Continue to Eat Right

Sorry to have been away for so long. I just had to come back with yet another study that showed eating a certain kind of diet can help depression.

Hint: it isn’t the “day after Halloween” diet plan. One of the academics quoted in the article basically says what a lot of people’s grandmothers used to say: fresh air, exercise, and eat your vegetables.  It’s not the be-all and end-all of staying mentally and physically healthy, but it helps.

I want to continue to work on and think about things to put in this space that aren’t just restatements of things you’ve already heard, but I’m reminded of a line that  Alexander Pope had about “what oft was thought but ne’er so well expressed.” We are all part of the human condition, so the universality of our joys and fears, hopes and suffering, make it unlikely that startlingly unfamiliar things will be said about what we have all been going through for the last six thousand years.


Eat your vegetables, sure, but like grandma often said, “then I’ll bring you a nice piece of pie.”

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I’m Alive: Keep It Simple, Care for Self

woman posing on pier

Photo by Allison Shannon on

Sorry for the long absence. When I find a good way to write about it while still maintaining appropriate professional boundaries (a good topic right there) I will. In the mean time, my basic approach is in the title, and I’m including a link which outlines the basics. Fortunately, keeping it simple is, in fact, simple. If you go to the link, be sure to watch the video that’s embedded there. In about two minutes it’s laid out.

Part of my approach to wellness has been that we may not be able to do away with bad things in our lives– a history of trauma, chronic disease (The two can be related) or the natural losses that we all suffer as we go through life, but we do have control over whether or not we get enough sleep, better food, or exercise, or touch base with other people.  When we take actions– mostly very small, immediate actions– no one can take this away. If I go for a walk, I know I did it. If I eat a piece of fruit instead of a piece of candy, I know I did it. And so on.  Take care of yourself.

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Mental Health Awareness Month


Recently I was with a group of people getting involved with Mental Health Awareness Month by discussing the question, What is mental health?” As the only full time professional there, I thought it would be good to remain silent and learn. The other people raised a lot of good points about happiness, feeling good, but missed something that clients present me with on a daily basis– how do you have mental health when life has handed you a bag of snakes? If my external circumstances are terrible, what is mental health then? It’s a commonplace that when life gives you lemons, make lemonade, but what if you have no sugar and no water and no pitcher?  What I learned from listening, on reflection, is that we tend to mix up happiness and mental health.

Finally I threw out the idea that no one had yet contributed– mental health is about coping. It’s not always about happiness, self-actualization, optimism, or other aspects of life that I would put more as criteria for thriving. Granted, the folks I was with did hit on resilience as an aspect of mental health, and resilience, almost by definition, happens when confronting adversity.

But I want to give a nod here to plain old dogged determination. I keep going because I keep going. Because that’s what I do. I may not be bouncing back, but I’m not giving up. I may be doing what the English are known for– “muddling through.” Note that I am not specifying “coping well.” I’m also not saying we don’t stop to rest. Rest is a necessary part of life. Above all, stopping to rest is not quitting. It may be gathering strength for the next phase of the struggle, or taking a minute to give yourself a pat on the back for an accomplishment.

Everyone I have worked with always wants to cope better– that’s a given. That’s why they’re in therapy. But I’ve met people whose idea of coping with anxiety involves large quantities of distilled spirits, or in other cases unlimited access to benzodiazepines. A friend of mine who has described himself to me as having both a bipolar diagnosis and alcoholism (and has never been symptomatic as far as I could see, so qualifies as in remission, or recovery if you choose) once opined that medication doesn’t solve your problems, it just helps to create a space for you to work on them. I like this perspective. It’s just to note that when you go to therapy, your therapist may have a different point of view about what is going to get you where you want to go. Some may be quicker to suggest medications than others. Is one more correct than the other? That’s a judgment call. But a good therapist presumably can help us figure out the most effective coping strategies, whether through self-discovery, skills training, or other means.

But my original point is that when we are in pain or adversity, wanting to feel better– and not being able to feel better right away– can be taken by some as a sign of a mental disorder. There are a host of problems in life that can be difficult to deal with that are not mental illness. Grief is an obvious one. Survival problems like poverty or being a refugee are others. Can mental illnesses arise from these? Sometimes, but not inevitably. Sometimes, my life can suck, but I’m not suffering from mental illness. I still have my mental health.

On a parallel track, a person can be diagnosed with a major mental disorder, and still have many good things in life– many of those things that would be considered thriving. I have known people bedeviled by auditory hallucinations who had meaningful relationships, contributed to their community, and had zero of the external signs we normally associate with people who are hearing voices.

Just like physical health is not a unitary entity, neither is mental health. The poem Richard Cory is probably the most well-known depiction of someone with no visible problems, yet who is killed by his mental illness. Which brings us to one of the recurring themes of mental health awareness– stigma.  The illness we conceal cannot be treated. And we hide symptoms– until they are too severe to hide– because of the fear of being thought fundamentally flawed, rather than in need of assistance. This is still the greatest barrier to treatment, in my opinion. And it is perpetuated at the highest institutional levels. Health insurance providers continue to, in effect, ration care and/or deny access to care, treating both those with illness and those who treat the illness as second class citizens. However, there is an ongoing movement at the grass roots, driven by need, to fight stigma and advocate for care. We can all take part. That’s the good news. And whether we’re feeling good or not, plain old dogged determination can help.

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Acceptance, Action, Self-Compassion


I can never get enough of this stuff. I don’t have time to add some of my own thoughts right now, but I can’t let this one pass without passing it on: it’s always helpful to accept yourself, especially when it comes to dealing with your physical self. We live in a society that has created multiple multi-billion dollar industries about making us unhappy with ourselves. Am I thin enough, fit enough (not the same thing!!!), hip enough, etc. enough? I always come back to a line that I originally heard was from the radical psychiatrist, R.D. Laing, but later heard had originated with Krishnamurti: To be well adjusted to a profoundly sick society is a dubious achievement.



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Stigma, Mental Health, Addiction, Cannabis


Mental illnesses and addictive disease are sometimes lumped together under the category “behavioral health.” One thing they have in common, unfortunately, is that both mental illnesses and addictions are highly stigmatized. Among other findings,  researchers have seen that reactions to mental illness include the following:

  1. fear and exclusion: persons with severe mental illness should be feared and, therefore, be kept out of most communities;

  2. authoritarianism: persons with severe mental illness are irresponsible, so life decisions should be made by others;

  3. benevolence: persons with severe mental illness are childlike and need to be cared for.

There are many myths about mental illness including the idea that people with mental illness are dangerous. In fact, they are ten times more likely to be victims of violence the the general population. Another widespread, incorrect belief is that people with mental illness are responsible for their illnesses. This belief is typically not held toward people with other health problems.

Stigma toward people with addictions is even worse. This is despite the widespread acknowledgement by various sources such as the DSM 5  that substance use disorders (SUD’s) are a category of mental disorder. Many myths about addiction continue to be widespread.

Into this already confused field comes the changing role of cannabis in society. Is it a miracle substance that cures otherwise difficult to treat ailments? Is it a deadly drug that is, as past anti-marijuana crusaders claimed, an “assassin of youth?” Fortunately, and National Academies of Science, Engineering, and Medicine have compiled an excellent review of the literature on the effects of cannabis and cannabinoids. What the review shows, not surprisingly, is that a great many claims, pro and con, have no basis in any research. However, from a mental health perspective, there were some key conclusions that anyone might want to note.

There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.

There is moderate evidence of a statistical association between cannabis use and increased incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users, increased incidence of suicide completion and increased incidence of social anxiety disorder (regular cannabis use).

Most importantly for anyone concerned about youth, the report finds that there is substantial evidence that  initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use and that there is moderate evidence that during adolescence the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, antisocial behaviors, and childhood sexual abuse are risk factors for the
development of problem cannabis use.


The short answer is yes. The DSM 5 includes cannabis use disorder. The criteria for a substance use disorder are as follows:

1. Substance is often taken in larger amounts and/or over a longer period than the patient intended.

2. Persistent attempts or one or more unsuccessful efforts made to cut down or control substance use.

3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from effects.

4. Craving or strong desire or urge to use the substance

5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued substance use despite having persistent or recurrent social or interpersonal problem caused or exacerbated by the effects of the substance.

7. Important social, occupational or recreational activities given up or reduced because of substance use.

8. Recurrent substance use in situations in which it is physically hazardous.

9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10. Tolerance, as defined by either of the following:
a. Markedly increased amounts of the substance in order to achieve intoxication or desired effect;
b. Markedly diminished effect with continued use of the same amount.

11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance;
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

Depending on how many of the eleven symptoms a person has, the disorder is qualified as mild, moderate, or severe.


How many people are currently using marijuana?

The main reference for this is the National Study of Drug Use and Health (NSDUH)

It found, in part, that:

Aged 12 to 17

In 2017, 6.5 percent of adolescents aged 12 to 17 were current users of marijuana (Figure 13). This means that approximately 1.6 million adolescents used marijuana in the past month. The percentage of adolescents in 2017 who were current marijuana users was lower than the percentages in most years from 2009 to 2014, but it was similar to the percentages in 2015 and 2016.

Aged 18 to 25

In 2017, about 1 in 5 young adults aged 18 to 25 (22.1 percent) were current users of marijuana (Figure 13). This means that 7.6 million young adults used marijuana in the past month. The percentage of young adults who were current marijuana users in 2017 was higher than the percentages between 2002 and 2016.

Aged 26 or Older

In 2017, 7.9 percent of adults aged 26 or older were current users of marijuana (Figure 13), which represents about 16.8 million adults in this age group. The percentage of adults aged 26 or older who were current marijuana users in 2017 was higher than the percentages in 2002 to 2016.


According to the NSDUH:

In 2017, an estimated 1.2 million adolescents aged 12 to 17 used marijuana for the first time in the past year (Figure 28), which translates to approximately 3,300 adolescents each day who initiated marijuana use (Table A.19A). About 1.1 million to 1.4 million adolescents per year in 2002 to 2016 were recent marijuana initiates. The 2017 estimate was similar to the estimates in most years from 2002 to 2016.

In 2017, 1.3 million young adults aged 18 to 25 initiated marijuana use in the past year (Figure 28), or an average of about 3,600 recent initiates per day in this age group (Table A.19A). The 2017 estimate for the number of young adults who initiated marijuana use in the past year was higher than the estimates in all years from 2002 to 2016.

An estimated 525,000 adults aged 26 or older in 2017 initiated marijuana use in the past year, which rounds to the estimate of 0.5 million initiates in this age group in Figure 28. This number averages to about 1,400 recent initiates per day in this age group (Table A.19A). The number of recent marijuana initiates in this age group in 2017 was higher than the numbers of initiates in all years from 2002 to 2014, but it was similar to the numbers in 2015 and 2016. Consistent with the pattern for cigarette and alcohol use, the majority of people in 2017 who initiated marijuana use in the past year were aged 12 to 25.


Recent information suggests that higher potency THC marijuana and THC for vaping may actually make this a different drug in terms of its effects on people. As the article linked mentions, “I think most people are aware of the phenomenon that ‘this is not your grand daddy’s weed,’ Gruber says. “I hear this all the time.” What is important to note is that high potency cannabis can actually have the opposite effect from what people associate with the effects of marijuana with low THC levels.

As an old hippie, I remember when people would actively counsel their friends, “you’re not the right kind of personality to do that drug,” or “You’re not in the right head space to do that right now.” Taking powerful psychotropic substances, medical or recreational, has risks. To do so without paying attention to the dosage, frequency, or environmental considerations only increases the risks. If you’re going to do it, who has your back?

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Your Sense of Self is Behind the Times

Image result for person looking in the mirror of an older person

I was reminded about this when I saw a post on NPR about insects changing their behavior situationally. It turns out that shy, solitary grasshoppers turn into swarming locusts under stress. Same critter, amazingly different behavior.

I first identified the issue of who you are– and under what circumstances– for us humans when I was working in substance abuse treatment. Someone would start treatment, become abstinent from alcohol and drugs, make a new circle of acquaintance and support in AA or NA, but would still have a self-image as a desperate alcoholic/dope fiend. The new person didn’t drink or use drugs, had a circle of new friends who didn’t and who had never seen them intoxicated, but had not yet grown into the self-concept of being a clean/sober person. Their self-concept was behind the times.

Later, I spotted the same phenomenon with respect to any and all of us with respect to aging. Someone who was middle aged talked about feeling like a seventeen year old whose body had mysteriously gone bad on them. If you’re not old enough to have had this sensation, watch for it. By the same token, people who have changed health habits in middle age (or always had good ones) can be described as biologically younger than their chronological age– something that I think gives great hope to us all. There are a lot of tests like this online. (To do the one I link to, you either need to know your weight in kilos or that fourteen pounds equals one stone (weird British measurement))

But I digress. The point is, we change both by deliberate effort and simply with the passing of time, and we sometimes don’t keep track. Because I have worked with people in treatment modalities that are skills based, such as Dialectical Behavior Therapy or Seeking Safety , I have seen this same process when people develop coping skills and resiliency that they didn’t previously have, but still see themselves as unable to cope with various problems in life. As a therapist I find it exhilarating to point out to someone that they successfully got through some challenge that used to be a huge crisis for them.

While there are tests we can take that show us to be biologically older or younger than our chronological ages, I don’t know of any simple test that can measure whether or not we have wisdom that is greater than or less than our chronological ages. I doubt that could be accomplished, not least because most of us take actions that can be seen as demonstrating a lack of wisdom and at other times we may take actions or say things that seem very wise indeed. Also, there are times when we have had the benefit of clear-eyed and deep wisdom spontaneously from the very young. We can also think of people in our circle of acquaintance who might be labeled as “old souls” or “forever young” regardless of chronological age.

The phenomenon I’m thinking of might, in a sense, be equated with a certain kind of humility– not the sense of eating humble pie or abasing oneself, but the sense of simply knowing oneself and acknowledging it to oneself. I think this is one reason why 12-step recovery has become popular with everyone from alcoholics to procrastinators and everyone in between. Step four has everyone take “a searching and fearless moral inventory” and step ten instructs recovering folk to “continue to take personal inventory” on a daily or even more frequent basis– to keep track of who you are. Many people interpret this as being strictly about what’s wrong with you, but a closer peek at the literature reveals that it includes keeping track of one’s pluses as well as aspects of oneself that just are. Of course, there are other schools of self-improvement that encourage the same kind of activity, including psychotherapy.

The original article on insects and humans has a beautiful phrase in it– “a vocabulary of selves.”  Looking at it this way, my sense of self may be more misplaced geographically than out of date. I may be a confident, expansive tour guide showing people around my home town and be a very shy and retiring person in the temple of a faith that’s new to me. In sports, I may be a bold mountain climber but a very timid sailor. One can multiply examples.

The door to change is that for a healthy sense of self we need to have a flexible sense of self– to be open to the idea that we may be more, or less, or just different from who we believe we are.  And who we are here, or who we were  then, is not who we have been– or might be– in other places or other times.


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Take Good Care of Yourself


5 Tips to peaceful sleepI have had a couple of things I have been working on, don’t have anything I feel ready to publish just yet, but ran across this from Center for Greater Good on how getting enough sleep is good for your relationships.

There are so many places where therapists talk about taking care of your mental health and end up talking about taking care of your physical health. Eating right, getting some exercise, and sleeping are all helpful. We know that the brain, the organ of thought and emotion, depends on proper care to work properly. In addition to the physical and obvious benefits of good nutrition, exercise, and sleep, there’s also the benefits in terms of a sense of self-efficacy– the sense that “I can do something that works.” In the case of self-care, this also dovetails nicely with self-soothing or self-nurturing, take your pick for what you want to call it.

There are times of extreme emergency when we can’t take a time out to self-nurture or self-soothe, but these are relatively rare. Even if I’m freaking out about taxes on April 14, I can still file an extension. I just need to get over my freakout before the extension expires. If I have a lifestyle that depends on the creation of crisis after crisis, that’s another conversation for a different time.

Many years ago, when AIDS was still a death sentence, I learned about some research that found that one group of women who were diagnosed with AIDS lived about six weeks after diagnosis. Given the nature of the disease, this was a shockingly short time, even before there were any medications. What further investigation showed was that these women were so busy taking care of others that they wouldn’t go to the doctor to get any help for themselves until they were nearly dead. The point here is that adequate self-care is also helpful to other people in your life. Taking care of yourself adequately means there’s less strain on others who might otherwise have to care for you, and you also have a greater capacity to help others in your life who you may wish to nurture.

For now, just recognize that when you take good care of yourself, you are also improving your ability to have good relationships and over all health. Self-care is not selfish.

image from

The site from which the image was taken has some good tips on healthy sleep as well.

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