Love After Love

Ran across a poem from one of my favorite poets:

Love After Love

The time will come
when, with elation
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other’s welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

Derek Walcott

 

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Fake News, Creativity, Fact Checking, Happiness

Three people thinkingIf I am someone with depression, I may go to a cognitive therapist. The cognitive therapist will then coach me on identifying my cognitive distortions, like all/nothing thinking, fortune-telling, discounting, labeling, over-generalization, and so on. The handbook for this is David Burns, The Feeling Good Handbook. If it had been published by another publisher in another time, it might have been called Cognitive Therapy for Dummies, except when you’re already depressed you don’t want to be called a dummy.

So here’s the thing, for me, about cognitive therapy. If I’m already depressed and wouldn’t like to get my treatment from a book like Cognitive Therapy for Dummies, I might also be a little sensitive about being told that a lot of my thinking consisted of cognitive distortions, either. So how to use the fearsome weapons of cognitive therapy to get on the right track without having to give my thinking a negative label, in effect kicking myself while I’m down? And how do I use the techniques without buying into the negative labels?

Here’s my suggestion: I see myself as a creative story-teller. As I go through life, I interact with people & the world, and I get a few facts, which I then use as the basis for making up stories. I’m a creative person and I like to make up stories. So, for example, someone invites me to a party. I start to make up a story– “I’ll go to the party, I won’t know anyone, I’ll feel shy and alone, will get even more depressed watching people have fun, will spend all my time eating junk food, maybe drink too much & make a fool of myself, and will have a terrible time.” My cognitive therapist tells me that I’m engaged in the cognitive distortion of fortune-telling and also all/nothing thinking. “I won’t know anyone” is obviously false– I got invited, so I know the host. Also, I’m making up a (sad) story about a future that hasn’t happened– fortune-telling.

So, bummer. I’m invited to this horrible party and now I’m thinking bad thoughts on top of it. Or, I could just think of myself as a journalist, or the editor of my own script. What are the facts? The fact is, I got invited to a party. That’s nice. All the rest is made up. I’m not a bad person, I’m just someone making up a story, and I fell in love with my own story so much that I forgot I made it up. Wow, I’m a great story-teller. But my story is a sad story. I’ve just been victimized by fake news– that I made up myself. So after I fact check myself, I make up a different story. In this story, I go to the party, decide I’m not having a good time, and leave early. So I don’t pig out on junk food, get drunk and disgrace myself. Or I make up another story– I go to the party, get the host to introduce me to some people, and make new friends, or reconnect with old ones. In actuality, given that my only real fact is being invited to a party, I can make up many stories, and they can all be more positive than the original bummer story. In fact, I have the ability to make up stories where I have some control– I decide to bring healthy snacks and non-alcoholic beverages to the party.

You get the idea.

image from : https://www.arthritisresearchuk.org/support-us/get-involved/quiz.aspx

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Mixed Feelings

http://www.npr.org/2017/02/02/513126985/house-votes-to-overturn-obama-rule-restricting-gun-sales-to-mentally-ill

On one hand, it would be nice if we could get away from stigmatizing people with mental illness.

On the other hand,

https://www.hsph.harvard.edu/news/magazine/guns-and-suicide/

gun suicides outnumber gun homicides two to one.

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“I Wish I Wasn’t So Good at This”

A trauma anniversary can send PTSD sufferers into a tailspin. Need some coping strategies for dealing with trauma anniversaries? Read this.This is just a quick meditation on recovery– or coping– or whatever name you want to give it. Happy New Year, by the way.

For many of us, including folks who don’t necessarily carry a DSM 5 label, life is full of what we may call hassles, challenges, or nightmares, depending on how we feel & how well (or badly) things are going.

I try to avoid labeling things “nightmare” personally, and I encourage others to think very carefully about using that particular word. This is partly because of a passage from a favorite author whose name will go unsaid because I’m not going to quote directly. He pointed out that it’s hard to explain in waking life why, in the nightmare, seeing uncle Albert standing behind the rhododendrons was so disturbing. Usually we are very clear on why it is disturbing to be trapped in a car in traffic on the Bay Bridge with a small child who needs to go potty while we ourselves run a fever of a hundred and two. I think the quality of nightmare that we are referring to is the time dilation effect I talked about in “depression forever,” the post before this.

Coping, as I’m thinking of it right now, is also called “dealing with” or sometimes “putting up with” something in life.  It can also, more clinically perhaps, be called “adapting to.” Some things in life are not going to be overcome. They will not go away. Some conditions are permanent. A very obvious one– loss of a limb. If someone experiences amputation, it’s possible to get a prosthetic and regain a lot of function. There are work-arounds that make life possible. But the loss is always the loss. In a less physical way, growing older and losing one’s parents is another example. I have known people in their 60’s who have both parents living and in their 80’s or 90’s, and I have known at least one person who lost both parents by age 18. In an example that’s both physical and mental, growing older is something that everyone encounters. Usually, we look forward to gaining independence as we grow up, but we dread loss of independence as we grow old. But given the choice of dying right now, most people choose to live one more day.

So we adapt.  It’s not seen as an enjoyable learning experience. It’s a struggle. It’s a hassle. It may even actually take on a truly nightmare quality. But we do it. Not only that, we get good at it. And there are millions of us, everywhere, all the time. People learn to adapt to chronic pain. People learn to adapt to side effects of medications. People learn to live missing a hand, or without sight, or hearing. We learn to live knowing that a seizure may strike without warning, or with precious little warning. Some conditions, like a physical disability, are visible. Others, including barely tolerable chronic pain, are not.

People can be shockingly inconsiderate of a physical disability, or even openly disdainful of  one that is not visible.”Get over it.” Don’t be a whiner.” “Aren’t you used to it by now?” “Move on with your life.” Or, perhaps worse, there are what are called micro-aggressions, the little insults that are built into the language of every day life. To a person fighting an addiction, drunk jokes may not be so funny. So someone whose anti-psychotic medication isn’t stopping the horrible voices, slighting references to hallucinations can be discouraging and isolating.

We learn to adapt, because given the choice to die right now or live one more day, we choose one more day. If this description fits, you know who you are. To you I say this– even though you wish you weren’t so good at this, you are. Even though others don’t know this story, you are its hero. Give yourself credit.

image from http://www.healthyplace.com/blogs/traumaptsdblog/2016/01/07/ptsd-recovery-coping-with-trauma-anniversaries/

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Depression Forever?

https://i2.wp.com/images.all-free-download.com/images/graphiclarge/3d_empty_room_01_hd_picture_167786.jpg

Imagine (or recall) yourself as a second grader. It’s a Friday afternoon in May, and the weather is beautiful. After school is out, you will get to play late outside, and you have the whole weekend ahead of you. But it’s 2:30 in the afternoon, and school doesn’t get out until three. The minute hand on the clock won’t move, and even the second-hand seems to drag.

This scenario may ring a bell for you or not, but most of us have had a time in our lives when time seemed to drag out endlessly. I’m deliberately using this relatively neutral scene because there’s the other, much more negative version of this– time standing still during an accident or disaster of some sort– the kind that may or may not lead to post traumatic stress disorder. But one way or another, we’ve all experienced the time dilation effect.

Let’s leave aside time dilation in trauma and emergencies for discussion some other time. I want to focus on the more hum-drum version, the non-emergency time dragging sensation. The thing that didn’t occur to me until I had been providing psychotherapy for quite some time was that when someone is depressed, that time dilation effect can make depression even worse. Not only am I depressed, but the time seems to drag on endlessly, with no foreseeable end. And unlike one’s second grade self on Friday afternoon, there is no weekend in sight.

This is a time for courage, often courage in the face of hopelessness. Remember, hopelessness is a symptom of depression. The courage involves being willing to do something– anything. My motto, both personally and for others confronting this problem, is “something beats nothing.”

There was a time in my early 20’s when I was going through a punishing depression. I would sit alone in my room and just sink lower and lower into depression. Somehow, I learned that I had to simply get out of the apartment, get into motion, go see anyone, go do anything. At the time, I called it distracting from depression, because I found that I would go meet up with someone or do something and I would forget that I was depressed. Viewing life the way I do now, I would describe the experience differently– I would say now that I was NOT depressed. If one is able to experience connection with others, some level of amusement or happiness, simply get into a neutral mood state– that’s a condition of being “undepressed.” Yes, I often returned to a depressed state when I went back to my apartment, but in the meantime, I didn’t feel down. I got out of the time stasis bubble of suffering.

Mark Twain supposedly said that the best way to cheer oneself up is through trying to cheer up someone else. This basic idea is one of the key concepts underlying all the 12-step programs– you can help yourself by helping others. People must like it, because there are oodles of 12-step programs. But one doesn’t have to be a 12-stepper to use the concept. And there are many other tools. But they all start by some kind of action. To me, that’s the key. I remember thinking to myself at one point in my depression, “If I’m going to be depressed, I might as well be depressed in the park,” thereby allowing myself to get into motion. I had a client one time who used what I call the power of negative thinking: he was depressed to the point of suicidality, so he would buy a lotto ticket twice a week just after the numbers had been drawn, thinking, “My luck is so bad, if I kill myself that will be the time my numbers hit.” The last time I heard, he had gotten into a new career and was very happy. Yes, he was using a kind of reverse psychology on himself– and anyone who wants to copy his example is welcome– but he was also taking action. It gets the clock moving again.p1010256

empty room image: http://images.all-free-download.com/images/graphiclarge/3d_empty_room_01_hd_picture_167786.jpg

Trail image James Matter, 2012 Pacific Crest Trail, northbound north of Shepherd Pass

 

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Seeking Safety– You Are Not Alone

 

Seeking Safety is a manual driven treatment for PTSD and addiction, developed by Dr. Lisa Najavits. It was originally designed for use with all female groups, but has since been used with a wide variety of different populations.

https://i1.wp.com/www.affordablehousinginstitute.org/blogs/us/safety_net_small.jpgOver the last several years I have had the honor of being trusted by a group of women in a Seeking Safety group.  One of the greatest benefits they get from participating in this treatment is being with others who have experienced trauma and/or addiction. One of the greatest barriers to recovery that they have mentioned, time and again, is having other people in their lives who don’t believe they have a serious problem. “Snap out of it.” “Get over it.” “Stop being a whiner and a crybaby…”are some of the nicer things people say to them. These are barriers to recovery for most behavioral health problems, but particularly so for survivors of trauma. For these women, it feels good to get in a group where they are believed, both about the original trauma and its aftermath. It should be noted here that in this form of treatment, there is a strong emphasis on not telling one’s trauma story. This is because it can be too traumatic for both the teller and the other group members.  The goal of the treatment is to build the personal resources to deal with trauma symptoms and to feel safe in the here and now.

I am thinking about this now because of the reported skepticism about why a large number of accusers have come up in such short order accusing Mr. Trump. It reminds of me of a story about a group of women in treatment for drug addiction twenty or more years ago in a program in San Francisco called Moving Addicted Mothers Ahead (MAMA). This program took place at Glide Church in San Francisco, which then had a charismatic pastor named Cecil Williams. Cecil was known as a spellbinding orator, come sermon time, and people listened. He was also known for addressing the needs of his urban congregation and addressing recovery issues.

In one Sunday’s sermon, he was addressing the classic AA saying, “We’re only as sick as our secrets” and the way out of the sickness– being willing to disclose. A group of women from the MAMA program were there, and one suddenly stood up and interrupted him. “I was molested as a child,” she said, “and it has affected my life ever since.” Another woman stood up, then another. One by one, they disclosed that they all had been victims of sexual abuse, either as children or as adults. But it took the courage of one to lead it off.

Let me point out the obvious differences from current events here– they were not all saying they were victimized by the same person. There was no election going on and no question of any ulterior motive. They were all at the same place at the same time. But there was the same “bandwagon” effect, kicked off by one person speaking out. I believe this is because it was easier once each of the women felt that she was not alone, and that she would be believed. I also need to say that to me the story is apocryphal– I wasn’t there. But based on my personal and clinical experience it makes sense. The MAMA program was a program of the Haight Ashbury Free Clinics, where I worked at the time, and the story was widely shared, and it transformed our approach to what is now widely known as trauma informed treatment– recognizing that many people coming into treatment for both addiction and mental health problems have suffered from trauma and have symptoms that need to be addressed. It seems obvious in retrospect.

While politics are involved in this discussion, it is not my direct intention to involve this blog in politics. It is to shamelessly exploit the controversy in order to speak out for victims of trauma. As others around me have pointed out, men can be the victims of trauma, both sexual and otherwise, and not all trauma results in PTSD. But people are exposed to traumatic events all the time– hurricane Matthew, the recent flooding in Louisiana, urban violence (another political topic which I’m skipping), even car crashes, witnessing domestic violence. It’s a long list.

For some, a traumatic event is a bad experience from which they can recover relatively quickly. It leaves its mark, but doesn’t overshadow the rest of life. For others, it can leave a legacy of nightmares, flashbacks, depression, anxiety, difficulties in relationships, even missing time episodes multiple personalities and out-of-body experiences. People who are living with PTSD know what I mean. And if you have someone in your life living with PTSD the biggest thing you can do is to believe that the symptoms are real. The sense of isolation, not being believed, is one of the greatest barriers to recovery. But believe it: after all, no one can see your headache, and they don’t tell you to “just snap out of it.” If you are living with PTSD and haven’t participated in a Seeking Safety group, you might want to find one. You are not alone. You can get better.

image source: http://www.affordablehousinginstitute.org/blogs/us/safety_net_small.jpg

Posted in Addiction, behavioral health, belongingness, Emotions, Feelings, group therapy, hope, mental health, Recovery | Tagged , , , | Leave a comment

Take Your Placebos- They’re Good for You

http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo

I suggest using the following placebos, as needed:
1) Vitamin C supplements for colds, 500 mg every four to six hours;
2) Vitamin D supplements for depressed mood, 1000 units once a day (may be some clinical evidence in support);
3) Dark chocolate chips, a handful every 2-4 hours for stress, not to exceed one ounce daily;
4) Chamomile tea for anxiety and upset stomach (some actual clinical evidence);
5) Walking, 30 minutes a day or 10-15 minutes as needed for depression or anxiety (clinical evidence supports this).

As always, check with your doctor to see if there are reasons not to do any of these.

But the basic idea is: if you think you’re doing something good for yourself, then you are. I know lots of people who do vitamin C supplements for colds, vitamin D for depressed mood, especially in winter, and lots of people who do chocolate for stress– I suggest chocolate chips because it’s easy to take smaller amounts. The chamomile tea thing actually has clinical evidence, (and just stopping to take some time for yourself) as does walking (or yoga).

Let’s face it, in our rushed lives we all yearn for sudden, dramatic relief from our dilemmas, aches, traumas, etc. But doing the small good things on a regular basis can have a cumulatively large effect.

Posted in behavioral health, Depression, Distress tolerance, mental health, physical health, physical health, Therapy processes, Uncategorized | Tagged , , , , | Leave a comment