Sunday, November 25, 2012

Seasonality: Energy and Mood in the Winter

As the days grow progressively shorter, my body and mind protest.  I never really have enough energy, but it seems to be in particularly short supply during the winter months.  And when the world around me begins to buzz in cheerful anticipation of the holiday season, I prefer to stay at home.  I used to revel in the spirit of Christmas.  Then, my grandmother died in 2003, just a week after Christmas.  For me -- and for much of my family -- my grandmother was Christmas.  She led the family festivities every year.  It was her holdiay.  Now, I miss her terribly and grieve her most during the Christmas season.  When I feel her absence so acutely I begin to wonder if I'll see her again someday, when my life is over.  Then I start thinking about death.  This leads me down a path of rather morbid thoughts; I end up feeling depressed.

Of course, I'm not the only one who struggles with mood and energy during the winter.  Studies suggest that approximately 10% of American adults experience negative changes in their mood and energy during the winter months that are significant enough to interfere with daily functioning. 

When a person has a history of feeling tired and depressed every winter, he eventually comes to expect it.  He may begin to anticipate the onset of depression and fatigue at the end of summer, long before any symptoms are present.  He begins to monitor his mood and energy level more closely, vigilantly looking for even very slight changes to either.  His hyper-vigilance makes him more sensitive to fluctuations in mood or energy, causing him to notice changes that others probably would not.  (Perhaps he notices changes that even he would not notice if they took place in the spring or summer).  Thus, if he wakes up one November morning feeling a bit down, he might see it as a sign of worse things to come.  "Well, here it is again," he might say to himself.  "Now I'll be depressed until spring comes around."  It becomes a self fulfilling prophecy. 

This is just part of the story; there are a number of factors that cause a person to feel depressed when the seasons change.  Still, one's thoughts and beliefs can contribute signficantly to the maintenance of such problems.  This has been the subject of growing interest to mental health professionals in recent years.  Reading some of the literature helped me to identify some of my own unhelpful beliefs about mood and energy during winter.  I thought I'd share some of the more common unhelpful beliefs (taken from the "Seasonal Beliefs Questionnaire"):

"I am worried about how bad I will feel this winter."
"I am dreading the next few months."
"No one else feels this way every year."
"I'm going to be depressed until spring."
"I need sunshine to feel happy."
"Dark, gloomy days are depressing."
"The weather should not affect me."

Even if your mood and energy have tended to change with the seasons in the past, it doesn't have to be a self-fulfilling prophecy.

Sunday, November 18, 2012

Awareness of Attitude

My supervisor knocked on my door one morning last week.  She peered into my office and asked if I had a few minutes to talk.  I braced myself for bad news.  It's rarely a good thing when your boss comes to your office for a private chat.  My intuition was right.  There was a problem and my supervisor wanted to discuss it.

"I've noticed at our last few meetings [weekly department meetings] that you've been extremely negative," she said.  Fortunately, I seem to have more control over my "automatic" reactions when I'm at work than I do in my personal life.  If, for example, it had been my husband complaining about my negative attitude I probably would have immediately become defensive.  My initial inclination when my supervisor confronted me was, in fact, to become defensive.  Thankfully, I bit my tongue long enough to think before I spoke. 

"Ok," I replied after a moment in what I hoped was a neutral tone of voice.

"I just wanted you to be aware," my supervisor explained.

"Ok," I repeated.  I proceeded to change the subject as quickly as possible.  My supervisor didn't seem to mind.  Maybe this whole thing was as uncomfortable for her as it was for me. 

Afterwards, I thought back to our last few staff meetings, trying to remember if I'd said or done anything "negative."  I was unable to recall anything specific one way or another.  Ultimately, I decided this was irrelevant anyway.  It didn't matter whether I thought I'd been negative.  Apparently, my supervisor noticed some sort of change in my attitude or she wouldn't have said anything to me.  I concluded that something about my attitude must have shifted without me being aware of it.

I did some soul searching.  The truth is, I was aware of a shift in my attitude.  Work has seemed so heavy lately.  I've been looking forward to long weekends and short weeks with more vigor than usual.  The weeks seem too long and the weekends too short; I return to work on Mondays feeling weary and unrefreshed. 

This happens to me sometimes, typically when I'm under a lot of stress and feeling overwhelmed.  I try not to take it out on others, but apparently it comes out inadvertently.

So have I been negative lately?  Probably.  I'm an expressive person by nature and it's difficult for me to conceal my emotions.  I suppose I need to try harder.

I suspect that what I really need is a vacation.  My work takes a lot out of me.  Sometimes, I need a week or two off to refuel.  I try to take at least a week off every six months; perhaps I need to do it more frequently...

Sunday, November 11, 2012

Suicide and Psychache

I distinctly remember attending a memorial service for the brother of a close friend when I was in college.  My friend's brother hung himself from a tree in his front yard; his stepdaughter discovered him when she went out to catch the school bus the next morning.  Funerals are never happy occasions, but this one struck me as particularly heartwrenching.  It seemed like the deceased's parents felt they needed to defend his character.  "He really was a good boy," I recall his father saying.  I was present on several occasions when members of the decedant's family recalled his last days.  They analyzed every conversation and every interaction, wondering if there'd been some sign of their loved one's intentions.  They second guessed everything they'd said and done in the days leading up to the suicide.  "If only I'd done this instead of that," some lamented.  Others blamed themselves.  "I should've known.  I should've stopped him."

Suicide is a tragedy in so many ways, both for those who commit the act and for those left behind.  Ending one's own life seems to go against the most basic of human drives: the will to live.  There are countless examples throughout the course of human history of men and women fighting to live.  Human societies value life and we believe in the inalienable right of each individual to protect the lives of himself and of those he loves.  With the drive to live so fundamental to our very nature, what could possibly provoke someone to take his own life?

This question comes up quite frequently among mental health professionals, as our patients have a higher risk of suicide than many other populations.  If we can understand why people kill themselves, we can use this information to  identify warning signs and intervene before anything happens.  The goal is suicide prevention.

To this end, there have been a number of studies undertaken and countless theories proposed.  One of the most influential ideas about suicide was presented by Shneidman in 1993.  According to Shneidman, people who contemplate suicide all have at least one thing in common: unbearable mental pain, or "psychache."  The desire of those who contemplate suicide is not necessarily physical death, Shneidman asserts.  Actively suicidal people want only to end their suffering; they believe that nothing short of suicide can accomplish this.  The idea is that people only contemplate suicide when their pain becomes unbearable, when suffering becomes a constant presence, and when there is no relief from their pain; they feel trapped. 

So how do you help someone who has reached this level of despair? 

First, we must listen.  We must try to understand the person's pain from his perspective.  What is it the person needs but is not getting?  What are his goals in life and why does he believe they are no longer attainable?  To the person thinking about killing himself, suicide is logical; it makes sense.  We must seek to understand why it makes sense to him.  We need the whole story and only one person has it.

Fortunately, listening does not require any special training; anyone can do it. This means we are all in a position to help someone who feels helpless.  Of course, a person who is suicidal should get professional help.  Still, that doesn't mean we can't all do our part.

Sunday, November 4, 2012

Chronic boredom

Boredom is a state of disengagement from your environment and/or whatever activity you happen to be doing.  Boredom involves desire in that a person who is bored wants to do something that will fully engage his attention.  Unfortunately, the state of boredom renders him unable to identify a sufficiently satisfying activity that will alleviate his condition. 

We all experience boredom from time to time.  For most of us, it is a transient condition that passes the moment we find something that absorbs our attention.  There are some, however, for whom boredom is more pervasive.  For whatever reason, these people are consistently unable to find activities that hold their attention.  For this reason, many are regular thrill seekers; they spend a considerable amount of time searching for something exciting to relieve their inner monotony.  Of course, excitement provides only temporary relief.  No matter what they do, the boredom always returns.  Thus, they find themselves caught up in a never ending quest for the next thrill.

What causes this condition and what can be done about it?  Bernstein attributes chronic boredom to loss of the ability to feel.  This occurs, he argues, as a result of early childhood experiences.  Specifically, chronic boredom occurs when a child is forced to hold his emotions in before he has developed socially acceptable outlest for discharing the tension these emotions arouse.  With no means to express his emotions, he simply learns to repress them.  A chaotic, over-stimulating environment will mask his absence of emotion.  However, when faced with a less stimulating environment later in life, he begins to notice his lack of emotion.  He feels under-stimulated, a condition that manifests itself as boredom. 

Kohut likewise attributes chronic boredom to childhood experiences.  He ascribes chronic boredom to the consistent failure of parents to be responsive to and to provide stimulation to their child.  Consequently, the child comes to crave stimulation and to seek it out in any form. 

Many believe that boredom masks an underlying sense of emptiness.  According to existential theorists, this emptiness is caused by lacking a purpose or meaning in one's life.  (This may or may not be due to childhood experiences).  Without a clear purpose, everything seems pointless.  If there is no purpose to a particular activity, why do it?  For one with no purpose in life, all activities are meaningless. 

So what can be done to help the chronically bored?  I will suggest a few techniques, but these are by no means exhaustive.

In researching ways to alleviate chronic boredom, I discovered that boredom is more prevalent among people with an external (versus internal) orientation.  To be externally oriented is to be habitually focused on the external environment.  When an externally oriented person feels bored he attributes it to an under-stimulating environment.  Because he sees the external environment as causing his boredom, he looks to the external environment to relieve it.  Unfortunately, this strategy is almost always ineffective, at least for the chronically bored. 

The conclusion I draw from this information is as follows: if the external environment doesn't hold the answer, perhaps it would help to turn one's attention inward instead.  What would happen if sufferers of chronic boredom adopted a curious stance towards their condition?  What if they attended to the physical sensations that accompany their boredom and observed how they change over time?  I suspect they might begin to see through (or perhaps beneath) the boredom.  If nothing else, they'd learn to tolerate the emotion and to simply be with themselves.  This alone would go a long way towards quieting their eternal restlessness.

De Chenne suggests that chronically bored people lack knowledge of their emotional and psychological needs.  Consequently, he suggests helping the chronically bored to clarify their needs and interests.  Once they determine what they need, they are better able to seek out activities that will satisfy and  fulfill these needs.

Now for my final suggestion.  If everything seems meaningless (and therefore boring), it seems logical that creating, discovering, identifying, or clarifying one's purpose in life would be beneficial.  This is admittedly a large task and it might seem too daunting for some.  If this is the case, start by simply taking the focus off of self and doing something kind or helpful for someone else. 

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