Gratification: Mean Doctors and Marshmallows

December 9th, 2013 By Steven Knope, MD

On some level, I would like to believe that I am a compassionate man. I really do care about people. However, I do not operate under the delusion that I was endowed with a copy of the Mother Theresa gene. When problem solving – especially when dealing with weight loss, smoking cessation, or substance abuse – I take a rather direct approach with my patients. As a result, I have been told on more than one occasion that I am “mean.” Really?! “Mean?”

During those times that I have been called a heartless bastard it has usually been in an affectionate way. But in every joke there is a kernel of truth. So I suspect that some of my patients were trying to send me an equally, not-so-subtle message. hostess twinkies

Time to Care

Early in my practice, when I had a panel of 3,000 patients, and saw 30 to 40 patients a day, I had little time to work with people who were struggling with behavioral problems. In those days, I had a mere 7 to 10 minutes to spend with each patient. During that period of time, I often had critically-ill people in the ICU. So whom do you think got most of my attention, the person on the breathing machine or the guy who couldn’t say “no” to a Twinkie?

However, people who have difficulty controlling troublesome behaviors – like overeating, drinking too much, or smoking – have very real health problems. They require and deserve more than a superficial chat with an overworked physician. After all, behavioral problems like these, especially when played out over a lifetime, often lead to an admission to the ICU.

Though being rushed is a negative, time constraints can be hidden gifts. They force us to get to the heart of an issue quickly. And in the case I am about to describe to you, I learned something very important in a time crunch that helped me to understand why so many people have difficulty solving these problems.

My Dog Ate My Homework

It will not surprise you to hear from a doctor that many people with weight problems or behaviors that they cannot control have elaborate excuses. If people are overweight, it is because they have a “slow metabolism.” If they can’t stop smoking, it is because they are “about to enter menopause and they don’t do well with multitasking.” (A true story.) If they drink too much, it is because their wife is overbearing, their boss is a jerk, or aliens have abducted their grandchildren. You get the picture.

So about 12 years ago, on a particularly stressful afternoon, a woman walked into my office and said, “Dr. Knope, I just can’t lose weight. No matter what I do, I gain weight. I eat a small bowl of Special K for breakfast, with skimmed milk. I eat a piece of celery for lunch. And for dinner, I have a skinless chicken breast with some green beans. And just look at me!” So I did. I just looked at her. I studied her facial expressions and listened as she professed to be the first human being on the planet to have a uniquely slow metabolism. Then I looked her in the eye and I said, “You’re lying.” She was utterly shocked! She said, “I can’t believe you just said that!!! I’ve never been so insulted in all my life.” I never removed my eyes from hers. I smiled at her and I said once again: “You are lying. You can’t possibly eat the way that you described to me and continue to gain weight.” To my astonishment, without missing a beat she laughed and said, “Okay, you are right. But…

“Whoa, stop right there!” I said. There are no buts. You just identified the problem, plain and simple. You eat too much. Now we are getting somewhere. Now we can begin to talk honestly about how you might change that behavior.

We both laughed. Her story changed from that of a drama to a comedy. Comedies are a lot more fun for both the actor and the audience. In a strange way, she seemed relieved to have finally told the truth. And from my end, I was just happy that she hadn’t thrown her water bottle at me.

Why the Self-Deception?

Starting in childhood, it is natural for us to want what we want, when we want it! But as adults, we know that there are consequences to consistently cheating nature. When it comes to our unflattering behaviors, we all deceive ourselves. We all use denial as a coping mechanism. It is just human nature to do so. When we recognize our weaknesses, we feel bad about ourselves. Coming up with elaborate excuses temporarily soothes our pain, but this also delays confronting the problem, which prevents us from solving it.

When we are embarrassed, we also have a need to deceive others as a way to save face. We make up big lies, because it protects our public persona. After all, if the problem with these issues is that we simply don’t have the ability to delay gratification, what does this say about us?

It’s the Habit that is the Problem

The problem with self-destructive behaviors is not a single night of overeating or overdrinking. Life should be as much about parties and celebrations as it is about work and achieving goals. The problem occurs when destructive behavior becomes a habit. It is the inability to delay gratification over the long run that is the primary reason for most of our failures in life. And this is why losing weight, quitting smoking, or cutting back on drinking can be so difficult. Bad habits become ingrained in us over years or decades. And it takes a great deal of intestinal fortitude to stop feeding the immediate gratification monster and turn ourselves around. There is pain involved, and pain is an acquired taste for most people.

I know what you’re thinking: “This is nothing new. I’ve heard this all before. Tell me something that will really help me master my own behavioral problems.”

The Marshmallow Study

Okay. If you want an appreciation for what I am really talking about, let’s go to the video tape. Let’s make the importance of delayed gratification a little more concrete and understandable. If you watch this short video until the end, I promise you will both laugh and be rewarded.

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