrated that major illnesses and injury result in significant, lasting decreases in subjective-well being.

But Lucas also found that individual differences play an important role. There is a great deal of individual variation in the degree to which people adapt to what life throws at them. We know that life events run in families: there is a genetic predisposition to having multiple life events. People who are destined to experience certain life events differ in their subjective well-being from those who do not, even before the occurrence of those events. As an example, people who were happy 5 years before their marriage, stay married, and also stay happier than those who are destined to marry and get divorced.

Lucas stresses that his findings do not undercut the importance of adaptation processes. Some degree of adaptation necessarily protects us from prolonged emotional states that may be harmful, and helps us attune to novel threats to our well-being rather than dwell on ones we are familiar with. Adaptation also helps us detach from goals that have proven unrealistic.

So what does this mean to us personally? It is rather like the statement attributed to the German priest and scholar Martin Luther, “Pray as if everything depends on God. Then work as if everything depends on you.”

  • Make the choice to be happy, but that choice will, on its own, achieve little unless you also work to change your life circumstances
  • The choice to be happy will not be crowned with success unless you really feel that you want it deep down inside: it has to be a core desire
  • Not everyone can make the choice because they are not wired that way
  • Do not be disheartened if you make the choice to be happy and things don’t quite work out. Some pop psychologists and gurus have told their followers that if they failed to find happiness, then they were inadequate, or did not want it enough. That kind of nonsense can cause needless guilt and suffering. Sometimes life chucks too much at you at once, and it’s okay to be unhappy. It does not mean that you are a wimp, or that you didn’t want happiness enough
  • The best way to deal with a world that throws a lot at you is to learn the art and science of resilience and acceptance

But also remember something else: the great sages have always taught that happiness is our natural state, and the art of living is to return to that natural state.

But most importantly, to help others get there as well.

“Action may not always bring happiness; but there is no happiness without action.”
–Benjamin Disraeli, 1st Earl of Beaconsfield (English Statesman, Novelist and, in 1868 and from 1874-1880, British Prime Minister, 1804-1881)

“Forgiveness is the key to happiness.”
–A Course in Miracles (Book of Spiritual Principles Scribed by Dr. Helen Schucman between 1965 and 1975, and First Published in 1976)

“Happiness is the very nature of the Self; happiness and the Self are not different. There is no happiness in any object of the world.”
–Ramana Maharshi (Indian Hindu Mystic and Spiritual Teacher, 1879-1950)


We have a new little kitten and this morning, despite trying to keep her in the house, she scooted outside and then ran into the local feline bully. The poor little creature came in with a nasty scratch on her ear, and perhaps the understanding that the world can sometimes be a scary place. We had tried to advise and guide her, put sadly she had to learn for herself that there can be unpleasant consequences from running outside.

Similary we all want the best for our children and the people around us, but sometimes we can do them harm if we don’t help them understand the consequences of their actions.

We teach children how to cross the road, and later on, how safely to drive a car and deal with dangerous or exploitative people. We can’t live their lives for them, but we can try to help them understand the consequences of their actions.

Sometimes this important gift fails to materialize when a child or other loved one is struggling with a chronic illness.

Let me explain.

During my clinical career I dealt with two groups of clinical problems in which the biggest difficulty was not diagnosis, but helping people to stay on the treatment that they needed. The two problems were diabetes and psychiatric illnesses. By treatment, I certainly don’t just mean taking medicines: I mean being able and willing to follow a course of action.

There are dozens of reasons why people decide against taking the treatment that they need, whether it’s surgery, medication, psychotherapy or homeopathic remedies.

  • Some people don’t see the point of treatment: they are happy as they are even if the illness is causing unseen damage
  • Others just forget their treatment
  • Others don’t like the side effects, or they are frightened that they may get side effects
  • People worry about stigma and about being seen as somehow different
  • There are even a few who like being ill: not just the experience of, say, having lots of extra energy, but being cared for and looked after. I have known people who have spent 40+ years in bed, sometimes with quite minor problems.
  • Some just deny that they are ill: The extent of the denial can be amazing.

I saw an article on the BBC this morning about a young woman who believes that she went blind from the complications of diabetes because she “rebelled” as a teenager and was probably in denial.

It reminded me of a young woman whom I was once treating. Her metabolic control was becoming worse and worse. She was getting blurred vision and she was rapidly gaining weight. Her mother became extremely indignant when I asked – very, very gently – if the young woman might be pregnant. The patient and her mother vehemently denied the possibility. Less than a month later – on Christmas Eve – I had to arrange for the teenager to have emergency laser therapy on her eyes for severe diabetic retinopathy. Four weeks later she gave birth to a healthy, but very large baby girl. Both mother and daughter were in denial until the very end, and mother did not want to help the daughter face the consequences of failing to treat her diabetes or the pregnancy.

I’d like to give you two other examples of failing to face consequences.

In the first, a family saw me on television and asked me to see their son. He had a major neurological illness, did not want to take medicine, and It turned out that he had already seen some of my colleagues in my department. The parents wanted me to force him into taking medicine.

The second involved someone with attention deficit disorder (ADD) who could not remember to take her treatment or to follow through with any of the therapies that we recommended. Her parents wanted us to treat her. After a while it became impossible, because she had no interest in being treated.

But here is the point. The young man with the neurological illness had something progressive. He could not yet be declared legally incompetent, but he could not see that without treatment he would become very sick. The young woman with ADD also had a potentially progressive illness and was on a slippery slope. Not that the ADD was becoming worse, but because the behavioral consequences of the illness were leading her into more and more risky behaviors.

In each case the parents wanted doctors and other therapists to “Do something.” Yet in each case the parents were probably the only people who could help their kids.

What do I mean by that? Some parents enable their children to avoid the consequences of refusing treatment. I asked the young man’s family what they did if he refused his medications? The answer was that they yelled at him. Yelling helps nobody. But they were aghast when I suggested that his treatment should be linked to having “privileges” at home.

If he truly genuinely needs help, and he can’t see it, sometimes the best way forward is for the person to have to face some consequences.

Whether or not he took his treatment, he might get yelled at, but after that he could go to his wing of the house, watch TV, play on his computer and order food. No
consequences. I suggested linking TV watching to participation in
treatment. The family would not countenance it. They wanted to displace
all the responsibility onto other people who should tell him what to
do. Yet they had unwittingly sabotaged every attempt at treatment in several

Treatment is a matter of discussion and agreement. And yes, of course, mentally competent people have a right to turn down treatment. But if they cannot see the consequences of their folly, then family and friends may be the only people with the leverage to help them.

Every one of us has wants and needs. If someone is stuck, then those wants and needs can help us to help them. This isn’t a matter of being coercive: it is sheer practicality.

The young man with the neurological problem saw no need for treatment because his every wish was being fulfilled: he even had servants waiting upon him. The young woman with ADD was probably not safe to be driving around in a car, yet her parents gave her one and paid for the gas and insurance anyway. They did not link treatment with providing all those things. So she saw no need to be treated.

Nobody wants to mean to a person suffering from an illness, but sometimes we need to mobilize all the resources that we have to help a person. It is entirely a matter of being pragmatic. The person saying, “Force my son to take his medicine,” is obviously speaking out of frustration. No clinician can or should do such a thing. Confrontation will scuttle any chance of setting up a therapeutic alliance with someone.

We do have some techniques for helping people. One very promising approach that we have been using is called motivational interviewing, and there are others. But even those will have little value unless people can see the advantages of treatment and the consequences of not being treated.

The best way of staying motivated to do something like stop smoking or manage your weight is to combine the advantages of taking action with the disadvantages of staying where you are.

If you know someone who has a real problem and is refusing help, ask if there is anything that you can do help motivate them to face the consequences of what they are doing. It can sometimes be the kindest and most loving thing that you can do for someone.

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