How about CAD, t2dm

k_rmSelf_vs_xpSelf  .. k_X_focusing_illusion  .. k_CAD

This blogpost started with a ADL/TPD focus and included some less severe but still chronic conditions detrimental to quality_of_life [wellbeing] in old age. Now I feel the ideas in this blogpost are relevant to a wide range of  (medical or non-medical) long-term conditions related to old age, like loneliness, gradual loss of mobility.

• eg 2: Christopher Reeve
• eg 9: In 2007, XXX.Hou (L.Hou’s dad) described himself as struggling-with (he sounded more like defeated-by) multiple conditions in nervous system, 内分泌 system, respiratory system, circulatory system, reproductive system, etc. Since then, I have always concluded that his life experience in those years was miserable, and he was suffering through those years, but really?
• Paul Allen may have suffered ill health for much of his later years, but … “Paul deserves much more time.” Unlike Bill Gates, we outsiders often hit DurationNeglect and fail to realized that Paul’s xpSelf wanted to live longer, albeit in a form of unhealthy_longevity (defined later in this blogpost).
• eg: in 2022 I jogged past a a street poster (treatment ads) showing a man’s upper body with dozens of skin lumps. What if the condition is chronic and can’t be treated? I think this condition is much less severe than ADL/TPD, so yes we will get used to living with it. The older we get, the more “appearance deterioration”will become chonic… including drooping, skull elongation, obesity.
• eg: My mom, always scared of losing mobility permanently in old age, is now positive about her will to live with that, but she said she would prefer to die if she falls into /vegetative/ state.
• eg: Ken.Lew‘s “desperate” workout… He is battling his long-term “condition” with long-term strategy. We outsiders (our rmSelf) tend to see his struggle as hopeless (he said “desperate”), but is his xpSelf suffering as if tormented day in day out in a prison? I don’t think so.
• eg: Rong.Zhu also described to me his chronic back pain — the “condition”. Well, it never disappeared, but he got used to it, exactly as Buddha predicted. Similarly, in the early 2000s, the 领头羊 young man described to me and ML his chronic migraine (the “condition”).

eg: 5k/M to support living with ADL is the main (but low probability) “condition” of this blogpost. Some people speculate that with 2 ADLs (or Total Permanent Disabilities) our quality_of_life is guaranteed to be  intolerable, and not worth living, so we probably want to end the suffering early.

I find this “guarantee” a very questionable evaluation by the rmSelf, largely influenced by mass media portrait of severe disabilities. Similarly, in the desparate: healthy lifestyle context, some would say Kenneth is desperate fighting a hopeless battle. “Is it worth fighting?” … the rmSelf asks itself.

In this kind of forecast and for most individuals, the rmSelf is the decision-maker. The xpSelf has no voice and is routinely neglected, but it deserves a lot of attention. The xpSelf ought to take the lead and decide whether such a quality_of_life is worth living. The evaluative rmSelf had better shut up and stop playing a backseat driver.

In my prognosis, I would surely /adapt/ to the ADL limitations (or TPD) and learn to enjoy a much reduced level of well-being and /satisfaction/fulfilment/. I believe my zqbx strength will shine through.

In reality, ADL limitations (or TPD) is not equal to “loss of all limbs” or “total loss of sight+hearing like Helen Keller”. Many ADL individuals live years of fulfilling life, in spite of their disabilities. (One of the first traction-secrets is refusing to compare with the able-bodied.) See Reeve.

Suppose from age 80 to 90 you have lived with fulltime nursing due to ADL or TPD, and now a family member tells you she is considering a similar insurance and asks:

Q: If you could choose a second life between two tough choices, do you prefer your kind of life (with the ADL) or a life that ends at 80, before the ADL event? In other words, would you rather be killed by the event? Is the 5 DALYs [from 80 to 90, but adjusted with a factor] worth nothing or worth living?

A layman on the street, considering the prospect of ADL, would probably choose the shorter life, believing (the “guarantee”) the final 10Y would be endured in misery. However, after living through the 10Y, you probably know it is a net-positive experience and therefore may choose to relive the same 90Y.

A disability-adjusted life year could be 2 twilight years spent disabled, but is worth more than zero.

With eg 9, XXX.Hou knows that his final decades (with multiple conditions) has been a net-positive and therefore may choose to relive the same life.

With eg 2, Reeve said he was “glad to be alive, not out of obligation to others, but because life was worth living.”^[79]

on P405-6, Kahneman gave a few pointers around the Focusing_illusion[2] over serious and chronic conditions.

• He pointed out that rmSelf’s evaluation of wellbeing (like CSASS) tends to compare the current life against life before the condition or agaisnt healthy people. I agree. The average person doesn’t “evaluate” her life every month, but when she does[2], indeed a comparison is automatically performed by System 1, often grossly incomplete. System 2 often does a quick review and approval, so she completes her quick-n-dirty evaluation, which usually reflects the condition. I would expect to see a below-average score on the CSASS.
• He pointed out experienced wellbeing (like hedonimeter or experience sampling) of paraplegics and colostomy patients is similar to healthy people !
• He pointed out that for many serious disabilities, there’s a large discrepancy between experienced (hedonimeter) vs evaluated (CSASS) wellbeing.
• .. I think the thought and imagery of myself (or a loved one) becoming disabled is depressing and pessimistic .. “a life not worth living”, partly because it is largely a comparison with the able-bodied quality_of_life. However, if I don’t dwell on[2] [constantly evaluate] my condition then my experienced wellbeing can be close to normal.
• .. to a lesser extent those with minor conditions are well-advised to avoid dwelling on it, including excessive reading and frequent testing.  If the condition won’t go away but receives adequate medical attention, then the fixation on it can create unnecessary suffering [loss of happiness and increase of dissatisfaction]. The xpSelf’s experienced wellbeing could deteriorate.
• He pointed out at end of paragraph1 on P406 — It appears that the (evaluative) rmSelf (of colostomy patients) is subject to a massive Focusing_illusion about the quality_of_life that the xpSelf endures quite comfortably. If you reflect on your condition, it’s tragic and you would rather have a shorter life “next time”; but if you don’t dwell on it, then it feels superficially fine.

It echoes the Buddhist insight of impermanence “Every pain and every 快乐 (bliss, satisfaction of desire) will die down.” In some unfortunate cases, the victim dies before the pain dies down (my mom’s mom). In all other cases, our biological systems adapt themselves to progressively reduce that pain/joy signal. After months or years, eventually we will learn to live with it (like covid19). We may no longer notice it, until we compare with the able-bodied.

positive eg: if after 10Y, a faithful couple continue to enjoy intimacy (even though the passion dies down somewhat), then they are lucky.

[2] https://btv-open.dreamhosters.com/wp-admin/post.php?post=549&action=edit describes — Focusing_illusion can be tricky to describe and understand. Here’s a striking example. Remember the story “We complain about our shoes / When some people don’t have no feet.” Is that a good habit to compare that way and feel less unlucky? What if one day you lose your foot? That habit is a double-edged sword and can amplify the negative self evaluation due to the Focusing_illusion.