Wednesday, November 18, 2009

Create your Holiday!

The holidays are a time that many look forward to and many dread! Which one are you? In my years as a private practice clinician, I have logged in a lot of hours assisting my clients with navigating through this time. In my observation there are a few things that seem to separate those who enjoy this time and those who, by January, are frazzled, sleep deprived, and thankful they made it out alive!

One thing to consider as you enter into holiday season is how much of your experience seems dictated by obligation and trying to meet the expressed or unexpressed expectations of others. One way of knowing this is to take an internal measurement of resentment. Resentment is wonderful at telling us that we need a different boundary and that we have often stepped out of healthy self care. Resentment is often created by saying "yes" when what we needed to say was "no." Take some time to check in with yourself. Are you doing something because you believe someone will be mad or hurt if you don't? You have probably already crossed over into trying to meet the expectations of others that conflicts with your own self care or the care of your family.

Focus on two things and I can safely say you will enjoy your holidays more!

First off, listen to your intuition, thoughts,and feelings around what your value system is as it relates to the holidays and give yourself permission to follow it. This value system will dictate how you spend your time and money and why. Is this a time for friends and family? Is this a time of relaxation and renewal? Is this about simplicity for you and a focus on the spiritual? Is it a time for gift giving and providing joy for others? Take some time to sit with this and let the answers come to you. This is not about selfishness. If you do this you will spend some time doing things you don't want to do but the difference is that you will feel good about it. For example, you may not feel ready to visit your grandmother at the nursing home but you will be loving yourself and her by visiting and you will feel positive later when you think about your visit. When we don't follow our own value system, we do things we don't want to do and feel resentment about it later.

The second piece is taking steps to create your holiday time by chosing what you want to do and start saying NO or limiting time spent on the rest. Identify the aspects of the holiday that bring you joy and that flow from your value system and decide to do them this year. Schedule them or begin planning them if they are events. Listen to your self about what is important to you. Sit down with your family and talk about it. Truthfully, kids don't enjoy spending time with their stressed out, frazzled parents who are too busy trying to create the perfect Christmas for them! Do you enjoy hours in the mall, shopping and looking at decorations? Great. If not, find a less stressful alternative for yourself. Are you crafty and enjoy putting extra time into wrapping gifts? Great. If not, throw them in a gift bag and move along. Love holiday parties? Great. Make them a priority and spend less time decorating your front yard. Find the parties torture? Great. Say no to the invite and sit home in front of your tree with some eggnog. Know that you can't or don't want to go to multiple family gatherings. Say no. Your anxiety will spike and then you will realize that everybody survived. If a family member stays upset, all that does is reveal what is already there (an unhealthy relationship) and you can then address that later if you chose to. You know that you are out of your value system if you are losing sleep, are irritable to those around you, spending money you don't have, or dreading too many hours in the week.

You are in an ongoing creative process, chose to create what you want for yourself and for your family. Don't agonize what to say "no" to, decide what you are going to say "yes" to and let that set the stage for your holiday season!

Wednesday, November 11, 2009

Our veterans and combat stress

In 1996, I was working at Barrow Neurological Institute in Phoenix, helping out with the cognitive assessments of patients in an Alzheimer's clinical trial. Because the patients came in often over a period of a year we got to know them pretty well. One patient and her husband became particularly close to my colleagues and me (I will call him John). He was a World War II vet and they had been married for a gazillion years. A few years later, I was living in Massachusetts and had just seen "Saving Private Ryan" and realized with regret that I never asked John about his experience or thanked him for his sacrifice. We exchanged Christmas cards (his wife was now in a nursing home and he had moved near by so he could go see her daily) and I said something about this in my card. A few weeks later my phone rang, it was John, he had sat down at his typewriter to type out his story to me and realized it would be much easier to just tell me. We were on the phone for two hours and he told me the story of his time in the military and his combat experience in the South Pacific as a pilot. He said that he rarely spoke of some of his experiences (the more horrifying ones) but it had become a bit easier as he got older. It was a profound experience. I lost touch with John over time, I know that his beloved wife is no longer with us. John had very few symptoms of Post-Traumatic Stress Disorder(PTSD) at that point, but told me it took years for him to be able to sleep well at night and for the constant anxiety to die down. He was able to go on to become a successful business man, a father, a devoted husband, and enjoyed a great life.

As you may or may not know, that is not necessarily the experience of all. In fact the statistics of those who come back from combat with PTSD are sobering, at least to me. Approximately 20% of the veterans of our current war have PTSD, and with each deployment the chances for PTSD go up. For those that are deployed for a third time, their chance are between 30-50% that they will return with PTSD.

Let me say a little bit about what PTSD is.......PTSD is a cluster of symptoms that fall under three categories, re-experiencing, avoidance, and hyperarousal. Those with PTSD may have flashbacks, where they are literally re-experiencing the traumatic event. It is not that they are thinking about the event, their brain has taken them back there. Nightmares would fall under this category. One might also get triggered by something in their environment and their brain associates it with the trauma, they then may experience severe anxiety or distressing feelings. For example, the sound a chopper blades can be a trigger for many Vietnam vets. Dust blowing in one's face can take a Desert Storm vet right back to Kuwait. These flashbacks, nightmares, and associated anxiety are not voluntary and often very difficult to intervene on. The brain has been changed by the horrors experienced and it is very difficult treatment wise to get it back in balance. The avoidance symptoms are in place because the mind and the psyche will do what it takes to not trigger the systems of the brain in charge of re-experiencing so one's life may become paralyzed by the desperate attempt to "not go there." The hyperarousal is based on the fact that sometimes the fight or flight system can't be turned off, or it gets turned on way too often. These symptoms are going to involve insomnia, inability to concentrate on daily life as one is in "survival mode), irritability, constant anxiety or the feeling of being "amped up."

Can you imagine living with these symptoms and trying to pursue a career? Parent a child? Have a fulfilling relationship? Enjoy hobbies? It can be a devastating syndrome. It leads one to pursue any means to alleviate the tormenting symptoms so drug and alcohol abuse are common, as is depression.

There are new treatments for PTSD that have proven to be helpful (EMDR, Somatic Experiencing therapies, group therapy, and medications) but we haven't figured out a way to cure this.

So, on this day when many honor the heroes and the mind of the country goes to the men who stormed Omaha beach, to the Pat Tillmans of the world, to those who provide the blanket of protection, please allow it to extend to those who continue to struggle with the impact of their sacrifice. He may be the homeless man in the downtown of a urban area, he may be the alcoholic in a local AA meeting, those whose "weakness" is often viewed with disdain by the same who originally honored their intention. Honor the living vet that have given his life, have a voice for him or her when they may not be able to have a voice for themselves, know that many die for this country but that it just may happen years after their combat experience is over.

Tuesday, November 3, 2009


Since my last entry was some clinical information on mental health and highlighted depression, I thought this week I would strike a little balance and talk about happiness. Happiness research is big right now, as is positive psychology. As a culture that literally has the concept built into our Constitution, which of course has trickled down into our personal constitution, it is valued highly. Happiness is often described as the experience of joy and contentment and is a psychological, emotional, and physiological state. I will use this blog to share with you some tidbits out of the happiness research contributions and offer a few observations of my own.

I think it is important to start off looking at how our perceptions of what we need and want may be way off from what actually impacts our life experience. Daniel Gilbert, PhD (I suspect will soon be called "Uncle Dan" by me, as he is a major contributor in my field) is one of the happiness gurus and is a professor and researcher at Harvard. He has discovered a fascinating fact about humans and happiness, that is, that we largely fail to anticipate what will actually make us happy! The research is staggering and humbling. Social psychologists can largely predict what poor decision most of us will make in given situations! (Check out Daniel Gilbert's Ted Talk on mistaken expectations). How happy are you right now? This is how happy you will be a short time after you win $250 million in the Powerball! Yes, there will be a spike of jubilation and incredulity, and then you will return to your basic state. How happy are you right now? This is how happy you will be shortly after the wedding you have been anticipating would finally bring you the happiness you seek. There is a fascinating study done prior to a recent election where people anticipated their disappointment vs. happiness based on the outcome. Even with as fear based as political opinions have gotten, people's happiness was largely not impacted by the election results. Those who were unhappy prior to the election, even if they received the outcome they had hoped for, the research shows are most likely still feeling that way. What is interesting about this has nothing to do with politics, it is the struggle for us to accurately predict what will bring us to the emotional, psychological, and physical state we prefer. If we can't predict it accurately, how can we create it? on.

So what does make us happy?? There is some interesting information out there about this and it would take me multiple blogs, but I will touch on some highlights.

Well, for starters, it isn't money or financial security. Even though this is counter-intuitive, I promise you the evidence is overwhelming. I am not minimizing the loss of a job or the importance of financial self-care. I am telling you that, once you have paid your bills, the amount of money you have in the bank is unrelated to how happy you are. In fact, in the pursuit of the ever elusive financial security or the quest for material possessions, largely takes away from the time and energy it takes to invest in those things that make us happy. Though, if we use our money to create experiences vs. purchasing things, the evidence is that this does increase our feelings of positive well-being.

One key component to happiness is connectedness to other people. Having quality relationships and community, according to research, is a common experience of those who report experiencing a general contentment with life. Cultures that emphasize the community over the individual have less depression and furthermore, seem to have some biological protection. The culture in the United States largely favors individualistic values which affords us some wonderful benefits as a nation. They key is to keep a balance between the "me" and the "we." If I may add my own observation, simply having people around you does not cut it. Seek out your kindred spirits! Seek out those that can "hold the space" when you are having a difficult time with life. Seek out those who also place a high value on connectedness with themselves, others, and their world......those relationships feed the soul.

Another tidbit of advise from the happiness experts? Turn off your TV. A recent study out of the University of Maryland found that happy people report spending more than 30% less time watching television. They are likely to be developing closer relationships, pursuing a hobby, exercising, listening to music, attending church or a spiritual meeting of some sort, creating, playing, being absorbed in a challenging task, meditating, spending time outside or other endeavors that lead to more enjoyment or meaning. Turn on the TV for a favorite show or sporting event and then let it slip back into playing a secondary role in your life. If you are watching TV with your children or your spouse, you are not actually spending much meaningful time with them. TV viewing is a solitary event. Food for thought..........

The last tidbit out of the happiness research to ponder comes out of the work of Mihaly Csikszentmihalfi's, a Czech psychologist, on "flow." Flow is the experience of being immersed, totally focused, and energized by a task. When one is in flow, time flies and the creative juices are, well, flowing! This task can be mental, spiritual, relational, or physical (athletes call it "being in the zone"). The key is to follow your bliss, your curiosity, your passion!

There is so much out there on this topic. I tried to pick the aspects of happiness that seem the most timely or impactful. I welcome your comments. In the meantime.......Carpe diem!