Gratitude

What does it mean to be grateful? Here are some thoughts:

*Gratitude means being thankful for what you have.
*Being grateful means not longing for more than what you have.
*To be grateful means not coveting what others have.
*Gratitude means saying thank you even for difficult experiences, as they generally have something to teach us.
*A grateful person is one who does not complain all of the time.
*Living a life of gratitude requires taking time on a regular basis to think about (or to write down) what you  have to be thankful for in your life.
*Practicing gratitude means recognizing that the good things in life are gifts that are bestowed upon you (rather than things that you earn or deserve). 
*A grateful person feels thankful for any opportunity to help others or to make the world a better place.
*To be grateful you must first let go of any and all sense of entitlement.
*Being grateful means not taking anything for granted.
*A grateful person is one who outwardly expresses his gratitude to others.
*Practicing gratitude means paying attention to all the "small" things we receive from others on a daily basis, such as service at the grocery store or post office, cooperation from coworkers, etc.

Just some things to think about...

Feelings as Habits

So I made it through the wedding and I actually really enjoyed myself.  When all the hubub died down I was emotionally drained.  During the days following the wedding I wavered between feeling exhausted, happy, anxious, and at peace.  When I first noticed myself feeling anxious I was confused.  Why would I be anxious?  After all, most of the excitement had died down and things were starting to go back to "normal" (whatever that means).  I did a brief inventory of what was going on in my life and ultimately determined that I had addressed everything that needed to be addressed and that there was not really anything in particular that I needed to worry about.  I immediately felt better after making this determination.  Still, several hours later I noticed myself feeling anxious again.  I did another mental assessment, determined that all was well, and again felt better.  I repeated this procedure several times a day.  After a few days it occurred to me that I'd been feeling so anxious for such an extended period of time (maybe starting two or three weeks before the wedding) that feeling anxious had become a habit of sorts.  My mind was simply resorting to the state to which it had become accustomed.  It took another week of reminding myself that I had nothing to be anxious about before my mind started to catch on.   

The fact that emotional states can become habitual is significant because I think that people often maintain a negative emotional state for no other reason than the fact that they've become used to feeling that way.  Research supports this observation.  Many studies have shown that, for example, feeling and expressing anger breed more feelings of anger.  Feelings of depression often lead to negative thoughts that create more feelings of depression that lead to more negative thoughts.  Any given emotional state is self-perpetuating,  In other words, feeling any given way becomes a habit.  When happiness breeds more happiness there typically aren't any problems.  When the self-perpetuating emotions are negative, however, they can be very disruptive.

I want to stress the importance of paying attention to your feelings.  Sometimes people interpret feelings of anxiety as a sign that something is wrong and they begin looking for things in their lives to worry about.  And of course if we look hard enough we can all find something in our lives to worry about.  The reality is that feeling anxious does not necessarily mean that there is, in fact, something to be anxious about.  That is why it is helpful to ask yourself, "Is there anything in my life right now that seems to be causing my anxiety?"  If the answer is no then recognize that there is no external cause for your anxiety and that it is most likely coming from some biochemical process taking place in your brain.  This gives you permission to stop looking for things to worry about...which is always a huge relief.

When Good Things Happen

I once did this self-help exercise that asked me to list the happiest, most exciting moments in my life.  That wasn't too hard to do.  Graduation from high school and then college were natural first picks.  I quickly made a list detailing my life's defining moments.  The second part of the exercise asked the following: "Which part or parts of you were present for each of these events?"  I put some thought into it and wrote down my answers.  As I looked over my responses I noticed something surprising; "Anxious Melody" was the only "part" of me that was present at every single event. 

So what does that say about me?  Well, it's pretty clear that whenever something big happens, whether good or bad, I feel anxious.  I'd say that this is probably true for change as well (i.e., whenever there is a big change in my life, whether good or bad, I feel anxious).  I don't think I'm unusual in this aspect.  Many people experience anxiety during periods of change and/or uncertainty.  What I think is sort of sad, however, is that anxiety is the predominant emotion I experience when good things happen in my life.  If you recall, the exercise I mentioned earlier asked me to identify the happiest, most exciting moments of my life.  One would logically assume that a person would feel happy and excited during these times.  But not me - oh no.  Me, I just feel anxious.

So what should I do about it?  Well, I've simply accepted it.  Some would say that it is simply not acceptable to feel anxious in situations where most people feel happy.  Some would say that it's a problem that needs to be treated.  I was first diagnosed with an anxiety disorder when I was five years old.  I've been developing ways to adapt to and cope with it for most of my life.  I've received treatment and have been taking medication to manage my symptoms for over ten years.  Most of the time I don't feel anxious.  This is an improvement for me and I am grateful for it.  And still, when big things happen in my life I feel anxious.  I probably always will.  I just try to cope with it in healthy ways and find hope in knowing that I'll get through the transition and the anxiety will eventually fade. 

I share this story for a few reasons.  For one, I think it is important to work to address and solve problems whenever possible.  When you've done all you can do, however, it is important to know when to stop fighting against what is and to simply accept it.  Secondly, I think anyone who has ever struggled with anxiety will probably be able to identify with some of what I've said.  And lastly, it's relevant to me at this particular point in time in my life.  I'm getting married on Saturday and my anxiety has been off the charts this past week.  So wish me luck...

America the Superpower

I don't talk about politics very often on this blog because I know it can be a polarizing subject and my aim is to bring people together, not to divide them.  However, given the recent midterm elections and the ever growing hostility between the two political parties I thought I should take a minute to reflect on the current political situation. 

The focus of the midterm campaigns was on the nation's financial situation, to include the economy.  This makes sense, given that so many people are unemployed (or underemployed).  People are worried about the national deficit.  They believe that our government is spending too much money and digging a financial hole that we'll never be able to get out of.  I'm not going to pretend to know the actual ramifications of an expanding deficit.  I'm assuming that at some point the taxpayers will be forced to pay for it.  I don't think anyone would argue that we should just continue spending and increasing our national debt without worrying about it.  The conflict arises over how to go about decreasing the deficit.

Now I'm no economist, but I have done a little reading on the subject.  From what I understand, there are two basic ways to decrease the national deficit: raise taxes (so the government takes in more money) or reduce spending (so the government spends less money).  Raising taxes is not popular.  No one wants to see more money coming out of their paychecks.  What about reducing spending?  Well, here's the thing.  A significant majority of government spending (and I mean a SIGNIFICANT majority) goes to pay for the following: Medicare, Medicaid, SSI, public assistance programs, and defense.  What politician wants to risk their career by proposing cuts to disabled people, uninsured children, or the military? 

So you can see the problem.  If we are to decrease the deficit in any significant way we have a choice between two unpleasant options.  Either raise taxes or cut government programs for some of our neediest citizens.  Or...reduce defense spending.

I work for the military and I support our service members 100%.  But here's something to think about.  What are our nation's priorities?  People say they want to decrease the deficit but they are not willing to give anything up in order to do it.  America is the only remaining world "superpower."  We need a big military so we can send troops all over the world to defend our way of life.  Or so goes popular sentiment.  I wonder though, can America really afford to be a superpower anymore?  I'm not saying we should cut our military down to nothing, but perhaps we could just mind our own business and let the world deal with itself.  That's not to say we shouldn't get involved in conflicts that threaten the safety of our country, but do we really need troops everywhere that we have them?  We have military bases all over the world in places where there isn't any conflict at all and hasn't been for decades.  Meanwhile, here at home, the economy goes down the tubes and we bicker about how to decrease the deficit.

It seems to me like our country has some hard choices to make.  The fact of the matter is, taxes are going to have to be raised, either now or later.  AND spending is going to have to be cut from places we don't want to cut it.  So what we really need to do as a nation is examine our priorities.  What is most important to us?  Where do we need to spend the most money?  Where can we spend less money?  It's just something to think about...

Self Destructive?

I recently read a short story by Stephen King called "Quitters Inc."  The story starts when the main character runs into an old friend at the airport.  The friend looks younger and fitter than ever and says he's making a lot of money working for some big corporation.  He tells the main character that his life turned around when he quit smoking.  When asked how he managed to quit he hands the guy a business card for Quitters Inc. and promises him, "They'll cure you."  The main character asks about the program used at Quitters Inc. to help people quit.  His old buddy refuses to say, stating that the contract he signed with Quitters Inc. has sworn him to secrecy.  The main character persists but his buddy won't budge. 

The next day the main character stops by Quitters Inc. after work.  The staff refuse to tell him about the treatment program but inform  him that he won't be charged a penny until he's been smoke free for a year.  The guy comes back the next day to begin treatment.  He shakes hands with the doctor and follows him down the hall.  "When does the treatment start?" he asks.  He is told that it already started - the moment he shook hands with the doctor.  It is too late to change his mind now.

Finally the doctor tells him about the treatment.  Our protagonist follows the doctor to a set of green curtains, which the doctor parts to reveal a window that looks into a room with a small bunny nibbling at rabbit pellets from a dish.  The doctor presses a button and the bunny begins to hop around.  His fur is standing out in all directions.  The doctor pushes the button again.  The bunny stops hopping and runs to the corner where he cowers fretfully.  The doctor proudly explains that if the bunny is "jolted" enough times while he's eating he will eventually learn that eating = pain.  He will then stop eating and ultimately starve to death while a bowl of food sits ten feet away.  "It's called aversion training," he explains.

The protagonist quickly changes his mind about the treatment and tries to leave, but it's too late.  Treatment has already started.  He is told that representatives from Quitters Inc. will be watching him daily.  If he smokes a cigarette, his wife will be brought to the "bunny room" and given a few jolts while he watches.  If he slips up again, he'll get a "jolt" himself.  A third slip up and he and his wife will be brought to the "bunny room" together.  A fourth time and his young, mentally disabled son gets a beating.  A fifth time and it's "jolts" for him and his wife and beatings for his wife and son.  The punishments get progressively worse until the tenth slip up, at which point the treatment (and the patient) will be terminated.

The main character lives in fear for a while but manages to avoid smoking.  Soon, his life begins to improve.  He starts spending more time with his son.  He gets a promotion at work.  He starts exercising and losing weight.

One day, while angrily sitting in traffic, he gives in to temptation and takes a few puffs from a cigarette.  When he arrives home he finds that his wife is not there.  Eventually, he heads to Quitters Inc. where he is forced to watch his wife endure a few jolts in the "bunny room."  Afterward, he has to explain to his wife what is going on.  He expects her to be angry and is surprised when she tells him that she's actually happy.  She tells him that Quitters Inc. is saving his life.

Anyway, the protagonist does not relapse again and goes on to lead a happy and successful life.

This story made me think.  It dawned on me that it does often come down to forcing a person to make changes that he or she knows are good for him.  A person might halfheartedly try to quit smoking only to give up a day or two later.  A person might say, "I know I need to start exercising" but never get around to it.  Someone might recognize that she is drinking too much but tell herself that she's young and she'll slow down when she gets older.  It often takes something big - a heart attack, the death of a loved one, a DUI - to get a person to actually make the changes that need to be made.  Why is this?  Why is it that people so often seem content to continue down a path of self-destructive behavior, even when they know it is not good for them or when they can clearly see that it is having negative consequences?  In the story, the character mentions that he's tried to quit smoking many times but has never made it longer than a few days before giving up.  Yet when he is placed under duress he is able to withstand temptation and only has one brief moment of weakness.  Why don't we have the motivation to make these changes on our own, without pressure?  Why would we rather do what's bad for us than what's good for us?  These are just some questions I started pondering after reading "Quitters Inc."  I don't have the answers, but would love to hear any insight other might have.   

Stop thinking!

American culture values rational thought.  We tend to admire those who are level-headed, who make logical, well thought-out decisions.  In fact, most of us would say that the "right" way to make decisions is by conducting a rational analysis of the risks and benefits of all available options.  "Good" decision making is an intellectual process.

Now I'll be the first to admit that it is typically less than ideal to make choices based entirely upon one's feelings.  In fact, emotions frequently interfere with judgment, rendering one incapable of making good decisions.

My personal belief is that decisions are best made using a combination of both thought and feeling.  This is what Marsha Lenehan, creator of Dialectical Behavior Therapy, calls the "wise mind."  The wise mind is the place where your rational mind and your feeling mind join in agreement.

So there are clearly times when it is beneficial to set your feelings aside in the name of good decision making.  I also believe, however, that there comes a time when it is best to set rational thought aside.  Consider this: most of us probably know or have known someone who we believe "thinks too much."  In my work I have encountered many patients who tell me they over-think things or that they can't turn their minds off when they want to relax.  Perhaps you can recall a time when you completely over-analyzed a problem or situation and ended up distressed or confused.   Clearly, it is possible to over-think things.  This can cause us to second guess ourselves, to look for meaning where none exists, or to become so overwhelmed by the sheer number of possible options that we become paralyzed and unable to take action.

I make this point as a reminder to myself.  I am one of those people who tends to think too much.  This inevitably leads me to question myself, my life, and the decisions I've made, which ultimately creates anxiety and self-doubt.  Of course, sometimes it is beneficial to examine yourself and your life, to identify where you can improve, to change direction, or to set new goals for yourself.  This is not, however, something that needs to be done daily.  Thinking too much about what I've chosen to do with my life just leads to insecurity and restlessness.  It prevents me from being satisfied with who I am and what I've accomplished.  There comes a time when it is best to just stop thinking - and enjoy living.

Coming and Going

From time to time I've had patients tell me that everyone who comes into their lives eventually leaves them.  Upon discussion, they are usually able to identify at least one person  who has consistently been there for them (thereby acknowledging that not everyone leaves them).  Still, they feel abandoned and unlovable. 

I've given this some thought and have reached the conclusion that it is the rule - and not the exception - for most people who come into our lives to eventually leave.  Sometimes there are reasons - someone moves away or you have an argument - and sometimes there really isn't any reason.  You simply "lose touch" with one another. 

I was thinking the other day about the various friendships I've had over the years.  The friends I had as a young child were no longer my friends by the end of  middle school.  I had two close friends as an adolescent who were like sisters to me.  We had a falling out during my junior year of high school and stopped speaking to each other after that.  I became close to a high school friend during college.  We were inseparable for years until she got hooked on drugs.  I eventually had to stop talking to her because I couldn't be a part of how she was living her life (and I couldn't stand watching her destroy herself).  After college I had two really close friends that I spent almost all my time with.  Nothing "happened" that ended the friendships; we just gradually drifted apart and went our separate ways.

And then there are the old boyfriends - the men who, at the time, I couldn't imagine living my life without. 

The fact is this: people come and people go.  Some really special people remain with us throughout our lives -- for me that's been my family.  Still, far more people have entered and left than have stayed.  And that's ok.  I think that's how it's supposed to be.  We cross paths with certain others, learn from one another, and then continue on our journeys.  And sometimes, the impact of those meetings linger long after you've both continued along your separate roads.

Normal?

Normalization is a simple yet powerful therapeutic technique that is often very effective in alleviating some of a patient's distress.  To normalize essentially means to let a person know that there are others who are going through what he is experiencing.  He is not alone and he is not, in fact, crazy (as he may have feared).  Even outside of therapy normalization relieves anxiety.  You tell a close friend about a problem you're having with your significant other only to find out that she has had the same problem with her significant other.  You immediately feel better.  You're not alone; what you're going through is "normal." 

Many people strive for normality.  People afflicted by a chronic illness long to be "normal."  Members of families with a lot of conflict wish they had a "normal" family.  Adolescents who don't quite fit in with their peers want only to be a "normal" teenager.  If you think for a moment you can probably recall a time when you bemoaned your own circumstances and wished for a "normal" life.

What is normal anyway?  Does it mean being just like everyone else?  (And doesn't that assume that everyone is alike)?  I personally believe that normality is an illusion.  We tend to think that because we have problems we aren't normal.  And yet, the people we think are normal have their own problems; we just aren't aware of them. 

I recently started reading a book by Paulo Coelho.  He is a gifted writer.  Time and time again he has created compelling stories with deeply existential themes.  Each time I finish reading one of his novels I am left contemplating the meaning of life for weeks.  One of the characters in Coelho's "The Winner Stands Alone" asks, "What does normal mean?"  Of the character Coelho writes, "He always asked the people he chanced to meet what 'normal life' was like, because he had forgotten."  He started keeping a list "of what constituted normal attitudes and behavior, based on what people did rather than what they said."  The list portrays a quite cynical view of humankind, but I thought I'd share a few of the entries on the character's list (with my commentary, at times):

*Normal is anything that makes us forget who we are and what we want.

*Spending years studying at university only to find at the end of it all that you're unemployable.  [How many high school graduates pursue a subject that arouses their passion only to find there are no jobs in this field?  They get a degree only to find that it's essentially useless.  They find something more practical to do but are forced to abandon their passion].

*Retiring and discovering that you no longer have enough energy to enjoy life and dying a few years later of sheer boredom.   [Is it lack of energy?  Or is it that for years we have so few interests outside of work that we don't know how to define ourselves once we stop working?]

*Making fun of anyone who seeks happiness rather than money and accusing them of "lacking ambition."

*Criticizing anyone who tries to be different. [It is human nature to fear the unknown].

*Investing a lot of time and money in external beauty and caring little about inner beauty.

*Never laughing too loudly in a restaurant however good the joke.

*Postponing doing the really interesting things in life for later, when you won't have the energy.  [I admit that I'm guilty of this one.  I usually put off things I'd like to do -- especially traveling -- until I "have more money."]

The list is much longer.  If you have a chance to read the book I strongly encourage you to do it.  In fact, if you have the chance to read anything by Paulo Coelho I strongly encourage you to do it!

Well, I've gone on enough.  Until next time...



















 

Another mindfulness handout - mindfulness of thoughts

I made a bunch of these handouts a while back.  I posted a few a long time ago and wanted to post another.

Forgiveness

I recently attended a training with several of my coworkers. I thought the speaker (Robert Grant, Ph.D.) was unique and really enjoyed hearing what he had to say.  I was surprised to learn that not all of my colleagues felt this way.  In fact, some of them were deeply disturbed by the speaker's message.  I heard that one woman in particular was so upset that she didn't want to return for the second day of training.  I honestly don't know what upset them so much -- I heard all this "through the grapevine" and didn't feel comfortable asking them.  I do, however, have a guess...

One of the topics the speaker addressed was how to forgive someone who has done something very bad to you.  He stressed that this is not always desirable or appropriate but indicated that some patients will want to forgive their perpetrators and we should be prepared to help them (when our clinical judgment says this is a good idea, of course).

The speaker explained that when we are de-humanized by a person we in turn tend to de-humanize that person in our minds.  The person who violated us is a monster, something other than human.  When embarking upon the path to forgiveness (forgiveness is a process, not a single event) the goal is for the "victim" to learn to see the perpetrator as human.  In order to do that a person has to acknowledge that he (and, in fact, all humans) is capable of the same type of behavior in which his perpetrator engaged.  Perhaps if his lot in life had been different - if he'd had different genetic vulnerabilities or the "right" combination of traumatic experiences - perhaps he could have turned out like the perpetrator.  A person might surmise that in order for his offender to have done such horrible things he must have experienced a lot of pain, suffering, and maltreatment in his own life.  This does not in any way condone the perpetrator's actions - it just enables one to see him as human.

This might not seem to be all that controversial of a concept.  What happened, however, is that the speaker gave some examples.  He attempted to empathize with (and to thereby humanize) a hypothetical sex offender.  The murmurs of protest from the crowd were immediate.  The speaker reiterated that he was not condoning the behavior of sex offenders and was not saying that a sex offender should not be punished.  Still, the crowd was displeased.

Personally, I thought this was a demonstration of how difficult it is to forgive someone who has done terrible things.  If a room full of chaplains, psychiatrists, and psychiatric social workers are resistant to empathizing with a hypothetical sex offender then forgiveness must be a difficult thing indeed.  This experience made me realize that we should never take forgiveness for granted for, when offered, it is truly a blessing.