CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
 THE CLINICAL VIEW
9  AUGUST  2001
By: Phillip E. Hoffsten, M.D.

Motivation and Freedom

Last week, this column dealt with the dangers of freedom and the medical consequences that come from abuse of our freedoms. To my surprise, the views expressed in that column must have been controversial because I received a number of letters and calls both agreeing and disagreeing with what was said and with more vehemence than usual.

There are aspects of medicine and health that really just cannot be fixed with any medicine that we know of or with any surgery that we know. Rather, certain personal characteristics and psychological considerations are pivotal to an individual's health. It has been pointed out in previous columns that individuals who are "angry all the time" or who are pessimistic or who carry unresolved shame issues have more illness and higher mortality rate than individuals who do not have these problems. Unfortunately, these personality characteristics seem to be learned at a young age and then carried through life often being taught to the next generation. Trying to learn new behaviors can be very, very difficult requiring special and intense effort if achieved.

But if there is one pivotal bottom brick in the structure of human behavior, it is the individual needing to decide for themselves what they will do. That is what freedom is: Your ability to choose what you want to do when you want to do it, your way and for as long as you want. Yet, it seems that the rest of the world is involved in one giant conspiracy to prevent this. From the time an individual is a child, parents impose i ales that either prevent certain behaviors or require certain rules molding the child's behavior. Everything from taking baths on time to washing the hands before meals, to not running in the street, to going to bed at a certain hour, etc., etc., etc., are imposed upon a child. Conflict begins right away between the child and his environment crimping the child's freedom. This is not to say the rules imposed on the child are not worthy or important. It simply states that it is against what the child seems to want.  Anyone who has ever had a teenager recognizes that this problem is simply amplified to untold heights by this young not quite adult individual demanding to do things their way when they want to do it. That drive to be free is so strong that teenagers classically do things that they do not even want to do because somebody has forbidden it.

Following high school, many restraints are removed as young adults enter the workforce or go to college. We have all seen the phenomenon of a freshman in college coming home at semester break 30 pounds heavier, flunking out and with more crazy ideas than the parents can imagine. Perhaps a most vivid example of a young adult's expression of their freedom is their car insurance rates. The young adult will drive as they darn well please; they are an adult now and do not have to obey all those senseless rules that parents and society put on them when they weir kids and there are more automobile accidents from 18 to 25 years of age than any other segment of the population.

As was mentioned in the previous column, it appears that the need to be free is hard wired into our brains. In the healthy state, this need to be free is expressed is motivation. The individuals whose freedoms are wisely and successfully expressed will be motivated to continue their activities as long as those activities are enjoyable and rewarding. Believe it or not, there are chemicals in our brain that are released when an individual is satisfied and happy and our behaviors are generally directed to maintaining a secretion of these chemicals so that we remain happy. Ironically, these chemicals are shaped and look very much like narcotics such as morphine which is used to stop pain.

The point of this column is directed to illustrate what happens when our freedoms are frustrated. First of all, it needs to be pointed out that while quirks of nature such as bad weather, storms, and accidents can be very frustrating, by far the most frustrating experience any human encounters is the behavior of other humans and especially those closest to us. When our freedoms are frustrated, the hard wiring in our brain tells us that we are not as happy as we would be if we had things our way. We then begin to do things to try and recreate our freedoms perhaps expressed in a different way. If we cannot be satisfied and gratified in one way, we will seek another way to stimulate those wonderful chemicals in our brain that make us feel good. As pointed out last week, unfortunately, many of these other activities are self-destructive.

Lastly, there seems to be the most unfortunate trait hard wired into some people's heads. This is our need to be like others or conversely have them be like us. Somehow, people seem to get the idea that if they cannot be happy, other people should not be happy either. I was once presented with a shirt for my birthday that had the message lettered on the front, "Lord, if you can't make me thin at least make my friends look fat, too". What a shabby thing to say but that idea seems to permeate our society. If our freedom to be happy and satisfied is crimped in some manner, we feel that others must undergo the same misery that we are undergoing. I do not even need to begin to describe the grief that creates. For example, there has been a lot of spouses yelled at and dogs kicked just because things went poorly at work that day.

This column is primarily descriptive and presented to lay the groundwork for next week's column. That column will be on the topic of addiction and addictive behavior. With this information as the groundwork, the concept of addiction and how to deal with it can be better understood.