The Boy Who Wanted to Be Happy

man beach sea coast sand person people boy vacation male model spring africa child black fish season muscle beauty african network south africa africans photo shoot barechestednessI have found myself recounting this story many times in the course of my professional work, most recently in the week just past. I read it many years ago in a collection of children’s stories, and I associate it with my being in what was then called junior high school, now middle school. In my vague memory, the story was attributed to a West African folk tradition. I have looked for it in various ways a number of times over the years and have never found a version that seemed like the one I remember. Memory is a fallible thing, as we know. If anyone recognizes it & can direct me to a reasonable facsimile, please feel welcome to contact me. I am not going to try to represent the story in its original form; just the bare bones plot details as I remember them.

A boy was fishing at the river, and he caught a magic fish, which promised to grant him a wish– a single wish– in exchange for being released back into the river. The boy wished, “I want to always be happy.” The fish, being a wise as well as magical fish, encouraged him to think about his wish carefully, but the boy persisted. What could be wrong with always being happy? So, poof! the wish was granted and the boy immediately felt very happy, and released the fish back into the river.

On returning to his village, he found that his family’s house had burned down. People were lamenting this unfortunate event, especially the rest of his family, but he was very happy. Everyone thought this was at least odd, if not downright disrespectful, or worse. Then he went into the jungle, where he soon found himself being chased by a lion. As he ran for his life, he noted that he was very happy, and even realized that if he were scared, he might be able to run faster. He then had several other adventures in which happiness was not called for. He finally went back to the river, was able to recapture the fish, and wished to always have the right emotion for whatever befell.

So many times, I have been with someone who bemoaned feeling anxiety, or depression, or another negative emotion. Yet, negative emotions are appropriate to negative events. Depression is not a mental disorder. Anxiety is not a mental disorder. If I have just lost my home to a hurricane, it is a time for depression and sadness. It is also a time for action. If I have anxiety about being able to retire, my worry about the future can lead me to save money today. If I am depressed and anxious about my health, it may lead me to start exercising and to stop having seconds on chocolate cake. A depressive disorder is when my depression impairs my ability to have a life, or is so severe that it immobilizes me, making it impossible to work toward having the life I want. An anxiety disorder is when my anxiety prevents me from living my life, or makes it incredibly distressing.

This also means that when I recover from a mood disorder, I cannot expect to be free from negative emotions. I will still be depressed or sad when bad things happen. I will still be anxious when I worry about the risks and uncertainties of life. What recovery means is that I can still work toward having the life I want, whether it means climbing up out of setbacks to get on level ground again, or setting out to climb the mountains of my goals and aspirations.

image source: https://pxhere.com/en/photo/1332002

 

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Resources on Youth, Vaping & Cannabis

https://cdn.schoolloop.com/uimgcdn/aHR0cHM6Ly9jdW5oYS5zY2hvb2xsb29wLmNvbS91aW1nL2ZpbGUvMTUwMDE3ODk3MzczNS8xNTIyNzQxMDk1MzEwLzY3NTkwNzc0NTM0MjcyMzQ0MTQuanBnI want to thank all the parents and youth who came to the cannabis forum informational event last Wednesday, October 17 at Manuel F. Cunha Intermediate School.You were very kind to me and to the other presenters. I was told that a link to this post was going to be made available to school parents and I see some people have already visited.

There are a great many sources of information about these sometimes controversial topics, and I have tried to limit myself to sources which I believe to be factual and to the extent possible, not controversial.

One of the things that we talked about at the forum is the fact that there are multi-billion dollar industries which want people to use nicotine and either the whole cannabis or its extract, THC. The purveyors of nicotine drug delivery systems are quick to point out that vaping is safer than smoking (still a somewhat controversial claim), but neglect to point out that breathing pure air is safer than vaping. The purveyors of THC will point out that you won’t suffer respiratory failure from THC overdose the way you do from alcohol overdose, but they won’t go out of the way to say  you are  at still more likely to crash your car if you drive high. Soda manufacturers won’t tell you that sugar rots your teeth, either. That’s life in America.

I have always strongly believed that knowledge is power, and I hope this will empower parents in talking to their kids. As I said at the forum, it’s never too soon to talk to talk to your kids about these risks, but you want to be armed with honest facts, not vague claims of, “it’s bad for you.” As Dr. O said so eloquently at the forum, you want to have the kind of open, loving relationship with your kids where these kinds of conversations can happen honestly.

Here are some web sites that give information on youth & substance use and substance use disorders:

The TEDS Report:  Age of first use of substances among people age 18-30 when admitted to substance abuse treatment programs.

FAQ’s from young people on alcohol/drug use from NCADD, 

Tobacco Prevention Tool Kit from Stanford.

SAMHSA free store of publications on a wide variety of topics.

 

In my own words, list of diagnostic criteria for substance use disorders:

  1. Had times when you used more, or for longer than you intended?
  2. More than once, wanted to cut down or quit, but you could not?
  3. Spent a lot of time getting it, using, it getting over the effects?
  4. Experienced craving?
  5. Using interfered with fulfilling job, family, or school obligations?
  6. Continued to do it even though it was causing problems with family & friends?
  7. Reduced or quit other activities that were important or interesting?
  8. Got into risky or dangerous situations due to use (for example, driving intoxicated)?
  9. Continued to use even if it made other problems, like depression or anxiety, worse?
  10. Experienced tolerance– having to use more than previously for the same effect?
  11. Experienced withdrawal– got sick from not getting it, or had to use a replacement?

mild= 2 or three symptoms

moderate = 4-5 symptoms

severe = 6+ symptoms

example: I want to vape, and if I don’t get to, I get cranky, irritable, and won’t feel right until I do. This would be criterion # 4, craving, along with #11, withdrawal, so right there I have a mild nicotine use disorder. If I get in trouble with my parents because they don’t want me doing it, and I risk getting busted because I’m using under age, one could say I meet #6 and #8, so that’s a moderate nicotine use disorder. The whole thing is not as clear-cut as this necessarily, but this gives a rough idea of how it works.

For a different view, here is the ASAM addiction definition  from the American Society for Addiction Medicine.

Statistics and studies on youth substance use:

NIDA (National Institute on Drug Abuse) pamphlet on vaping

NIDA teens & e-cigarettes

New Yorker article on JUUL

Centers for Disease Control and Prevention fact sheet on tobacco

DATA ON SUBSTANCE USE AND HEALTH

Monitoring the future 2017

This is a national survey on youth and a wide variety of drug issues.

With introductory remarks & some additional links to vaping/cannabis info:

https://www.drugabuse.gov/news-events/news-releases/2018/06/full-survey-annual-teen-drug-use-now-available-additional-data

National Survey on Drug Use and Health (NSDUH) 2017 This is a summary. The full NSDUH runs hundreds of pages and is a treasure trove for statistics nerds.

California Healthy Kids Survey is a statewide survey on a variety of issues including drugs, alcohol, tobacco, mental health, school safety.

CANNABIS HEALTH EFFECTS SUMMARY  This is the conclusions summary of a committee  from the National Academies of Sciences, Engineering, and Medicine after an extensive review of the literature on the effects of cannabis. Highlights include that the committee found that there is substantial or conclusive evidence that cannabis is effective for chemotherapy-induced nausea and for treatment of chronic pain in adults and other potential benefits of medical use.

On the other hand, the committee also found out that there is substantial evidence for a statistical association between cannabis use and increased risk of motor vehicle crashes, substantial evidence of a statistical association between use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users, and moderate evidence of a statistical association between use increased incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users.

The committee also found substantial evidence that initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use.

October 30, 2018 update: article on adolescent cannabis cessation from NPR

Please feel welcome to contact me.

 

 

 

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Pay Attention When I’m Talking to Me!

little girl talking to herself in the mirror

Just want to follow up on the last post, because I met with a client earlier a couple of weeks ago who specifically wanted to start working in a cognitive way. The hardest part of doing cognitive therapy, I’ve found, is to start. This makes doing cognitive therapy a lot like everything else, of course, but I’ll forego a juicy opportunity for digression.

The thing is, when we think, we are talking to ourselves. Thinking is not an automatic pronouncement of absolute truth, a description of absolute reality, or anything else. It might be a pronouncement of absolute truth, a description of absolute reality– but most likely not. What it usually is, is an inner monologue. Sometimes, it’s true, we may think in music, or think in images, but mostly we are talking to ourselves, either consciously and deliberately or not.

Cognitive therapy involves looking at this inner monologue and challenging the cognitive distortions. So if I’m feeling depressed over a failed relationship I might tell myself, “All my relationships fail. I’ll never have a successful relationship.” One cognitive distortion there is fortune telling. Another one is all/nothing thinking. In this case, the two overlap. Even the assertion that “All my relationships fail” may be suspect– perhaps if I review my relationship history I’ll realize I have sometimes dumped other people, or we called it off mutually. Even if I determine that I was dumped every time, I will likely have to admit that the relationships worked for a while. In short, the statement was not a statement of absolute truth, it was a judgment call– and I may have slanted the judgment against myself!

But the hardest part for so many people is to recognize that what I’m looking at here is my own inner monologue, not a statement of objective truth or reality.  The best statement I ever heard about this process came, as so many pearls of wisdom have, from a client. She said, “When I’m talking to myself, paying attention is a form of self-respect.” Listening carefully to the inner monologue and recognizing it as my own voice, talking to me, is a sometimes difficult but invaluable step in being able to change.

Image source: https://www.mnn.com/health/fitness-well-being/stories/go-ahead-talk-yourself-its-good-you

Note: the image source also includes a post about the practice of deliberately talking to oneself and why it helps. Here I’m writing about something significantly different, the process of being mindful of one’s own inner monologue, which seems (and may be) spontaneous and unguided, and the recognition that it comes from me.

 

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Power Tool Safety

Hardware Power Tool, Vector Files

A theme that I come back to again and again in my work with clients is that one’s mind is powerful. My joke about that is that you need to use such a powerful tool safely. Another thing to keep in mind– and we learn this from mindfulness practice–is that you are always thinking. You may be thinking about what you want for lunch, or you may be thinking about the kid that bullied you in second grade, or you may be thinking about a revolutionary way to deliver behavioral health care. It’s all thinking. Additionally, you may be flooded with emotions of various kinds, be hearing mental music, or other kinds of mental processes may be going on, but whatever is happening, the mind is always on.

One of the most salient examples of how we think– again, one that comes up repeatedly– is how “should” statements work. When I first started studying cognitive therapy, this one baffled me, I’ll admit. Isn’t it true that people sometimes should behave in certain ways? Isn’t it true that we should be polite, be considerate of others, be responsible for ourselves, and a long list of other shoulds?

Albert Ellis, who famously originated REBT, used to tell people, “You’re shoulding all over yourself!” When I first began to understand the problem with should statements, I realized that they are comparisons.  The world is one way, and we want it to be another. I used to tell people that when they used should statements, they were at war with reality, and reality would always win. That seemed harsh to me, and I looked for a different way of putting it. One day I came up with an alternate frame. I told my client, “Every time you say ‘should’ you just created a parallel universe where things went differently.” This is in keeping with my view that each of us has a very powerful creative mind. Our minds are so powerful that we can, with a single word, create a parallel universe where things went differently. It also takes the harsh, judgmental edge off of spotting our shoulds. It’s OK to wish for something different; we just want to recognize that we don’t have it.

From whatever trick of language, however, the should always comes out as a kind of accusation: you should be better– but you’re not. You are, in fact, bad, and in addition to being bad, you’re shoulding all over yourself.  Dang, Dr. Ellis! I already feel bad– that’s why I’m in therapy! Can’t you be a little nicer? Well, any therapist will tell you that sometimes you have to give people bad news, and sometimes you have to be blunt.  But the flip side of that is the well known saying that diplomacy consists of telling someone where to go so nicely that they look forward to the trip.

To me, that’s the whole thing about having the  power to create a parallel universe where things turned out differently– with a single word. So to come back to my original puzzlement with the problem with should, there’s absolutely nothing wrong with visualizing a world where people are polite, are considerate of others, are responsible for themselves, and so on. It’s just that it’s a goal statement. Of course people want a world where people are polite, considerate of others., and so on. To crib yet another trite and true statement, for your dreams to come true, you must first dream. But the problem arises when you forget that it’s a goal, not a reality. “I should be more assertive.” “I shouldn’t be so depressed, anxious, obsessive…” Language is such a weird tool, isn’t it? Try saying it this way: “I want to be more assertive.”  “I want to feel more relaxed, more positive…” Now it’s a goal statement, not an accusation.  Now I’m using that power tool– my mind– in a safer, dare I say it– saner– way. I’m trying to get to a better place, not condemning myself for not already being there. And taking credit, as well as responsibility, for being a powerful, creative person.

Image source: http://clipart-library.com/clipart/76963.htm

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The Life You Save May Be Your Own

My apologies to those who have been waiting. Someone who I see personally reminded me that I hadn’t posted anything for quite some time, and I reiterated that I first started this with the avowed intention of creating only original material, but a busy schedule is the enemy of reflection, and I have been busy.

The topic that I’m thinking of right now is hardly original– suicide, and the prevention of suicide. The intention to write more about it was galvanized into action by reading an item on the NPR website about cutting suicide risk after a hospitalization for an attempt. One of the key points in the story is that suicidal thoughts, feelings, and urges don’t last very long– anything from a few minutes to a few hours. For those who have followed this blog, you may remember my post about how the negative mood time dilation effect can make an hour seem like forever. Still, it’s endurable, and survivable. Some of the ways to get through this crisis time are skills such as those taught in DBT; self-soothing, distraction, and turning the mind.

The story also points out that what has worked is creating a safety plan with the help of a trained professional. I have done the safety plans  with a number of people who were in crisis, and all of them are alive today.  If you are thinking of doing the safety plan on your own without use of a professional, my suggestion is to contact a professional mental health person as soon as possible, but if you feel an urgent need to create a safety plan for yourself, then go ahead– but get the professional help.

The other thing that I have written about before which relates to this is the truth that we can be experiencing very strong negative emotions– grief being chief among them– without having a mental disorder. We can also, alas, have strong grief and other negative emotions concurrently with a mental disorder. Life doesn’t allow us to put one problem on hold while dealing with another, unfortunately. My image for this has always been that the ship of my life is at sea with a leak in the hull and a fire on deck. If I only fight the fire, the ship sinks. If I only fix the leak, the ship burns to the waterline. Sometimes there’s no getting around it. But experience shows that when we get through the crisis, life can have good things for us again on the other side– or even in the middle of the crisis.

When I think of this topic I remember a client I had who shot himself in the head– before I ever met him. By some miracle, no part of his brain was definitively damaged, and he recovered. By the time I met him, he was seeking help for other problems, and was no longer suicidal. In fact, after his attempt, he had endured trials that would have made other people become suicidal, but was not. Sometimes the light at the end of the tunnel really is daylight.

 

(image from https://www.rd.com/culture/rainbow-facts/)

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May Is Mental Health Awareness Month

Just wanted to give that shout out to Mental Health Awareness Month before it’s over. Before looking it up, I didn’t know that it has been going on in one form or another since 1949

.Image result for mental health month 2018 images

This year the theme is #4mind4body and there are various things about mind/body wellness that you can find at the link.  Here’s just one item from the toolkit:

Health and wellness are hot topics, but did you know a healthy lifestyle can help to prevent the onset or worsening of depression, anxiety and other mental health conditions, as well as heart disease, diabetes, obesity and other chronic health problems? It can also help people recover from these conditions. Learn about the mind-body connection with this year’s #MHM2018 fact sheets: bit.ly/MayMH

There’s also some interesting stuff about new developments in gut health and mental health. As a part-time tree-hugger, I like the idea that every person is a walking ecosystem and that care of our personal gut ecosystem can make us feel psychologically better.

For me, the great advantage to doing the physical health side of mind/body wellness has always been the concrete, tangible nature of it. If I go for a walk or eat a healthy food, I know I did it. I know I can do it again. It’s real & nobody can take that away from me.  That, in itself, creates a mental boost.

Take care of yourself, and reach out to each other. This month, and every month.

image from http://www.star-center.org/mental-health-awareness-month/

 

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Anger…

…is not necessarily bad. The two best things I try to remember about anger come from the Seeking Safety book and from a training I attended some years ago on facilitating anger management groups (which tend to be mostly mandated clients with criminal justice involvement).

The first idea, from Seeking Safety, is the idea that anger is a sign of unmet needs. That makes complete sense to me. If there is something I need, and I’m not getting it, I can get angry.

DSCN1620The second idea, from anger management, is that anger is not a primary emotion. It is, in this view, a secondary emotion, a front for either underlying sorrow or fear. In fact, the trainer who taught the course went so far as to say that anger is never the primary emotion, and that it always is a front for sorrow or fear. Such a categorical statement piqued my interest, and especially my sense of contrariness. Is there never an exception? This was many years ago, and I’m still looking for an exception.

Here’s the basic idea about why we get angry: fear and sorrow are vulnerable emotions. Anger, and especially rage, represent a strong, even an invulnerable feeling. The ultimate version is when someone goes berserk or runs amok– two words, one from the Vikings and one from Malaysia, that represent what some translators have called “battle fury,” the extreme fight-or-flight reaction where strength greatly increases, sensitivity to pain may be greatly diminished or absent, and rational thought is on hold.  When a person gets addicted to being high on their own fight/flight chemistry, this person is the classic “rageaholic.”

From some perspectives, we can see the up side of anger– if I’m truly in a life threatening situation, going berserk has survival value. We have heard the stories of the mom who lifts up a car when a jack slips, pinning her teenage son, and pulls him to safety, or the wounded soldier who runs fifty yards to safety after losing a foot. There are various true examples of how this extreme physical reaction can be life-saving. What the stories don’t include is that the mom has a bad back forever after & the wounded soldier is still in very bad shape. But lives have been saved.

But most of us are not in life or death situations when we get angry. So what’s the up side then? Well, feeling strong, feeling less vulnerable. If you hurt me and I get angry with you– even fly into a rage– now I feel strong, not vulnerable. So which do I want to feel? Strong and invulnerable, or hurt and vulnerable? It’s understandable, seen in this light, how one might choose the strong, angry feeling over the vulnerable, sad or fearful feeling.

The problem with choosing the invulnerable anger response is that when it borders on or becomes rage, rational thought is typically shut down. Perhaps I can’t stop to think that my spouse obviously didn’t mean to get in a car wreck– I just focus on the fact that the car got wrecked and my spouse was driving. I may not even stop to think if it was the other driver’s fault, or if I do my rage might be dangerously directed to that person. The anger management people suggest that when the fight-or-flight chemicals dump into my system, it will take at least half an hour for them to wash out.

Here’s where I double back, to the Seeking Safety idea that my anger is the sign of an unmet need. If I’m angry about the damage to my car, it may be due to my sudden fear that my loved one might have been injured or killed, or worries about money, or any number of perfectly valid fears. But none of those needs can be addressed with a baseball bat or shouting. If need be, I take half an hour to calm down before talking to anyone– especially the person I’m upset with. It’s always interesting to me that some people have intuitively figured out that they need to take a walk, or sit in a quiet room, or otherwise calm down before continuing to deal with an upsetting situation. It’s equally interesting (puzzling, I’ll admit) that people can get coaching on this, including the physiological reason for why it’s necessary, and still not give it a try.

The other thing about anger is that anger is a form of energy. We can think of emotions as our motivators– the driving forces of our lives. So it’s good to have energy, but it needs to be usefully directed. The rational mind is the part that channels the energy. Practically speaking, it’s better to self-monitor and respond to unmet needs (anger) when they are still manageable. This is the part where the client-therapist dialogue, or an inner dialogue with oneself, begins. How do you stay aware of your own needs, your sorrows, your fears, your anger? How do you monitor yourself? What ways do you have to meet your needs? If you feel you have an anger problem, you need to be able to answer those questions in order to successfully cope with anger and without negative outcomes. Anger management is an entire industry, but enough for now.

 

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