Happy New Year, from your friendly health insurance provider

Thirteen days into the new year and already I've spent a disproportional amount of 2013 figuring out how to appeal my insurance provider's decision to deny coverage for the medication I've been taking for the past nine years.  I received a letter notifying me of their decision last week.  My stomach has been in knots ever since and I've been plagued by incessant dread.and a sense of impending doom. 

This is not just me being melodramatic.  There is a lot at stake here and the potential consequences for me are huge.  The medication will end up costing me about $325 a month if I can't convince the insurance to continue paying for it.  Yet not taking the medication isn't an option either, unless my doctor can come up with something that works just as well.  I don't hold out a lot of hope for that though; we tried probably five different medications before trying the medication I take now.  None of the other ones worked.  

So I find myself in a situation that seems hopeless to me.  It appears that the only way to prevent a significant setback in my life - probably a financial one, since not taking medication would pose a serious risk to my health - is to convince the insurance company to pay for my medication.  I am, of course, going to focus all of my energy on building a persuasive argument.  My interactions thus far with the insurance company, however, have not been encouraging.  I spent the whole of last week trying to get information from them.  They say I should receive something in the mail, but I've yet to get anything.

Even my doctor seems to have abandoned me.  I called her office last Monday morning...and Tuesday and Wednesday and twice on Thursday...and nobody ever called me back, not even when I said it was urgent.  On Friday, I went to the office in person to find out what was going on.  There, the staff members at the front desk were extremely rude.  I was told that my doctor can't help me and that it's my responsibility to deal with the insurance company...As a [mental] health professional myself, I know that the doctor does, in fact, have if not a legal then an ethical obligation to help me with this situation.  The insurance company wants to know why the doctor considers my medication to be "medically necessary."  Obviously, the doctor is the best person to explain this.

I left my doctor's office on Friday feeling depressed and defeated.  I took the weekend off from worrying, but I'll be back at it again tomorrow.  I've scheduled an appointment with my doctor; it will no longer be possible for her to ignore me.  I had hoped she would be an advocate for me; I feel like I could really use one right about now.

The things that helped me most

About a year ago, my little sister was going through a difficult period in her life.  My heart ached for her, both because I hated to see her hurting and because I knew how she felt; I went through a very similar period in my own life several years ago.  I did all the normal things that sisters do in times like these - mostly just being there to talk and to listen - but I felt there should be something more I could do to help.  Ultimately, I decided the best way to help was to share with my sister what helped me in my own struggle.  To this end, I wrote her a letter.

I realize that just because something helped me doesn't mean it will help someone else.  But it might.  I'm not going to share the more personal tidbits of the letter I gave my sister, but I do want to share the strategies that helped me get through some pretty dark times.  So here goes:

A visual journal: I poured my heart and soul into visual journaling for about a year.  The art itself was at times mediocre; at times it was quite shitty.  The process of creating the art…it was amazing.  It was like I was literally pouring my emotions out.  They made so much more sense when I could see them on the outside (and not just inside of me, where they usually hang out).  I found a good article that explains the whole process.  Check it out:

http://www.psychologytoday.com/blog/the-healing-arts/201006/cool-art-therapy-intervention-4-visual-journaling

Looking for patterns:  People tend to act out their unresolved psychological or emotional conflicts.  Look for patterns.  Look back over your life and identify any behavior or set of behaviors that have repeated themselves over and over again.  For me, this was repeatedly falling in love with emotionally unavailable, commitment phobic men.  There were all sorts of reasons for this, not all of which I have identified even now.  Still, it’s important to see the pattern and to think about what might be driving it. 

Identifying your emotional needs and not expecting one person to meet them all: I read this book once that completely blew my mind.  It was called “How to be an Adult in Relationships” by David Richo.  He says that we should not expect a partner to meet more than 25% of our emotional needs.  The rest we have to get met in other people (friends, family, coworkers, etc.) or activities (art, music, relaxation, etc.).  We also have to learn to meet some of them ourselves.  Briefly, the “5 A’s” are: attention, acceptance, appreciation, affection, and allowing (yourself and others to be as they are).  You should really read this book.

Pay attention to how you talk to yourself: Everybody talks to themselves, either out loud or in their heads.  When I first started working out, I remember “motivating” myself to push harder by telling myself, “Move your fat ass” or “Keep going bitch!”  I used to think to myself that maybe I was unlovable.  (I later learned that there is no such thing as unlovable, but more about that later).  Just thinking these things made me feel like shit.  Yet, I still didn’t understand why I didn’t like myself.  Here’s the deal: you have to treat yourself like you treat people you like.  You don’t go around calling your friends bitches or worthless and you shouldn’t do it to yourself.  If you want to learn to love yourself then the first thing you have to do is to be nice to yourself.  Don’t put yourself down.  (Tell yourself to shut up when you do put yourself down). 

Acceptance: Accept yourself as you are without wishing to be something or someone else.  That doesn’t mean that there aren’t things you want to work on or goals you want to achieve.  It’s always good to work to become better; just don’t do it because you think you aren’t good enough as you are.  Accepting yourself as you are is not something you can just do once and be done with it.  (I wish it were that easy).  Self acceptance is something you have to do over and over again, every time you notice that you’re unhappy with how you are. The irony of self-acceptance is this: it is not until you accept yourself as you are that you are able to change.  If you always put off being happy with who you are – I’ll be happy when I get a good job, I’ll be happy when I get my own place, etc. – then you will always end up being disappointed. Acceptance – contentment – is something that happens right now, in the moment, or not at all. 

Self-compassion: Think about how you would feel if you see someone you love suffering.  You feel for that person and offer them love, warmth, and kindness.  You don’t judge him or say to him, “See, that’s what you get,” even if his suffering is the result of his own bad decisions.  “Everyone makes mistakes,” you tell him.  “Don’t beat yourself up.  You’re only human.”  You might go out of your way to check up on your loved one or to do something nice for him because you know he’s having a hard time. This is compassion.  Most of us have no problem offering compassion to other people.  Yet when faced with our own suffering, we tend to respond in ways that are decidedly un-compassionate. Take time to acknowledge when you are hurting; don’t try to ignore it or “suck it up” in hopes that it will eventually go away.  Recognize that you are going through a difficult time and think of ways to comfort yourself.  Give yourself extra attention.  Instead of judging or criticizing yourself, give yourself permission to be human.  Making a mistake or going through a hard time is part of being human.  You don’t have to beat yourself up for it.  Some people think, “If I’m not hard on myself then I won’t learn from my mistakes.”  This is not true.  Putting yourself down doesn’t teach you a lesson, it just makes you feel like shit.  It’s not helpful.

Core beliefs: These are the things our problems are made of.  Core beliefs typically operate on a subconscious level, so most of us are not really aware of them.  There is so much going on in our external environment at any given moment that there is no way our brain could take everything in.  Our brains use our core beliefs as filters.  Information that is consistent with what we believe about ourselves, other people, and the world is deemed important and is allowed into our conscious awareness.  Information that doesn’t fit with our core beliefs is deemed unimportant and is filtered out without ever reaching our conscious awareness.  In this way, our core beliefs influence how we perceive the world around us.

People need core beliefs; we can’t function effectively without them.  Sometimes, though, people have beliefs that are extreme and distorted.  This inevitably creates problems.  The core belief that created so many problems for me was, “I am unlovable.” 

Most people suffering with depression have at least one or two unrealistic core beliefs that are contributing to their negative emotions.  It is important to identify yours so that you can work to change them.

I hope this helps!

Are emotions worth it?

I recently picked up a book I’d never heard of before by an author I wasn’t familiar with just to have something to read.  The book was “Forbidden” by Ted Dekker and Tosca Lee.  I definitely didn’t go into it expecting any profound insights; I just wanted to be entertained. 

The book takes place in a distant future in which all human emotions except for fear have been selectively eradicated from the human genome.  Fear was left intact because it was considered the “only emotion necessary for survival.”  I’ll agree with this in premise; fear is definitely necessary for survival.  I remember reading about a woman who sustained a head injury in an accident that rendered her unable to experience fear.  As a result, she frequently found herself in dangerous situations.  She’d been attacked and robbed several times.  Her doctors were concerned for her safety.  Without a mechanism to warn her she was in danger, she was unable to differentiate between what was safe and what wasn’t.

On the other hand, too much fear can be debilitating.  I see a lot of patients who are plagued with anxiety.  They see danger or the potential for danger everywhere, even in places that are perfectly safe.  Often, they are completely unable to relax.  They live in a constant state of alertness; they are always on guard.  Many of them avoid going to places where large groups of people gather; they stay away from malls, popular restaurants, concerts, PTA meetings, parties, and they plan their trips to Wal-Mart in the middle of the night when everyone else is asleep.  (This seems a bit backwards to me; aren’t you more likely to encounter a criminal at one or two in the morning than in the middle of the day?  I don’t know). 

In addition to thinking about fear, the book got me thinking about human emotion and what it would be like to live without them.  There are a few characters in the book whose abilities to experience emotions are restored after drinking a serum.  The main character wavers between embracing and cursing his newfound emotional palette.  He is initially exhilarated by his first taste of love.  He realizes that the love he and his mother felt for one another was merely was hollow and motivated by fear.  His mother is killed by people searching for the serum.  He grieves – really grieves – for the first time in his life.  He grieves for the loss of his mother, but also for the fact that he only gained the ability to really love her after she died. 

He sets out with his childhood (female) friend to discover how and why all humanity is bereft of all emotion except fear.  When he sees her for the first time after drinking the emotion-restoring serum, he realizes that he is in love with her.  He wonders why he never realized this before.  (Probably because he was incapable of love before).  He is intoxicated and invigorated by his love.  He sees that it gives his life meaning but also that he is willing to die for it, if need be.

And then the love of his life is killed by their enemies before his very eyes.  He is devastated.  He curses love.  He wants to die.  Life has lost all meaning for him.  He begins to think that maybe humanity is better off without emotions. 

Here he captures a fundamental truth about human emotion: with great joy comes great sorrow.  With great pleasure comes great pain.  There is no happiness without sadness, no love without loss, no hope without disappointment. 

This book lays out a very poignant argument for embracing all emotional experience, even those that are painful.  In many ways, this is the very thing I attempt to convey to my patients.  Sure, you can cut yourself off from your emotions to avoid feeling sad, insecure, or anxious, but at what cost?  Is it worth the loss of joy, happiness, pleasure, and love?  You can’t just cut out “bad” emotions; when you cut yourself off from your feelings, you sever ties with all of them, both good and bad. 

Is it worth it?

Challenging Perfectionism

For most perfectionists, there is some sort of rule or assumption underlying their need to be perfect.  Each rule or assumption has its own particular variation.  Most, however, take one of the following forms:  "I have to be perfect or ...."  "If I'm not perfect then..." "If I make a mistake it means..." "If I allow myself to accept anything less than perfection then..."  Notice that each of the previous statements suggests the presence of some sort of fear.  "If I am not perfect then..." I must be a failure.  Or people won't like me.  Or whatever.  "If I allow myself to accept anything less than perfection then..." my life will turn into a complete mess.  Everything I do will be mediocre.  I'll never be successful.  Or whatever. 

In this way, perfectionism serves to protect a person from his deepest fear.  Usually the fear is rooted in the belief that one is not good enough as he is.  If he is perfect, however, people will not see how inadequate he really is.  When he is perfect, he can forget about his own perceived inadequacies, at least for a time. 

Oh, but when he makes a mistake...When he makes a mistake, he becomes overwhelmed with the knowledge of his own deficiency.  He berates himself for erring and expects others to do the same. 

Maybe perfectionism has served him well in life.  Perhaps it has garnered him praise and recognition.  Perhaps he has achieved great things.  Would this have been possible if he hadn't demanded of himself perfection?

Perfectionists know well the consequences of their unattainable standards and relentless need for perfection in all things.  Yet because perfectionism can be advantageious at times, there is quite often ambivalence about efforts to change.  Thus, the first step in "challenging" perfectionism is to make a list of its advantages and disadvantages.  Complete a thorough cost-benefit analysis; what does perfectionism cost you and how do you benefit from it?  This enables you to fully explore your ambivalence.  In most cases, it also helps to increase motivation for change. 

So what about the benefits of perfectionism?  How do you let go of something that serves you so well in so many of your endeavors?  Ask yourself this: Is perfectionism the only way to attain these benefits?  Can you still be successful if you set more realistic standards and become less self-critical?  Will people still like and respect you if you're less than perfect?  Will you still do good work?  Will things still get done?  Or will you become just another mediocre member of society who never accomplishes anything notable?

There's only one way to find out; do it and see what happens.  Develop and carry out a few "behavioral experiments."  Start small.  Pick some small job you are tasked with completing each day.  Most likely, you expect yourself to complete even this small task with 100% accuracy.  Determine what this (100%) looks like.  Then decide what 90% looks like, 80% looks like, 70%, and so on.  Designate a specific period of time -- say, three days -- and resolve to perfrom the selected task with 80% effort and accuracy.  Pay attention to what happens as a result.  Do people berate you?  Does anyone even notice?  And how do you feel?  Do you feel more or less stressed?

Alternatively, you can try intentionally making small mistakes and observing the outcome.

What you're really doing is testing your assumptions.  Remember, perfectionism serves as a defense against underlying fears of inadequacy, rejection, etc.  The goal of your 'behavioral experiments" is to see if what you fear actually comes to pass when you intentionally perform in a less than perfect manner.  (Spoiler alert: What you fear almost never comes to pass.  Although you might want to enlist the help of a good therapist to ensure that you've selected appropriate behaviors to adjust). 

Hopefully, these strategies will get you started on the path to change.  Keep in mind that old habits die hard.  Change is never easy but it's always possible.

Is perfectionism always a bad thing?

Perfection is an ideal faultlessness, a state of being complete and correct, such that nothing is wanting.  It is the highest attainable state or degree of excellence.  Perfection is a standard to which many strive, although most fall short.  I believe this is, in part, because perfection means different things to different people.  What constitutes perfection is quite subjective and therefore depends on who you ask. 

There tends to be general agreement that while a person may achieve perfection (however it is defined) on a given occasion, no one attains perfection in all venues at all times.  Human beings are falliable creatures; we all make mistakes.  Thus, we are challenged to accept a fundamental truth about human nature: nobody's perfect.

Some people have more difficulty accepting this than others.  These are people who believe perfection can and should be always within reach; we call them perfectionists.  The negative implications of perfectionism have been studied at length and are well documented.  It has been associated with chronic feelings of failure, unwarranted guilt, lack of self-worth, pervasive self-doubt, indecisiveness, excessive self-criticism, procrastination, and low self-esteem.  Perfectionism has also been linked to the development and maintenance of several mental health disorders, to include major depression, generalized anxiety, obsessive-compulsiveness, anoerexia, and alcoholism. 

While no one disputes the negative consequences associated with perfectionism, there are some who insist it has positive implications as well.  Adherents to this school of thought distinguish between "normal," "adaptive," or "healthy" perfectionism and "pathological," "maladaptive" or "unhealthy" perfectionism.  They argue that "healthy" perfectionism is often beneficial and its development should be nurtured and encouraged. 

So is there a "healthy" perfectionism?  Or is perfectionism always pathological? The answer depends on how you define perfectionism.  Those who promote the potential benefits of "healthy" perfectionism define the concept differently than those who insist it is always pathological. 

Proponents of "healthy" perfectionism divide the phenomenon into several dimensions:

1. The consistent setting of very high standards for performance and achievement.

2. Extreme and excessive concern about making mistakes.  Mistakes are equated with failure. 

3. Chronic self-doubt, causing one to second guess oneself and one's decisions.  There are frequent doubts
    regarding the adequacy of one's work and/or performance.

4. Strong emphasis on and desire for organization in all aspects of life.

We can clearly see that not all of these dimensions have negative implications and that some of them have the potential to be quite beneficial.  In particular, having high standards for oneself and being exceptionally well organized are qualities commonly labeled as assets.  Together these characteristics (collectively referred to as "perfectionistic strivings") are associated with high levels of conscientiousness, extraversion, endurance, positive affects, life satisfaction, active coping styles, and achievement. 

In contrast, the dimensions of self doubt and conern about mistakes (collectively referred to as "perfectionistic concerns") are associated with increased incidences of obsessive compulsive disorders, depression, anxiety, eating disorders, procrastination, and an increased risk of suicide. 

When conceived of this way, it is clear that certain aspects or dimensions of perfectionism are adaptive and that others are maladaptive; it would be difficult to argue otherwise. 

Still, there are those who maintain that perfectionism in any form is never a good thing.  Adherents to this school of thought define perfectionism thus: a personality style characterized by the setting and compulsive pursuit of unrealistically high standards and/or unattainable goals coupled with the tendency to be over-critical in evaluations of one's own behaviors and efforts.  The psychopathology is inherent in the definition.  They assert that any "healthy" dimensions of perectionism cannot truly be called perfectionism, as perfectionism only refers to that which is unhealthy or maladaptive. 

Personally, I am concerned about beliefs and behaviors that interfere with personal functioning.  In my next post, I'll talk about strategies for overcoming (or at least coping more effectively with) this kind of perfectionism.

Are there reasons not to forgive?

I've been thinking a lot about forgiveness lately.  I initially had no strong opinions on the subject; rather, I had a vague sense that while forgiveness is a worthy endeavor, there are certain situations where forgiveness would not necessarily be a suitable goal.  After doing some research on the subject, I've adopted a firmer, more coherent position on when I believe forgiveness is an appropriate goal (and when it isn't).  I've come to the conclusion that forgiveness is only necessary when both the victim and the offender want to reconcile and rebuild their relationship.  If there is no desire or intention to repair a broken relationship, forgiveness is unncessary at best and detrimental at worst. 

The currently prevailing models of forgiveness describe it as a process that begins with acknowledging the pain casued by the betrayal and ends with developing empathy for the offender and acknowledging our own falliability and capacity to offend.  We know we have forgiven someone when our negative feelings about that person and his actions have been replaced with positive emotions.

I think back to my own experiences with betrayal.  I no longer feel any anger towards people who hurt or betrayed me in the past, nor do I feel any pain associated with these incidents.  Still, I cannot honestly say that the anger and hurt I once felt have been replaced with positive emotions.  When I think back to a particular time when someone mistreated me or betrayed my trust I don't feel anger or hatred, but neither do I experience a flood of compassion for the one who offended me. 

Historically, when a person has hurt or betrayed me, I have coped with the situation by  acknowledging and working through the negative emotions associated with these incidents; in most cases, I was eventually able to understand the various factors that contributed to the offenders' actions.  Truthfully, I no longer harbor any resentment or ill will towards anyone who has ever hurt or betrayed me.  The caveat: most of these people are no longer a part of my life. 

I'm not the kind of person who is quick to cut someone out of my life at the slightest offense.  Yet there have been people in my life who proved to be toxic; when, over time, I came to realize this, I chose to protect myself by ceasing to associate with these people.  This was never a decision I made lightly.

The problem with replacing negative feelings about a person and his actions with positive ones is that having positive feelings about a person increases the likelihood that you will allow that person to be a part of your life (in some way or another).  In other words, "true" forgiveness increases the likelihood of reconciliation.  If you reconcile with a toxic person who has not changed and thus remains toxic, you enable that person to continue to affect your life in a way that will most likely be negative. 

This assertion is supported by research.  Studies suggest that forgiveness in toxic relationships facilitates reconciliation, even while the offender continues to engage in toxic behavior.  One study found that victims of domestic violence who reported that they forgave their partners for the abuse were more likely to return to their partner (and thus to the abusive relationship).  A recent study by J. McNulty supported his hypothesis that forgiveness can "increase the likelihood that offenders will offend again by removing unwanted outcomes for those offenders that would otherwise discourage them from reoffending."

In sum, I believe that complete forgiveness is not always adviseable.  However, it is not necessary to forgive in order to let go of anger and hatred and move forward with one's life.

How to Forgive

Forgiveness.  Some of us offer it too readilty; others refuse to offer it at all.  It can be given freely or begrudgingly, conditionally or unconditionally.  The decision to forgive is a deeply personal one and can be quite difficult to make.  Anyone who has ever been forgiven knows forgiveness for what it is: a gift, which bestows upon its recipient a deep sense of gratitude and appreciation.

Often, when we have been hurt or betrayed by another, our initial response is to distance ourselves from the resulting emotional pain.  We become angry because anger is easier to deal with than pain.  This is a natural reaction that serves a protective function in the immediate aftermath of a betrayal.  As a long term coping mechanism, however, anger is far from adaptive.  Anger that is nurtured and fed over time becomes hatred.  Hatred eats at a person until it consumes every aspect of his life.  Thus, the person is twice victimized: first by the one who betrayed him and then by himself, in his choice to remain angry instead of trying to move forward.

We can choose forgiveness instead.  This may or may not mean restoring the relationship between victim and offender.  Sometimes the relationship can be mended.  At other times, reconciliation is ill-advised.  Fortunately, forgiveness does not require reconciliation.  Rather, forgiveness represents a change in the emotional response of one person towards another.  Forgiveness means working through the hurt and the anger and then moving past it.

Forgiveness is not something that happens immediately; it is a process that takes place over time.  There are many theories about forgiveness and each one has its own ideas about the specific path one must take on the way to forgiveness.  Still, most theories agree on a few basic tasks that must be completed in order for forgiveness to occur. 

Before a person can forgive, he must first accept the reality of the offense committed against him.  He must recall the offense in detail and allow himself to experience the emotions associated with the betrayal.  He should acknowledge and explore his anger and hatred.  He will probably find that beneath these emotions lie feelings of hurt, fear, and vulnerability.  He must allow himself to experience these emotions as well.  Hopefully, he will come to view himself with compassion and to let go of any self-blame.

I believe this is the most important step.  It is, in my opinion, where most of the healing takes place.  Personally, I think a person could work through this part of the process and go on to live a happy, psychologically healthy life.  Nevertheless, I have committed to writing about the process of forgiveness in its entirety, so I'll move on to step two.

The second phase of the forgiveness process is building empathy for the offender by learning to view him as human and therefore falliable.  An effort is made to see things from the offender's persepctive, to put yourself in his shoes and try to imagine his thoughts and feelings.  There is an attempt to identify and understand the factors that might have contributed to or motivated the offender's actions.  It is important not to confuse empathy with condoning or excusing the offender's behaviors.  Rather, the goal is to avoid the pitfall of labeling the offender a "bad person."  People are rarely all good or all bad.  Good people often do bad things.  And sometimes even "bad" people do good things. 

The third and final task of forgiving involves acknowledging that we are not unlike our offender in that we too are human and have, at some point in our lives, behaved in ways that were hurtful to others.  In this final task, we are called upon to reflect on our own lives; we are asked to recall times when we were the offender and required others to forigve us.  In some ways this is an extension of phase two, in that acknowledging our own failings makes it easier to empathize with someone else who has done something wrong.  Admitting that we too are capable of behaving selfishly prevents us from being overly judgmental or self righteous.

Keep in mind that every situation is different and that forgiveness is not always the best option.  Still, we should be aware that it is an option and should have the freedom to choose forgiveness if we so desire.

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.

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...

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.