Wednesday, January 20, 2010

"Why Me?"

I thought my sister-in-law, Susan, was a pretty amazing person and THEN she went and donated a kidney. To a stranger. Now I am using the thesaurus to try to find a bigger, stronger word! Fantastic? Incredible? Remarkable? It just doesn't seem adequate..... Susan has been married to my brother for 25 years (he is also wonderful....brilliant, hilarious, and rock solid character) and I have known her since I was 12. I could list the qualities I admire in her and there would be many! She is brilliant, one piece of evidence to support this is her graduate degree in engineering. She has raised, and continues to raise, four great kids, often stepping out of the culture's current pattern (that may be another blog....) for how to do that. She has a deep faith, inclusive of ALL, curious about life, always educating herself, wonderful writer, open about her vulnerabilities and weaknesses, she is just really, well, "real." But this isn't what I want to write about......back to that kidney thing. Susan wrote an essay on why she donated a kidney and I would like to insert the last paragraph, where she elaborates on her 4th reason, so you can hear her thoughts in her own words.

"4. I wanted to be right. A friend of mine insists the world has more darkness than light, more brokenness than wholeness. We’ve argued many times whether God’s touch of joy is more like a trickle or a flood. I stood squarely in the light-wholeness-flood camp. That is, until I, too, experienced a few years of confusion and hurt. More than anything, I hated that he was even partially right. So, this act of donating life is about healing a bit of brokenness and creating a flood of joy. Or, in this case, creating a flood of urine."

So I read this, and I see the threads of what in my field is called resiliency. Resiliency is a way of describing the clusters of characteristics, qualities, behaviors, strengths, that when in combination allow someone to "get through" and thrive, after difficult childhoods, traumas, wars, illnesses, etc.

An aspect of resiliency is how one views the world and the people in it. I don't mean the pollyanna view that comes with the denial of suffering and pain. But one with resiliency rarely ruminates on the question, "Why Me?" They don't see themselves as deserving of pain or tough circumstances but they also don't see themselves as entitled to the absence of them either. The resilient person is not prone to the bitterness and resentment that befalls living IN the question, "Why Me?"

A resilient person can hold two, apparently contradictory realities together, that in life there is the chance to experience staggering tragedy and pain, as well as deep love and joy. The resilient person, after what they have gone through or will always go through, continues to believe and experience the good in others, and yet, is very realistic about the limitations of human nature.

See, the thing is, Susan, has not had it easy and she still wrote that paragraph and acted on her belief in the world. I won't parade her experiences and pain, that is not the point. I will tell you that she has experienced staggering loss and that one of those losses was her and my brother's first born son, James. And, like many resilient people, she has gained compassion and empathy for those that struggle. Those that see themselves as strong, but are actually in a defensive posture to keep their pain at bay, are more likely to judge those that struggle to deal with their difficulties.

I have attached a link in order to provide more information on resiliency (see below). It comes easier to some than others, but many of the skills and perspectives can be learned over time.

Until we "meet" again.

Thursday, December 31, 2009

A New Year, A New Beginning

I love New Years! It is my favorite holiday. I thrive in the festivities, I love staying up until midnight and counting down to the next year, I love that there is football the entire next day.........many of the things that bring me joy are wrapped up into this holiday. I think what I like the most is that it has, since I was a little girl, brought my attention inward and forward. I am into new beginnings and reflecting on where one is. And, wouldn't you know, I end up in a profession that is about new beginnings, reflection, change, and reflecting upon where one is and where one is moving towards.

Change is an interesting thing though. It seems to me that humans think it is easy when it is someone else that is working on change, and we bump up against how difficult it is when it is our own process. Someone announces they want to start exercising and their helpful support system tells them, "Well, just go to the gym." That word just, like it is just about getting in the car and driving to the gym. It seems like it should be, right? That change is about deciding to do something differently and then creating actions to bring about the desired result. If you look around, the evidence is staggering that this is just not that easy!

I love my job because I get to see people change all of the time! I love that sometimes I can see it coming, but that other times, I get to be fascinated by the timing and the circumstances of the shifts when they happen. Sometimes it is about deciding, but time and again the shift seems to come from deeper within and has an emotional component. The thinking part is the last to know but often gets the credit! It often seems to come from accepting (the kind that comes without judgment) where and who one is, warts and all, that allows one to finally shift out of the pattern, the behavior, the perspective, the relationship, the job, the pain.

Change cannot come about without walking through, and with, the fear. No way around that one. If you want the deep, loving relationship you have to confront the fear of loss and abandonment. If you want the new adventure, career, education, you have to confront the fear of failure or, more often, of success. By the way, if you try to "kill" your fear, it will only make it stronger. Countries have played that one out since the beginning of time.

So, as you count down to 2010, reflect on where you are and meet yourself there with compassionate acceptance. From that place, what awaits will unfold.

Blessings to all in the New Year.

Wednesday, December 2, 2009

Some Things My Job Has Taught Me, Part 2

It is exciting that, with this blog, "Some Things My Job Has Taught Me" will officially be a series! As I have commented, I do often say to my clients, "Well, one thing my job has taught me.....". It is true for me that there is a difference between reading something in a book and seeing it play out over and over in your life and the lives of others. This leads me to tell you another thing my job has taught me........

Boundaries are the key to happiness!

Okay, maybe a bit overstated, but, well, not by a whole lot. I often see poor boundaries being at the foundation of anxiety, depression, and difficult interpersonal relationships and when my clients take steps to improve their boundaries, often the results are transformative. Truly. I have also experienced this in my own life. Sometimes defining and honoring our own boundaries can be very painful emotionally, the decisions aren't easy and the aftermath can be tough. But they realign us with our value system, the path best for us, and set life in motion in a different and better direction. One can look back months and years later and see how changing one boundary from unhealthy to healthy changed the course of their life for the better. It is often a leap of faith at the time, as this change is often counterintuitive or emotionally upsetting, or, when they are real doozies, both!

So what are boundaries? Hard to put into a nutshell. Boundaries are how we define ourselves and they are a way we take care of and protect ourselves. Boundaries can be relational, physical, emotional, spiritual, and intellectual. Too much to go into here (I think I might need Part 2 of Part 2).........

Have you ever asked someone for something and had them say "yes" only to have them later, by their action tell you that their answer was actually "no." Ever done it yourself? The truth is we cannot be honest (a basic requirement for a healthy relationship) and be a people pleaser at the same time! If you "can't say no", you are not living an authentic life and you are not able to live with honesty and integrity. Sorry, it is a brutal truth. Now, I know, many of you have been taught that self-sacrifice is supreme and that you are "selfish" if you say "no." Self-sacrifice is a beautiful thing. But it is only genuine when it flows from one's value system and true calling, when it is about avoiding anxiety and worrying about hurting others feelings it IS self-serving and selfish, just hiding under the facade of "doing for others." The price is exhaustion and resentment. Boundaries are about defining for ourselves what we value and adjusting our priorities accordingly. But, first, if you do not value yourself you will have your priorities off and all will be out of balance. Those who take time to sleep, relax, enjoy a hobby, pray, exercise, maintain friendships, eat healthy, maintain finances, and deal with their emotions as they come up have more to give others (yes, including children), their vocations, their causes, and their faith, not less. Told you that it was counterintuitive!

The previous paragraph was mostly about relational boundaries and how we spend our time, critical aspects of healthy boundaries. I now want to briefly touch on emotional boundaries. Emotions are not good or bad, they just are. Emotional boundaries are about recognizing, honoring, and expressing in a healthy way our emotions and allowing others to do the same. One of the common manifestations of unhealthy emotional boundaries is when somebody feels the feelings of somebody else, for example sadness, because the don't have a strong enough boundary in place. They don't like feeling sad and they often also feel quite anxious because of the powerlessness they feel, so then they result to unhealthy caretaking of that person to fix their sadness, and in turn, their own. It is a great anxiety reducer and becomes addicting (this is when it crosses over to codependency). Lets face it, we keep doing unhealthy behaviors because they often work in the short run. Unfortunately this fixing comes at a very high price and it always destructive to the relationship. The flip side of this coin is feeling numb when someone else is in distress. Sometimes one compensates for a leaky emotional boundary by putting up a wall.

The balance between the two is empathy. Empathy comes from knowing ourselves and spending conscious time in our own emotional worlds and experiencing acceptance of all of the emotions in our emotional range. Then when people in our lives are feeling something, we tap into our own experience and can therefore "get it." We can hold the space for them and allow them to go through it in their own way because we can tolerate our own experience of that emotion. It is very freeing to not have to fix other peoples feelings and personal relationships thrive when caring, healthy boundaries are in place.

If this blog resonates with you, try something this week:

Whenever you feel distressed (anxious, hurt, angry, resentful) take a minute to have a conversation with yourself. Ask yourself, "What about this situation is creating this distress in me?, Am I feeling any other feelings? What in this situation, if it changed, would eliminate or reduce my distress? If I were feeling courageous, what action could I take to bring that about? Just observe, just listen. The first step to working on boundaries is becoming conscious.

Here is an inspiring quote for the road:

"When you are doing what is right for you, it's okay to say it once, simply, and then refuse to discuss anything further"-Toby Rice Drews

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!

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.