Breaking Up without Depression

Breaking Up - Couple ArguingSome people seem to find it much easier to weather the breaking up of a romantic relationship than others. Sure they may feel sad, they may worry about what it means that their relationship ended, but relatively soon they’re able to move on. Others get mired in doubt and find it hard to reenter the dating world.

A study from Stanford University suggests that one psychological trait can help explain how people react to something like a breakup.

It turns out that having a relatively strong belief that personality traits are unchanging is associated with greater difficulty moving on after a relationship has ended. People with this belief about an unchanging personality tend to conclude that the breakup of a relationship reflects some inherent flaw in their personality, one that they will find themselves confronting over and over as they move into new relationships.

The research, published in the Personality and Social Psychology Bulletin, examines the link between rejection and a person’s sense of self.Carol Dweck, a professor of psychology, co-authored the paper along with psychology doctoral student Lauren Howe, who was the lead author.

As reported in Stanford News, Lauren Howe explains the study this way…

“Few things in life are more traumatic than being rejected by someone who knows you well and then, with this insight, decides that she or he no longer cares for you or wants to be with you,” Dweck said, adding that romantic rejection, in particular, poses a tremendous threat to the self.

Howe added, “The experience of being left by someone who thought that they loved you, then learned more and changed their mind, can be a particularly potent threat to the self and can drive people to question who they truly are.”

How people view human personality was especially significant to the study. For example, participants were queried about whether they believe that people can significantly change their personality (a growth-oriented view), or that “the kind of person you are” is static and thus can’t be changed much (a fixed view).

The study found that people differ in whether and how they connect romantic rejections to their self. It turned out that people with a fixed mindset about their personality – those who believe that their personality is simply fixed and unchangeable – allow romantic rejections to linger longer in their lives.

Dweck noted, “To them, a rejection reveals that it is fixed at a deficient level. On the other hand, people who believe in their ability to grow and develop, while of course hurt by rejections, can more readily bounce back and envision a brighter future.”

Howe said, “Those who see rejections as revealing a core truth about themselves as a person, something about who they really are, may be more likely to struggle with recovery and carry rejection with them into the future.”

The research also found that people who believe that a rejection revealed a new, permanent defect worry that this defect will surface in future romantic relationships.

“This concern haunts them and can make them guarded and defensive in future relationships – something we know is likely to impair these future relationships,” Dweck said.

In short, this group sees rejections as changing both their view of themselves and their relationship prospects in the future, according to the study.

Indeed, these people reported still being negatively influenced by rejections that had occurred more than five years ago, Dweck and Howe wrote.

This research points to the negative effects of having a view of personality that is relatively rigid and constrained. In fact, the whole field of psychological research tends to demonstrate that how we act, our personality, is very much a product of circumstance. Until recently it was hard to really specify character traits that weren’t significantly affected by the environment and therefore subject to change as we move into different environments.

It also points to the value of seeking alternative explanations for negative events in relationships.

In that regard, it connects to a lot of data that shows that a tendency to ascribe personal meaning to negative events is a major risk factor for depression, research that led to the development of the Cognitive Behavioral Analysis System of Psychotherapy by psychologist James McCullough.

For more on this topic…

Chronic Depression: What you see depends on where you look

Self Confirming Beliefs

Relationships and Chronic Depression


Howe LC, Dweck CS. Changes in Self-Definition Impede Recovery From Rejection. Pers Soc Psychol Bull. 2016 Jan;42(1):54-71. doi: 10.1177/0146167215612743. Epub 2015 Oct 23. PubMed PMID: 26498977.

Kathy Leichter and Here One Day

We had the absolute pleasure of talking with director Kathy Leichter about her experience of making her movie, Here One Day.  Here One Day is an intimate look into Kathy’s mother’s experience with Bipolar Disorder as well as her own experience, as her daughter.

Question: How did you come up with the idea of Here One Day?

Kathy Leichter: I’ve been a filmmaker for over 25 years, since 1988. I never thought I would make a film about my own story. I was very interested in social change, wanting to educate audiences about poverty and other social issues. Nine years after mom died, I had done a lot of grieving, I’d seen a therapist, gotten married, had a child. I had never dealt with the loss of a parent. I was grieving, but didn’t realize what would happen to me nine years after my mom’s death when I found out I was having a second son. My second son was a messenger for a new phase of healing. I was pregnant with a boy, I was devastated because I thought it was inevitable that I would have a daughter. And then I realized it wasn’t a desire to have a daughter, but instead, it was really a desire to have my mother back! I wanted to retrieve and repair my relationship with my mother through a daughter. So instead, I began making Here One Day. The process was mercurial and a documentary. I began. The film is about my mother; it was how I was going to reconnect to my mother. The film helped me move further through the grieving process. It was liberating, healing, growing. And now it is helping others to do some of that internal and external healing work as well.

Question: One thing that comes to mind is the issue of shame and stigma. How do you imagine people are going to respond to the film when it’s out there?

Kathy Leichter: Yeah, I think I was very much a victim of stigma. When I started making the film, I think I had told 20-25 people that my mother had died by suicide. Nine years later, I still couldn’t say suicide. I didn’t talk about it or her a lot. There was both stigma and shame. I felt very alone. Survivors often feel alone because of shame and stigma. The film was very personal. I was not thinking, “What are people going to do with this information?” I actually thought, “Who is going to care about this besides me and my family?” Now I get requests daily from strangers to see the film! I didn’t understand it was such a universal story; it came from a personal place, but no matter what background, whether you are form Scotland, Australia, India—in the many countries Here one Day has shown–these experiences affect everyone. Of course culture matters but people can watch the film and see themselves in it no matter where they are from, no matter their specific circumstances. It is a universal story of family and relationships, recovery and resilience. Talking about and sharing the story dissolves the stigma. I’m not going to be silent about this. I’m going to tell this story out loud.

Question: The issue of what to say or not to say, is a powerful theme on our website forum. You have shared benefits of being so public. Are there any downsides?

Kathy Leichter: I had to navigate and consider my relationships with family members and discuss making the film with them right away to let them know that people would hear our story. At first, my brother felt the story was private. He didn’t want to show his feelings on camera. I wondered how not to have him in the story. Then, he saw a short fundraising trailer and he realized that it was his story too and he decided to be in the film. It was very courageous. I wondered about how my dad was going to feel. I wondered if I was going to be judged. I felt incredibly high stakes as a storyteller and an artist, telling my mother’s story. I wanted everyone to be seen as a whole person. It was important to show everyone as a human being. My mother is a whole person. I didn’t want her to just be labeled as someone with mental illness. I wanted audiences to know all of who she was: poet, teacher, political activist. I didn’t want anyone to be seen simply as villain or victim. Life and people are more complicated than that. Could I paint a true picture of our family experience? I didn’t want to get it wrong. Who we were. Can I do this in a way that is true? Could I accurately portray what I wanted people to know and what I wanted them to see?

Question: So no regrets?

Kathy Leichter: I would have to think about that carefully. I’m not prone to regrets, so no. I would say instead that Here One Day has surprised me. The journey of making it has been incredible. The rewards are boundless, continue to be boundless. I have received the most amazing emails from people reacting to the film; a student at a community college, an older man who attempted suicide, and another person whose mother has Bipolar Disorder. These are the people the film is touching. There are thousands. Making Here One Day expanded my relationships with my father, brother, and aunt and all of the extremely talented people I worked with. The process was deeply rewarding. No regrets come to mind. My only regret is that she is not here to see what I have done and this amazing transformation. I have imagined showing her the film. There will likely be an NPR story on the radio. If she could know that! She would love it! That is the one thing I would change, that she could be here.

Question: It is interesting for me to think how the film is an idea that embodies her spirit. That is where it came from. A sense of longing for her spirit and willingness to be direct about topics that were off limits.

Kathy Leichter: Exactly. I didn’t know that at the time. She was a mental health activist. She was really active with NAMI—The National Alliance on Mental Illness. I am going to screen with NAMI on Saturday! I work with their groups all over the country. Doing this activism and continuing along her path. She was also playful and I am too.

Question: What was it like for you to listen to your mother’s tapes?

There were moments where I felt I had to look at what I was doing as a journalist and daughter to be going through her things, is it ethically okay? I felt she left these things, documents and recordings. She says in the movie, “I don’t know if anyone will come across these accidentally.” She was wondering who might read these documents. As a son and daughter; were these for us to read? My mom was un-boundaried in some ways. It was not out of her character to share personal things. I also felt that it may be passive aggressive on my part, or aggressive; you’re not here, this stuff is up for grabs, you don’t have the right to say yes or no anymore mom. There were some moments while making Here One Day that I was terrified that she would be furious or angry with me even though she was dead. It was healthy to help me work through my relationship with her. Our relationship changed over time, past the time of her death. It’s still changing. For instance, I had to examine why I thought she might be angry with me. I wondered, what is that about? She was a poet and also a storyteller and I am a storyteller too. I had to navigate the mother, daughter relationship all along the way of making Here One Day. In the end, I realized that she would be proud. I had to go through this process and ask her if it was okay. But, in the end, I had to decide that it was okay to include her writings. In fact, it was necessary so that audiences could really get to know who she was. We also decided to include her audiotape recordings. This was hours of audio that she had recorded—like an audio diary, really. We first made the film without this audio; I was terrified to listen to her voice, I thought I couldn’t do it emotionally. I waited 16 years after her death, until we were way into the editing process, but I knew that the material was critical. It was my mom talking! Her voice, her thoughts and feelings—live. My editor and I listened to them. It was healing and incredible. It was great to hear her voice. Funny. Angry. Witty. Wry. Loving. Sad. Her real voice.

Question: One of the things that is another hot topic has to do with the boundaries – bipolar as a trait and bipolar as a disorder.   Have you thought about that?

Kathy Leichter: I really struggled with that and I never quite understood it. When I was around 10 years old she told me she was taking medication for her moods. I didn’t know who was my real mother. The one on the drugs or the one without them. When you go to the doctor, and there is a physical condition that makes it hard to function in the world, it becomes something to address. I think about what you are asking all the time. We create labels to understand and describe physical and emotional states. We are comfortable describing it as an illness. In some cases, it does seem like an illness, a physical state that needs to be changed. I have friends in the mad pride movement who believe that it is society that is sick, not the individual. I think this dialogue and conversation is important and interesting. My mother’s experience is what is called bipolar. At the time it was so debilitating. Was it the medication or side effects that compounded her physical and mental state? I am always wondering about an answer. I don’t have one. The debate is healthy and important. I am wary of using vocabulary. It is politicized. Personal. It is an illness in certain environments and not in others.

Question: I think the end state of suicidal obsession, is not a state of wellness, it is difficult to say when does that begin? I have this conversation with a colleague who is bipolar and his take is that it is not an illness but I also know for him to live the way he does, has required huge adjustment on everyone around him. Is that reasonable to ask of everyone?

Kathy Leichter: I imagine another society where my mother could have navigated her situation and not ended up where she was. Where we are supportive of people who don’t fit the mold that we have created about what is normal. It is important to look at this. Is it an illness or a trait? We can’t always think in terms of the individual. Sometimes society is considered ill, what could we do differently to help individuals in these situations? One step would be to provide parity that would also reduce stigma, raise awareness, and provide additional types of support. Talk therapy. Art therapy. Diet. Nutrition. Different ways to shift away from medical model. Many approaches are now about recovery and finding ways to live successfully with one’s experiences;. This wasn’t in the lexicon when my mother was alive. Recovery is empowering and interesting. I like thinking about what does society can do differently.

Question: What did you learn about bipolar disorder from listening to her tapes?

Kathy Leichter: I learned so much. I wouldn’t say I learned more about bipolar disorder. I learned more about my mom. The tapes expanded my understanding of what she was up against as a human being. The incredible way that she interpreted the world. Once, when she was visiting me she said she needed to go lay down and turn out the lights because the world felt so stimulating; not stimulating in a positive way, but rather exhausting, difficult, too much. At the end, she couldn’t go from one moment to the next and know how to get there. It didn’t justify her killing herself. I wish she had made a different choice, but the tapes helped me understand more. They gave me a sense of how hard and also how interesting things were for her-what a cool mind she had.

Question: Any final thoughts about the movie or responses you have gotten, where you are going next?

Kathy Leichter: Making Here One Day is the most fulfilling thing I have ever done. The movie is screening across country. Here One Day is being used to help communities talk about issues of mental health and suicide. It is screening in community centers, medical, nursing, social work and journalism schools, churches, synagogues, law enforcement agencies, for mental health professionals and suicide survivor groups. I give out my contact information so viewers can contact me and I am available in person and am willing to travel all over for viewings and discussions. This is the work I love to do. A pastor at a church where I screened the film in Baltimore, said, “This is your calling.” I believe that; this is my service to provide.

To download or stream Here One Day, learn more about the film, or to schedule a screening please go to:  Also, click the video below to view the Here One Day Trailer.





On the Borderline

borderlineI am writing a presentation for the UCSF Bipolar Program on the topic of the relationship between Borderline Personality Disorder and Bipolar Disorder and I thought I would jot down some of my thoughts in a quick post.

Borderline personality disorder involves a “pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” which begins by early adulthood and is present in many different aspects of a person’s life.

Bipolar disorder also begins by early adulthood, almost always affects many aspects of a person’s life, and is associated with unstable affect (or mood). Mood instability usually affects other aspects of a person’s life (self-image and interpersonal relationships) and some people with bipolar disorder also have a pattern of impulsivity in making decisions.

Clearly there is a lot of overlap.

Add in the fact that often bipolar is associated with posttraumatic stress (either childhood or adult trauma, such as violence, rape, etcetera), and the likelihood that someone with bipolar might also appear to be borderline becomes even greater.

One of the most thoughtful review articles I have read about borderline personality recently was an attempt to develop a theory of what is fundamentally wrong with brain function in people with borderline personality. In the article (Dysregulation of regional endogenous opioid function in borderline personality disorder) the authors argue that people with borderline personality have a problem regulating their emotions in response to stressors. This inability, they suggest, may be due to a defect in the opioid system in the brain.

I was intrigued by this notion because in our clinic we have had a fair amount of experience with people who have borderline and have “discovered” opiates (pain pills or even heroin) and become addicted. Opiates made them feel “OK” but, then they learned that they could not control their use. And in some people we have been able to achieve much better mood stability when we used buprenorphine as a treatment for their addiction.

This argues that the fundamental difference between borderline mood variation and bipolar mood variation is that in patients with borderline personality the issue is hyper-responsivity to external stressors, whereas in most people with bipolar what emerges over time is mood variation that is not connected to external events.

Here is where adding posttraumatic stress to bipolar complicates things – because the key feature of PTSD is also a heightened reactivity to certain events (ones that connect in some way to the traumatic events).

Things are already plenty complicated anyway.

One of the things that I see all the time is that the brain’s need to understand and explain events means that most people are able to come up with events that “caused” their mood to shift, even when, on closer examination, there doesn’t appear to be any relationship between the event and the mood… or the mood change began before the event… and it was the change in mood that made the event seem so stressful. (For example, someone says that they are depressed because they have been having pain from a chronic knee injury, but further exploration reveals that there have been many times when the pain was not nearly as disturbing in the past, because the person’s mood was better then).

When trying to figure out whether a person has borderline personality –

  • Consider whether the events that trigger mood shifts are almost always related (at least thematically) to traumatic events. (A young woman has an extreme reaction to visits with her doctor because she was raped by an older man, for example).
  • Evaluate whether mood shifts are associated more with intense dysphoria (negative mood), which would suggest borderline personality, or more with sympathetic nervous system activation (physical symptoms of  anxiety like racing heart, tremor, shortness of breath, etcetera; or going on “alert” and perhaps getting hyperactive, as though one suddenly has to prepare for dealing with catastrophe).
  • Look at the pattern of mood changes to see if they have a “cyclic” pattern or are more rapid and dramatic. 

Guide to RatingsThis graph illustrates how complicated all of this can be. This is a mood chart (anxiety, sensitivity, mental speed, and optimism or pessimism) along with a sleep record for someone who has bipolar (inherited from her father) plus borderline personality.

What you see is the sleep record across the top (dark blue line) and below that a graph of mental energy (orange line) and outlook (the highlighted blue grey line at the bottom).

This record covers the period from September through March of this year. Menses Effect

The next few graphs show how there are at least three different sources for mood variation. There is a distinct pre-menstrual pattern of pretty dramatic worsening of mood (the red arrows show when her menses took place and show how some of the variation in mood is clearly linked to a sudden dip before menstruation.

The next graph shows that her mood has pretty marked day to day variation (some amount of variation is typical, it is very rare to Daily Variationsee a mood chart that looks like the kind of smooth graphs that one imagines should characterize a bipolar mood swing). She consistently rates herself as dipping down into the deepest state of pessimism every few days throughout the record. The same variability is seen in her sleep and her self rating of mental energy. This is the hyperresponsivity to stress that is characteristic of borderline personality (in that it is a shift into intense negative mood much more than a shift into hyperalertness (as one might see with someone with PTSD).

Finally, if you pull back from the chart you can also see a longer term trend in her mood which seems more characteristic of bipolar mood variation. For one thing, it begins a week or two after starting Prozac. And 3-17-2013 10-45-39 AMfor another it follows the typical mood pattern that she has – she tends to shift quickly from depression into a slightly energized (hypomanic) state. Then that energized state gradually drifts back down to “normal” and, often, drifts further down into a depression that can last for many months. When she is depressed her mood shows less variability (she doesn’t have sudden bursts of energy). This pattern of a quick shift into hypomania or mania and then a gradual drift down into depression is known as the DMI pattern.

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

Borderline Emotions

borderline emotionsOriginally, the label “borderline personality disorder” was applied to patients who were thought to somewhere  between patients with neurotic and psychotic disorders in terms of psychopathology.

Increasingly, though, this area of research has focused on the heightened emotional reactivity observed in patients carrying this diagnosis, as well as the high rates with which they also meet diagnostic criteria for posttraumatic stress disorder and mood disorders..

An article in  Biological Psychiatry by Dr. Anthony Ruocco at the University of Toronto and his colleagues suggests that there may be a biological basis for the strong dysregulation of emotions seen in people with borderline personality.

They reported increased activity in brain circuits involved in the experience of negative emotions and reduced activity in brain circuits that normally suppress negative emotion once it is generated.

Compared with healthy control subjects, BPD patients demonstrated greater activation within the insula and posterior cingulate cortex. The insular cortex is involved in the experience of visceral emotion. It has an important role in the experience of pain,  anger, fear, disgust, and sadness.


Conversely, they showed less activation than control subjects in a network of regions that extended from the amygdala to the subgenual anterior cingulate and dorsolateral prefrontal cortex.

The authors performed  a meta-analysis of previously published neuroimaging studies. They reviewed data from 11 studies and pooled the results so that they had data on 154 patients with borderline personality disorder and 150 healthy control subjects.

Ruocco said,

“We found compelling evidence pointing to two interconnected neural systems which may subserve symptoms of emotion dysregulation in this disorder: the first, centered on specific limbic structures, which may reflect a heightened subjective perception of the intensity of negative emotions, and the second, comprised primarily of frontal brain regions, which may be inadequately recruited to appropriately regulate emotions.”

The reduced activity in the subgenual anterior cingulate, may be unique to borderline personality disorder and could serve to differentiate it from other related conditions, such as recurrent major depression.

Dr. John Krystal, Editor of Biological Psychiatry said, 

“This new report adds to the impression that people with borderline personality disorder are ‘set-up’ by their brains to have stormy emotional lives, although not necessarily unhappy or unproductive lives.”

The article is “Neural Correlates of Negative Emotionality in Borderline Personality Disorder: An Activation-Likelihood-Estimation Meta-Analysis” by Anthony C. Ruocco, Sathya Amirthavasagam, Lois W. Choi-Kain, and Shelley F. McMain (doi: 10.1016/j.biopsych.2012.07.014). The article appears in Biological Psychiatry, Volume 73, Issue 2 (January 15, 2013), published by Elsevier.

In Memoriam

In MemoriamIn memoriam.

He was brilliant, a creative artist and writer with a strong and clear voice.

He was impulsive and he had a generally paranoid view of the police, which they reciprocated. He had been arrested several times. When we met him he was on probation and that was why he came to see us at all.

He could be charming, and attractive in a dark and mysterious way. Women loved him until his behavior got to be too wild.

He was easy to get angry with. He knew exactly what to say to make you feel small. He told me I was a petty bureaucrat masquerading as a doctor.

He was outrageous. He thought about crazy stunts to get attention… and then did them.

He loved his mother and she loved him.

This past week the demons that had always pursued him got the upper hand. He died in a violent suicide.

He burned so brightly in life, he will always be remembered.

Self Confirming Beliefs

self confirmingThere are dangerous ideas that can shape an entire life. Ideas that suggest that “no one will ever really love me” or “if I tell someone what I want they will leave me” or even “I can’t trust anyone.” These ideas may not have much basis in fact, they may have been handed to us as children from our parents, who learned them from their parents… and have absolutely nothing to do with who we are, in our unique personality and nature. But that doesn’t necessarily reduce their power.

We spent some time today talking to a beautiful, intelligent, caring, successful young woman who was taught that “no one who is any good will ever really love me.” She has gone about living her life according to that idea, and, not surprisingly, the idea has shaped her experience of relationships in very unhappy ways.

When she is in a relationship she is constantly looking for the evidence that the other person doesn’t care. Often the other person does things that are not thoughtful, but occasionally a relatively neutral statement or action will lead her to obsess about where things are going.

As you can imagine, the person she is with tends to get a bit tired of this level of scrutiny. He pulls away a bit, just for self protection. But that is confirmation of what she has feared.

Because she really is all of those wonderful things that we said, the relationship limps on for quite a while, but the outcome is pretty much pre-determined.

There is hope, however. those self-confirming beliefs lose some of their power when they are clearly visible. And they lose more of their power when you learn how to ask yourself, “how much of my ‘take’ on what is happening right now is related to the actual event, the person I am with, what is being said right now, and how much of it is based on the lessons I learned in my past that really don’t have much to do with the specifics of the conversation?”

This process is hard work, if the beliefs were learned over years from a parent, for example, but it is not impossible.

It isn’t, however something that you can do on your own. To get started you need a good therapist. But if you want to find out a bit more about this process you can watch this video that we made. And you can buy this very short, and pretty dense, book about something called Cognitive Behavioral Analysis System of Psychotherapy (CBASP).


Misunderstandings: Feeling and Thinking

Misunderstandings. There are so many ways that we can misunderstand each other. We like the Myers Briggs for its non-pathologizing approach to understanding and describing the differences among human beings.

Yesterday we were talking to a young woman who told us of a “classic” misunderstanding that potentially could have had a catastrophic outcome.

The young woman was talking with her beau about difficult topics (hurt feelings, feelings that both were having of not being loved or appreciated).

The two of them are examples of the wonders and challenges of relationships between people who are quite different from each other (no boredom, lots of confusion and potential irritation).

She is, in the lexicon of Myers Briggs, a “feeling” type. She makes judgments about things based on values and deeply held feelings. He is a “thinking” type. He makes judgments about things based on rational analysis, weighing the pro’s and con’s.

As the conversation proceeded they both retreated into their most comfortable modes of thought. She became more emotional and he became more rational. As she described it,

“I was becoming hysterical – do I need to cut myself open to show I bleed… I was filled with anger and feeling that I am being “honest”  by expressing that anger ever more vigorously. He was increasingly rational and obsessional… this made me feel worse… more desperate and more misunderstood.  Finally he lashed out at me as I am crying and I just get hysterical… I go out on the balcony and I am planning suicidal destruction…fortunately  he came out… said he was sorry and gave me a hug. That was the perfect thing to do.”

Take home lessons –

  1. The way I think through problems is not the only way that is “OK.”
  2. Vehement and energetic emotion is not usually more “honest” than an awareness of the many feelings we have about someone (love, hate, anger, caring…).
  3. We don’t get an owner’s manual when we get married… but sometimes it can be helpful to do some exercises (counseling, taking a Myers-Briggs, going on a retreat) to try to understand each other better…


narcissism“You’re such a narcissist!”

It’s easy to see why people with moods are often accused of being narcissistic.

When we are depressed we become focused on ourselves and our mood and our pain. This is also what happens to people with chronic pain of other types.

And when we are manic, we become preoccupied with our importance and specialness.

But how to distinguish the typical self-preoccupation of almost anyone wrestling with the up and down of moods, from more extreme forms that may require special attention?

We were recently asked this question by one of the people who’s visits this site and we thought we would post some thoughts.

Self preoccupation is only part of what makes someone a narcissist. The key to the term, in the language of psychology and psychiatry, is the notion that the narcissist is so unable to deal with any feelings of inferiority or doubt that he or she has to leap to the opposite extreme and insist that he is great and special all the time.

The power behind this need is such that it tends to drown out any feelings of empathy and concern for the other person. Hence the narcissist is not just preoccupied with him or herself, but absolutely has to convince the world that he or she is better, more powerful, more significant than anyone else.

In other words, unlike the self preoccupation of anyone dealing with depression and mania, the person with narcissism is self-preoccupied all the time, and not just self-preoccupied but specifically preoccupied with proving that he or she is wonderful, special and loveable, as a way of avoiding the sense of doubt that lurks in the shadows of his or her mind all the time.

If you wonder if this term might apply to you or someone you love, these are good books on the topic: