Health
Tue Feb 13 2024
The Importance of Agency
Dr Lee Penn, Phd
Dr. Lee Penn, PhD
Psychologist and Author
The Importance of Agency Hero


What do world leaders, sore losers, and my tantruming toddler all have in common?


The need to feel in control.


Big or tall, young or old, spiritual or atheistic, it is generally accepted that human beings have a deep-seated need to feel mastery over life’s circumstances. Note, this is not to say that we all desire to exercise control — that’s a whole ’nother can of psychological worms.


Indeed, the illusion of control will do. We like to know that options are within our reach and accessible should we so choose to reach out our hand.


It’s not what we would do, but what we could do that matters.


You don’t want to give your maturing toddler one outfit to wear if you have any respect for your eardrums and kneecaps. No, you let them choose between two or three options.


Have you ever been invited to a party that you didn’t want to go to? How nice to be able to choose to stay home.


Now, have you ever not been invited to a party that you didn’t even want to go to anyway? The nerve! Not only does the social rejection sting, but the careless host has denied us the privilege of choice. Our sense of mastery over time and space has been challenged, perhaps irreparably…


…even though our desired outcome is the same.


This need for a sense of control, or what we refer to as personal agency, transcends age. It never truly goes away. In my work as a psychologist for nursing homes, I observe daily how important this need is and what happens when it is not met for our aging and older citizens.


One time, I was even forced to leave the facility without my shoes.


…..


Early in my career, I had the opportunity to work with an older gentleman who had quite the reputation within the nursing home. The nursing staff used words such as “demanding,” “manipulative,” and “foul-mouthed,” to describe him. This description said as much about the staff as it did about the patient and when I met with him I soon understood why.


A lover of cards, dice, and all manner of games of chance, (Codename) “Deuces” had atrophied legs and hand/finger contractions that limited much of his ability to do things for himself. A proud man, Deuces required a lot of help with everything from rolling over in bed to bringing food to his mouth. Most of the things that able-bodied humans are capable of doing for themselves to survive and thrive, Deuces was no longer able to do.


In short, his disease progression had taken away his sense of agency. He was now reliant on others, and he did not cope well with this from an interpersonal standpoint.


I was called in to work with him after he lost the privilege to use his electronic wheelchair due to bumping into another patient with said chair, resulting in a slight “fender bender.” Deuces was deemed unsafe to operate a moving vehicle, and his means of moving independently throughout the facility was taken away.


He opted to curse and fight until he could get it back.


Understanding what we do about the importance of personal agency, this reaction — though inappropriate — makes sense. With so little in his control, he strove to influence the world through the behaviors available to him. Add to this the fact that electric wheelchairs are a kind of expensive status symbol within nursing homes, and further light is shed on the issue.


Deuces felt emasculated and that made him dangerous.


When I met with him for the first time, he sized me up right away as the short, timid, inexperienced little psychologist that I was.


“Can you get me my chair back?” he asked.


“I don’t have that power, no,” I said.


“Then get out of here, ***hole. I don’t want to talk.”


“Do you want to play cards?”


“What are we playing for?” he asked.


I pondered this. “What do you want?”


“Gimme your shoes if I win.”


A word of advice is poignant here. If an angry card player with a moniker of “Deuces” or some such challenges you to gamble your shoes on games of skill, then you should tread very cautiously.


I agreed.


…..


I met with Deuces once a week for the following two months. He could not hold up cards due to his disability, and often he would reveal his hand by accident. But we used cardholders, and we took turns choosing the game. Blackjack, Texas Hold’em, Five Card Draw — we played a wide range.


We kept a running tally, with my shoes as the ultimate prize.


During the games, he would tell me about his life. He loved the games, but he grew to appreciate the chance to talk. He shared his regrets, the people he had loved, his proudest moments. To my chagrin, he related the massive jackpots he carried away from Las Vegas casinos, some of which blacklisted him for various reasons.


Soon, Deuces took a big lead in the score. His attitude by now had softened, even with the staff. Though I was fit in ways he could no longer be and carried a professional degree next to my name, we were on an equal playing field at the gambling table.


As they say, “All is fair in love and cards.”


He understood that if he wanted to keep playing our games, he’d have to rein in his behavior. But more than that, he felt powerful and capable for at least one hour each week.


…..


Eventually, I was able to convince the medical director to return Deuce’s electric wheelchair, championing a stance of quality of life needs.


Deuces was happy, the staff members were relieved, and my work within the nursing home was almost at a close.


During my last meeting with Deuces, I was taken aback when he demanded his payment, and I felt a cold flush of shame trickle down my back.


Deep down, a part of me thought I would get away without having to give up my shoes.


Or be the first doctor to walk out of the facility barefoot.


My foolish hope was that returning the chair would be enough to satisfy the compulsive gambler, but I should have known better by now. I was so far in the hole of losses that there was no hope of coming back to save my dignity. I also knew that I could walk away, and there would be nothing he could do about it.


At stake was all of the progress we had made. Like a bookie on an unlucky day, he smiled as I unlaced my Doc Martens.


…..


Looking back, I don’t know whether or not that was the right way to handle the situation. I imagine my clinical supervisors suffering brain aneurysms while reading this, knowing that I let a patient have that much control in the therapeutic dyad.


You can tsk-tsk or laugh all day, but that’s how it happened.


But I knew that Deuces needed to feel in control, and in my mind, a pair of shoes was a small price to pay for another man’s sense of personal esteem.


….


Note: the above qualities of persons and settings have been altered to protect individual identities. Characteristics from multiple patients and nursing staff have been combined, though the content and overarching message are true reflections of my experience as a mental health provider.


…..


If you’re interested in exploring these ideas more, check out my first book available on Amazon: The Golden Rules of Retirement: A Psychologist’s Guide To Living Life to the Fullest, No Matter Your Financial Situation. Kindle and paperback editions are available now by going to the following link: https://www.amazon.com/Golden-Rules-Retirement


As well, check out my new book, The Golden Rules of Life Satisfaction: A Psychologist’s Guide to Living a Longer, More Satisfying Life No Matter Your Age!


And, stay tuned for details, including release date, upcoming sales, and future books in the Golden Rules series by visiting my website: lifecanbegolden.com/


-Lee Penn, PhD

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