I just wanted to update anyone who is interested...I won my appeal. My insurance company has agreed to pay for my medication for a period of one year. I guess after that I have to appeal again, or something.
Anyway, I've had a rough week. I haven't been feeling well so I haven't really been able to put together a coherent blog post. I'll be back on track next week though...
Sunday, February 17, 2013
Sunday, February 10, 2013
Middle child syndrome?
My sister and her husband have two daughters. My nieces are 7 (almost 8) and 5. They are expecting a new addition to their family - a third baby girl - to arrive in June of this year. My seven year old niece is excited and can't wait to meet her new sister. My five year old niece is slightly less enthusiastic...In a few short months, she'll no longer be the baby in the family; she'll be the middle child.
My parents also have three daughters and I happen to empathize a bit with my five year old niece; I was just shy of five years old when my younger sister was born. In one of our family albums there's a picture of the three of us (my older sister, my younger sister, and me) on the day my little sister was born. My older sister is holding her and smiling. I'm sitting next to them, scowling. I remember that day. My parents told me I wasn't old enough to hold the baby. I was pissed. It's a longstanding joke in my family that this incident set the tone for the rest of my childhood.
Maybe you've heard of something called the middle child syndrome. Well, if such a thing truly exists then I had it, no question. I can remember feeling like I had no place in our family. My mother confirms that I told her as much, repeatedly.
As an adult, it seems odd that I resented being the middle child. I love my sisters and I'm glad there are three of us. We each have our role in the family. We have a close relationship with one another and with our parents.
If you ask me how being a middle child shaped my personality I'm not sure I could explain it. I know I went out of my way to be as different from my older sister as possible because I wanted to be my own person and not just "Tina's little sister." I remember wanting to protect my younger sister; I was quick to go after anyone who was bullying her. Thinking about it now, it seems like I got the best of both worlds by being both an older and a younger sibling. Yet I know I didn't always feel this way.
There is a large body of research exploring how birth order affects everything from intelligence to education attainment, from personality to perfectionism. While traditional wisdom accepts that birth order has a strong impact on who a person becomes and what he achieves, the research is inconclusive. Some studies suggest that birth order has a significant impact on a range of other variables; other studies find no evidence for this at all.
What I really wanted to know when I started looking into this topic was this: Is "middle child syndrome" a real thing? The short answer is no. There is no empirical evidence to suggest that as a whole middle children tend to feel lost, neglected, confused, or resentful (or at least not with any more frequency than other children). So empirically, scientifically, professionally speaking, middle child syndrome does not exist. The evidence simply doesn't support it.
Yet a quick Google search of the term "middle child syndrome" indicates that while there may be no empirical evidence to support it, society readily accepts it as a valid phenomenon. It is a cultural myth.
And yet, don't these things tend to contain some kernel of truth? What do you think?
My parents also have three daughters and I happen to empathize a bit with my five year old niece; I was just shy of five years old when my younger sister was born. In one of our family albums there's a picture of the three of us (my older sister, my younger sister, and me) on the day my little sister was born. My older sister is holding her and smiling. I'm sitting next to them, scowling. I remember that day. My parents told me I wasn't old enough to hold the baby. I was pissed. It's a longstanding joke in my family that this incident set the tone for the rest of my childhood.
Maybe you've heard of something called the middle child syndrome. Well, if such a thing truly exists then I had it, no question. I can remember feeling like I had no place in our family. My mother confirms that I told her as much, repeatedly.
As an adult, it seems odd that I resented being the middle child. I love my sisters and I'm glad there are three of us. We each have our role in the family. We have a close relationship with one another and with our parents.
If you ask me how being a middle child shaped my personality I'm not sure I could explain it. I know I went out of my way to be as different from my older sister as possible because I wanted to be my own person and not just "Tina's little sister." I remember wanting to protect my younger sister; I was quick to go after anyone who was bullying her. Thinking about it now, it seems like I got the best of both worlds by being both an older and a younger sibling. Yet I know I didn't always feel this way.
There is a large body of research exploring how birth order affects everything from intelligence to education attainment, from personality to perfectionism. While traditional wisdom accepts that birth order has a strong impact on who a person becomes and what he achieves, the research is inconclusive. Some studies suggest that birth order has a significant impact on a range of other variables; other studies find no evidence for this at all.
What I really wanted to know when I started looking into this topic was this: Is "middle child syndrome" a real thing? The short answer is no. There is no empirical evidence to suggest that as a whole middle children tend to feel lost, neglected, confused, or resentful (or at least not with any more frequency than other children). So empirically, scientifically, professionally speaking, middle child syndrome does not exist. The evidence simply doesn't support it.
Yet a quick Google search of the term "middle child syndrome" indicates that while there may be no empirical evidence to support it, society readily accepts it as a valid phenomenon. It is a cultural myth.
And yet, don't these things tend to contain some kernel of truth? What do you think?
Sunday, February 3, 2013
Self Forgiveness
Willingness to forgive is a trait that varies in degree from individual to individual. Some people are so quick to forgive that they become easy to take advantage of. Others nurse grudges for years over minor infractions. Most of us fall somewhere between these two extremes: we are willing to forgive most people for most offenses but have identified certain conditions under which forgiveness is simply not possible.
One thing I've noticed fairly consistently with my patients is that most of them are willing and able to forgive others but have a difficult time forgiving themselves. Many of my patients who struggle with self forgiveness have been burdened by guilt and self blame for years. By the time I see them, what started as guilt has become shame and self loathing. How does this happen?
Think of someone you know (we'll call him Person A) who has a grudge against someone else (we'll call him Person B). Whenever Person A hears Person B's name so much as mentioned he becomes angry. He tells everyone he knows not to talk about Person B around him, but he sometimes brings Person B up himself just so he can say something mean about him. Depending on how bad the grudge gets, Person A might go out of his way to learn things about Person B, especially things that suggest Person B is unhappy or having problems. "It serves him right," Person A says when he learns of any malady in Person B's life. Hating Person B can become quite an obsession if things get out of control...And so imagine this turned inward. Imagine directing all this anger and hatred at oneself.
Hall and Fincham offer another explanation. When one person has been hurt by another, his instinct is often to avoid that person so as not to activate negative thoughts and feelings associated with the offense committed against him. Often, it is possible to avoid the transgressor indefinitely: reconciliation is not necessarry, even if one chooses to forgive the offender. This is not the case with someone who feels guilty about an offense he has committed against someone else. It is not possible to escape negative thoughts and feelings about the offense by avoiding contact with the transgressor when one is the transgressor; it is not possible to avoid contact with oneself. Attempts to avoid contact with oneself eventually lead to self estrangement or self destruction.
So what needs to happen for a person to forgive himself? According to Hall and Fincham, before a person can forgive himself he must acknowledge the wrongness of his actions and accept responsibility for what he has done. Acknowledging wrongdoing and accepting responsibility are likely to generate feelings of guilt or regret. This is all part of the process. These emotions must be experienced fully and allowed to run their course, no matter how difficult, in order for self forgiveness to occur.
This may sound simple, but true self forgiveness is often a long and arduous process. It is typically quite painful for a person to admit that his actions caused very grave consequences. The guilt that ensues is a heavy burden that becomes a constant companion from the moment responsibility is accepted until the moment self forgiveness occurs.
For many people, feelings of guilt precipitate conciliatory behaviors and motivate efforts at restitution. When apologizing to the victim is not possible, some confess their misdeed to God (or another higher power) and ask for His forgiveness. Research suggests that people find it easier to forgive themselves when they believe they have been forgiven by their victim or by God. Thus, receiving forgiveness from others sometimes enables us to forgive ourselves. (Remember this next time you think about holding a grudge).
Something else that can help with self forgiveness is trying to find something positive to take away from an otherwise bad experience. This is akin to finding the silver lining in a dark cloud. Thus, while one acknowledges the negative consequences that resulted from his actions, he is able to take something positive from the experience as well. Common examples of this include learning a valuable lesson, changing your priorities, or realizing how much a particular relationship means to you.
One thing I've noticed fairly consistently with my patients is that most of them are willing and able to forgive others but have a difficult time forgiving themselves. Many of my patients who struggle with self forgiveness have been burdened by guilt and self blame for years. By the time I see them, what started as guilt has become shame and self loathing. How does this happen?
Think of someone you know (we'll call him Person A) who has a grudge against someone else (we'll call him Person B). Whenever Person A hears Person B's name so much as mentioned he becomes angry. He tells everyone he knows not to talk about Person B around him, but he sometimes brings Person B up himself just so he can say something mean about him. Depending on how bad the grudge gets, Person A might go out of his way to learn things about Person B, especially things that suggest Person B is unhappy or having problems. "It serves him right," Person A says when he learns of any malady in Person B's life. Hating Person B can become quite an obsession if things get out of control...And so imagine this turned inward. Imagine directing all this anger and hatred at oneself.
Hall and Fincham offer another explanation. When one person has been hurt by another, his instinct is often to avoid that person so as not to activate negative thoughts and feelings associated with the offense committed against him. Often, it is possible to avoid the transgressor indefinitely: reconciliation is not necessarry, even if one chooses to forgive the offender. This is not the case with someone who feels guilty about an offense he has committed against someone else. It is not possible to escape negative thoughts and feelings about the offense by avoiding contact with the transgressor when one is the transgressor; it is not possible to avoid contact with oneself. Attempts to avoid contact with oneself eventually lead to self estrangement or self destruction.
So what needs to happen for a person to forgive himself? According to Hall and Fincham, before a person can forgive himself he must acknowledge the wrongness of his actions and accept responsibility for what he has done. Acknowledging wrongdoing and accepting responsibility are likely to generate feelings of guilt or regret. This is all part of the process. These emotions must be experienced fully and allowed to run their course, no matter how difficult, in order for self forgiveness to occur.
This may sound simple, but true self forgiveness is often a long and arduous process. It is typically quite painful for a person to admit that his actions caused very grave consequences. The guilt that ensues is a heavy burden that becomes a constant companion from the moment responsibility is accepted until the moment self forgiveness occurs.
For many people, feelings of guilt precipitate conciliatory behaviors and motivate efforts at restitution. When apologizing to the victim is not possible, some confess their misdeed to God (or another higher power) and ask for His forgiveness. Research suggests that people find it easier to forgive themselves when they believe they have been forgiven by their victim or by God. Thus, receiving forgiveness from others sometimes enables us to forgive ourselves. (Remember this next time you think about holding a grudge).
Something else that can help with self forgiveness is trying to find something positive to take away from an otherwise bad experience. This is akin to finding the silver lining in a dark cloud. Thus, while one acknowledges the negative consequences that resulted from his actions, he is able to take something positive from the experience as well. Common examples of this include learning a valuable lesson, changing your priorities, or realizing how much a particular relationship means to you.
Monday, January 28, 2013
Guilt and shame
I've always thought of guilt and shame as two sides of the same coin. In theory, when you do something wrong you feel guilty; when people find out about it, you feel ashamed. Thus, one can feel guilty about something he's done even when no one else knows about it; he only feels ashamed, however, once his actions are discovered and his guilt is brought to light.
In my mind, shame was a mixture of embarrassment and guilt brought about by having one's misdeeds made public. I saw guilt, on the other hand, as a moral compass of sorts, one that alerts you when you've strayed too far off course. Apparently, though, I've had it all wrong. It turns out that people who study this type of thing think about guilt and shame quite differently. To feel guilty is to condemn specific actions, i.e., you feel guilty about something you've done. When, in contrast, a person feels shame he condemns himself. In other words, I feel guilty about what I've done; I feel ashamed of who I am.
I have no problem with this perspective; it makes a certain amount of sense. Who am I to argue with the experts? Moving on...
Guilt is often uncomfortable and unpleasant but it also serves an important social function in that in promotes cooperation and adherence to group norms. (Consider this: the inability to experience guilt and remorse is a characteristic of most psychopaths). Studies show that guilt tends to motivate conciliatory behaviors and efforts at restitution. Because it serves as an impetus for corrective action when social norms are violated, guilt facilitates the restoraction of peace and cooperation, thus enabling individuals to live and work together in communities.
Shame, on the other hand, yields very little in the way of benefits (at least according to the experts). Whereas guilt often motivates reparative actions, shame tends to induce behaviors that are self destructive. With guilt, the focus is on one's actions and their consequences to other people. Shame, however, is a self-focused emotion characterized by a a sense of unworthiness and self-directed contempt. Shame is associated with negative attributions towards oneself and is frequently accompanied by low self-esteem.
Over time, shame leads to self loathing. Pause for a moment: have you ever known someone who hated himself? Think about what this person was like...
Probably very sensitive to any negative feedback. People who carry a lot of shame tend to be very defensive. You see, the job of the human "ego" (or sense of self, subconscious, identity, self concept, or whatever you want to call it) is to protect itself and to maintain its integrity. Shame leads to self loathing; this poses a serious threat to the "ego." The "ego" of someone who hates himself is under constant attack from the inside; an attack from the outside would be crippling. So it builds up a network of defenses to protect it. Thus the shame filled individual blames others for his mistakes and refuses to accept responsibility for his actions. We think he's just being an asshole. The truth is, his fragile ego cannot withstand the blow of acknowledging he did something wrong; he can't even admit it to himself. And obviously if a person can't admit he did something wrong, he certainly can't come to forgive himself...
Which is what I plan to talk about next week - self-forgiveness.
In my mind, shame was a mixture of embarrassment and guilt brought about by having one's misdeeds made public. I saw guilt, on the other hand, as a moral compass of sorts, one that alerts you when you've strayed too far off course. Apparently, though, I've had it all wrong. It turns out that people who study this type of thing think about guilt and shame quite differently. To feel guilty is to condemn specific actions, i.e., you feel guilty about something you've done. When, in contrast, a person feels shame he condemns himself. In other words, I feel guilty about what I've done; I feel ashamed of who I am.
I have no problem with this perspective; it makes a certain amount of sense. Who am I to argue with the experts? Moving on...
Guilt is often uncomfortable and unpleasant but it also serves an important social function in that in promotes cooperation and adherence to group norms. (Consider this: the inability to experience guilt and remorse is a characteristic of most psychopaths). Studies show that guilt tends to motivate conciliatory behaviors and efforts at restitution. Because it serves as an impetus for corrective action when social norms are violated, guilt facilitates the restoraction of peace and cooperation, thus enabling individuals to live and work together in communities.
Shame, on the other hand, yields very little in the way of benefits (at least according to the experts). Whereas guilt often motivates reparative actions, shame tends to induce behaviors that are self destructive. With guilt, the focus is on one's actions and their consequences to other people. Shame, however, is a self-focused emotion characterized by a a sense of unworthiness and self-directed contempt. Shame is associated with negative attributions towards oneself and is frequently accompanied by low self-esteem.
Over time, shame leads to self loathing. Pause for a moment: have you ever known someone who hated himself? Think about what this person was like...
Probably very sensitive to any negative feedback. People who carry a lot of shame tend to be very defensive. You see, the job of the human "ego" (or sense of self, subconscious, identity, self concept, or whatever you want to call it) is to protect itself and to maintain its integrity. Shame leads to self loathing; this poses a serious threat to the "ego." The "ego" of someone who hates himself is under constant attack from the inside; an attack from the outside would be crippling. So it builds up a network of defenses to protect it. Thus the shame filled individual blames others for his mistakes and refuses to accept responsibility for his actions. We think he's just being an asshole. The truth is, his fragile ego cannot withstand the blow of acknowledging he did something wrong; he can't even admit it to himself. And obviously if a person can't admit he did something wrong, he certainly can't come to forgive himself...
Which is what I plan to talk about next week - self-forgiveness.
Sunday, January 20, 2013
A personal story...
Last week I mentioned that my insurance company no longer wants to pay for the medication I've been taking for the past decade. I'm in the process of appealing this. It has been extremely stressful. I sought help from my doctor, who said there was nothing she could do to help, and from the state insurance commissioner, who told me his office won't get involved until after the appeal is completed. I requested additional information from the insurance company; in response, I got a letter stating that I could submit a request for more information. After a week of this, I realized that I was going to have to figure out the whole appeal thing by myself; nobody was going to help me. So I got to work.
The first thing I did was write a brief personal statement about how the medication has helped me and what the consequences will be if I can no longer take it. This was fairly easy and I finished it quickly. The next part was a lot harder. My task was to find empirical evidence demonstrating that the medication at the dose I'm taking is effective. I worked on it all of last week. I finally finished it on Friday and faxed it to the insurance company. Now I just have to wait.
Because I've been so consumed with this whole insurance things, I haven't had much time to think about blogging. Still, I like to be consistent in posting something at least once a week. So today I though I'd share the personal statement I sent the insurance company. It's part of my story and it's a part I've never talked about on the blog. Anyway, here it is:
The first thing I did was write a brief personal statement about how the medication has helped me and what the consequences will be if I can no longer take it. This was fairly easy and I finished it quickly. The next part was a lot harder. My task was to find empirical evidence demonstrating that the medication at the dose I'm taking is effective. I worked on it all of last week. I finally finished it on Friday and faxed it to the insurance company. Now I just have to wait.
Because I've been so consumed with this whole insurance things, I haven't had much time to think about blogging. Still, I like to be consistent in posting something at least once a week. So today I though I'd share the personal statement I sent the insurance company. It's part of my story and it's a part I've never talked about on the blog. Anyway, here it is:
My
name is Melody. I have
narcolepsy. My symptoms started during
my senior year of high school. I began
falling asleep in my classes. I remember
one occasion when I fell asleep during a test.
When I woke up, everyone was passing their tests in. I looked down at my own paper, which was
completely blank. I realized with dread
that I’d slept through the entire thing.
Needless to say, I failed that test.
I
started college the following year. I
struggled to stay awake during lectures.
In between classes, I’d crawl into the back seat of my car and
sleep. One morning, I fell asleep while
I was driving to school and caused a car accident. I decided then that I needed to see a doctor;
something was seriously wrong.
I
related my concerns to my psychiatrist, who was already treating me for
depression. Over the next two years, my
doctor prescribed a number of medications at different doses in an effort to
control my symptoms. I tried
methylphenidate, dextroamphetamine, and mixed amphetamine and
dextroamphetamine. None of these
medications successfully alleviated my symptoms. Finally, my psychiatrist recommended I see a
neurologist.
The
neurologist ordered an overnight sleep study and a daytime MSLT. The results were suggestive of narcolepsy. Later, he ordered blood work to test for
specific human leukocyte antigens (HLA) strongly associated with narcolepsy (I
tested positive for these antigens).
After all the tests were completed, the neurologist diagnosed me with
narcolepsy; I was 21 years old.
Having
a diagnosis didn’t solve the problem.
The neurologist initially prescribed modafinil. Still, I kept falling asleep: at school, at
work, and while driving. After trying
modafinil, the neurologist prescribed Adderall XR. He started me at 30 mg. first thing in the
morning and 15 mg. a few hours later.
This controlled my symptoms until about 2:00 in the afternoon. Unfortunately, I had several classes later in
the day (I was still in college); I couldn’t simply go home and crash at 2:00
PM. My neurologist gradually increased
the medication dosage until we arrived at a dose that successfully controlled
my symptoms throughout the entire day: Adderall XR, 30 mg., three times per
day.
I
have been on Adderall XR at this dose ever since. I have been able to live an almost normal
life. I graduated college and went on to
graduate school. I have a successful
career as an outpatient psychotherapist.
Never once have I fallen asleep during a patient’s session. I can drive the forty five minutes to and
from work without fear of falling asleep behind the wheel. I can go to the gym after work, come home,
and eat dinner with my husband. I can
wake up the next morning and do it all again.
I can function. I can live.
And
now all of that is in jeopardy. My
health insurance company changes its rules and decides it will only pay for
Adderall XR 30 mg. once a day. This is
one third of the dose I’ve been taking for the past nine years. They say I can continue taking Adderall XR 30
mg. three times per day, but I’ll have to pay for what they don’t cover. It will cost me around $300 a month. I simply cannot afford it.
Sunday, January 13, 2013
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.
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.
Sunday, January 6, 2013
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:
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:
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!
Sunday, December 30, 2012
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?
Sunday, December 23, 2012
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.
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.
Sunday, December 16, 2012
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.
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.
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