Wednesday, July 16, 2014

Strange Place...

I'm in a bit of a strange place lately.  I have not been feeling well physically.  I've known for a long time that I grind my teeth at night.  In college, my doctor gave me medication to help with the headaches I got from it.  The assumption was that I was under a lot of stress.  I finished school, I was less stressed, and the headaches didn't occur as often.  Over the years I've gone through phases.  Sometimes I'll get headaches every day for a month or two.  Then I won't get any for a while.  I know the teeth grinding is a problem though, because my dentist tells me it has damaged my teeth.  I had to get a crown on one tooth because I'd completely cracked it in half.  Apparently the tooth on the other side of my mouth is cracked and might also require a crown.

I've looked into treatment for bruxism (the official term for teeth grinding).  My dentist recommended an occlusal guard (to wear at night), which costs about $600.  I'll admit it - I'm cheap.  I didn't want to spend $600 on a mouth guard. 

Unfortunately, my headaches started occurring more frequently.  So I stocked up on ibuprofen and basically ate them like candy.  Over the past one to two months I've felt nauseous.  I initially attributed it to medication changes (and certainly some of it was due to that).  When, however, the nausea persisted long after my body should have adjusted to the new medication I started to consider other possible causes.  (I seriously considered the possibility that something in my office was making me sick.  I know it sounds silly, but I moved to a new office around the same time I started feeling bad.  I thought there might be a correlation).  What I eventually realized (purely by accident, when I heard my husband make a comment about needing to eat before taking Tylenol), is that eating ibuprofen like candy was upsetting my stomach.  I'm pretty sure I far exceeded the recommended dose; I guess I didn't realize how often I was taking it.

Anyway, this finally convinced me to do deal with the problem.  Before investing $600, I decided to look online.  I found a company that claims to make mouth guards for dentists.  For $150, they mailed me a kit.  I took impressions of my upper and lower teeth.  I mailed them back.  They should send me a mouth guard in the mail within a few weeks.  I'm crossing my fingers.  If it doesn't work then I will just pay the $600 and go through my dentist.  At this point, it is causing enough misery to be worth whatever I have to pay.

So I'm feeling hopeful about that.  But something is also going on with me emotionally and I'm not quite sure what it is.  I suspect it might be related to switching from one antidepressant to another; the new one just doesn't work the way the old one did.  Thinking back, when I was first treated for depression (back in high school) I tried multiple medications before finding one that worked.  I took that one for several years.  At some point I thought it was making me gain weight.  I started something else and took it for seven or eight years.  At that time, I complained about always feeling exhausted.  My doctor said the particular antidepressant I was on probably made this worse so I switched to another one.  I took this for about five years. 

I switched medications again about three or four months ago.  I've tried to give it a fair chance to work.  I've actually found it difficult to tell if it's "working" or not.  I haven't really been "depressed," my mood has not necessarily been sad or dysphoric, but I definitely don't feel as good on a daily basis as I did with the other medication.  I frequently feel irritable and want to be left alone.  It's like my average mood went from a seven to a five.  I can function at a five but I felt better, could concentrate better, and was more productive at a seven.  I'm grateful it's not worse; I think that's why I haven't asked the doctor to try something else yet. 

Anyway, that's where I am at the moment.  I am hopeful that I'll figure things out.  My new mouth guard should arrive any day now and I'm optimistic about it.  I see my doctor in three weeks; we'll discuss my options and make some changes.  Until then, forgive me if I'm not writing as regularly as I usually do or if my thoughts seem slightly less coherent.  I'm working on it; give me some time.

Wednesday, July 2, 2014

On Vacation!

I just got back from vacation!  My husband, stepdaughter, and I went to Miami for five days.  We'd initially planned to go to Jamaica, but some unexpected setbacks required us to change plans at the last minute. 

I think most would agree that vacations are beneficial.  Time away from work for rest and relaxation is critical for happiness and well being.  Intuitively, we know we feel better after a few days off work; there's also a large body of research demonstrating the benefits of vacation.  People who take regular vacations report higher overall levels of satisfaction with life than those who don't.  Employees returning to work after vacation show increased work engagement and job performance and decreased emotional exhaustion and burnout. 

Unfortunately, the measurable benefits of vacation are short lived.  Study after study finds that work productivity and burnout return to pre-vacation levels within two to four weeks.  This remains true even when people take extended vacations (say, longer than fourteen days); within a month, productivity and burnout are back to pre-vacation levels. 

This suprirsed me.  I am a strong advocate of vacations.  We spend all week pining for the weekend.  We rejoice when we finally reach Friday.  An upcoming vacation has the same effect, only amplified.  We can look forward to a vacation for weeks or even months.  And afterwards...well, some of my best memories are of vacations past.  I cherish those memories.  They never fail to make me smile.

But how do you measure that?  I'm not sure you can.  I think many of the benefits of vacation are not measurable.  As far as science goes, if you can't measure it then it doesn't exist.  But science is not life. Life is full of intangibles that cannot be seen, touched, or measured but that nonetheless enrich our lives and give them meaning.

Wednesday, June 18, 2014

Self-Criticism versus Self-Compassion

A lot of us are our own worst critics.  We're hard on ourselves.  We do it because it motivates us to achieve.  To go easy on ourselves is to become lazy and complacent.  Self-criticism is motivating because we are driven by our desire to avoid it.  We don't want to make a mistake and we don't want to fail because we dread having to face our own negative judgment.  We use self-criticism to shame ouselves into action.  Every endeavor comes with high stakes; anything less than total success leads to a barrage of self-condemntation.

The weapons of self-criticism are fear and shame.  Fear and shame tell us that we are inadequate and unable to cope with the environment.  Thus, what was intended to motivate action ultimately makes us too afraid to try. 

There is an alternative to self-criticism; it is called self-compassion.  Self-compassion is a way of relating to oneself.  Kindness and concern replace harsh words and ultimatums; comfort replaces condemnation.  Every human life has value; every human being deserves to be treated with respect and dignity.  We are no exception.  We are human; therefore, we have value and deserve to be treated with respect and dignity.  This principle applies not only to how we should be treated by others but also to how we treat ourselves. 

Kristin Neff captures the essence of compassion: "Compassion...entails feelings of kindness, care, and understanding for people who are in pain, so that the desire to ameliorate suffering naturally involves recognizing the shared human condition, fragile and imperfect as it is."  Self-compassion, then, means offering kindness, care, and understanding to oneself when in pain. 

For some of us, this is  a surprisingly difficult thing to do.  A good way to start is by removing yourself from the equation.  Instead, imagine a friend faced with similar circumstances.  Would you tell him (or her) to stop whining and get over it?  Of course not!  Think about what you would say - perhaps words of comfort or support.  Once you've come up with something write it down.  Then, read what you've written to yourself out loud.  Do it a few times.  Set it down and come back later.  Read it again. 

Like anything, self-compassion takes practice.  Try to catch yourself being self-critical.  Say to yourself, "Oh yeah, I'm not doing that anymore.  I'm learning to be nice to myself."  Then give yourself some compassion instead. 

Wednesday, June 11, 2014

Mood, meds, and maintaining

The past several weeks have been extremely difficult for me.  I mentioned before that I'm trying to get pregnant; I therefore changed medications [antidepressants] from something less pregnancy friendly (Cymbalta) to something more pregnancy friendly (Prozac).  I honestly did not foresee this causing any problems.  The two medications are similar.  The transition should be easy.  No big deal.

Or that's what I thought when everything was stable and I felt pretty good.  Unfortunately, things have not gone as smoothly as I'd hoped.  First I got bad advice from my OB, who told me to just stop taking the one pill and start taking the other.  Three days later I started having symptoms of withdrawal.  It was extremely unpleasant.  So I went back to taking the old medication at half the dose: from 120 mg. to 60 mg.  And I made an appointment with a psychiatrist to get some guidance.

Things went okay for maybe two weeks.  I gradually decreased my dose of the Cymbalta while titrating up the Prozac.  There's a problem with Cymbalta though: the lowest dose it comes in is 30 mg.  So after about a week at 30 mg./day, it was time to stop taking it.  After three days I was having withdrawal symptoms again. 

Let me explain what this is like.  You don't expect it so initially it takes a while to figure out what's wrong with you.  The first thing I notice is that I can't think clearly.  The harder I try the worse it gets.  Eventually I realize that trying to focus on any one idea, conversation, or activity for longer than a few minutes actually makes me lightheaded.  This makes it difficult to work, since my job requires me to carry on reasonably intelligent and ideally helpful conversations with patients all day long. 

Then my muscles start to ache and cramp up.  It gets really bad in my forearms and later on in my neck and shoulders.  In the neck it feels exactly like the kind of crick you get when you've slept in an awkward position.  Except I didn't wake up with it so I know it didn't come from how I slept.

Finally - and by far the worst - is the nausea.  Apparently some people actually throw up.  Not me.  I wish I would throw up; I think I'd feel better if I did.  The nausea just sits there.  It periodically intensifies so for a moment I think I am going to vomit.  Then it subsides to its original intensity.  After a while it's all I can think about. 

Then there's my mood, which has not been great.  I've been coping by trying not to dwell on it.  I go back to the doctor in two weeks; I'll ask her to make changes to the medication when I see her.  Until then, my goals are to: 1. Try not to take my bad moods out on other people, especially my husband. 2. Go about my normal routine.  3. Act the way I usually act, despite feeling down.  I'm sure we'll get the medication right eventually.  Until then, I just have to hang in there.

Wednesday, June 4, 2014

Our Many Selves

I encourage my patients to talk to themselves.  It doesn't have to be out loud, but it can be.  It is widely believed that talking to yourself is a sign of being  "crazy."  This is a complete fallacy.  The fact is, talking to yourself is completely normal.  We all do it, all the time, whether we're aware of it or not.  At any given moment, we all have some sort of running commentary taking place in our minds.  Some of us are more attuned to it than others but we all have it.  And whether we're tuned in to our self talk or not, it has a profound effect on our perceptions and emotions.

Not only do I encourage my patients to talk to themselves, I encourage them to talk back to themselves as well.  This is because we all have more than one inner voice; to maintain a healthy balance, we need to prevent any one voice from dominating the conversation. 

This may all seem a little strange at first but it actually makes a lot of sense.  We tend to think of the "self" as a single entity.  In reality, each person has multiple selves or "sub-personalities."  Each sub-personality has its own unique qualities and characteristics.  Many of our sub-personalities fill specific roles.  For example, I think and behave one way at work, another way at home, and another way when I'm out with my friends.  I may have a very responsible sub-personality and a thrill-seeking sub-personality.   Different sub-personalities are active at different times.  Ideally, all the "sub-personalities" or parts of a given individual should be aware of and communicate with one another.  They should work together cooperatively. 

It is important to avoid identifying with any one sub-personality.  When we identify with whatever part of the personality is activated in a given moment we become controlled by that part.  When we later look back from the perspective of another part of ourselves we may say, "I don't know what got into me!  I'm not usually like that!"

Through awareness and mindful observation we can become less identified with any one sub-personality and thereby gain more control over when, where, and how each one is activated.  When we are aware of the different parts of ourselves we can ensure that the desires, goals, and needs of each subpersonality are adequately addressed andd that no part is ignored or neglected.  When we neglect the desires and aspirations of any one part of ourselves we are vulnerable to being hijakced by the neglected part as it asserts itself in a desperate bid for attention. 

Wednesday, May 28, 2014

Paradoxes and Contradictions

Some of life's contradictions:

1. True happiness stems from leading an authentic and meaningful life.  Unfortunately, sometimes being authentic - acting in ways that reflect your true nature and core values - leads to suffering or death.  It is not always possible to be happy and live authentically.  Such is the case for martyrs. 

2. Total contentment in life is extremely demotivating.  If a person is completely satisfied with life then he has nothing to strive for; he becomes complacent.  Thus, complete happiness is not necessarily in our best interest.

3. In contrast, dissatisfaction and unhappiness are powerful motivators for growth and positive change. 

4. Actively pursuing happiness tends to have the paradoxical effect of making people unhappy

5. People often cope with their fear of death by withdrawing or pulling back from the fullness of life.  Thus the fear of death sometimes prevents people from really living

Wednesday, May 21, 2014

The Inner Child

We've probably all heard someone refer to his or her "inner child."  It's another one of those psychology terms that somehow made its way into popular culture.  Carl Jung, a disciple of Freud and one of psychiatry's founding fathers, called it the "wonder child."  According to Jung, the "wonder child" is the part of the psyche with the capacity for awe and a sense of natural wonder; it is curious, creative, and loves to explore. 

The website gives the best definition of inner child I have found so far.  It defines "inner child" as that part of the psyche that retains feelings the way they were experienced in childhood.  When it is healthy, the inner child is naturally innocent, playful, and uninhibited; it has an approach to life that is simple and straightforward.

Today, you might hear clinicians talk about the "wounded inner child."  John Bradshaw ( is one of the best known proponents of "inner child work."  He has authored several books on the subject and apparently appeared on several nationally televised PBS series.  Among other things, he now travels the country conducting "inner child workshops."  According to Bradshaw, an inner child becomes wounded when normal childhood dependency needs are not met during childhood.  Normal development is arrested and dysfunctional childish behavior persists into adulthood.

While some of Bradshaw's work is a little too "touchy feely" for my taste, he does get a lot of things right. 

From birth to adulthood, a child's parents are responsible for meeting all of his or her needs.  This includes physical needs like food and shelter as well as psychological needs like security, intimacy, structure, and - later on - autonomy.  Even the very best parents don't do this perfectly.  Parents are human - they make mistakes.  To further complicate things, very young children cannot speak.  This makes it hard for them to communicate their wants and needs.  Even after they start speaking they may be unable to communicate their wants and needs because children often do not know what they want or need.  So for parents, there is a lot of guesswork.  Sometimes parents guess correctly; sometimes they don't.  Fortunately, a child doesn't need perfect parents to turn out okay.  For healthy development, a child simply needs parents to be "good enough."  (I am not making this up.  If you don't believe me, see Winnicott's ideas on the "good enough mother"). 

Sadly, there are parents who are absolutely nowhere near "good enough."  There are lots of reasons for this.  Some parents fall short due to circumstances beyond their control.  Some parents are neglectful or abusive.  Whatever the reason, if a parent doesn't meet a child's needs during childhood then that child enters adulthood with significant emotional and psychological deficits. 

So in normal psychological development, other people (i.e., parents) fulfill one's psychological and emotional needs.  It is natural, then, for those whose needs have not been met by the time they reach adulthood to look for other people to fulfill them.  To this end, they enter into relationships expecting others to fill the emptiness inside them.  They are uncertain of themselves and look to others for validation and affirmation.  They do not know how to love and appreciate themselves so they rely on others to give them love and appreciatiation.  Inevitably there comes a time when they feel empty, unloved, unworthy, or unappreciated.  They blame those people they'd expected to complete them and are left feeling disappointed or even betrayed.

They may continue their search for someone to meet their emotional needs.  They will never find such a person; no such person exists.  During childhood, our emotional and psychological needs are met by other people (i.e., parents); once adulthood arrives, the time for others to meet these needs has passed.  The window of opportunity closes.  A person must learn to provide for himself whatever needs have not been met by adulthood.

It's definitely harder this way.  It is so much easier to get what we need while we're children.  As adults, it is difficult to give ourselves what we did not get from our parents.  It is difficult, but it's not impossible.  In fact, this is often the work of therapy: learning to meet your own needs, to be your own person, and to love and accept yourself. 

Wednesday, May 14, 2014

Existential Challenges

We hear the term "existential crisis" thrown around in pop psychology fairly often.  According to Urban Dictionary, an existential crisis is a deep, obsessive concern with unanswered questions about the meaning of life and existence.  Existential psychology identifies four "existential challenges."  These "ultimate concerns" are the "givens" of life.  They are the fundamental truths that capture the essence of the human condition.  Our lives are defined by how we respond to these challenges.  A "crisis" occurs when we become overwhelmed by these truths and can no longer cope.

The four "human givens" we must all face are:

1. Death: The curse of human consciousness is an awareness of our eventual death.  We must live while knowing we will die, yet not despair.  We must love others with the knowledge that we will ultimately lose them.  Even long life is a mixed blessing, as we gradually lose everyone who matters most. 

Most of us use denial to cope with the inevitability of death.  We refuse to think about it.  We focus instead on staying healthy and living longer.  As a society, we relegate death to certain places (e.g., hospitals), where we don't have to see it.  Denial becomes less effective as we get older.  At some point, we are forced to confront death, either our own or someone else's. 

2. Meaning:  Most of us are not content to simply exist; we need a purpose in life.  "Why are we here?"  We must each answer this question for ourselves.  Your purpose might be different than mine.  We can choose to spend ourlives however we see fit.  Those who thrive devote their time to things they find meaningful.  They feel fulfilled.  Those who lack purpose find their lives meaningless.  They tend to feel empty and lost.

3. Freedom: We each have the freedom of choice.  We are free to make decisions about our lives and to determine our own paths.  With freedom, however, comes responsibility.  We are responsible for whatever choices we make.  We cannot blame others when we are unhappy.  If we want things to change then we have to change.  Freedom can sometimes feel overwhelming.  It can be tempting to ask others to make decisions for us and to hold them responsible for the outcomes.  This too is a choice - a choice to hand over freedom and to allow others to control our destiny.

4. Isolation: We come into this world alone and that is how we leave it: alone.  We can never completely share an experience with someone else; it is impossible for one person to know exactly how another feels.  And yet, humans are innately social creatures.  We long to connect with others.  Every connection comes with the risk of being abandoned (which is inevitable - see number one).  We are alone and yet we fear being alone.  So we do things that make us feel less alone. 

These four truths really do capture the essence of what it means to be human. 

Wednesday, May 7, 2014

Tips for Dealing with Chronic Complainers

Whiners, gripers, chronic complainers - we try to avoid them lest we get stuck listening to their latest litany of problems.  Unfortunately, we don't always see them coming fast enough to get away.  Or circumstances require that we interact with them for extended periods of time.  Whatever the reason, sometimes we are forced to deal with people like this, no matter how unpleasant we may find their company.

So how do we avoid getting sucked in by their negativity?  How do we keep their antagonistic attitude from bringing us down?  Here are some suggestions:

1. Smile and nod.  This is a tip I picked up during a training I attended a few years back.  The key here is to remain silent.  When a person starts ranting about what's wrong with the world, anything you say in response just adds fuel to the fire.  If you listen quietly without feeding the flames the complainer eventually runs out of steam. 

2. Model better behavior.  In her book "Managing Difficult People," Marilyn Pincus recommends finding three positive things to say during every conversation you have with a complainer.  Not only are you setting an example, accentuating the positive can protect you from becoming infected by the complainer's negative outlook. 

3. Make a pre-emptive strike.  Start a conversation before the complainer has a chance to say anything.  Pick a topic - preferably something neutral -  and start talking.  That way, you get to decide what to talk about.  Just be sure to steer the conversation away from whatever might be bothering the complainer today.

4. Agree and move on.  Agree with the complaint.  "Yeah, that does suck."  Then change the subject.

5. Set firm limits.  Set a limit on how long you're willing to listen.  Give the complainer a few minutes to vent.  Then say something like, "I don't mean to cut you off but I've got a lot of work to do." 

6. Put the ball in their court.  In "Complaining, Teasing, and Other Annoying Behaviors," Robin Kowalski recommends holding complainers accountable for finding their own solutions.  Say something like, "Wow, that does sound tough.  What are you going to do about it?"

7. Remain emotionally detached.  When we are repeatedly exposed to another's complaints we may begin to consider the ways in which our own lives are lacking.  Or we may become frustrated when our attempts to help a chronic complainer ultimately prove futile.  Try to avoid becoming emotionally invested in the chronic complainer's problems.  Remember, they are not your problems; do not take responsibility for them.

Wednesday, April 30, 2014

Complaining and Complainers

All of us have probably met at least one chronic complainer. You know the type. He always has something negative to say. He's never satisfied. He's quick to find something he doesn't like in any given situation. He's not very pleasant to be around; he casts a dark cloud wherever he goes. Even the most compassionate of us has a point at which listening to the woes of others becomes emotionally depleting.  Being around the chronic complainer is draining; he leaves us feeling exhausted.  For this reason, we try to avoid him whenever possible. 

Or maybe you've known someone who seems to complain about the same thing over and over again. She never does anything to change or improve the situation in question.  She is quick to reject suggestions or advice.  She seems completely uninterested in solving the problem yet she constantly complains about how unhappy it makes her. You eventually get sick of hearing about it.  Her negativity and hopelessness are contagious.  You become frustrated when your attempts to help are repeatedly rejected.  Talking to her makes you feel bad.  Understandably, you start avoiding her calls.

This kind of complaining has negative social consequences. Nobody wants to be around someone who complains all the time.

And yet complaining is pervasive, despite the negative social consequences. It stands to reason, then, that we must derive some benefit from it. Why else would we be willing to risk social ostracization?

As it turns out, there are actually a lot of good reasons to complain. On the most basic level, complaining allows us to express frustration and to receive validation from a sympathetic other. It enables us to discharge negative emotions, to "vent," or to "blow off steam." It has a cathartic effect. We feel better after complaining. In fact, research suggests that people who rarely complain have higher levels of depression than people who complain regularly.

Complaining also helps to avoid the consequences associated with holding emotions in. We need an outlet for our negative emotions. We have to have some way to express them. They don't simply go away if we choose not to deal with them. Feelings like frustration, anger, and resentment tend to fester. We ruminate on the object of our frustration, which only makes us angrier. These feelings eventually boil over and we lash out at whoever happens to be nearby.

Complaining is essential to maintaining healthy relationships. It is the means by which each person in the relationship expresses dissatisfaction or brings to light existing problems. Once problems are identified they can be addressed and ultimately resolved. This prevents the build up of resentment and other emotions known to be toxic to relationships.
So while complaining is beneficial and even healthy, in excess it becomes caustic.  The problem is that most people who cross the threshold from healthy to excessive complaining are not aware of having done so.  We rarely tell someone we are put off by his or her constant complaining; instead, we start trying to avoid him.  I suppose one day the chronic complainer wakes up to find himself isolated and alone with no idea why.  Ironically, this gives him something else to complain about...if he can find someone to listen.

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