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. 

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