Experience a Sense of Plenty

experienceNothing can seem more urgent, important, and real than the sense that there is not enough for us. Not enough love. Not enough food. The sense of scarcity may not even connect to any clear sense of what is missing. But that doesn’t take away its power.

Regular readers of this blog know that we appreciate the insights of Rick Hanson.

He wrote an elegant post on the opposite of this feeling of deprivation, the sense of being “full”, having plenty and we would like to encourage you to read it – just follow this link.

While you are at it, why not subscribe to his blog. It is often inspirational, and Rick, who is a neuropsychologist, and a frequent speaker at universities and workshops around the country, is very wise and thoughtful.

 

Cluelessness: Getting Stupid

Late on a Friday afternoon,  I found myself with two patients (back to back) who were yawning and seemingly drifting off during the course of our conversation.

Now, that could have meant that I was being particularly boring.

But, in this case, it was the manifestation in the office of something that had been going on at home and causing both of them a great deal of distress – feeling overwhelmed and, in the words of one of them, “clueless.”

Both of them were searching for jobs, and both were trying to decide what career path made the most sense, after a long period of limited success and much frustration in their former jobs.

Not surprisingly, they felt anxious and were having trouble making decisions.

With both of them, I could reliably generate yawns and signs of fatigue by turning the conversation to a particular subject – one that evoked feelings of shame or guilt.

This process of shutting down one’s brain is mostly unconscious, but if you pay attention to what is going on, you have some ability to avoid the paralysis that it can create.

The younger of the two, was a young man who recently graduated from college. He recently finished a great experience teaching at a summer camp. And when I saw him right after the camp he was energetic and excited…

But two weeks later he was in my office saying he felt “clueless” about looking for a job.

How did he get from A to B? We tried to diagram the process.8-23-2013 4-25-25 PM

The first thing that happened was that he said to himself, “you need a break after the camp”, instead of seizing on the opportunity to leverage his good energy and make progress on finding a new job. As he said today, he kind of knew that the voice telling him he needed a break was taking him down the wrong path (hence the devil picture).

Then, as his mental energy drifted downward, he began to feel depressed and, at the same time, “clueless.”

What was interesting about the sense of cluelessness was the fact that it was being actively maintained by a set of thoughts that was making him more and more isolated.

His sense of shame and guilt, never far away, was triggered by his dwindling energy, and that led to a series of distorted thoughts (“I am on my own, no one wants to help”) which kept him from reaching out to the many people who could have helped him get out of this funk.

We could both see how what seemed like a simple process of losing energy, becoming tired and unable to think, turned out to be something that was actively maintained by a set of distorted thoughts connected to feelings of shame.

Sometimes our brains can trick us, and that things that seem “inevitable” may be the result of a lot of unconscious activity.

And feelings of being inadequate or stupid often end up being connected to shame and anxiety. A little exploration of what is going on may lead to a solution.

Memory, Stress and Aging

agingMany older people are concerned about impaired memory, and the relationship between memory, stress, and aging can be difficult to untangle. Obviously worry about memory problems can be a source of anxiety and stress. But can stress and anxiety be a cause of memory problems? And if so what can be done about it?

Elsewhere we will be talking about some of the proposed natural treatments for elevated cortisol.

In this post we want to talk about an article  we ran across when trying to make some suggestions to an aging woman, who had always been incredibly high functioning until a series of health problems came along, which led to multiple surgeries, and then increasing levels of anxiety and increasing concerns about memory impairment.

The authors cite information which demonstrates that elevated anxiety can have significant effects on memory, especially in older adults. They also have shown that serotonin reuptake inhibitors (SSRI’s like Prozac, Zoloft, Lexapro and others) reduce cortisol levels in older adults with anxiety.

Numerous studies have shown that cortisol impairs memory in older and younger adults.

In this study they showed that SSRI treatment of anxious patients lowered cortisol in those who responded to treatment and this lowering of cortisol correlated with significant improvements in memory on standardized tests of cognitive function.

The take home lesson?

As our brains get older they get more susceptible to stress induced increases in cortisol. An anxiety disorder is a major source of stress. Getting treatment can make a difference, by lowering cortisol it can improve memory function in the short run. Other studies suggest that lowering cortisol may have long term benefits, as well.

Lenze, E. J., Dixon, D., Mantella, R. C., Dore, P. M., Andreescu, C., Reynolds, C. F., Newcomer, J. W. and Butters, M. A. (2012), Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder. Int. J. Geriat. Psychiatry, 27: 454–462. doi: 10.1002/gps.2732

Anxiety and Substance Abuse

substance abuseMatt Kushner, PhD discusses the issue of substance abuse in individuals with anxiety disorders. Because substance abuse is more common in those with anxiety in comparison to the rest of the population, Kushner has created a list of risk factors and screening tools to help doctors identify individuals experiencing both disorders.

Some risk factors for substance abuse in people who have already been diagnosed with anxiety disorders include using drugs and alcohol to deal with anxiety, a family history of anxiety and depressive disorders, binge drinking habits, being a male, or being younger.

Ways to screen for a substance abuse disorder is to look at a patient’s history of drug and alcohol abuse problems, the 4-item CAGE questionnaire, 10-item AUDIT, and a truncated 3-item version of the AUDIT. CAGE stands for cut down, annoyed, guilty, eye opener. AUDIT stands for Alcohol Use Disorders Identification Test.

An example of some questions included in CAGE are:

  1. Have you felt you should cut down on your drinking?
  2. Have people annoyed you by criticizing your drinking?
  3. Have you felt bad or guilty bout your drinking?
  4. Have you ever had a drink first thing in the morning?

 

For more information about screening questions and the association between anxiety disorders and substance abuse, check out the rest of Kushner’s article at this link:

http://www.psychiatrictimes.com/anxiety/substance-abuse-screening-patients-anxiety-disorders?GUID=2F8F4F62-9FC2-45C5-81D3-364723F68E03&rememberme=1&ts=26072013

Odd Couple’s Therapy

therapyI met today with two interesting people: they’re both attorneys. They have a remarkably different style and presentation. One of them is usually animated, energetic, and optimistic. However, he also has bipolar mood cycles. Sometimes his energized vibe may get a bit intense, while at other times he will be in a depressed state that makes it hard for him to do his work at the standard that he would like to. His partner is thin, tall, and seems a bit on the anxious or obsessional end of the spectrum.

They’re a bit like Jack Spratt in terms of how different they are, and even how they appear.

Like Jack Spratt, they have really made their working relationship a success by building on each other’s strengths.

However, they came in because the more obsessional one was increasingly worried about his partner’s mood cycles. They had gotten a bit more intense because his wife had died, and he had been falling in love with another woman. Both events are pretty extreme and would be likely to trigger mood changes in almost anyone.

It was a very interesting meeting in that the context was a work relationship, in which many of the techniques of couple’s therapy would not have been appropriate. Delving into feelings and emotions was not point, for the issue was to reassure one partner that things were not getting worse, and to also come up with a way of talking about the mood cycles of the other partner; a way that was not apologizing, but was helpful. I think the conversation was very useful for both. Too often, this kind of conversation does not happen, and the result is that one of the other partners has worries that tend to grow in the dark of ignorance. Finding a way of having conversation with those who are affected by moods is very rewarding but also challenging.

A Spoonful of Courage

The-Thing-You-Cannot-Do

In a previous post, I shared Linda Graham’s views on resilience from an excerpt from her article Bouncing Back :Rewiring the Brian for Maximum Resilience and Well-Being. After further reading, Graham also discusses the importance of having courage when creating a more positive outlook on life.

We have the ability to experience great personal growth when engaging in new things.  Often people are scared to dive into new, uncharted territory and have difficulty expanding their horizons in life. In order to overcome our fear of the unfamiliar, we rely on the neurotransmitter dopamine.

In every day situations, dopamine levels rarely fluctuate. It is when something unexpected occurs that dopamine levels change and create inner feelings of tension. This explains why people feel uneasy and scared when they are about to do something new or unexpected.

By doing something that scares us, we are actively putting ourselves in an uncomfortable situation in order to have a new experience. By facing the new situation, the previous feelings of fear associated with the experience are paired or replaced by the courageous response.

Linda Graham recommends an exercise to the public that will help individuals rewire their brains to face new situations with courage. In this exercise, the public is encouraged to do one scary thing every day. First, individuals must pick one fear to focus on. After making a decision, that individual must face that fear. After repeating this exercise for several years, Graham says people will start to notice a change in the way they feel about approaching scary situations.

Instead of feeling timid, afraid, and uneasy, your body will become so used to doing new things that you will instead start facing your fears with a much more positive attitude. You will gain confidence in your abilities to be successful and start believing in yourself. This is an example of how you can rewire your brain from being afraid to courageous and resilient.

Dare to challenge yourself, and test your limits. I think Graham’s advice is a great way to gain confidence in our abilities and increase our self love and appreciation. By consistently encountering new situations, we will learn to better cope with struggles and become more resilient. When we are faced with something scary in the future, we will have the tools to recover much more quickly.

Sleep Strategies

sleepOne of the most frequent causes of insomnia is anxiety.

Insomnia of this kind is caused by increased activation of the sympathetic nervous system at night.

The body releases norepinephrine (the flight or fight hormone) at night when that system should be inactive.

You wake up and you feel “wide awake.”

A current patient of Dr. Forster’s is having difficulty sleeping at night due to anxiety. Now she worries about not getting enough sleep. She started with a couple of nights waking up due to anxiety,,, but then she began to worry about the consequences of not getting enough sleep. “Isn’t it true that without enough sleep you age faster?”

So now when she woke up in the middle of the night she had something else to worry about.

There are several sleep hygiene techniques that can lead to a better night’s sleep. These include:

– Keep a regular sleep schedule – our bodies and brains cannot change the times we sleep suddenly, before electricity the time we went to sleep and the time we woke up never varied by more than a few minutes a day.

– Avoid forcing sleep

– Exercise regularly for at least 20 minutes a day 4-5 hours before bedtime

– Avoid smoking

– Do not go to bed hungry

– Adjust the bedroom environment – make sure that your room is cold and dark and quiet.

– Deal with your worries before bed time – it may be helpful to write down your worries and plan some time in the future to review them.

– Do not watch TV, read, eat , or worry while in bed – your bed needs to be associated with sleep.

If after following these tricks you find yourself awake and trying to fall asleep then get out of bed if you are unable to go to sleep within 20 minutes. Only return to bed when you are sleepy. Many people with anxiety induced insomnia find it helpful to write in a journal. When overwhelmed by ideas, thoughts, and feeling, it is a great stres reliever to write them all down on paper. Writing down these anxieties is a way to release them from weighing down on your subconscious.

In addition, there are other measures that can be taken to help ease you into a state of sleep.

–  Take an epsom salt bath

– Listen to relaxing CDs (can help regulate sleep waves)

– Read something spiritual or uplifting (not suspenseful)

– Make sure you are exercising regularly

Coming Home

homeWhere does the mind go when it is not occupied by the worries, frustration, and anxiety? Does it go to a happy place, or are people naturally angry? According to Rick Hanson, PhD, the mind constantly fluctuates between a reactive and responsive state. When in the responsive state, the body is able to relax and reenergize. It is a time of repair that leaves the mind feeling happy, loving, and healthy. Fortunately, the responsive state is the default state that the mind will enter in the absence of stress. It is a comfort to know that our truest nature is one of contentment where we are able to engage with the world with feelings of positivity and safety.
On the other hand, when disturbed or perplexed, the mind enters the less desirable reactive state. The reactive state activates the fight or flight systems of the body in response to stress caused by things such as overwork or exhaustion. Entry into the reactive state focuses the mind on fear, anger, disappointment, and a myriad of other unpleasant emotions. The mind goes into the reactive state in order to cope with the stress caused by external factors in daily life. Although the reactive state is necessary to overcome certain challenges, it is not healthy to be in this state all the time.
If under constant stress, the body will be unable to repair itself. This will result in both negative physical and emotional repercussions. The body will be worn out and exhausted, while the mind will focus on emotions of sadness and anger after being under constant pressure and anxiety. Too much time spent in the reactive state will result in a shorter lifespan and a less enjoyable view of life.
How can you prevent this from happening? Lucky for us, the mode we choose to occupy our mind is a choice. We have the ability to transition our mind into our default, responsive state of tranquility and healing. To relax the mind, focus on the senses, live in the moment, and breathe. Get a sense of being in your body and make a conscious effort to be in every moment.
Hanson puts it best when he reveals that in times of external change. The internal sense of home (our responsive state) is our anchor.

For more on this subject I encourage you to read his post. 

Stress and Your Brain

stressStress has a major affect on our bodies and our brain. The release of catecholamines (adrenaline and related chemicals) and cortisol causes significant changes throughout our body that are designed to prepare us for “fight or flight.” By shutting down all non-essential functions the stress response system prepares us for a life and death struggle

Nowadays there are no life or death struggles, and the non-essential functions that get shut down are pretty essential to navigating our busy and complex world and include our brain’s ability to think clearly. 

I recently ran across an excellent review of the scientific literature on the effects of stress on brain function. This post is a summary of that article.

The effect of stress on brain function is fairly dramatic. In particular, the functioning of the prefrontal cortex (the newest part of the brain, and the part that does most of what we consider “thinking”) is severely impaired by stress.

One way of thinking about why this happens is that, in the past, stress implied the presence of a significant threat. Facing such a threat it was often better to rely on instinct rather than careful analysis (when you are facing a saber-tooth tiger you don’t really have time to think about why the tiger is there).

Nowadays, when we experience stress there is usually no acute threat… we are just dealing with a pressure to perform better at work… or perhaps lose a job. In those situations our thinking ability is essential and so the stress response of the body becomes a problem rather than a solution.

The best studied impairment in brain function is a dramatic decrease in what is called “working memory.” Working memory refers to the brain’s ability to hold many pieces of information in awareness at the same time, without relying on external reminders. A good example of working memory is being able to remember a number (a phone number for instance) without relying on repetition (many people may have to say the number over and over while they dial it, “415-555-8099… 415-555-8099….”).

That is a fairly trivial example of the role of working memory. Working memory is also essential in deciding what the best solution is to a problem with many options (“should I marry Joe or should I go off with Jim… what are the pros and cons?”). With impaired working memory the ability to consider a range of options is reduced and the likelihood of engaging in “black and white thinking” is increased.

Dopamine is a chemical which is involved in many brain functions, including motivation. As an example, most drugs that are abused activate the dopamine system in the emotional or limbic part of the brain which is why there is such and overwhelming motivation (or craving) for drugs.

In the prefrontal cortex, a particular dopamine receptor (dopamine one) plays a key role in allowing us to focus on important information. With too little dopamine one brain cells in the prefrontal cortex aren’t able to turn on when important information comes in (the brain can’t focus because it isn’t active enough).

Too much dopamine one overwhelms the ability of the brain to turn off when irrelevant information comes through (it overwhelms the cooling down function of a key set of receptors called the HCN receptors). The result is that lots of dopamine one also makes it hard to focus, because the brain is over-stimulated by unimportant information.

Stress also overactivates norepinephrine (noradrenaline) circuits and this further reduces the ability of the brain to selectively focus attention.

In summary, there are at least two different ways that neurotransmitters (brain chemicals) that are released by stress causes a non-selective (not just in response to important information) activation of the prefrontal cortex that makes it much harder to focus only on the important information and thus reduces working memory.

Cortisol (the main stress hormone released in the body) plays a role in these effects. It reduces working memory, while at the same time increasing vivid memory. Think of it this way, when you are facing that saber-tooth tiger you better remember everything that happens, your brain shuts down the thinking function (instincts are faster than thoughts) and at the same time turns on a real time recorder of everything that takes place (so that you can learn the important lessons of the encounter).

There is some evidence that we can undo the effects of stress activation in daily life – for example prazosin (a blocker of excessive norepinephrine activation) and guanfacine (an activator of the circuits that help with selective attention) have been shown to help with attention deficit disorder and posttraumatic stress disorder, both conditions with impaired attention.

However, for now these kinds of interventions are experimental. And the best solution to the harmful effects of stress on the brain is to retrain yourself to not activate stress systems when dealing with everyday stressors… Mindfulness and meditation are two of the most effective ways of doing that.

Reference

“Stress-induced cognitive dysfunction: hormone-neurotransmitter interactions in the prefrontal cortex,” 

Rebecca M. Shansky* and Jennifer Lipps. 

Front Hum Neurosci. 2013; 7: 123.

Needing to be Perfect

perfectThe need to be perfect is one of the “dangerous ideas” that can destroy a life. It often comes from the fear of abandonment that all of us have, and which can be easily activated in childhood by a mismatch in personality with one’s parent.

A wonderful, smart, attractive, funny, energetic woman talked with us about her experience of this. It all began with parents who were absolutely focused on wanting her to be successful, and who, in their unrestrained preoccupation with that idea, went well over the top in terms of their criticism of her “failures.”

This created so much fear in her that she became consumed with the thought that she needed to be perfect in order to be lovable.

Internally she began to experience an intense alternation between the feeling that she might actually achieve the goal (associated with a sense of almost euphoria, lasting for a few minutes) and the sense of despair that she was completely worthless as a person (with hours of vicious self-castigation).

This unregulated internal turmoil also manifested in several self destructive behaviors. Most particularly in her relationship with food. Since for her, as for many of us, food was a substitute for love, she tried to create an internal sense of security by eating, and began to binge eat. This was of course shameful, and was associated with an intense fear of being discovered. And when she did gain weight it activated her parent’s criticism. So she began to experience the same alternation between the feeling of euphoria associated with severe diets and, briefly, with her binges, and long periods of shame about her need to eat.

Her hungers became unregulated: food had very little to do with physical needs, it was all about emotional needs, with the result that she ended up not knowing when she was really hungry.

All of this behavior might conceivably have made some sense when she was young, but that now her fears were really completely unrealistic. Even when she was binging heavily she remained a very attractive and lovable woman. Except that she was so self critical that she hid that aspect of herself.

The process of unlearning these lessons begins with the repeated recognition that the fears are no longer valid.

In the course of writing down these thoughts we ran across some quotes from the Daily Celebrations website that reminded us that these issues are ones that many, many of us have had to deal with… 

Both the artist and the lover know that perfection is not loveable. It is the clumsiness of a fault that makes a person lovable. ~ Joseph Campbell

Striving for perfection is the greatest stopper there is. You’ll be afraid you can’t achieve it. It’s your excuse to yourself for not doing anything. Instead, strive for excellence, doing your best. ~Laurence Olivier

Good enough is good enough. If something’s worth doing at all, it’s worth doing halfway. Seeking perfection in art or in life is a lesson in futility. ~ Ron Kent

I’m a perfectionist in recovery. I’m trying to deal with that monster inside of me that wants to do everything right. Or better than right. ~ Shakira, NY Times, 11/13/05

Indiscriminate pursuit of perfection infallibly leads to mediocrity. ~ Henry Fuseli

Every human being must thus be viewed according to what it is good for; for none of us, no, not one, is perfect; and were we to love none who had imperfections, this world would be a desert for our love. ~ Thomas Jefferson

Mistrust in Action

MistrustI was talking to one of my clients, a very bright and wonderful woman, mother of a delightful young girl, and usually one of my favorite people. This visit, however,  I began to experience the cycle of mistrust.

When she came in I was in a good mood, I smiled and said hello. She looked serious.

The last time we were together she had said that she was feeling disconnected and more uncomfortable than in the past talking to me. Her seriousness got me to wondering how today’s session would be.  Then, in the first few minutes, she twice misinterpreted something neutral that I said in a very negative and critical way.

Both times she got angry and pointed to the interactions as proof that I really didn’t understand her.  It took a fair amount of effort to calm her down, and I don’t think I ever did convince her that the way she interpreted those remarks was not the way I intended them, either consciously or unconsciously.

At this point, I found myself being very careful about everything I said.  When that happens, I know that I tend to become less expressive emotionally, as I try to monitor everything to make sure that I don’t inadvertently convey some unintended criticism.

As I became more removed and cautious, she experienced that as proof that her mistrust was justified, and the cycle of mistrust was in full-gear.

There is a way out of this cycle.  Just as when you look for potential criticism coming from the other person that tends to create mistrust, when you reveal something personal or yourself emotionally vulnerable you elicit caring and tenderness from the other person.  This creates its own positive feedback loop of growing trust and emotional connection.

Why it is that we switch back and forth between these two patterns is sometimes mysterious.

If you are wondering why your relationships are seeming less close, it can be helpful to try to look at your conversations from a third-person perspective.  Write down exactly what the other person said that made you most upset and then later try to see if someone else hearing the same words might have understood what was meant differently.  This technique is the basis for a form of psychotherapy that can be very helpful for people with chronic depression (who often get stuck in mistrust more or less permanently) called the Cognitive Behavioral Analysis System of Psychotherapy (CBASP).

Back to my conversation – it was, of course, difficult to sit in the room with her, but I was even more affected by the realization that mistrust is terrible painful and isolating for the person who is trapped in it. I wanted to somehow reach out to her and take away the fear, anger and anxiety. I didn’t find a way to do that then, but we did manage to end our conversation on a slightly more positive note… and then the next time we met she had switched out of mistrust and was back to her usual self.

10% of Americans Suffered Childhood Sexual Abuse

abuseApproximately 10 percent of American adults were sexually abused as children, according to a study reported in Comprehensive Psychiatry. They are more at risk of psychopathology and suicide attempts than are adults who were not sexually abused as children.

This study fits with other evidence. The global prevalence of child sexual abuse has been estimated at 19.7% for females and 7.9% for males, based on a 2009 paper published in Clinical Psychology Review that examined 65 studies from 22 countries. Studies have generally found that in North America approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.

The Comprehensive Psychiatry study was headed by Carlos Blanco, M.D., a professor of clinical psychiatry at Columbia University. It included a large national sample of the United States population—some 34,000 individuals aged 18 or older. They were interviewed face to face, and psychiatric diagnoses were made according to DSM-IV criteria.

“Our study has clinical and preventive implications,” Blanco and his colleagues said. “The initial effects of child sexual abuse include…sleep and eating disturbances, fears and phobias, depression, shame, guilt, anger…school problems, truancy, running away, and inappropriate sexual behavior. Therefore, clinical screening for child sexual abuse is important for early treatment to reduce the impact of psychological trauma.”

Feeling Already Full

fullA wonderful friend sent us a note that this post had been very helpful to him. It is, once again, from the Just One Thing site. The practice is called “Feel already full” and it is a perfectly timed reminder that so much of what we see in life (TV especially) is specifically designed to make us feel unhappy with what we have… but that unhappiness is completely self destructive.

We won’t copy the whole post… instead you should stop by Rick Hanson’s site. Follow this link.

If you can really follow this practice I can practically guarantee that you will not only feel your life is better, you will have a better life.

 

 

Take a Chance

chanceIf you are feeling depressed or anxious, today’s post from Rick Hanson (part of his Just One Thing blog) may be helpful. If you are already feeling energized, you might not need more encouragement to do something risky/taking a chance…

Rick’s post is about how, as children, we learn to avoid certain types of conversations that seem too risky, and then as adults we come to realize that by avoiding emotionally risky conversations we live lives that are limited and unsatisfying. He talks about how to change this pattern.

His post is (as usual) well written and thoughtful.

One word of general warning about self help instructions, reading the post may seem simple, and you might find yourself thinking, “I already know that.” In a sense you are right. Nothing he has to say is likely to seem like completely new information. However, the key to changing behavior is not “book knowledge” but rather practice. If you practice his exercise you will find that it can be remarkably effective, even if it seems a bit simplistic.

To find out more, click this link. 

Money and Security

moneyHow much money does it take for someone to feel really secure?

This seems like a sensible question. Certainly, many of us have been dealing with  insecurity because of a lack of money.

In other words, there is a relationship between money and security.

On the other hand, over the years, we have never run into anyone who managed to achieve a sense of security by amassing money. The problem is that, while having enough money is arguably necessary to feel secure, the amount of money that is needed to allow one to feel secure is not that great, and money by itself is not adequate to achieve security.

There are many aspects of feeling insecure, and many things that probably contribute to security, but we want to focus here on the sense of being loved.

Not only is money by itself not enough to achieve security, but the single-minded pursuit of money often is destructive to relationships.

Despite the fact that the strategy is not successful, it is extremely popular. We have run into many people, seemingly especially those who already have a fair amount of financial security, who have become entirely focused on getting more money as the way to achieve overall security.

This morning, we were talking to a wonderful and very successful professional man. He is an attorney, who is married to an equally successful attorney. We’ve been working together for almost a decade.

One of the things that he first came in to talk about was his struggle to meet his wife’s need for “security” before she would consider giving up her brutal job in a high power law firm. He and I observed the clear destructive impact of this job on his wife’s health and their relationship.

Because he’s basically a very caring and devoted husband, he has spent the last ten years doing what his wife insisted he needed to do in order for her to be secure enough to quit her job: He has been investing his money in very successfully and running an increasingly lucrative business, all while taking care of their daughter and running the household.

The results would seem to meet almost anybody’s criteria for “financial security.” However, today, we had to jointly face the fact that there has been no progress towards the goal of allowing his wife to feel more comfortable about changing jobs. Her work environment has gotten worse, although that would have seemed impossible when we first met, yet she seems incapable of thinking about leaving her job.

Over the years, I had advised him on several occasions that I thought that this strategy was a mistake, that I had not found the financial security = overall security equation to work.

Why did he do it?

One of the reasons is surely that his wife has insisted that this is what she needs. Any effort on his part to suggest that maybe she is depressed (which seems quite likely) or that the sense of being disconnected from her family because of her crazy work hours might actually be making her more insecure, has been met with scorn.

Another reason is the allure of being able to measure progress. That is one of the tantalizing things about money – you can easily tell how you are doing.

The same problem often occurs in the medical field. There are many examples of how doctors got fooled into using a treatment because it clearly did something that “should” have improved people’s health (anti- arrhythmic medications which made the heart’s rhythm look normal… but, it later turned out, actually contributed to increased mortality).

Often the problem is that the thing that you are measuring (an improved cardiac rhythm) is pretty easy to measure and seems as though it should lead to the actual improvement (less mortality) but it doesn’t.

It also may be true that he was influenced by a pervasive bias against psychological or psychiatric intervention in society.

A study by a group of economists from Australia looked at how to spend your money if you want to achieve happiness (not quite the same thing as security). They found that one of the best ways was to invest in psychotherapy. That hasn’t had much effect on the sales of luxury goods, however.

Reclaim Your Home: Engaging in the World

I have always loved what I now call the territorial sports: the cross country skiing, running, hiking, bicycling, etc. These are sports that involve navigating through the outdoors where the goal is to cover a fair amount of territory in the process of getting exercise.

However, it wasn’t until the San Francisco earthquake of 1999 that I understood one of the very important functions that these activities can play.

One of the problems with disasters is that they can be extremely isolating. We are usually instructed to go home or find some safe place and, almost inevitably, we will turn on the radio or television or some other source of information and stay glued to this program. All of this tends to be very isolating and, especially, takes us away from the outdoors and the real world. In fact, it tends to make us afraid of the outdoors.

I remember watching and listening to stories about looting and the fire burning in the Marina District. We could look out our window and see the flickering ray of lights and that, combined with the stories of looting in downtown, made me wonder what would happen next. Would the mobs head this way?

All night, I had difficulty sleeping, as you will imagine. And of course there were also aftershocks to deal with.

The next morning, I decided, bravely I thought, to go for a run on my longer run which took me to the top of Twin Peaks. From there, I could see the entire city.

That run is one that I will always remember. It transformed my experience. Before it, I was fearful and not sure whether I could trust anything or anyone. After it, as I ran through the familiar terrain and saw familiar people, I felt as if I had reclaimed my sense of home in the neighborhood.

These are kinds of experiences remind us that we are animals, social animals, animals that need to be active and engaged in the world, not isolated and fearful.

Retraumatization

RetraumatizationAfter nearly 20 years of work in the field of post-traumatic stress disorder, one thing that continues to trouble and baffle me is the phenomena that was described by Freud as the repetition compulsion.  Why is it that people who have been victimized in terrible ways are at much higher risk of being victimized again.  One would think that they would be more cautious, having already seen the results of traumatic events.

Perhaps they are.

If so, is there something about people who become victims that predicts another trauma but isn’t related to having experienced trauma?

Maybe it is having grown up in more troubled families… But studies to identify this have not been successful. Even controlling for other risk factors, there is still a higher risk of experiencing a second traumatic event in those who have had one.

I have sat with many women who were victimized by men, either as children or adults, and I have heard them talk about men that they were beginning a relationship with.  I have been stunned to learn that they find themselves attracted to men who, as I listen to their description, seem to be at high risk of victimizing them again.

There seems to be something that is attractive about the danger, or the possibility of facing danger and yet having a different – better – experience, or to rescue the other person… I’m not really sure, although it does seem as though danger is part of the appeal.

There is clearly a change that takes place in the brains of people who have been traumatized.  This change involves a reduced reactivity to ordinary events and a heightened reactivity to potentially traumatic events.

This phenomenon was described well in Vietnam and other wars: you never wanted to go out with a green platoon leader.  They just weren’t alert enough or, perhaps, they weren’t hyper-alert enough.  The experienced platoon leader was the one who could see the rustle of the leaves. But that same experienced platoon leader would sometimes be bored by ordinary life.

So some of the attraction may be seeking the stimulus of danger because ordinary life seems bland.

Yesterday, we were with a young, attractive and intelligent woman who has been victimized many, many times and we found ourselves again wondering why this happens, and when we asked her about people she found attractive or intriguing we could see that there was a mixture of interest and fear about “dangerous” men.

Then the thought occurred to us that the fascination with why this happens might be our own kind of psychological distortion.  Maybe focusing on “why” is not the important thing.

Maybe what is important is working to teach victims about this tendency and to help them to develop a safety net so that when they’re in a situation that is a potentially risky one, they can recognize that and stop themselves.

At the beginning of the session, when I asked the young woman what she would do if she saw the man who multiply raped her as a young adolescent, she said she would hug him.

The work of the session was getting her to say she would call 911 instead.

Disaster’s Aftermath

disasterThe recent hurricane that hit New Jersey and New York reminded us of the research on the aftermath of disaster conducted by a friend and colleague, Kent Harber, PhD.

Kent has been very interested in posttraumatic stress disorder, and in particular, the work of Dr. James Pennebaker, on the value of sharing one’s story in the aftermath of trauma. Jim Pennebaker showed that if you took college students who had had a traumatic event in their past and got them to write in detail about what had happened, there was a significant reduction in various markers of distress over the next school year, including fewer visits to the student health center.

In the days after the San Francisco earthquake of 1989, Kent wanted to study how social factors influenced people’s response to the disaster..

Early on he found that there was a real outpouring of concern and a willingness to share: both in terms of directly providing help but also by listening to people’s stories. This period of engagement and sharing lasted about two or three days.

After that there was a period that lasted for a couple of weeks, during which people were really no longer interested in hearing others’ stories (although they still wanted to share their own).

This period of compassion fatigue, directly correlated with a drop in people’s sense of concern for each other… and the emergence of a period of cynicism (where is FEMA? They don’t care about us. Nobody cares about us. And no, I don’t want to hear your story).

Right now, in New York and New Jersey, we see the same process at work. People are very much less interested in helping each other, and in listening to each other. There are fights about gasoline. People are much more cynical about each other and about government.

Experience teaches us that this happens after every disaster. And it doesn’t last, although it can be a period of great subjective distress in those who are struggling to cope.

One antidote would seem to be reaching out to those outside of the area to talk about one’s feelings.

A number of studies suggest that this kind of effort can pay off in terms of a greater sense of well being, fewer physical and mental health problems, etc..

Ghosts

ghostToday is Halloween.

The holiday is felt by many to be derived from the Celtic festival of Samhain. On this night the door of the underworld opened a crack and spirits of the dead, as well as other beings, like faeries, traveled back to their old homes.

Costumes developed as a way to avoid being harmed by these spirits, who were not always well disposed to those they left behind.

We have been thinking about possession recently. The idea that spirits can take over our minds and bodies.

It is hard not to feel that extreme moods, and psychosis, aren’t a form of possession. A delightful older woman is in our office on Monday talking articulately about the family that she loves, and by Friday she is immersed in such a sense of darkness and sorrow that the only thing preventing her from killing herself is her low energy and the lack of easy access to something lethal.

The thing of it is, we think that the natural feeling that one wants to hide from these terrible influences is wrong.

We have to turn on the light (of knowledge, of love, of hope) and face our demons directly. That is the only way to find a path through the dark places of our soul.

When we were very young, we had what would be considered a psychotic experience if it happened to us as an adult.

We were terrified of the dark in our room, and, in particular, there was one corner of the room were there was always a pile of clothes and other odd shapes. In the dark we experienced these shapes as evil spirits.

We didn’t think maybe they were evil spirits, we knew that they were. And then when our mother turned on the light the shapes actually transformed themselves into ordinary objects. We were quite sure of that.

A while ago we ran across an interesting survey, 5 – 10 % of Americans reported seeing spirits, or UFO’s – and of these only half seemed to have any kind of psychiatric condition.

In Iceland, Landvættir (“land wights”) or spirits of the land are so important that freeways detour to avoid places where they congregate.

We do believe in spirits and ghosts, we just don’t know that they exist outside of our minds, but that doesn’t matter, they still have the potential for great power and influence.

We have sat with people whose fears were so real to them that it was impossible not to be infected by the fear, even though what they were afraid of was something that was objectively impossible.

In those times we have had to seek comfort in our connections with others, in reaffirming our belief in the strength of love and hope, and we have had to face those fears, fortified by that support, and when we did so they gradually disappeared.

Many months after the period in childhood of our greatest fear of the dark shadows, we stirred up our courage and walked over to the dark shapes. As we approached, in terror, the shapes gradually resumed the shape of a pile of clothes. And they never changed back.

Mood Phobias

mood phobiasWe were talking with a couple of wonderful psychologists about what it is that helps people come to terms with moods and learn to live with them creatively.  One of the barriers to successful mood surfing is a fear of moods.  I suppose the analogy is of someone who is afraid of the waves trying to learn how to surf.  The fear of what is happening overwhelms the ability to learn from the event, and to react creatively.

There are good reasons why people develop a phobia of moods.  One older gentleman that we have seen for a while has had the experience of almost losing his marriage every time his mood becomes manic.  His wife is very important to him, and he is terribly sensitive to even the slightest elevation in mood or energy.

Many people have experienced suicidal despair and darkness of incredible things, from episodes of severe depression.  Some have come close to death.

Of course, mood states that are this extreme are going to provoke anxiety and perhaps fear.

However, the problem is that having this kind of extreme fear reactions actually seems to make the feared outcome more likely.

A common example is someone who always seems to move straight into severe depression whenever his mood becomes a little bit worse.  What happens is that he (or she) notices that his (or her) mood is a little worse.  At first, he is able to deal with this and not get too anxious, but as the mood persists, he finds himself increasingly afraid that it is going to turn into one of those dreadful depression episodes. This fear makes it harder for him to do some of the practices that are helpful in preventing depression. It makes it difficult for him to interact with people socially because he is afraid it is very obvious that he is becoming depressed, and it makes it very hard if not impossible for him to practice mindfulness.

A lot of the work we do is trying to help people to develop a sense of confidence that there are tools that can prevent this kind of severe mood episode and then working with them to gradually expose themselves to more mood variation so that they can learn that minor shifts in moods don’t have to be catastrophic.

Otherwise, we end up prescribing doses of medication that are so large that in order to “stabilize” a person’s mood, you end up with somebody who is flat or constricted.

It’s very helpful to have support.  You want your partner, and your friends to understand that you want to experience a gradually increasing amount of mood variation.

It’s useful to develop a crisis plan so that your partner or spouse can feel safe, just as you do.  And it is of course very helpful to have a therapist and psychologist who can help you figure out what it is, how much mood stress is appropriate.