Monday, October 26, 2009

Depressed? You aren't alone.....

As someone who has been in some form of the mental health profession for 17 years, I frequently get comments and questions about my job. One of the most frequent comments I receive is in the vein of "I couldn't listen to people's problems/complaining all day." For me, I don't see myself as listening to problems all day and it is very rare that I have clients that incessantly complain. Truly. I am someone who, along with many others in mine and related fields, treats mental health disorders, which includes mild, moderate, and severe depression. Before you feel exempt, know that you have probably qualified to seek the services of a mental health professional at some point in your life. Anxiety and depression especially are VERY common in the good 'ol USA. I thought with this little blog, I would give out some general info on mental disorders, and specifically, depression. The following excerpt was taken directly from the National Institute of Mental Health (NIMH) website:

"Mental Disorders in America

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.2Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44.3 Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.1

In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).4

Mood Disorders

Mood disorders include major depressive disorder, dysthymic disorder, and bipolar disorder. Statistics for 2008.

  • Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.1
  • The median age of onset for mood disorders is 30 years.5
  • Depressive disorders often co-occur with anxiety disorders and substance abuse."
Depression is a cluster of symptoms that affect general arousal systems and impacts sleep, appetite, attention, motivation, mood, and energy. Depression can be a feeling. For example, it is a common feeling experienced after a loss. It is often not caused by one specific thing and it strikes all people in all walks of life. The depression I am talking about here though includes feelings (depression, sadness, irritability, and guilt), changes in sleep and appetite, lack of motivation and interest, inability to focus and concentrate, physical pain, loss of hope and self-confidence. It is not uncommon for one to feel suicidal (as a loss of hope is a symptom of depression, many experience a false reality that things won't improve and they find their despair intolerable). Please note that these feelings are more than false beliefs that one cheery friend can just talk them out of, it is how they experience their world. The very systems that get impacted by depression are the very ones that one often needs in place normally to seek treatment and/or healthy environments. This is often not the case in other conditions. It can therefore easily become a vicious cycle. Depression is a disorder than can be treated.

There is so much to depression, whether it is the varied types of treatment, research on its causes, the public response to depression or those that are depressed, etc. I figured I would just start the ball rolling with some general info and will follow up with more on depression. Stay tuned.

Monday, October 19, 2009

Psych 101: Uncle Sigmund Was Right.

I have to get something off my chest and I have decided that now is a good time! Since my blog is just a newborn, it is a good time to confess as there aren't too many witnesses. Okay, here it goes......I think Sigmund Freud was/is a staggering genius and I see confirmation of this almost daily in the manifestation from my psyche and the psyches of others. I used to write him off as a sex obsessed, cocaine snorting whacko and now I have a lot more respect for what he brought through. I have realized I fell into the classic trap of discrediting the work/art/words of another because I was not smart enough, open enough or evolved enough to understand or......because it created fear. Plus his collaboration with Uncle Carl (Jung) helped CJ evolve into my favorite grandpappy of psychology. Frued definitely had his quirks but wow, did he nail a few things and humans have not thought of themselves the same way since! He honored us with a few gifts and I would like to highlight a few.....

Uncle Sigmund's Gift #1: Identifying the unconscious

Now, many have talked about the idea that we aren't aware of most of the activity and potential of our brains. Uncle Sigmund really expanded this idea and highlighted how much of our psyche is operating without our consent or direction! Enough said. Well, at least for now.

Uncle Sigmund's Gift #2: Defense Mechanisms

Defense mechanisms are securely built on the foundation of Gift #1, many of the defense mechanisms that he observed come from the unconscious. Usually fueled by anxiety, we have very creative ways of making sure that uncomfortable material doesn't cause psychological distress. While you may think defense mechanisms are negative, I think they deserve our respect. Thank God they are in place or many would not be able to function in their daily lives. Our psyche knows what we can or can't handle. Now, when there is material festering down in the depths that is being diverted through defense mechanisms, it causes problems, that is for sure. There does comes a time to release the defense mechanism, face the pain and anxiety, and heal the past, but that timing is different for everybody. One of the most interesting defense mechanism to me is projection. Projection is when we unconsciously cast our undesirable or unwanted thoughts, emotions, attributes, cravings or desires onto another person, religion, country, group, political party, etc. Of course it is a bit tricky. How can you tell the difference amongst your value system, your preferences or your projections? The best way is to follow the charge-the anger or the fear. When it is projection we feel a lot of energy and the situation looks very black or white to us! Do you get confused when a political candidate campaigns passionately against some issue and then turns out to have the same skeleton is his or her closet? Projection. Isn't fascinating when everybody can see it clearly but them. We all do it! We would have healthier people, families and nations though if we all took time to examine our projections. Shadow work is always transformative.

Uncle Sigmund's Gift #3: Defining dreams as the language of the unconscious

I love me a good dream! There is no way to prove to the skeptic that dreams are really more than just your brain taking out the garbage at the end of the day. I get that. Certainly very difficult to research. I am a convert though, thanks to Uncle Carl. I believe that they are always telling us what is going on in the depths of our psyche. More on dreams later.

"Psych 101" will be another blog series of mine. Now that I have a venue, I don't think I can pass up the opportunity to write and dialogue about some of the fundamentals the study of human behavior and the human psyche.

"Knowing your own darkness is the best method for dealing with the darkness of other people."-Carl Jung

Monday, October 12, 2009

Why Can't People Just Get Over It?!

Ever known somebody that seems to be stuck on a particularly painful event or situation in the past? Notice how most of the focus returns to that precipitating event and they circle the drain absorbed in anxiety and pain? Now, the discussion about what keeps people stuck can take up hundreds of blogs. But to start, I would like to share with you some things that are critical to our understanding about the development and treatment of trauma as well as our compassion and treatment of those that have been traumatized, the walking wounded.

I had the wonderful opportunity last week to hear a leading researcher in the impact and treatment of trauma (this includes, but is not limited to, physical, sexual, and emotional abuse as a child or adult, combat, significant stress like a death or huge financial loss, etc), Bessel van der Kolk. Dr. van der Kolk spent 28 years at Harvard and now has his own institute in the Boston area. I will try to highlight some of the really important stuff.......

When we are born, our brain has a lot of development still left to do, a lot of the old brain (what we share with the animals) is in there and ready to fire and our frontal lobe, well, its under construction. Our frontal lobe is new brain, its the part of our brain that is huge in defining our personalities. Its what makes me "Sarah." One of the system that is relatively intact when we are born is our fight or flight system, this is what gets kicked into high gear when we perceive a threat (it is important for compassion and education purposes to know that most of the perceiving of such things is done unconsciously, or in other words, by old brain, NOT by the frontal lobes). We develop a second system as little people that allows us to self regulate, basically to calm down. This system is developed through interaction with the environment and primarily through interaction with the primary caregivers. If the environment is chaotic, abusive or neglectful that system is underdeveloped, so that creates an internally anxious, hypervigilant, stressed out person. Most, about 80%, of this systems nerves are efferent, meaning they go from the body to the brain! This is why telling people to think differently and "move on" is useless, and often cruel. The conscious, thinking part of their brain didn't cause this and therefore can't fix it. Someone in this position isn't remembering what happened, they are reliving it. It is important to note that negligence can be very distructive, for it is often viewed as less detrimental. For example, there are many children of alcoholics that had a "happy" drunk or a "calm drunk" for a parent, as opposed to a violent one. It appears as though their systems are also significantly impacted, most likely because an impaired parent is often not present emotionally, intellectually, and on many subtle levels, interacts with their children very differently. Adult children raised in these environments often see the world as negative, they often feel very anxious, they find that they are often controlling and judgmental, in other words, the world and its inhabitants are continued to be interpreted (by their survival focused brain) as lacking. When this system is working, the frontal lobes stay online during stress. The person is able to stay in the present, to know that they are safe and to address their environment appropriately. If you can do this, be grateful.

So, what happens if this system is faulty? Well, if one cannot internally physiologically and emotionally self-regulate they seek out external means of doing so. Substance abuse and addictions of various sorts, food, smoking, compulsive relationships, perfectionism (big in US culture), all work to physiologically alter one's internal experience. Down the healthier avenue, one may seek out exercise, body movement meditations such as yoga and tai chi, mediation and prayer, etc.

One is more likely to be retraumatized as an adult if this system did not fully develop. The foundation is not there and so the stress response takes over. For example, those who survived 9/11 but came from troubled childhoods were more likely to develop PTSD (Post Traumatic Stress Disorder-a severe, pervasive, anxiety condition) than those who weren't. They simply have different brains.

We can treat this! There are techniques and evidenced-based approaches that are making an impact. For example, EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, other therapies that focus on the physiology are showing wonderful results. Stay tuned. I am passionate about the treatment of trauma and will have more to say!

Monday, October 5, 2009

Some Things My Job Has Taught Me, Part 1

I am not sure when it started, but for a while now I have noticed that I often say to my clients, "Well, one thing my job has taught me......," or a variation of that phrase. I made a list one night and came up with 27 off the top of my head and decided then that this needed to be a series on my blog. In order to become a licensed mental health professional in the state of Arizona, you have to have a certain level of schooling, a certain amount of training and you have to pass a test.....amongst other things. The idea is that you are the professional and you will offer your clinical skills and education to the clients that you serve. What they don't tell you is how much you learn after you receive all of your training and that this education comes courtesy of the amazing people that you get to work with and the opportunity to observe the patterns in human behavior and relationship that one is exposed to when having the privilege to do my job. And so it begins.......

One thing that my job has taught me is that the truth really does set you free and its close cousin, you are only as sick as your secrets. This may be a bit dramatic but I think this is the key to higher levels of mental and emotional health. The road to honesty is extremely difficult and there are many obstacles to overcome. For starters, one needs to be honest with themselves and that takes time for self-reflection, courage to face the truth, and usually some type of consequence which inspires one to do it differently. Emotionally, shame is the biggest hindrance to this endeavor, followed closely by fear........(they often work together). Let me expand on the shame thing.....because its role is paramount. Many hide their secrets from themselves or others because of the shame it triggers. Shame is that feeling, that state of being, that is about feeling less than, unworthy, unlovable, inadequate, invisible, alone in the world and we have all sorts of defenses to prevent that from coming up into our consciousness. One has to confront their shame and it defenses in order to find the freedom that comes from being who they actually are, demons and all. "Being who you actually are" sounds great when its all the good stuff about us, but what about when we have to say that who we actually are is also an addict, or someone who is cheating on their spouse, or someone who as been abused or has abused, or someone who's family was less than perfect, etc, that's when we tend to put up the walls. We use all of Uncle Sigmund's (the grandpappy of psychology, Sigmund Frued, will always be referred to by me as, "Uncle Sigmund") identified defense mechanisms to then create the story we want to believe and the story we present to the world. We have all done this, we will all do this.

So, what is the benefit of living in your truth and revealing your secrets? The irony is the one often feels a significant reduction in shame after going through the gate of honesty and self revelation. The build up of shame, the depression and anxiety caused by the pent up emotions, the fallout experienced in once's close relationships, the addiction that is fed by the secrets, the energy it takes to maintain the facade, all take a toll. Don't get me wrong, the gate of honesty is very difficult to walk through, especially when another is involved. This is where the fear comes in, usually at the foundation one must confront their fear of abandonment and their fear of rejection.

I have observed, both in my life and the life of my clients, the greatest beneficiary of truth telling is in one's relationships. Your relationship with others, your Higher Power, and yourself. Secrets block intimacy. For example, you cannot lie to your spouse (and yes, minimizations and omissions count) about an extramarital affair and have a close emotional connection with them. The lie prevents healing. Unconsciously and consciously, you will protect the secret and many other aspects of you get shoved down as well. Most spouses and 99.9% of the children know something is going on so this further increases the wedge. In the example of addiction, one has to reveal the full extent of their addiction and places it has taken them in order to experience the fullness of grace given to them at that level of sobriety. Or, on a smaller scale, one gets to be, and therefore attract, people that live genuinely, demons and all. Food for thought.........

"Knowing your own darkness is the best method for dealing with the darkness of other people"-Carl Jung

Thursday, October 1, 2009

For as long as I can remember, I have been fascinated by human behavior, others and my own. I can recall making a vow to myself before my first day of 3rd grade that I would behave that year. I promised myself that this year, I would be different. My target behavior was that I decided I would NOT get in trouble for talking in class, not even once. I am sure you will be shocked to hear this, but I failed spectacularly. My desire to behave differently seemed to have little effect of my actual behavior.

We live in a culture that seems to hold tightly to the idea that we can change if we decide to and that much of our poor behavior is due to poor cognitive decisions, a lack of knowledge, or even low intelligence. In my practice and when I hear people's stories, I find that this is often not the case. While I am a proponent of personal responsibility and empowerment, I have also observed that human behavior is often counterintuitive and its causes are much more complex. The field of psychology has discovered some fascinating things about human behavior. I hope to add information and encourage exploration of this with this blog. For example, we can try to chalk up the continued use of an individual's alcohol and drugs to bad decision making, when the complexity of the underlying causes of addiction can fill volumes. Or many in our culture are surprised when a beautiful person with money turns out to be troubled........we are confused, "They have so much going for them." In actuality, there is very little evidence to support the idea that money or beauty will insulate you from the pain of life or protect you from depression.

The field of psychology has discovered some fascinating things about human behavior. I hope to add information and encourage exploration of these things...........stay tuned!