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The High Art of Handling Problem People

Image: Woman with hazard stickers on her face

The walk-in medical clinic was about to close for the day when Susan Biali got a call from one of her longtime patients. Could the doctor please hang in a bit longer? The caller was feeling very ill and needed to see her immediately. An exhausted Biali extended her already burdensome day and waited for the patient to arrive. Some time later, the woman sauntered in; she was perfectly fine. She just needed a prescription refill.

“She totally lied to me,” the Vancouver doctor recalls. “Afterwards, I was so upset that the degree of my reaction troubled me. I’m a general physician with some training in psychiatry. Yet I couldn’t put my finger on exactly why I was so bothered. I thought it was a flaw in myself.”

Eventually, she identified what set her off: “You think you’re in an innocuous situation—a typical doctor-patient encounter. But the woman took complete advantage of my compassion. Then, not only wouldn’t she acknowledge the lie, but she looked at me blankly and demanded, ‘Can’t you just move on and give me my prescription?’ She made me feel that I was the problem.” 

Ever wonder how an encounter goes so quickly awry? Doubt your own perceptions? Feel thrown totally off balance by another person? Find yourself acting crazy when you’re really a very nice person? Manipulation comes in many forms: There are whiners. There are bullies. There are the short-fused. Not to forget the highly judgmental. Or the out-and-outsociopath. But they often have one thing in common: Their MO is to provoke, then make you feel you have no reason to react—and it’s all your fault to begin with! Feeling deeply discounted, even totally powerless, while having to jettison the original aim of an interaction is a distressing double whammy of social life—and a cardinal sign you’re dealing with a difficult person. No, it’s not you. It’s them. And it’s the emotional equivalent of being mowed down by a hit-and-run driver.

It doesn’t take a sociopath; anyone can be difficult in a heartbeat. “To a great extent, the problem is in the eye of the beholder,” says Topeka, Kansas, psychologist Harriet Lerner, author of the now-classic Dance ofAnger and the just-released Relationship Rules. “We all come into relationships with hot-button issues from our own past. For one person what’s difficult might be dealing with someone who’s judgmental. For another it might be a person who treats you as if you’re invisible.” That said, she adds that there are certain qualities that make people persistently hard to handle—hair-trigger defensiveness that obliterates the ability to listen, meanness, and a sense of worthlessness that leads people to bulk up self-esteem by putting down others, just to name a few.

Experience motivates most of us to avoid or minimize interacting with such people. But sometimes that problem person is a sibling, a boss, a coworker. Even your mother. And managing the relationship by distancing yourself or cutting it off altogether is impossible or undesirable. The goal, in such cases, is to prepare in advance for an encounter, knowing it will take a special effort to hold onto your own sense of self, and to stay calm.

Although it is typically disturbing to be in the presence of such people, remaining composed in the face of unreasonableness helps you figure out exactly what species of difficulty you’re dealing with. Therein lies your advantage. It allows you to predict the specific emotional trap being set for you, which is your passport to getting your own power back.

In dealing with a difficult person, the setting is everything.

Handling difficult people at work is not quite the same as coping with problem people in family life. The goal is to get the work done, and that requires great caution and considerable strategizing. “It’s not like amarriage, where the dailiness of living will allow you to repair a lot of interactions gone wrong,” Lerner observes.

In a marriage, she says, it’s often advisable to exit a conversation. Of course, there are a variety of ways to do that. A common one is to scream “I hate you” and slam a door behind you. Better, she advises, to say something like: “I love you, I want to be here for you, I want to hear your criticisms, but I cannot listen when you throw them at me rat-a-tat-tat. I need you to approach me with respect. So let’s set up a 15-minute meeting after breakfast and start over.” The difference is clarifying a loving position versus escalating things further.

Image: Woman with caution tape on her body

            In the Hothouse at Home vs. Tough at Work

Cumulative life stress decreases working memory and prefrontal cortex size.

neuroticthought:

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Two of my colleagues here at the University of Wisconsin, Richard Davidson and Seth Pollack, have collaborated with others in a sobering study that demonstrates brain changes caused by childhood stress:

A large corpus of research indicates that exposure to stress impairs cognitive abilities, specifically executive functioning dependent on the prefrontal cortex (PFC). We collected structural MRI scans (n = 61), well-validated assessments of executive functioning, and detailed interviews assessing stress exposure in humans to examine whether cumulative life stress affected brain morphometry and one type of executive functioning, spatial working memory, during adolescence—a critical time of brain development and reorganization. Analysis of variations in brain structure revealed that cumulative life stress and spatial working memory were related to smaller volumes in the PFC, specifically prefrontal gray and white matter between the anterior cingulate and the frontal poles. Mediation analyses revealed that individual differences in prefrontal volumes accounted for the association between cumulative life stress and spatial working memory. These results suggest that structural changes in the PFC may serve as a mediating mechanism through which greater cumulative life stress engenders decrements in cognitive functioning.

study in the same vein on rhesus monkeys also notes late life heath effects of early adversity:

This paper exploits a unique ongoing experiment to analyze the effects of early rearing conditions on physical and mental health in a sample of rhesus monkeys (Macaca mulatta). We analyze the health records of 231 monkeys that were randomly allocated at birth across three rearing conditions: mother rearing, peer rearing, and surrogate peer rearing. We show that the lack of a secure attachment relationship in the early years engendered by adverse rearing conditions has detrimental long-term effects on health that are not compensated for by a normal social environment later in life.

I have to say I’m jealous that Dr. Bownds is colleagues with Richard Davidson - one of my all time favorite neuroscientists.

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