I Am Grateful Not to Have to Pretend to be Grateful

Musings from the nuthouse*

*”Nuthouse” is an affectionate term for the mental health clinic I am currently residing in. It certainly is full of nutcases - not least the staff - but this is not derogatory. Being sane all the time is overrated & lacks imagination.

Photo by Jon Tyson on Unsplash

I am currently residing on a farm which has been converted to a mental health facility in beautiful, rural Kent where the staff are simply wonderful (especially, but not only, the dogs). I, myself, was suspected of having had a depressive collapse because I simply ground to a halt while staying at my mother’s house to put her affairs in order following her sudden death. When I stopped going out, the husband was concerned. When I stopped getting dressed, he was worried. When I stopped making tea, he understandably declared a state of emergency. However, I have recovered my spirits so much just from being out of the house and in the sunshine with other people that I think I just needed not to be spending so much time alone surrounded by my mother’s things in the house where she died. Complex grief is my current working diagnosis.

My recovery now will be mostly physical, I think. I am already quite a bit more mobile but it’ll take a few weeks until I can get about properly. I am so much more ‘myself’ already that it will likely be mostly be a matter of keeping spirits up while I rebuild my physical strength and stamina. I am planning to remove soon to a nearby hotel that has a well-equipped gym, a personal trainer, many classes & a swimming pool so that I can focus more intensively on that.

A problem associated with my mental recovery is that my personality appears to be coming back full force including my liberal individualism and my fighting spirit. I like these aspects of my personality but they do not always work so well in an institutional setting which seems to arouse my tendency to argue. Mostly, there is nothing to argue with, because everybody is so highly skilled and professional as well as seeming to have been selected for being wonderful, empathetic people. However, sometimes there is! I have been very grateful to the staff and other patients here, but I really, really do not like being expected to be grateful at 9.15 every morning.

Gratitude, or the state of being grateful, can defined in various ways but it is hard to find a definition that does not include the words “thankful,” “appreciative” and, often, “blessed”. That is, gratitude is widely understood to be what we feel towards someone who has knowingly helped us. Somebody who believes in God or a higher power can feel gratitude towards Him/it for any fortuitous happening. Those of us who do not cannot. The word we tend to use when things work out well for us without any conscious mind intending to do us a service is “fortunate.”

There are people for whom things more frequently work out well because of the way they are situated in society, and the words most often used to describe them are ‘advantaged’ or ‘privileged.’ However, the term ‘privilege’ is too often applied simplistically and reductively to various identity groups in current political discourse. Consequently, the very use of it can raises hackles among those for whom life is particularly difficult in 21st century Britain despite their possession of a penis or low levels of melanin. This is a reasonable objection and it is seldom helpful to explain to an individual reliant on food banks or in danger of losing their home due to the cost-of-living crisis and/or interest rate hike that privilege theory simply means their hardship was not caused by their sex or race. This is particularly the case if they never claimed it was and the individual lecturing them on it never gets around to discussing issues of class. Nevertheless, social advantage does exist and is relevant when discussing the concept of gratitude in psychology, mental health and addiction.

For these reasons and more, however, I cannot feel that ‘gratitude’ is the right term to express my awareness of my own good fortune. In considering the reasons I am having so much difficulty with this, I have come up with five:

1. I decline to pretend to believe in a God or a higher power.

2. I decline to pretend my good fortune to be the result of some cosmic power smiling upon me when, in reality, it is largely a result of my parents being rich.

3. I decline to outsource my own agency and achievements to anybody or anything else (including people and things I believe to exist).

4. I reserve the right to express the gratitude I feel sincerely towards others sincerely.

5. I decline to pretend to feel any way I do not feel.

The first reason is particularly important to me. I am an atheist, a philosophical materialist and a liberal individualist with very negative experiences of religion, mostly due to not being at all spiritual and thus having interpreted it very literally. The use of ‘gratitude’ in the therapeutic context I now find myself in is very much based on the 12 steps programme developed by Bill Wilson in the United States following a profound Christian spiritual experience and relies upon ‘group conscience.’ The second step is faith and the second tradition states: “For our group purpose there is but one ultimate authority — a loving God as He may express Himself in our group conscience”.

The spiritual element of gratitude persists within psychology more broadly. As the leading gratitude researcher, Robert Emmons writes with Robin Stern.

In its worldly sense, gratitude is a feeling that occurs in interpersonal exchanges when one person acknowledges receiving a valuable benefit from another. Gratitude is a cognitive-affective state that is typically associated with the perception that one has received a personal benefit that was not intentionally sought after, deserved, or earned but rather because of the good intentions of another person.

And

The transcendent meaning of gratitude is widely recognized in the major spiritual traditions in which thanksgiving is a worldwide response to life. This fundamental spiritual quality to gratitude, which is at the core of every major religious tradition, is aptly conveyed by Streng (1989): “In this attitude people recognize that they are connected to each other in a mysterious and miraculous way that is not fully determined by physical forces, but is part of a wider, or transcendent context” (p. 5). This spiritual core of gratefulness is essential if gratitude is to be not simply a tool for narcissistic self-improvement.

This presents a problem for people like me. Not being spiritual or having an intuitive grasp of ‘the transcendent’ is not a choice for people like me. This simply isn’t part of our psychological make-up. Even if we could choose to be spiritual, have faith or conceive of the transcendent, I think it should be a perfectly valid option to choose not to. I will “recognise that I am connected to others in a mysterious and miraculous way that is not fully determined by physical forces’ when there is evidence to suggest that this is an accurate representation of reality. Until then, I am a materialist and accept provisionally the hypothesis that everything is determined by physical forces. Nor do I wish to have a group conscience, but will continue to hold on to my own. I do not think this makes me a narcissist. Nor do I think it helpful to consider non-spiritual people narcissistic, especially if you want them to recover from mental illness.

There was a time, not too long ago, when I would have ‘New Atheisted” at this proposition quite vigorously. I would have said something along the lines of “There is no higher power that cares whether a member of an ape species on one wet rock in a vast universe uses drugs or alcohol or not. We are simply not that important in the grand scheme of things. We are only important to each other. Using God or spirituality to enable you to get off drugs and alcohol is not a solution or a recovery but simply finding another crutch to help you cope with life and continue ignoring your own responsibility for how it works out and the problems that come from inside you. To truly thrive, you will have to get off spirituality too at some point and face reality.”

I still believe there to be some truth in this but the dismissive attitude was naive and unhelpful. Although I do not seem to have an innate sense of spirituality, more people do and they cannot be argued out of this any more than I can be argued into it. There is evidence that spirituality and religious community can be beneficial to mental health and there is no inherent link between being religious or spiritual and opposing LGBT rights and women’s rights, denying objective truth or calling people who are not spiritual ‘narcissistic.’ “Group conscience” has a totalitarian, tribal ring to it but it can simply mean voluntarily forming groups around shared values. Most people do that. I do that. Humans do that and gravitating towards like-minded people does not require policing other people’s values.

Fortunately, I do not have to do much of the spiritual, transcendent gratitude thing as I am not one of the people recovering from addiction and it would be presumptuous and unhelpful of me to tell those who are how they should do that. If people find that leaning into a pre-existing spirituality helps them to overcome addiction, this can only be a good thing. I will respect this as ‘other people’s beliefs’ and continue to be, myself, a materialist. (Recognising that I am a particularly literal person and unapologetic about being so will be helpful to following this essay).

I hope there are also groups for non-spiritual people fighting this battle. It is not clear that a programme created in 1930s Christian America will be suitable in all ways to 2020s Brits. The awe-inspiring war-induced PTSD sufferer and alcoholic whom we are all missing right now as he has reentered the world believes neither in God nor a higher power. He is, however, a remarkable human being who cares deeply for other human beings and a man whom I am honoured to have met.

The second reason is also important and is another aspect of materialism. I am economically advantaged and this is how I am able to be addressing my depression in an expensive clinic in the glorious countryside of Kent. I do, indeed, feel very fortunate to be here. It is an excellent service with multi-faceted approaches to treating depression and highly trained and dedicated staff. I also recognise that I am privileged to be here while other people suffering at least as much as I am are having to continue to try to make ends meet and the support they can expect with this is limited to the prescription of anti-depressants by their GP or the addition to an NHS waiting list that never gets any shorter. As the great comedian and author of Depression and How to Survive It, Spike Milligan, said, “Money can’t buy you happiness but it does bring you a more pleasant form of misery”.

I cannot straightforwardly feel gratitude for being here as the reason I am able to be here is because my father made a lot of money in business and then died. I am grateful to my father for many things, but spending so much time at work and dying are not among them. I wish he had done less of the former and also think this would have made him live longer. I can feel fortunate to be here and recognise that I am here because of his wealth. I think it is important to be materialist in the latter sense too as it is more likely to inspire the wealthy to contribute to mental health charities and, more importantly, campaign and vote for social change that enables more people to have the same speedy access to good mental health services that we do.

There are sound philosophical and economic reasons for being sceptical of gratitude as a therapeutic intervention, but I suspect there are also good psychological ones. Does being grateful to a higher power not risk outsourcing one’s own agency? I felt that it did when a man who was recovering from addiction was handed ‘the book’ and read a passage about knowing that avoiding the temptation to use was a sign of God acting in his life. He was a very young man and, if I were he were my son, I’d want him to take credit for that and also to gain personal strength from it that he could then build on.

Relying on the whim of a god for one’s own strength or weakness does not seem a very secure foundation for overcoming addiction. Some of them are said to be very capricious. This seems to me to be an additional inherent problem with crediting God for successfully avoiding substance use. Does it not logically imply that a relapse is caused by God not acting in one’s life and enable “I couldn’t help it. God was not there.” This may well be an example of me being way too literal again, but it certainly seems like it could get in the way of an individual accurately identifying patterns that could indicate situations and states of mind in which they are at higher risk of relapse. As a non-addict with absolutely no expertise in addiction, I did not say this - well, OK, I did, but diplomatically and only once - as it would not be helpful for me to opine all over a successful substance abuse programme. Nevertheless, I cannot like this.

My objection to being grateful on demand also relates to my parenting style. When asked after breakfast every morning, “What are you grateful for?” I am reminded of nothing so much as being a child and told to “Say “Thank you” by my parents when given a present or a treat. Being told to express gratitude as a small child is often simply part of the teaching of manners which children need to thrive in society. However, it can also be infuriating and confusing. I remember my mother collecting me from a friend’s house and waiting for her to pause in her chatting on the doorstep so that I could say my “Thank you for having me.” However, there often was no pause and she would go straight from the chatting to the“What do you say?” prompt. On occasion, this would lead me to say not “Thank you” appreciatively but “I WAS GOING TO!” indignantly. It seemed very unjust to my childish brain that the doorstep ritual required me either to be rude by interrupting the grown-ups to say my thank you or have it prompted and thus no longer being my own and my friend’s mother having no idea whether I genuinely appreciated her hospitality or not. Sincerity matters and is undermined by prescription.

I admit it seems likely my overthinking began quite young. Nevertheless, this sense of injustice at having my feelings prescribed for me & then prompted or coerced stayed with me when I had my own child. This was not only in relation to ‘thank you’ but also to ‘sorry.’ Another distinct memory I have as a child (I am having a lot of therapy right now - deal with it) is of the rage of a small child required to say ‘sorry’ to another child when they are quite clearly not at all sorry. Being forced to say something that is untrue was particularly difficult for me and I frequently asked and received no satisfactory response to whether this was a situation in which it was acceptable to lie. (I would later be diagnosed with Moral Scrupulosity). I determined to find ways to teach my daughter manners and address wrongdoing that did not require her to pretend to feel anything she did not feel. I flatter myself that I have been quite successful at this, although this could be more to do with my offspring’s naturally sunny nature which she inherits from her father.

I simply do not see any plus side to instilling insincerity into children or in teaching them to express beliefs they do not hold for the sake of social approval. While social skills, manners and consideration for others are important and failures of them can be both unpleasant to experience and restrict an individual’s chances in life, as a species, we are much more prone to the opposite problem. Individual members of the big brained social mammal we call Homo Sapiens have been much more likely to survive if they conform to the values and narratives of their group than if they express their own views openly or seek truth outside those narratives. The moral psychologist Jonathan Haidt explains this in an intuitively graspable way in A Righteous Mind when he describes humans as having not an inner scientist but an inner lawyer (or press secretary). Haidt argues,

As hominid brains tripled in size over the last 5 million years, developing language and a vastly improved ability to reason, why did we evolve an inner lawyer, rather than an inner judge or scientist? Wouldn’t it have been most adaptive for our ancestors to figure out the truth, the real truth about who did what and why, rather than using all that brainpower just to find evidence in support of what they wanted to believe? That depends on which you think was more important for our ancestors’ survival: truth or reputation.

Humans cannot survive on their own. We will die without other humans and, in our ancestral past as hunter-gatherers, fairly quickly. The pressure to keep the good opinion of one’s group is therefore hardwired into us and extremely difficult to resist, making reputation-curation and preference falsification a central part of human existence. I am particularly concerned about the prevalence of “preference falsification” in our political and cultural climate today. This phenomenon in which people respond to social pressure by pretending to feel differently to the way they do was so labelled by the professor of social science, Timur Kuran, in his 1995 book, Private Truths, Public Lies: The Social Consequences of Preference Falsification and is described thus:

Preference falsification is “an individual act” that depends on the context: people mask their preferences in one setting but not in another, often depending on the rewards or punishments associated with a chosen preference. Sometimes, it can occur in "very innocent situations," said Kuran, in a 2020 interview, when people falsify their opinions in order not to hurt someone, i.e., telling a "white lie." Kuran has described preference falsification as the “tyranny of the should”.

The extent to which we are able to mitigate this tendency depends very much on the rules of the society (or the context) we live in and what the rewards and punishments for heterodox views are. I want, above anything, for us to work for a society in which people feel able to express a variety of opinions with no further consequence than some people thinking they are a bit of an arse. I would even go further and aim for a society in which people have a high threshold for bestowing judgements of arseishness upon others. This is what underlies my defence of freedom of speech and the value of viewpoint diversity. To return to Haidt:

[E]ach individual reasoner is really good at one thing: finding evidence to support the position he or she already holds, usually for intuitive reasons. We should not expect individuals to produce good, open-minded, truth-seeking reasoning, particularly when self-interest or reputational concerns are in play. But if you put individuals together in the right way, such that some individuals can use their reasoning powers to disconfirm the claims of others, and all individuals feel some common bond or shared fate that allows them to interact civilly, you can create a group that ends up producing good reasoning as an emergent property of the social system. This is why it’s so important to have intellectual and ideological diversity within any group or institution whose goal is to find truth (such as an intelligence agency or a community of scientists) or to produce good public policy (such as a legislature or advisory board).

This kind of thinking preoccupies my mind so much that I was rather startled on my first day here to be asked, “What are you grateful for” and responded, “I’d be grateful not to have to pretend to feel grateful.” But am I being oppressed and socially pressured into preference falsification in this context? Of course not. This was a therapy group, not a struggle session. The purpose of the morning gratitude is to encourage people going through a really tough time overcoming addiction to remain positive and remember the good things that happen in their lives. Had the question been “What can you be positive about today?” I would not have had this reaction. I reacted to the word ‘grateful’ because it denotes appreciation of a sentient mind outside the self that has the power to bestow or withhold favours. As a philosophical and political materialist, the power that is larger than me is other people - culturally dominant forces in society which do not necessarily have my best interests at heart. This is not what other, religious or spiritually-minded, people think of as a ‘higher power.’ That is something good which very much has their best interests at heart.

This essay, then, is partly a consideration of the assumptions underlying language used here but also a consideration of my own assumptions and reaction to that language and what this means about the way I think. I hope that this clinic and psychology more broadly will think about what asking for statements of gratitude as a therapeutic intervention can - and likely must - mean for those (overthinking) individuals who disbelieve in any higher sentient power than humans to whom it is possible to be grateful.

However, I am not being oppressed or expected to feel things I don’t or pledge allegiance to any dominant cultural group in society. I can and have been working around this with my own language. As a Brit, I am quite accustomed to doing this. As the anthropologist, Kate Fox, points out in Watching the English, we say ‘Sorry” and “Thank you” so often as a reflex, that when we genuinely are remorseful or grateful, we have to convey this by using more words. I am using different words. In ways reminiscent of little me with my mother on my friends’ doorstep, I get in first before I can be asked to express my gratitude. I say things like, “I am privileged to be able to go seal watching,” “I am fortunate not to have a banging headache today” and “I am grateful to my fellow patient for making me tea when I did have one.”

I come to the end of my two weeks here today and go on to the hotel for two weeks of physical therapy with check ins from the doctors and therapists here before coming back here for a final week before going home, hopefully restored to full functionality and with a plan to keep improving my health. I am privileged to have been able to stay in this beautiful place, fortunate to have met the people I have and found new friends, and grateful to the staff for their warmth, skill and empathy, making me feel so welcome and accommodating my overthinking weirdness.