The gentleman was a 52-year old executive who came to the clinic because he wanted something to help him sleep.  He said that he tried all of the over-the-counter preparations and they just didn’t seem to help.  I looked at his blood pressure recorded on the chart and it was 160/100 mm of mercury.  He was obviously a very tense, emphatic individual and as the interview progressed, it became obvious that things were much more complicated than a little loss of sleep.

     He had been raised in a large eastern city, one of four brothers.  His parents had been very strict requiring top performance in anything the brothers did.  The patient recalled bringing home a report card in the 4th grade with five A’s and one B.  His parents had chastised him for slipping and getting a B.  He says that his whole life had been like that all the way through business school where he had graduated cum laude with a Masters of Business Administration.  He subsequently passed the very difficult CPA exam on his first try, an unusually difficult accomplishment.  He had married a very physically attractive woman that he met in graduate school and they had three children who were very healthy but described by the patient as “only B students”.  His daughter was on the high school gymnastics team.  He stated that at a recent gymnastic meet, she got first in the balance beam but “only 2nd” on her two other events.  On further questioning regarding recreational activities, he stated that he loved to go hunting but hadn’t gotten out much in the past year.  He stated that he got rid of his dog that had cost him almost $5,000.00 to buy and train.  It seems that the dog didn’t find several pheasants that he had shot and his friends chided the patient about spending so much for a dog who couldn’t even find the bird.

     Then came his business considerations.  He had been a “top” accountant in a major accounting firm that had to reorganize because of an accounting scandal with which the patient had no involvement.  He had accepted a position with a firm in central South Dakota as being his best choice at the time but neither his wife nor his children were happy with moving to central South Dakota, although they seemed to be very well adjusted now.  He was still ruminating over how he might have made a better choice even though he was very successful at this time.

     I asked him to slip his shirt off so that an examination could be done.  He meticulously folded his shirt after he took it off stating that his shirts were specially tailored through a shop in Minneapolis.  He stated that shirts purchased in central South Dakota simply were not good enough.

     When I asked if he took any medications, he stated that medicines were for sick people and there was nothing wrong with him except that he was having trouble sleeping.

     There is a recent article in the Scientific American magazine that talked about maximizers and satisfiers.  A maximizer was described as a person who always had to have and do the best.  A satisfier was a person who recognized when something was “good enough” even if it was not the best.  This gentleman was a classical maximizer.  Everything had to be the best and once it was achieved, the best was still not good enough.  Through the entire interview, he expressed no joy or pride in anything that he had done or that his family had done.  I inquired about what he thought was fun and recreational and got a blank expression as he stated that he really didn’t do anything that was fun.  This gentleman’s case was extreme and presents a major dilemma on how to help him.  His weight was not excessive and with his necessity to “eat the best diet”, his cholesterol was well controlled although his blood pressure was substantially high.  He didn’t use alcohol because it would “keep him from doing his best”.  I began to think of him as an automobile with the engine racing whether the car was moving or not.  He seemed such a tragedy in his endeavors to do well and deriving so little joy from it.

     While his case is extreme, many of the traits described above occur in those who are more normal.  Those traits can be destructive in normal people although not to the extreme that this gentleman was finding.  It seems strange to suggest to someone that they should not always try to do their best.  But that seems to be what it comes down to.  Everyone needs an area of their life where they can relax and enjoy something without having to do their best.  I referred this gentleman to a counselor which seems like a simple step.  I first had to help him find a “best counselor”.  As you might expect no local individual would do and he currently drives a great distance to meet with an individual whom I hope is helping him.

     I guess we have computers and got to the moon and have all the marvelous precise technology that we have today because of people like this gentleman.  It seems strange for me to advise someone that there needs to be a time when they don’t have to do their best.  But that is the message of this column.  If individuals do not take advantage of “down time” and enjoy leisurely activities, major medical problems such as insomnia, high blood pressure, depression, and anxiety are predictable results.  Eventually, these lead to real organic medical illness such as heart attacks and strokes and ulcers, etc.  Applying ones self to achieve a given result is laudable.  But this must be tempered with the overall health of the individual.