Failure is problematic for any number of reasons. There are small failures and serious failures. There are failures that knock us way off track and are difficult to recover from. There are other failures that somehow result in new opportunities. What is striking about failure is that it represents a kind of crossroads. Now, as you blues fans know, Crossroads Blues is a famous song by Robert Johnson (and Cream). Johnson was reputed to have made a pact with the devil: he exchanged his soul for his extraordinary ability to play guitar (Johnson clearly got the better part of that deal). Many cultures have folk tales concerning crossroads which are viewed as a location between the natural and supernatural, representing liminality, i.e. a place neither here nor there, or betwixt and between (http://en.wikipedia.org/wiki/Crossroads_(culture)). If we think about failure as a kind of crossroads, it can be viewed as a point at which an important choice is to be made. We can see it as having the potential for learning and adaptation or retreat and loss of hope. Back to baseball:

When a major league ballplayer comes to the plate he can’t dwell on his last failure to get on base. To do so would compromise the most important thing he can do- see the ball (paying attention to what kind of pitch the pitcher throws). Previous experience with that pitcher and his statistics (what he throws and when) figure in to be sure. But, when it counts, it is the present moment that defines the batter’s reality: no past, no future, no place other than at the plate, a place that is always indeterminate. All the training, all the practice, every review of mistakes, leading up to that moment provide the backdrop to the immediacy of being at the plate; but they don’t define it. That only occurs when the pitcher throws and the batter decides (with remarkable speed) whether to swing or not. A batter wants to get a hit, maybe even needs to get a hit, but he also knows that if he is thinking about getting a hit, he is not fully present to the ball coming at him. Staying focused requires good preparation and the ability to block out distractions. It means to let go and to take a risk. All success is predicated on just these factors: preparation, focus, and risk. Or, as Seneca the Roman philosopher (and the Marine Corps by the way) puts it: Luck is what happens when preparation meets opportunity.

In a highly competitive society that seems to regard failure as a moral weakness, yet exhorts us to learn from our mistakes, it is very hard to experience failure as a necessary part of learning and success. To do so would mean to suspend our expectation of having to get it right every time (whatever ‘it’ is). If you’re concerned with getting it right, you’re not paying full attention.

Failure inevitably involves tolerating our emotional response to failure. If we learned that failure is responded to with disapproval, we are likely to experience failure as deeply wounding. You can’t learn or take a necessary risk when you’re hurt like this because the task is to recover one’s equilibrium and feel better rather than to ask oneself what there is to learn from the failure. If too much pain follows failure, focus is deflected and risk is avoided.

To sum up, failure is integral to success because it shares with success 3 factors: preparation, focus, and risk. That failure occurs should come as no surprise since one can never be certain that one is fully prepared, completely focused, or fully cognizant of all that risk entails. But, we are going to come up to the plate whether we want to or not. Life is full of crossroads. Are you going to watch the ball or think about striking out?

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First, it is my view that each citizen has a social and communal responsibility to care for her or himself. It’s not the physician’s job, it’s not the government’s job. It’s our responsibility to society and ourselves. It’s our job to be informed, to advocate for ourselves, to select the right doctor- no one else’s. It is our job to follow what our physician advises, provided we understand its rationale or, to work with the physician to develop a treatment plan that we are willing- with help- to put into action. It is not our role as patients to be taken care of in the sense of waiting passively for the physician or her or his office to reach out to us.

Second, the way medicine is taught and practiced in the U.S. renders it rather poorly prepared to treat chronic illnesses over the duration of the illness. When there are acute episodes of the illness or changes that are unexpected, medicine can respond quite well. However, for the long haul, it is the patient who must manage her or his disease in conjunction with a physician’s recommendations for self-care. This is particularly true for middle-aged and older adults: the interaction between a chronic illness and age-related changes is inevitable. So must be the assumption that we must be active participants in our own care.

Find the physician who wants to collaborate, who sees her or his responsibility as, in part, insuring that you can learn what your role is in your own care, and will hold you accountable. Sometimes we can’t follow a prescribed regimen: that’s not necessarily a failure on your part or the physician’s, but a real problem for you and your physician to work through (e.g. what are the obstacles to following a specific treatment plan?).

This is an adult approach to health care. The rest is wishful thinking and politics.

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Emerging Adulthood
Young men and women in their twenties are faced with two significant tasks: they must launch a career, and emotionally separate sufficiently from their family of origin to establish adult relationships with peers and begin the task of finding a life partner. These are complex activities with many obstacles. Psychotherapy can be helpful in assisting the person in developing plans, focusing on vital issues, strengthening self-esteem, and overcoming the effects of self-defeating behaviors that made successful achievement and effective communication difficult. Creating a healthy forms of self-care lays the foundation for healthy adulthood.

Middle Adulthood
Competing demands from many sources make mid-life (~30-60+) particularly difficult. One is often confronted by the consequences of decisions made in the past (e.g. career, spouse) as well as the limits of one’s talents, opportunities for achievement, and enjoyment of work. Responsibilities for family and to one’s life-partner are many. Psychotherapy may involve assisting the person in working through unresolved conflicts from the past, identifying new areas of growth, and tempering a mature and flexible self-esteem. Developing and strengthening self-care is essential to these tasks. Life transitions and mid-life crises test one’s ability to maintain continuity as well as to change and adapt to new circumstances. See my articles, “Longevity I” and “Cognitive Fitness I”

Late Adulthood
The challenge of late adulthood (70+) is to maintain a sense of vitality and openness to life while at the same time learning to compensate for physical difficulties and the losses of significant others that come with longevity. The kinds of difficulties people face at this time in life include grief over lost loved ones, especially spouses, difficulties with coping with physical impairment and chronic illness, and loss of independence (e.g. no longer able to drive). This also a time of discovery where a person begins to see in clear relief the contours of a long life lived, of appreciating the complexities of that life, and that the lessons learned, were learned for good reason.

Research in the neurosciences has demonstrated that the cliché, use it or lose it, probably holds true. And, there are some things we do know that are more specific. For example there are two rough categories of learning that are being suggested. One has a maintenance function: practicing what you know helps you maintain that skill. So, if you’re a little rusty on multiplication (in your head rather than on a calculator), practicing will bring back previous skills. Same with crossword puzzles: if you’ve always done them, then you are maintaining your skill and not learning something totally new (e.g. Dean Olser on NPR, All Things Considered, June 23, 2009, http://www.npr.org/templates/story/story.php?storyId=105808456). Maintaining skills is important and creating routines that result in practicing skills is the kind of creative adaptation necessary in middle and late adulthood.

Learning something that’s completely new to you is a different matter: drawing, learning the guitar, developing a new sport, etc. There are many, many things on the menu. Take a look at Anne Underwood’s article, Can Dementia Be Prevented?” http://newoldage.blogs.nytimes.com/2009/06/11/can-dementia-be-prevented/?scp=1&sq=can%20dementia%20be%20prevented&st=cse). She points out that what matters seems to be that the learning be complex, engaging a variety of cognitive skills. For example, learning to play a musical instrument requires that we learn to listen differently, attending to how sounds relate to each other and to the melody, how sounds can be represented in musical notation, learning about tempo and how that is represented visually, etc. Oh yea, one has to practice like crazy because one’s hands and eyes have to work together in new ways. Challenging!

That practice and new learning are likely to improve cognitive fitness should come as no surprise: the brain is an organ of the body, and we know ‘physical fitness’ improves our health. Why should the brain be any different? The issue is: are you going to take deliberate action designed to improve your cognitive fitness?

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For all races in the U.S., life expectancy at birth in 1900 was 47.3; in 1950 it was 68.2, and in 2005 it was 77.5 (with females 80.4 and males 75.2; my source is: The Centers for Disease Control, http://www.cdc.gov/nchs/data/hus/hus08.pdf#026). These are rather extraordinary numbers. Using these data, in the United States, you can expect to live much longer than your great-grand or grand parents. What does this mean for us?

For our purposes here, let me point out that in addition to the need for greater financial resources, cognitive, social/emotional and physical well-being will also be essential in the years following retirement (which could last 20 or more years!). Preparation for this period of adulthood will need to begin much earlier so that one is able to take advantage of the significant changes that accompany retirement.

Let’s use an example: If you are working, think about your average day: you have a schedule, responsibilities, and individuals with whom you interact. Work, in one sense, is about structure – social, motivational, and goal-directed in real time. This complex structure mobilizes many of our abilities that include cognition, sociability, and physical endurance. If you aren’t working, what will replace this complex structure? How will you stay motivated to learn or perform, develop new relationships, stay physically fit over a decade or 2?

More about this. Thank you for reading this post.

The Spanish philosopher, George Santayana, is famous for his aphorism, “Those who cannot remember the past are condemned to repeat it.” However, he has another that speaks directly to the issue, “Repetition is the only form of permanence that nature can achieve.” I interpret this quotation as follows: life is inherently conservative. We do not make changes quickly because it would be dangerous to do so. Why? We seem to perceive change as destabilizing our sense of permanence, of security. So, we do the same thing over and over again, thinking that through repetition we gain that security. The irony of this choice (one that is rarely conscious) is that this assumption (that repetition provides security) often leads to a marked decrease in our ability to respond to our world in creative and more adaptive ways. We see only what we want to see, remaining within the illusion of safety. Learning about oneself and one’s impact on others becomes less important than maintaining the status quo. More about this later.

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But, my guess is that these words are not so easy to bring to life, that we all feel that we fall short on each. I think the reason for this is based on how we are educated as children and how children interpret what they are being taught. From early on we are instructed to be persistent, to practice, practice, practice, to do our homework every day. While it is true that such teaching works (after all, most of us got through school), it may also be true that youngsters hear those instructions as a sort of infinite command followed by a very real finite response; meaning that we come to evaluate ourselves in terms of absolutes. Sort of a ‘do it right or don’t do it’. The problem is that many things can’t be done right every time or even most of the time. Self-discipline seems always out of reach because we expect ourselves always to get it right. So, if you don’t make it to your work out every time then you aren’t very self-disciplined. My experience with this is rather different. The task begins before the activity- we have to plan how we are going to do things that take into account the fact that we are very busy, often fatigued, etc. Setting modest goals, regarding success as defined by showing up rather than always achieving the goal of the activity, and not looking back are pragmatic ways to structure a disciplined activity.

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