This Is Me

Strange Place...

2014-07-16T07:21:00.005-04:00

I'm in a bit of a strange place lately. I have not been feeling well physically. I've known for a long time that I grind my teeth at night. In college, my doctor gave me medication to help with the headaches I got from it. The assumption was that I was under a lot of stress. I finished school, I was less stressed, and the headaches didn't occur as often. Over the years I've gone through phases. Sometimes I'll get headaches every day for a month or two. Then I won't get any for a while. I know the teeth grinding is a problem though, because my dentist tells me it has damaged my teeth. I had to get a crown on one tooth because I'd completely cracked it in half. Apparently the tooth on the other side of my mouth is cracked and might also require a crown.

I've looked into treatment for bruxism (the official term for teeth grinding). My dentist recommended an occlusal guard (to wear at night), which costs about $600. I'll admit it - I'm cheap. I didn't want to spend $600 on a mouth guard.

Unfortunately, my headaches started occurring more frequently. So I stocked up on ibuprofen and basically ate them like candy. Over the past one to two months I've felt nauseous. I initially attributed it to medication changes (and certainly some of it was due to that). When, however, the nausea persisted long after my body should have adjusted to the new medication I started to consider other possible causes. (I seriously considered the possibility that something in my office was making me sick. I know it sounds silly, but I moved to a new office around the same time I started feeling bad. I thought there might be a correlation). What I eventually realized (purely by accident, when I heard my husband make a comment about needing to eat before taking Tylenol), is that eating ibuprofen like candy was upsetting my stomach. I'm pretty sure I far exceeded the recommended dose; I guess I didn't realize how often I was taking it.

Anyway, this finally convinced me to do deal with the problem. Before investing $600, I decided to look online. I found a company that claims to make mouth guards for dentists. For $150, they mailed me a kit. I took impressions of my upper and lower teeth. I mailed them back. They should send me a mouth guard in the mail within a few weeks. I'm crossing my fingers. If it doesn't work then I will just pay the $600 and go through my dentist. At this point, it is causing enough misery to be worth whatever I have to pay.

So I'm feeling hopeful about that. But something is also going on with me emotionally and I'm not quite sure what it is. I suspect it might be related to switching from one antidepressant to another; the new one just doesn't work the way the old one did. Thinking back, when I was first treated for depression (back in high school) I tried multiple medications before finding one that worked. I took that one for several years. At some point I thought it was making me gain weight. I started something else and took it for seven or eight years. At that time, I complained about always feeling exhausted. My doctor said the particular antidepressant I was on probably made this worse so I switched to another one. I took this for about five years.

I switched medications again about three or four months ago. I've tried to give it a fair chance to work. I've actually found it difficult to tell if it's "working" or not. I haven't really been "depressed," my mood has not necessarily been sad or dysphoric, but I definitely don't feel as good on a daily basis as I did with the other medication. I frequently feel irritable and want to be left alone. It's like my average mood went from a seven to a five. I can function at a five but I felt better, could concentrate better, and was more productive at a seven. I'm grateful it's not worse; I think that's why I haven't asked the doctor to try something else yet.

Anyway, that's where I am at the moment. I am hopeful that I'll figure things out. My new mouth guard should arrive any day now and I'm optimistic about it. I see my doctor in three weeks; we'll discuss my options and make some changes. Until then, forgive me if I'm not writing as regularly as I usually do or if my thoughts seem slightly less coherent. I'm working on it; give me some time.

On Vacation!

2014-07-02T07:06:00.001-04:00

I just got back from vacation! My husband, stepdaughter, and I went to Miami for five days. We'd initially planned to go to Jamaica, but some unexpected setbacks required us to change plans at the last minute.

I think most would agree that vacations are beneficial. Time away from work for rest and relaxation is critical for happiness and well being. Intuitively, we know we feel better after a few days off work; there's also a large body of research demonstrating the benefits of vacation. People who take regular vacations report higher overall levels of satisfaction with life than those who don't. Employees returning to work after vacation show increased work engagement and job performance and decreased emotional exhaustion and burnout.

Unfortunately, the measurable benefits of vacation are short lived. Study after study finds that work productivity and burnout return to pre-vacation levels within two to four weeks. This remains true even when people take extended vacations (say, longer than fourteen days); within a month, productivity and burnout are back to pre-vacation levels.

This suprirsed me. I am a strong advocate of vacations. We spend all week pining for the weekend. We rejoice when we finally reach Friday. An upcoming vacation has the same effect, only amplified. We can look forward to a vacation for weeks or even months. And afterwards...well, some of my best memories are of vacations past. I cherish those memories. They never fail to make me smile.

But how do you measure that? I'm not sure you can. I think many of the benefits of vacation are not measurable. As far as science goes, if you can't measure it then it doesn't exist. But science is not life. Life is full of intangibles that cannot be seen, touched, or measured but that nonetheless enrich our lives and give them meaning.

Self-Criticism versus Self-Compassion

2014-06-18T09:23:00.002-04:00

A lot of us are our own worst critics. We're hard on ourselves. We do it because it motivates us to achieve. To go easy on ourselves is to become lazy and complacent. Self-criticism is motivating because we are driven by our desire to avoid it. We don't want to make a mistake and we don't want to fail because we dread having to face our own negative judgment. We use self-criticism to shame ouselves into action. Every endeavor comes with high stakes; anything less than total success leads to a barrage of self-condemntation.

The weapons of self-criticism are fear and shame. Fear and shame tell us that we are inadequate and unable to cope with the environment. Thus, what was intended to motivate action ultimately makes us too afraid to try.

There is an alternative to self-criticism; it is called self-compassion. Self-compassion is a way of relating to oneself. Kindness and concern replace harsh words and ultimatums; comfort replaces condemnation. Every human life has value; every human being deserves to be treated with respect and dignity. We are no exception. We are human; therefore, we have value and deserve to be treated with respect and dignity. This principle applies not only to how we should be treated by others but also to how we treat ourselves.

Kristin Neff captures the essence of compassion: "Compassion...entails feelings of kindness, care, and understanding for people who are in pain, so that the desire to ameliorate suffering naturally emerges...it involves recognizing the shared human condition, fragile and imperfect as it is." Self-compassion, then, means offering kindness, care, and understanding to oneself when in pain.

For some of us, this is a surprisingly difficult thing to do. A good way to start is by removing yourself from the equation. Instead, imagine a friend faced with similar circumstances. Would you tell him (or her) to stop whining and get over it? Of course not! Think about what you would say - perhaps words of comfort or support. Once you've come up with something write it down. Then, read what you've written to yourself out loud. Do it a few times. Set it down and come back later. Read it again.

Like anything, self-compassion takes practice. Try to catch yourself being self-critical. Say to yourself, "Oh yeah, I'm not doing that anymore. I'm learning to be nice to myself." Then give yourself some compassion instead.

Mood, meds, and maintaining

2014-06-11T07:26:00.002-04:00

The past several weeks have been extremely difficult for me. I mentioned before that I'm trying to get pregnant; I therefore changed medications [antidepressants] from something less pregnancy friendly (Cymbalta) to something more pregnancy friendly (Prozac). I honestly did not foresee this causing any problems. The two medications are similar. The transition should be easy. No big deal.

Or that's what I thought when everything was stable and I felt pretty good. Unfortunately, things have not gone as smoothly as I'd hoped. First I got bad advice from my OB, who told me to just stop taking the one pill and start taking the other. Three days later I started having symptoms of withdrawal. It was extremely unpleasant. So I went back to taking the old medication at half the dose: from 120 mg. to 60 mg. And I made an appointment with a psychiatrist to get some guidance.

Things went okay for maybe two weeks. I gradually decreased my dose of the Cymbalta while titrating up the Prozac. There's a problem with Cymbalta though: the lowest dose it comes in is 30 mg. So after about a week at 30 mg./day, it was time to stop taking it. After three days I was having withdrawal symptoms again.

Let me explain what this is like. You don't expect it so initially it takes a while to figure out what's wrong with you. The first thing I notice is that I can't think clearly. The harder I try the worse it gets. Eventually I realize that trying to focus on any one idea, conversation, or activity for longer than a few minutes actually makes me lightheaded. This makes it difficult to work, since my job requires me to carry on reasonably intelligent and ideally helpful conversations with patients all day long.

Then my muscles start to ache and cramp up. It gets really bad in my forearms and later on in my neck and shoulders. In the neck it feels exactly like the kind of crick you get when you've slept in an awkward position. Except I didn't wake up with it so I know it didn't come from how I slept.

Finally - and by far the worst - is the nausea. Apparently some people actually throw up. Not me. I wish I would throw up; I think I'd feel better if I did. The nausea just sits there. It periodically intensifies so for a moment I think I am going to vomit. Then it subsides to its original intensity. After a while it's all I can think about.

Then there's my mood, which has not been great. I've been coping by trying not to dwell on it. I go back to the doctor in two weeks; I'll ask her to make changes to the medication when I see her. Until then, my goals are to: 1. Try not to take my bad moods out on other people, especially my husband. 2. Go about my normal routine. 3. Act the way I usually act, despite feeling down. I'm sure we'll get the medication right eventually. Until then, I just have to hang in there.

Our Many Selves

2014-06-04T07:32:00.000-04:00

I encourage my patients to talk to themselves. It doesn't have to be out loud, but it can be. It is widely believed that talking to yourself is a sign of being "crazy." This is a complete fallacy. The fact is, talking to yourself is completely normal. We all do it, all the time, whether we're aware of it or not. At any given moment, we all have some sort of running commentary taking place in our minds. Some of us are more attuned to it than others but we all have it. And whether we're tuned in to our self talk or not, it has a profound effect on our perceptions and emotions.

Not only do I encourage my patients to talk to themselves, I encourage them to talk back to themselves as well. This is because we all have more than one inner voice; to maintain a healthy balance, we need to prevent any one voice from dominating the conversation.

This may all seem a little strange at first but it actually makes a lot of sense. We tend to think of the "self" as a single entity. In reality, each person has multiple selves or "sub-personalities." Each sub-personality has its own unique qualities and characteristics. Many of our sub-personalities fill specific roles. For example, I think and behave one way at work, another way at home, and another way when I'm out with my friends. I may have a very responsible sub-personality and a thrill-seeking sub-personality. Different sub-personalities are active at different times. Ideally, all the "sub-personalities" or parts of a given individual should be aware of and communicate with one another. They should work together cooperatively.

It is important to avoid identifying with any one sub-personality. When we identify with whatever part of the personality is activated in a given moment we become controlled by that part. When we later look back from the perspective of another part of ourselves we may say, "I don't know what got into me! I'm not usually like that!"

Through awareness and mindful observation we can become less identified with any one sub-personality and thereby gain more control over when, where, and how each one is activated. When we are aware of the different parts of ourselves we can ensure that the desires, goals, and needs of each subpersonality are adequately addressed andd that no part is ignored or neglected. When we neglect the desires and aspirations of any one part of ourselves we are vulnerable to being hijakced by the neglected part as it asserts itself in a desperate bid for attention.

Paradoxes and Contradictions

2014-05-28T06:56:00.000-04:00

Some of life's contradictions:

1. True happiness stems from leading an authentic and meaningful life. Unfortunately, sometimes being authentic - acting in ways that reflect your true nature and core values - leads to suffering or death. It is not always possible to be happy and live authentically. Such is the case for martyrs.

2. Total contentment in life is extremely demotivating. If a person is completely satisfied with life then he has nothing to strive for; he becomes complacent. Thus, complete happiness is not necessarily in our best interest.

3. In contrast, dissatisfaction and unhappiness are powerful motivators for growth and positive change.

4. Actively pursuing happiness tends to have the paradoxical effect of making people unhappy.

5. People often cope with their fear of death by withdrawing or pulling back from the fullness of life. Thus the fear of death sometimes prevents people from really living.

The Inner Child

2014-05-21T06:57:00.000-04:00

We've probably all heard someone refer to his or her "inner child." It's another one of those psychology terms that somehow made its way into popular culture. Carl Jung, a disciple of Freud and one of psychiatry's founding fathers, called it the "wonder child." According to Jung, the "wonder child" is the part of the psyche with the capacity for awe and a sense of natural wonder; it is curious, creative, and loves to explore.

The website desert-alchemy.com gives the best definition of inner child I have found so far. It defines "inner child" as that part of the psyche that retains feelings the way they were experienced in childhood. When it is healthy, the inner child is naturally innocent, playful, and uninhibited; it has an approach to life that is simple and straightforward.

Today, you might hear clinicians talk about the "wounded inner child." John Bradshaw (http://www.johnbradshaw.com/) is one of the best known proponents of "inner child work." He has authored several books on the subject and apparently appeared on several nationally televised PBS series. Among other things, he now travels the country conducting "inner child workshops." According to Bradshaw, an inner child becomes wounded when normal childhood dependency needs are not met during childhood. Normal development is arrested and dysfunctional childish behavior persists into adulthood.

While some of Bradshaw's work is a little too "touchy feely" for my taste, he does get a lot of things right.

From birth to adulthood, a child's parents are responsible for meeting all of his or her needs. This includes physical needs like food and shelter as well as psychological needs like security, intimacy, structure, and - later on - autonomy. Even the very best parents don't do this perfectly. Parents are human - they make mistakes. To further complicate things, very young children cannot speak. This makes it hard for them to communicate their wants and needs. Even after they start speaking they may be unable to communicate their wants and needs because children often do not know what they want or need. So for parents, there is a lot of guesswork. Sometimes parents guess correctly; sometimes they don't. Fortunately, a child doesn't need perfect parents to turn out okay. For healthy development, a child simply needs parents to be "good enough." (I am not making this up. If you don't believe me, see Winnicott's ideas on the "good enough mother").

Sadly, there are parents who are absolutely nowhere near "good enough." There are lots of reasons for this. Some parents fall short due to circumstances beyond their control. Some parents are neglectful or abusive. Whatever the reason, if a parent doesn't meet a child's needs during childhood then that child enters adulthood with significant emotional and psychological deficits.

So in normal psychological development, other people (i.e., parents) fulfill one's psychological and emotional needs. It is natural, then, for those whose needs have not been met by the time they reach adulthood to look for other people to fulfill them. To this end, they enter into relationships expecting others to fill the emptiness inside them. They are uncertain of themselves and look to others for validation and affirmation. They do not know how to love and appreciate themselves so they rely on others to give them love and appreciatiation. Inevitably there comes a time when they feel empty, unloved, unworthy, or unappreciated. They blame those people they'd expected to complete them and are left feeling disappointed or even betrayed.

They may continue their search for someone to meet their emotional needs. They will never find such a person; no such person exists. During childhood, our emotional and psychological needs are met by other people (i.e., parents); once adulthood arrives, the time for others to meet these needs has passed. The window of opportunity closes. A person must learn to provide for himself whatever needs have not been met by adulthood.

It's definitely harder this way. It is so much easier to get what we need while we're children. As adults, it is difficult to give ourselves what we did not get from our parents. It is difficult, but it's not impossible. In fact, this is often the work of therapy: learning to meet your own needs, to be your own person, and to love and accept yourself.

Existential Challenges

2014-05-14T07:05:00.000-04:00

We hear the term "existential crisis" thrown around in pop psychology fairly often. According to Urban Dictionary, an existential crisis is a deep, obsessive concern with unanswered questions about the meaning of life and existence. Existential psychology identifies four "existential challenges." These "ultimate concerns" are the "givens" of life. They are the fundamental truths that capture the essence of the human condition. Our lives are defined by how we respond to these challenges. A "crisis" occurs when we become overwhelmed by these truths and can no longer cope.

The four "human givens" we must all face are:

1. Death: The curse of human consciousness is an awareness of our eventual death. We must live while knowing we will die, yet not despair. We must love others with the knowledge that we will ultimately lose them. Even long life is a mixed blessing, as we gradually lose everyone who matters most.

Most of us use denial to cope with the inevitability of death. We refuse to think about it. We focus instead on staying healthy and living longer. As a society, we relegate death to certain places (e.g., hospitals), where we don't have to see it. Denial becomes less effective as we get older. At some point, we are forced to confront death, either our own or someone else's.

2. Meaning: Most of us are not content to simply exist; we need a purpose in life. "Why are we here?" We must each answer this question for ourselves. Your purpose might be different than mine. We can choose to spend ourlives however we see fit. Those who thrive devote their time to things they find meaningful. They feel fulfilled. Those who lack purpose find their lives meaningless. They tend to feel empty and lost.

3. Freedom: We each have the freedom of choice. We are free to make decisions about our lives and to determine our own paths. With freedom, however, comes responsibility. We are responsible for whatever choices we make. We cannot blame others when we are unhappy. If we want things to change then we have to change. Freedom can sometimes feel overwhelming. It can be tempting to ask others to make decisions for us and to hold them responsible for the outcomes. This too is a choice - a choice to hand over freedom and to allow others to control our destiny.

4. Isolation: We come into this world alone and that is how we leave it: alone. We can never completely share an experience with someone else; it is impossible for one person to know exactly how another feels. And yet, humans are innately social creatures. We long to connect with others. Every connection comes with the risk of being abandoned (which is inevitable - see number one). We are alone and yet we fear being alone. So we do things that make us feel less alone.

These four truths really do capture the essence of what it means to be human.

Tips for Dealing with Chronic Complainers

2014-05-07T07:05:00.000-04:00

Whiners, gripers, chronic complainers - we try to avoid them lest we get stuck listening to their latest litany of problems. Unfortunately, we don't always see them coming fast enough to get away. Or circumstances require that we interact with them for extended periods of time. Whatever the reason, sometimes we are forced to deal with people like this, no matter how unpleasant we may find their company.

So how do we avoid getting sucked in by their negativity? How do we keep their antagonistic attitude from bringing us down? Here are some suggestions:

1. Smile and nod. This is a tip I picked up during a training I attended a few years back. The key here is to remain silent. When a person starts ranting about what's wrong with the world, anything you say in response just adds fuel to the fire. If you listen quietly without feeding the flames the complainer eventually runs out of steam.

2. Model better behavior. In her book "Managing Difficult People," Marilyn Pincus recommends finding three positive things to say during every conversation you have with a complainer. Not only are you setting an example, accentuating the positive can protect you from becoming infected by the complainer's negative outlook.

3. Make a pre-emptive strike. Start a conversation before the complainer has a chance to say anything. Pick a topic - preferably something neutral - and start talking. That way, you get to decide what to talk about. Just be sure to steer the conversation away from whatever might be bothering the complainer today.

4. Agree and move on. Agree with the complaint. "Yeah, that does suck." Then change the subject.

5. Set firm limits. Set a limit on how long you're willing to listen. Give the complainer a few minutes to vent. Then say something like, "I don't mean to cut you off but I've got a lot of work to do."

6. Put the ball in their court. In "Complaining, Teasing, and Other Annoying Behaviors," Robin Kowalski recommends holding complainers accountable for finding their own solutions. Say something like, "Wow, that does sound tough. What are you going to do about it?"

7. Remain emotionally detached. When we are repeatedly exposed to another's complaints we may begin to consider the ways in which our own lives are lacking. Or we may become frustrated when our attempts to help a chronic complainer ultimately prove futile. Try to avoid becoming emotionally invested in the chronic complainer's problems. Remember, they are not your problems; do not take responsibility for them.

Complaining and Complainers

2014-04-30T08:04:00.000-04:00

All of us have probably met at least one chronic complainer. You know the type. He always has something negative to say. He's never satisfied. He's quick to find something he doesn't like in any given situation. He's not very pleasant to be around; he casts a dark cloud wherever he goes. Even the most compassionate of us has a point at which listening to the woes of others becomes emotionally depleting. Being around the chronic complainer is draining; he leaves us feeling exhausted. For this reason, we try to avoid him whenever possible.

Or maybe you've known someone who seems to complain about the same thing over and over again. She never does anything to change or improve the situation in question. She is quick to reject suggestions or advice. She seems completely uninterested in solving the problem yet she constantly complains about how unhappy it makes her. You eventually get sick of hearing about it. Her negativity and hopelessness are contagious. You become frustrated when your attempts to help are repeatedly rejected. Talking to her makes you feel bad. Understandably, you start avoiding her calls.

This kind of complaining has negative social consequences. Nobody wants to be around someone who complains all the time.

And yet complaining is pervasive, despite the negative social consequences. It stands to reason, then, that we must derive some benefit from it. Why else would we be willing to risk social ostracization?

As it turns out, there are actually a lot of good reasons to complain. On the most basic level, complaining allows us to express frustration and to receive validation from a sympathetic other. It enables us to discharge negative emotions, to "vent," or to "blow off steam." It has a cathartic effect. We feel better after complaining. In fact, research suggests that people who rarely complain have higher levels of depression than people who complain regularly.

Complaining also helps to avoid the consequences associated with holding emotions in. We need an outlet for our negative emotions. We have to have some way to express them. They don't simply go away if we choose not to deal with them. Feelings like frustration, anger, and resentment tend to fester. We ruminate on the object of our frustration, which only makes us angrier. These feelings eventually boil over and we lash out at whoever happens to be nearby.

Complaining is essential to maintaining healthy relationships. It is the means by which each person in the relationship expresses dissatisfaction or brings to light existing problems. Once problems are identified they can be addressed and ultimately resolved. This prevents the build up of resentment and other emotions known to be toxic to relationships.

So while complaining is beneficial and even healthy, in excess it becomes caustic. The problem is that most people who cross the threshold from healthy to excessive complaining are not aware of having done so. We rarely tell someone we are put off by his or her constant complaining; instead, we start trying to avoid him. I suppose one day the chronic complainer wakes up to find himself isolated and alone with no idea why. Ironically, this gives him something else to complain about...if he can find someone to listen.

Why we're so obsessed with work

2014-04-23T20:35:00.000-04:00

I recently read an article by Andrew Sullivan of The Dish called "America and the Protestant Work Ethic"
(http://dish.andrewsullivan.com/2014/02/06/america-and-the-protestant-work-ethic/). The article touches on a theme that's interested me for some time: the American obsession with work. My interest stems from an ongoing disagreement with my husband (who is a Jamaican immigrant). I've repeatedly complained about his obsession with making money. He insists we're poor, even when I produce evidence that our combined income places us firmly in the top 50% of American families. This isn't good enough, he tells me. So in addition to his day job, he does some photography on the side. He also buys various products, makes some improvements, and sells them for a profit. Initially he bought and sold photography equipment - cameras, lenses, lights, backdrops, etc. Lately, he's been buying and selling motorcycles and jet skis.

I have no problem with his extracurricular activities. I complain only when the number of jet skis and motorcycles residing in our back yard approaches maximum capacity. I then insist he sell some before buying any more.

My husband believes I too should take on some extracurricular projects for extra income. I have absolutely no desire to do this. And so, my husband complains about my lack of drive and ambition. "You don't care if we're poor," he accuses.

My husband may not be American but he has definitely bought into the "American dream." He came to the "land of opportunity" in order to prosper; that's exactly what he plans to do.

Which is why I so enjoyed Sullivan's article. Sullivan recognizes that to understand the American relationship with work one must look to its origins. Among the first European settlers in what is now the United States were religious minorities who sought a place to practice their faith without persecution. They were mostly Protestants of various denominations - Puritans, Quakers, Lutherans, Calvinists, Mennonites (Anabaptists), etc. - although there were also some Jewish and Catholic groups. Many of these religious groups abhorred luxury and extravagance, believing them symbols of sin, greed, and corruption.

For example, the "Rules of Discipline" from an early Quaker settlement in Philadelphia advises all followers to "keep out of the world's corrupt language, manners, vain and needless things and fashions, in apparel, buildings, and furniture of houses, some of which are immodest, indecent, and unbecoming." It further cautions them to "avoid immoderation in the use of lawful things, which though innocent in themselves, may thereby become hurtful; also such kinds of stuffs, colours and dress, as are calculated more to please a vain and wanton mind, than for real usefulness."

They believed a Godly life was one of simplicity: hard work, frequent prayer, good deeds, and modest behavior were key.

As the original settlements expanded and a fledgling nation emerged, these beliefs became embedded in the American psyche. A lot has changed in three hundred years. Americans abandoned simplicity as an ideal long ago. We are no longer a pious nation; our faith in God has been replaced with faith in capitalism, consumerism, and a free market economy. As a people we have become less communal and more self-centered. While we have discarded most of the values espoused by those early settlers, the "Protestant work ethic" remains an integral part of American culture today.

The Protestant work ethic was first introduced by Protestant theologian John Calvin. According to Calvin, everyone must work because hard work is the will of God. Today, this basic principle is reflected in the widely held beliefs that hard work leads to success and that the harder you work the more successful you will be. It also lies at the very heart of the American dream: "freedom includes the opportunity for prosperity and success, and upward social mobility and can be achieved through hard work" (http://en.wikipedia.org/wiki/American_Dream). This same creed explains America's widespread enmity towards recipients of "welfare" and other public assistance programs. If hard work begets success then people who are not successful must not be working hard enough. And those who are least successful must be downright lazy.

Never mind that the wealthiest Americans are not necessarily the hardest working ones. Never mind that outside economic and social forces can leave destitute people who have worked hard their entire lives. Never mind that the American economy doesn't even have enough jobs to employ every able bodied American adult.

Americans hold dear the value of hard work. It is acceptable to neglect all other aspects of life in the name of work. It is, in fact, a noble sacrifice. We will never be criticized for devoting ourselves to work; people will respect us for it. Of course this has consequences. Our lives lack balance. We aren't happy. We feel lost and unfulfilled.

But Sullivan thinks things may be changing. He argues that current economic realities are challenging our Protestant work ethic. I'm not convinced this is the case. Cultural change is extremely difficult. But if, as Sullivan asserts, things are changing then I for one say it's long overdue.

The past in the present - memory in the body

2014-04-15T08:47:00.000-04:00

Our bodies remember everything we experience, even events for which we have no conscious recollection. Most of us have no overt memories of our lives prior to age four or five. Yet abuse, neglect, and other forms of trauma experienced by children younger than five can have a profound negative impact that lasts an entire lifetime. Over the years, I've worked with a number of adult patients who were abused as young children. Those whose abuse happened when they were three or four years old typically have no memory of the abuse. Nevertheless, they report symptoms associated with the abuse, such as difficulty with intimate and/or sexual relationships, low self esteem, emotional instability, anxiety, anger, agression, and depression.

Maurice Merleau-Ponty was among the first to attribute this phenomenon to body or somatic memory. He believed that the body stores memory that is implicit but not necessarally unconscious. Rather, body (or somatic) memory is manifested through things like behavioral patterns, situations a person avoids without noticing, opportunities not seized or perhaps not even recognized ("blind spots"), predispositions, attitudes, tendencies, and personal boundaries. Somatic memory is sometimes tied to a specific event, particularly a traumatic one. Most often, however, the "habit structures" of somatic memory result from an accumulation of past experiences.

Somatic memory is tyipcally beneficial (see my post from last week). Sometimes, however, the memories stored in the body lead to patterns of behavior that are problematic or even self destructive.

Traumatic events are not encoded into memory the way other experiences are. Instead, past trauma remains present as a way of being that is imprinted on the body. This imprint is experienced as a predisposition to react with fear and anxiety and an oversensitivity to situations that are in some way similar to the trauma. The trauma "memory" is not "remembered" as an event that took place in the past. Rather, it is experienced physically and emotionally as if the threat exists now, in the present moment.

Kurt Lewin talks about somatic memory being present in our "life space" or "lived space." We literally act out the past in the space we inhabit. This explains why we so often repeat the same destructive patterns of behavior again and again. We may know these behaviors are damaging and make a conscious effort to change them, yet continue to do them and to suffer the consequences. Freud called this the "repetition compulsion." According to Freud, if a person represses, surpresses, or otherwise does not remember past trauma he is likely to repeat it by acting it out, typically without being aware of it. This is his way of remembering.

My purpose in all of this is to stress that psychotherapy should not ignore the physical and physiological aspects of experience. The body plays an important role in maintaining symptoms and can thus be an avenue for intervention. In fact, many people are unable to engage in other treatment modalities until the distress associated with their physical experience of certain symptoms is mediated. These are usually the "sickest" patients, the ones who don't respond to the most commonly used treatment methods. In my clinic, we say these patients need "glue" to hold them together; our job is to provide this glue.

Medication, babies, and such

2014-04-08T09:05:00.002-04:00

I know I promised to write about somatic memory this week. I've actually started on that post and I will make sure to put it up next week. Currently, I'm dealing with some medication issues though and I'm a bit distracted. So I thought I'd talk about that. (It's funny, I feel I can share things on the internet that I wouldn't necessarilly share in "real life").

I've been taking an antidepressant since I was 18. It's not really a big deal. I hardly ever think about it. I go to the doctor every few months for a refill, take a pill in the morning with my other medication, and that's it. I had to try a few different medications initially before I found one that worked. That period of trial and error was difficult. It was so long ago, however, that I remember it only vaguely. I eventually landed on something that helped and that was that. End of story.

I've always been of the opinion that if something works you should leave it alone. Why mess with a good thing? Thus, I have never thought to stop taking the antidepressant. For the most part I've felt fine and my mood has been stable (with the normal ups and downs, of course). Why change anything?

Until now. I'm currently "trying" to get pregnant (with my husband's cooperation of course). My doctor told me that the antidepressant I've been taking should not be taken while pregnant or trying to get pregnant. Not to worry though, she tells me. I should be able to replace it with a safer medication without any problem. I just stop taking the one and start taking the other. No big deal.

Except it didn't work out that way. The first couple of days were fine. I stopped one medication and started the other. On the morning of day three I felt nauseous. By the time I got to work I was having tremors. My brain felt confused and agitated. About a year ago, I ran out of medication for a couple of days because the pharmacy had to order it. I started having withdrawals. It felt exactly like I was feeling now. Ugh.

I would go back to the doctor but unfortunately, she relocated. She gave me several refills so I thought I'd have a few months to find a new doctor. Now I'm scrambling to find one. And I don't feel good.

I was recently asked if my husband and I are actively trying for a baby or if we're just not not trying. "Aren't they the same thing?" I replied, apparently revealing my ignorance. At the time we weren't in any rush. I've had several friends who stressed and obsessed about getting pregnant and I didn't want to do that. I am now rethinking my position. Maybe we need to try harder.

Somatic Memory

2014-04-01T09:30:00.001-04:00

Memory is a funny thing. We rely on memory to provide us with an accurate recollection of past events. Memory gives us quick access to critical information. It enables learning and facilitataes mastery of certain tasks and processes. Any perceived decline in one's memory elicits worry and fear. I cannot tell you how many patients have come to me distressed about impaired memory. People tend to assume that increasing forgetfulness is a precursor to overall cognitive decline, ultimately resulting in Alzheimer's or some other form of dementia.

I suspect that on some level, the fear of losing one's memory triggers a fear of losing one's very self. After all, memory is essential to maintaining identity. When I awaken each morning it is memory that gives me the sense of being the same person that went to sleep the night before (Shusterman, 2011). It is memory that gives me a past, a history of experiences that have shaped who I am. I cannot know who I am if I don't know who I was. Without memory, I would be forced to reinvent myself from one moment to the next. Imagine the energy and resources this would require! There would be little left over for anything else!

Most people associate memory with mind. We see memory as a cognitive or mental phenomenon that is regulated by the brain. It is true that the mechanisms governing memory are physically located in the brain. The brain, however, does not exist in a vacuum. There are networks in the brain that extend throughout the entire body. This means that most of what happens in the brain does not stay confined there. Rather, mental processes affect and influence the entire organism. Memory is no exception.

Memories of past events often consist of mental images and accompanying narratives. When we recall a particular experience we remember what happened first, what took place next, and what happened last. We simultaneously visualize the event in our mind's eye.

Memory, however, is not just a mental phenomenon; it is also a physical one. The body has its own way of remembering that may or may not be linked to recollection of a specific event. Physical or somatic memories are stored in the body's cells and molecules.. Memory traces can even reside in our body's tissues and organs.

Somatic memories are mostly implicit; they occur outside of conscious awareness and have no verbal component. They emerge as acquired skills, behavioral habits, emotional responses, instinctual reactions, and intuition. That "bad feeling" I get about my new coworker -- that's somatic memory. It's somatic memory that enables me to drive home on "autopilot" and remember nothing about the trip. I use somatic memory when I play my favorite tune on the piano; I know it so well the notes glide off my fingertips without any effort. Somatic memory is in play when a person or place "feels" familiar to me. Somatic memory is also one of several vital components of personal identity; it's the part that "feels" like me from one day to the next.

Somatic memory is an ever-present force acting behind the scenes in virtually all aspects of life. Because it is implicit, we are not aware of its central role in our day to day experiences. Sometimes, however, disruptions in somatic memory create problems that are difficult to ignore.

I've decided to stop here to prevent this post from becoming too lengthy. I'll continue where I left off in my next post.

The body's role in healing emotional pain

2014-03-25T10:44:00.000-04:00

Although we talked a lot in college about the "bio-psycho-social" approach to treatment, most of the focus was on the "psycho" and "social" components. In college I learned that, as a process, therapy is emotional, psychological, and interpersonal; there is nothing physical about it.   There was a lot of discussion about emotions but never any mention of how emotions are actually experienced. I only later learned that at their core, emotions are physical experiences. They are literally felt on a physical level. And yet not once during my formal education and training was this discussed. Instead, we talked about emotions as if they exist in our minds.

Most of my patients are people who have experienced trauma in one form or another. It turns out that physical experience is especially important to the coneptualization of posttraumatic stress disorder and other trauma related syndromes. Most of my patients are plagued by intrusive memories of past trauma and have extreme physical reactions to anything associated with their traumatic experiences. Some of my patients have panic attacks, which are defined by a variety of unpleasant physical sensations to include heart palpitations, sweating, trembling, chest tightening, shortness of breath, nausea, dizziness, tingling, chills, etc. Almost all of my patients complain of being hyper-alert and physically unable to relax. So while my patients may come to me for help with psychological or emotional problems, their difficulties are also very physical in nature.

When exposed to a life-threatening event, we automatically enter "survival mode;" our brains instinctively activate the "fight or flight" response by stimulating the autonomic nervous system. This activation creates a number of physiological changes in the body. Some of these changes include increased heart and lung action, inhibition of stomach and upper intestinal tract so that digestion slows or stops, constriction or dilation of blood vessels, pupil dilation, relaxation of bladder, inhibition of salivation, increased blood flow to the muscles, increased muscle tension, and increased blood pressure. The purpose of the "fight or flight" response is to provide the body with increased strength and speed in preparation for fighting or fleeing. Once the fight or flight system is triggered, the body feels compelled to do one or the other - either fight or flee. If neither response is possible in a given situation, the fight or flight system becomes overwhelmed. The result, according to Herman, is that, "each component of the ordinary response to danger...tends to persist in an altered and exaggerated state long after the actual danger is over." This explains the physiological symptoms experienced by people with posttraumatic stress.

There is a growing body of research suggesting that unresolved physical reactions associated with trauma must be identified and experienced physically for healing to occur. This is particularly true for people who experience their physical sensations as intolerable and overwhelming. This describes a lot of my patients.

I would therefore like to incorporate aspects of physical experience into my work with patients on a regular basis.  Thus far I have only managed to do this in a few small ways. When talking about emotions, for example, I ask patients to describe the physiological sensations associated with various feelings. Sometimes I ask patients to identify where in their bodies they feel a particular emotion. Patients frequently describe these requests as strange or odd. Most have never thought of emotions as phsycial sensations taking place in the body. I suspect this is the case not only for my patients but for most people in general.

I suspect there are a lot of people who are not particularly comfortable inside their bodies. How often do most of us tune in to our internal body sensations? We live in our bodies yet we rarely listen to them. Experience tells me this is particularly true for men, who are often socialized to believe that displays of emotion are not masculine.

To be honest, "body centered" psychotherapy has always seemed too "touchy feely" for my taste. I've heard colleagues describe it as "hokey" and "froo froo."  Some clinicians don't see it as "real" therapy.

Every therapist has his or her own personal "style" of therapy. Whether or not we adopt an unfamiliar technique depends a lot on how well it fits with our pre-existing therapy style. We choose techniques that feel natural to us. It's easy, however, to become too comfortable.  When a clinician considers a new technique the primary concern should be potential patient benefit. If a certain tool or technique might be useful we should try it, even if it makes us uncomfortable. And so, in the coming weeks I hope to step outside of my comfort zone a little bit. I'll let you know how it goes.

Feel Good Moment

2014-03-18T07:18:00.000-04:00

One of the primary reasons I went into the mental health field was to help people, yet there were times early on when I wasn't sure I was accomplishing this goal. I used to spend a lot of time worrying about this. I worried about it so much, in fact, that it became a distraction. I began to dread seeing those patients who didn't seem to improve. They made me feel helpless and ineffective. I eventually started to dread going to work altogether. I didn't want to see patients at all anymore.

I considered a career change. In search of guidance, I even completed a few online career assessments. To my chagrin, every assessment suggested "therapist," "counselor," or "social worker" as good career choices for me.

I became depressed. I hated my job but felt I'd invested too much in my education and training to do anything else. And honestly, I couldn't think of anything else I wanted to do. I started counting the years until retirement but that made me even more depressed: I had at least forty years to go. How was I going to make it?

And so obviously something had to give. I did a lot of soul-searching, a lot of reading, and some self-help exercises. At some point it occurred to me to stop pressuring myself to "make people better" and instead try to focus on just being present with my patients. I decided to simply do the best I could with patients, regardless of the outcome. I made a sincere effort not to take it personally when a patient didn't improve. "You can't help everyone," I told myself. "Just do the best you can."

Work became more tolerable as a result of these changes. I learned to accept that there will always be patients who don't get better. There are lots of reasons for this, many of which have nothing to do with my ability as a therapist.

Now fast forward. I am nine years into my career. As a therapist, I am more genuine and more engaged with my patients than I was early on. I don't spend much time thinking about how helpful I am...it's a slippery slope and I don't want to start sliding. I just do my job the best I can and hope some people benefit from it.

Last week, I had a very rewarding experience. Our clinic runs a two week therapy group for active duty service members who have experienced some sort of combat trauma. A former patient of mine sometimes speaks to the group about his own experiences with trauma and its aftermath. I know he does this but I've never had the chance to sit in on one of these talks. Last week the opportunity arose.

My patient walked to the front of the room and introduced himself. He then turned and pointed at me. "The reason I'm here today is because of that woman right there." I was a little embarrassed when everyone turned to look at me. My patient continued. He talked about being in Afghanistan and about the difficulties he encountered there. He talked about coming back home and the problems he started having. He related his attempts to seek help, the first of which was disheartening. Finally, he talked about coming to our clinic and starting therapy with me.

My patient shared what he learned in therapy and identified what he found most helpful. He shared things I'd said and insights he'd achieved as a result. He seemed to remember everything we'd ever discussed. I, on the other hand, had forgotten what we'd talked about until I heard him speak.

It's not that I don't think about patients after they've moved on from therapy. Often I recall a specific patient and think to myself, "I wonder how he/she is doing now." I have never, however, remembered a patient and thought, "Wow, I really did a great job helping him/her." It's just not something I do, primarily for the reasons I mentioned earlier. When my former patient talked about the work we did in therapy it was almost like he was talking about some other therapist. It wasn't until later that I said to myself, "He was talking about me. I did that." And it felt really good to know that I helped.

Defensiveness and Blame in Conflict

2014-03-11T07:15:00.002-04:00

Over the past couple of months I've expressed frustration about how conflict is handled in my marriage. Specifically, I've said I feel like I automatically get blamed when something goes wrong. I started doing some research because I wanted advice on how to deal with this effectively. I wanted my husband and I to learn to resolve conflict constructively.

Unfortunately, I didn't find the kind of advice I was looking for. While a lot of research has been done on conflict there was very little about how to respond to being verbally attacked and blamed. I did, however, discover a few helpful tips: Avoid responding to negative emotion with negative emotion; this only escalates the conflict. Express empathy (e.g., "I can see you are feeling hurt and angry"). And above all, try to remain calm.

This is good advice but it seems to be asking a lot. It is very difficult to remain calm when someone you love criticizes your very character and blames you for problems you didn't cause. When attacked, most people automatically become defensive.  We quite naturally want to protect ourselves. A range of emotions are triggered, from fear to sadness to anger. In the face of this emotional torrent, rational thought and clear reasoning are severely compromised.

Not that I'm a complete hothead. There have been times my husband blamed or criticized me that I initially remained calm. In what seemed like a calm (but firm) voice I have replied, "Please stop blaming me." I said things like, "It doesn't matter whose fault it is," "If one of us 'wins' the other loses. That means the relationship loses," and "Let's focus on solving the problem, not on blaming each other." My composure gradually evaporated, however, when my attempts were met with continued blame and criticism.

It occurred to me that it might be easier to remain calm and express empathy if I could understand what was motivating my husband's behavior. You see, my husband is essentially a good man so I assumed his intent was not malicious. Maybe there was some underlying reason for his hostility during conflict.

And so I set out to learn about "conflict behaviors." My initial findings reinforced what I already knew: defensiveness and hostility during conflict is associated with high levels of "marital distress" and increased likelihood of divorce.  Nobody had to tell me this.  Each time a conflict went unresolved I felt a little more hopeless than the time before.  A sense of distance arose in my marriage that had not been there before.  For a marriage to work there must be away to resolve conflict.

I then learned that "aggressive denial of responsibility" (e.g., criticism, blaming) is employed most frequently by people with fragile and/or unstable self-esteem. I read about "contingent" self-esteem, whereby one's sense of self-worth is dependent upon maintaining certain self-imposed standards. (What if those standards include "always being right" or "never losing an argument?" If that were the case I was completely screwed)!

"Conflict behavior" is also related to "attachment style."  Briefly, attachment style as a concept comes from attachment theory. Attachment theory states that an infant's relationship with his primary caregiver becomes a template for his interpersonal relationships throughout life.  A healthy, secure infant-caregiver relationship facilitates "normal" social and emotional development. Problems in the infant-caregiver relationship disrupt social and emotional development. Inconsistent availability and/or responsiveness to infant needs by the caregiver leads to the development of an anxious or ambivalent attachment style. The defining feature of this attachment style is anxiety over abandonment. Adults with an anxious/ambivalent attachment style have a higher tendency than others to display hostility during conflict, to include the use of blaming, threatening, and other verbal aggression. When compared to adults with secure attachment, they show greater attempts to dominate conflict discussion.

My research led me to a tentative conclusion: "defensive hostility," "criticism," "aggressive denial of responsibility," and similar "conflict escalating behaviors" stem from underlying insecurities. (Incidentally, none of the research seems to suggest such behaviors stem primarily from "being an asshole." So that's good news). It is not immediately clear to me how to use this information. Assuming my conclusion is accurate, my husband is unlikely to ever acknowledge said insecurities, perhaps not even to himself. But perhaps just being aware will arouse my compassion in the midst of conflict. Maybe seeing criticism as motivated by fear and anxiety will help me to take it less personally.

Getting Offended

2014-03-04T09:17:00.000-05:00

I am not a fan of meetings. They always seem to drag on forever. Conversation tends to stray from the intended topic. I do okay if I have something to read or a crossword puzzle to do. This doesn't work very well in small group meetings, however. When there are only four or five people in the room it's harder to hide the fact that you're doing something completely unrelated and are not paying attention to what's being said. In these types of meetings I end up talking too much in an effort to stay engaged.

It's always been difficult for me to just sit quietly and listen to someone talk for extended periods of time. You may recall that I have narcolepsy; extended periods of inactivity tend to put me to sleep, literally. In college, I used to read and take notes during lectures. It was actually easier for me to pay attention when I was simultaneously engaged in doing something else than it was for me to give my "undivided" attention.

Because I can't avoid meetings (which would definitely be my preference if given a choice) I try to cope with them the best I can. Since the strategy for paying attention I used in college worked well for me I naturally continued to use it when I joined the workforce. Unfortunately, this caused a lot of problems when I first started at my current job. My supervisor at the time made comments to others about how disrespectful it was of me to read during meetings and presentations. It was obvious to me (and to a lot of other people) that my supervisor did not like me very much. It wasn't until the comments he'd made got back to me that I understood why.

I decided it was in my best interest for my supervisor to like me. I started going out of my way to show I was paying attention in meetings. I participated and contributed way more than I wanted to. But it seemd to work. Over time, my supervisor gradually warmed up to me.

Something about me ...When I get excited about something (which isn't very often) I have a tendency to go overboard. I keep talking about it when I know I should shut up. I realize this is a personal flaw but I have a very difficult time controlling it. This sometimes happens in meetings at work. Because I feel compelled to engage (as I mentioned before) I go out of my way to participate in discussions. Occasionally something interesting comes up and I get excited about it. Because I'm excited I keep talking about it far longer than necessary. I'm sure this annoys people; it annoys me. On the other hand, everyone has flaws. Most of my coworkers know me well enough to realize my intentions are good.

But apparently this is not always the case. The other day my boss (not the same supervisor I mentioned earlier) came to my office. (I absolutely hate it when this happens because it's never a good thing). She wanted to tell me that one of my colleagues who'd attended a meeting the week before was very upset because I'd interrupted him. She was of the opinion that he could have easily handled the problem at the meeting by simply telling me to let him finish speaking. She didn't understand why he felt the need to complain to someone else (who then went to her for feedback). Nevertheless, she advised me to be mindful of this in the future.

I checked my email later that day. I noticed I'd received an email from the colleague who had complained about me. I opened it. The email was brief. He wanted to talk to me about "something that happened at the meeting last week" and wanted to know when I would be available.

At this point I was annoyed. Okay, so maybe I was already a little annoyed but now I was irritated. It seemed far too much was being made over a very minor incident. This guy's complaint had already gotten me scolded by my boss. Now I had to schedule a time for him to call and chastise me?

I didn't respond right away. Actually, I considered not responding at all. The more I thought about it the more pissed off I became. My mind went back and forth with itself. Was I being too defensive? Was I just upset because I'd been criticized? I know I don't like criticism -- nodbody does. But I make a conscious effort to try to accept it when it's warranted, no matter how defensive I feel.

Honestly though, I wasn't even sure it was the criticism itself I was upset about. Okay, so I interuppted him. I know I have a habit of doing this when I get excited. I know it's a problem. It might sting a little to have someone else point it out but it's probably the best thing to help me break the habit.

The thing is, the guy who complained hadn't pointed it out to me. Instead, the chain of events went something like this: 1. I unintentionally offend a colleague at a meeting. I do not know I have offended him. He says nothing about being offended. 2. He apparently pulls my coworker aside after the meeting. He tells her he is offended. He says if I am going to interrupt him then he is not going to come to the meetings anymore. He asks her to speak to me about it. 3. My coworker doesn't feel comfortable speaking to me about it. Instead, she goes to our boss for advice. My boss says she should advise the offended colleague to simply tell me he was offended. She was sure I didn't mean to offend him and would promptly apologize for doing so. 4. My coworker communicates this message to the offended colleague. 5. In the meantime, my boss comes in to my office to talk to me about another issue. She also mentions that a colleague was offended that I'd interrupted him. She asked me to be mindful of this in the future. I say okay. 6. The offended colleague receives the feedback advising him to address his concern with me himself. He sends me an email to schedule a time to talk about "something that happened in the meeting last week." You know the rest.

I was convinced that my offended colleague had not handled the situation correctly. There are a lot of un-offensive, socially acceptable ways to say, "Please don't interrupt me" or "Please let me finish speaking." If he'd said something, I probably would have apologized right then and shut up. No big deal. Still, I wasn't sure if this was a valid reason for me to be upset.

I ended up seeking advice from a trusted coworker. She agreed that the whole thing had been blown way out of proportion. She suggested I reply to the offended colleague's email telling him my boss had already spoken to me about the issue and apologizing for interrupting him. So that's exactly what I did.

He emailed a response. He accepted my apology. He also suggested that, in the future, I don't give any feedback unless someone asks for it. Ha!

Lying Liars: Normal versus Pathological Liars

2014-02-25T10:20:00.001-05:00

I have a strong aversion to habitual liars. I'm talking about people who make up stories about the places they've been, the things they've done, and the feats they've accomplished. These are people who lie about stupid things - for example, they tell you they grew up in Seattle when they've never seen the West Coast. I don't like having to dig for the truth when I talk to someone. I don't like having to view everything someone tells me with suspicion. And most of all, I don't like being lied to. Discovering you've been deceived is painful. You feel angry, hurt, and betrayed. You feel embarassed about being played for a fool. You second guess yourself and your judgment.

But are habitual liars - pathological liars - all that different from the rest of us? Everyone lies. We may, as a society, condemn lying. We may say we value honesty. And maybe we do. But we still lie.

Apparently, lying is normal. We all do it and most of us do it quite frequently. Studies have shown that the average adult tells at least one lie per day. Mostly we lie to benefit ourselves (according to DePaulo, Kashy, Kirkendol, Wyer, and Epstein). We lie to enhance our reputations, to avoid undesirable consequences, or to gain an edge over others. Perhaps this is a natural consequence of individualism. If the needs of the individual are primary then anything that benefits the individual over the group is useful. Since lying often gives the individual an advantage over the whole, the individual sees lying as acceptable, or at least justifiable.

While most of our lies are self-centered, we also lie to benefit others. We do this mostly to spare the feelings of people we love ("That dress looks great on you," "This dinner you made is delicious," "I love the gift you gave me"). When we lie about our feelings we generally do so to benefit others and typically pretend to feel more positively than we actually do.

Saxe points out that lying is often situationally determined. Circumstances that increase the likelihood of lying include those in which the risk of getting caught lying is low, the potential benefits of lying are high, and the potential consequences of being honest are severe.

So if lying is such a widespread practice, at what point does it become "pathological?" Dike explains the difference between "normal" and "pathological" lying. Oridnary lying is goal directed; it is done for a specific purpose with a desired outcome in mind. Pathological lying has no identifiable purpose or, if it does, the lie is extremely disproportional to the benefit expected to be gained. Sometimes the lies are even damaging to the person telling them. For a pathological liar the benefit is psychological; lying in itself is rewarding.

What kind of person enjoys telling lies? Bursten suggests those with a "manipulative personality." According to Bursten, someone with a manipulative personality has a fragile self-image. He attempts to bolster this image by proving to himself that he is "better" than others. By telling lies and getting away with them, he gains a sense of power over those he deceives. He feels a level of contempt for his victims for lacking the ability to detect his deception. This enables him to feel superior.

Before we judge the pathological liar too harshly we should first consider the following. Pathological liars may not be able to control their lying. Some experts suspect lying is compulsive for the pathological liar. He lies in spite of himself; he cannot help it.

There may also be something different about the brains of pathological liars. Several studies have demonstrated a relationship between pathological lying and increaed white matter in the prefrontal cortex.

So what have I learned about pathological liars? Mostly I've learned that we don't know much. There is a lack of consensus among experts about how even to define the term "pathological liar." We don't know if pathological lying is a disorder unto itself or if it exists only as a symptom of other disorders. We aren't sure how much, if any, control pathological liars have over their lying. We don't even know if pathological liars always know they are lying!

What I do know is my own preference, which is to be lied to as rarely as possible.

We can't handle the truth! Self deception and why we lie to ourselves

2014-02-19T13:05:00.001-05:00

We all lie to ourselves. Some of us do it more than others but all of us do it. There are obvious disadvantages to self deception. When we deceive ourselves about the nature of reality we are ill-equipped to cope with the problems reality presents.  We can't deal with a reality we don't know exists. This makes us vulnerable to threats we don't see until it is too late. We are more likely to be blindsided by misfortune for which we could have prepared if we'd been more honest with ourselves.  When extreme, self deception becomes obvious to others, who respond with anything from pity to ridicule. And yet, despite these disadvantages, we all engage in self deception.

So why do we do it? The most widely accepted theory is that - in certain circumstances - self deception serves a protective function. For example, self deception can preserve confidence and self esteem in the face of failure. In the aftermath of tragedy or trauma, self deception can preserve a sense of safety and security we need to move forward. Self deception can motivate us to persevere when the odds are against us. Self deception can help us endure hardship and maintain hope for the future. When the truth is too much to bear we lie to ourselves instead.

On the surface, self deception seems like a paradox. I'll explain. Technically, deception is an intentional act. If I do something intentionally then by definition I am aware that I am doing it.  To deceive myself is to intentionally tell myself something that is not true. But if I do this intentionally then I must be aware I am doing it. If I know I am telling myself a lie then don't I also know the truth? And if I know the truth then I haven't really deceived myself, right?

The question, then, is how can someone lie to himself and not know it? To my surprise, there are actually a number of ways this can happen. One method involves information processing and attention. A person can deceive himself by encoding only desirable or welcome information into memory while preventing unwelcome or undesirable information from being encoded. This is essentially a matter of "selective attention," i.e. paying attention to certain aspects of available information while ignoring the rest. This can be done on a conscious level, an unconscious level, or somewhere in between; we may or may not be fully aware of what we're doing.

Another method of self deception is through avoidance. I can keep myself uninformed of information or truths I do not want to know by avoiding activities, situations, or circumstances that might reveal them to me.  For example, a wife can avoid discovering her husband's affair by not calling him at work when he claims to be working late. If she did call his work she would be told he'd left hours ago. But she doesn't call because she doesn't want to know.

Self deception can also occur via biased interpretation. Imagine I am presented with a large amount of information, some of which confirms my stance on a particular subject and some that contradicts it. I accept the information that affirms my stance as empirically valid. I decide the information contradicting my stance comes from an unreliable source and is therefore not valid. I may reach this conclusions even if all of the information comes from the same source. Self deception does not necessarally follow the rules of logic.

I'll end with a couple of principles of self deception:
*People do not tell themselves the whole truth if a partial truth is preferable.
*In self deception, people tend to be motivated by what they want to be true.

A "Good" Apology

2014-02-12T10:23:00.000-05:00

Dov Seidman nostalgically recalls a time when apologies really meant something. These days, he believes apology has become a sort of theater. This is particularly true for public figures, whose apologies more and more frequently seem like performances rather than genuine expressions of remorse. Seidman contends that the behavior of public figures simply reflects a broader societal norm. According to Seidman, people today use apologies as a "verbal escape route" or a way to "get out of jail cheaply." This trend has so cheapened the apology that it has become all but meaningless.

And so Dov Seidman, together with Andrew Ross Sorkin, have started a campaign to draw attention to the current "aplogy crisis." Their project is called "Apology Watch" and can be found at nytimes.com/dealbook. and on Twitter under the hashtage #ApologyWatch. Seidman and Sorkin are asking readers to help them track new public apologies in real time. The plan is to rate each apology on its level of overall sincerity.

I first heard about Apology Watch on NPR. I was immediately intrigued at the idea. As I do with most things that spark my interest, I decided to do a little research on the topic. While the focus of Apology Watch is primarily on people in the public arena, I am personally more interested in the function of apologies in interpersonal relationships. Still, I hoped that some of Seidman's ideas might be applicable on both the large and small scale.

Seidman believes that the sincerity of a given apology can be measured not so much by its content but by what comes both before and after it. Before issuing an apology, Seidman contends, an offender should take the time to do some soul searching. A good apology first requires a period of introspection.

An example of this, Seidman says, is the 2011 apology made by Netflix CEO Reed Hastings for raising subscription rates. The rate increase sparked an immediate backlash from consumers, who cancelled their subscriptions in droves. Stock prices fell over 7% in the weeks after the decision was announced. Two months after implementing the rate increase CEO Hastings issued an apology and restored prices to their original level. Hastings' apology was good, explains Seidman, because it began with "a complete vulnerable revelation" (i.e., success had made him arrogant and that this arrogance motivated his decision to raise prices). Seidman believes that Hastings could only have come to this realization by looking inside himself and being honest about what he found (i.e., introspection).

Seidman's suggestion, then, is that before issuing an apology an offender should take a complete moral inventory of himself. Ken Blanchard and Margaret McBride suggest an offender ask himself the following:

*What mistakes did I make?
*Did I dismiss the feelings, wishes, or ideas of another person?
*Why did I do this?
*Was it an impulsive thoughtless behavior?
*Or was it calcualted?
*Did I act out of fear, anger, or frustration?
*What was my motivation?
*How long did I let this go on? Has this behavior become a repeated pattern in my life?
*What truth am I not dealing with?
*Am I better than this behavior?

So according to Seidman, a period of introspection, self-examination, etc. should be undertaken before offering an apology. There are also certain things that should come after a genuine apology.

Seidman states that a genuine apology must be followed by intentional and sustained changes in behavior. If an apology is sincere, the person apologizing immediately begins to take action to repair, mitigate, or at least atone for whatever damage he has caused.

So often people want forgiveness but are unwilling to accept the consequences of their actions. Saying I'm sorry does not immediately restore trust once it has been betrayed; the restoration of trust takes time. The victim of a betrayal may need the offender to take certain steps to demonstrate his trustworthiness, above and beyond what would otherwise be expected. The offending party does not get to dictate what measures are "reasonable" or how much time it should take before trust is regained. If he is genuinely sorry and truly wants forgiveness he must be willling to do whatever it takes for however long it takes. These are the consequences of his actions. Aplogizing does not exempt him from these consequences.

This is something Seidman does not mention in his writing but that I think is relevant. Perhaps we, as a society, let people off too easily. Maybe we are too willing to forgive and forget once a public figure apologizes for bad behavior. A movie star does something appalling; we still watch his movies. A CEO takes advantage of his customers; we still buy his products or services. A company abuses its employees; we continue to shop there. A chemical company dumps toxins in the water supply? A slap on the wrist and a license to keep operating. We no longer hold anyone accountable. We're probably lucky that people bother to apologize at all.

Rigid Personality

2014-02-05T10:48:00.001-05:00

My husband says I'm inflexible. He's not the first person to tell me this. I don't deny it. I have a strong preference for structure over chaos. It takes me a while to adjust to big changes. I am easily stressed out, even over small things. I like my space to be clean (or at least tidy). Messiness makes me feel like the room is closing in on me.

If something needs to be done I prefer to go ahead and do it as soon as possible; I rarely procrastinate. I like to plan activities and/or events in advance. I don't like spur of the moment invitations and will typically decline them. I am very attached to my routines. If there is somewhere I've planned to go at a particular time or something I do regularly on certain days I generally resist any attempts by other people to intefere.

So no, I am not particularly flexible. I can bend and I do bend, but only under a limited number of extenuating circumstances.

I admit that I can be too "rigid" at times. This sometimes leads to negative consequences. As I said before, I get stressed out a lot. I'm not always anxious but I do struggle with anxiety. I am stubborn to a fault. I become irritable and unpleasant when I feel overwhelmed.

My husband highlights these consequences and insists that I change. I'm too rigid, he says. I won't listen to reason. (I completely disagree with the latter sentiment. I do listen to reason. It's just that I do not always find his "reason" compelling. I listen to it and then I disagree. I have a right to disagree. It doesn't mean I'm unreasonable).

While I disagree with the crux of my husband's argument, buried within it lies a valid point. I can be too rigid.

And yet this very same quality bestows so many benefits. I am consistent, steady, and reliable. I get things done. I am responsible. I am conscientious. I am predictable. This may not make me the most exciting person in the world but I'm okay with that. People know what to expect from me; there is something comforting about that. I finish what I start; I follow through with committments. Because of this I have, for example, no difficulty exercising regularly and maintaining healthy eating habits. In fact, I don't really have a problem maintaing any positive habit, once it becomes a habit. I'm good at habits. Habits are my thing.

It is difficult for me to know where to draw the line. Yes I'm a bit rigid but to a certain degree this works well for me. It enables me to structure my life in a way that ensures I have time to devote to every important person, activity, event, and/or obligation. I realize, however, that being too rigid creates problems. Sometimes I refuse to budge, even when I know I'm making things more difficult than they have to be. There is definitely room for improvement.

When it comes to my marriage, I know that trying to be more flexible will decrease conflict and increase harmony. I also believe, however, that a great deal of benefit would come from my husband putting effort into trying to understand and accept me as I am, for who I am, instead of wanting me to be a different "type" or "kind" of person. (And that goes both ways, of course, i.e., me learning to accept him as he is). I am open to self-improvement but I can't be a different person. I don't want to be a different person. And I don't want anyone to pressure me into being anyone other than myself. If I say to my husband, "This is who I am. Please try to accept me," am I just being rigid and obstinate? I am confused at this point about whether I should be working on changing myself or encouraging him to to accept me as I am...

Blaming yourself when bad things happen

2014-01-30T07:32:00.001-05:00

I've talked before about the role of self-blame in maintaining depression. As I've read more on this topic I discvoered that self-blame is not always associated with depression. (I guess I don't really see those people who blame themselves but aren't depressed. They don't tend to need therapy). Based on personal experience, it seems like self-blame often provides people with a greater sense of control. If I did something wrong that caused something bad to happen then all I have to do to keep it from happening again in the future is to change my own behavior. For many of my patients, gaining this sense of control decreases anxiety but also causes a lot of guilt which, over time, leads to depression.

According to the research literature, however, this type of self-blame should not lead to depression. Peterson, Schwartz, and Seligman explain that attributing a negative event to one's own behavior increases perceived controllability (as I said before) and creates the sense that one's bad behavior was situation specific. (In other words, a person sees his behavior in a given situation as a one time thing. He doesn't see it as representative of a broader pattern of bad behavior or as a reflection of who he is as a person). Peterson et al. call this phenomenon "behavioral self blame" and describe it as an "attributional defense mechanism...[that is] inconsistent with depression."

So what gives? Why do I see so many depressed patients who blame their bad behavior for causing significant negative events? According to research, this sort of self-blame is a defense mechanism and should protect them from depression. Why does this not seem to be happening?

I don't have a definitive answer but I do have some ideas...

One thing that stands out to me is how many of my self-blaming patients seem unable to forgive themselves for making mistakes. Theoretically, attributing a negative event to their own behavior should boost their sense of control, leading to increased hopefulness about their ability to prevent similar events from taking place in the future. And yet, I don't often see hopefulness. Instead I see a tendency to dwell on perceived mistakes, which creates an overwhelming sense of guilt and self-doubt. It's difficult to feel hopeful about the future when you're busy condemning yourself for mistakes you made in the past. Part of "behavioral self blame" is "admitting I did something wrong." For some, making a mistake is simply unacceptable. In such cases, "behavioral self-blame" equates to perpertual self-condemnation; this inevitably leads to depression.

Or perhaps certain kinds of negative events are simply so terrible that normal rules don't apply. The negative events experienced by the majority of my patients fall into one of two categories: 1. Combat-related incidents in which one or more people were seriously injured and/or killed and 2. Sexual assault. Rape and violent death are more extreme than most other negative life events. Perhaps the reactions people have to these experiences are therefore more complex.

Another possiblity for some is their inability to identify what exactly they did wrong. That is, they have the general sense that they did something to cause a negative event but despite replaying the event in their minds again and again they are unable to identify a specific behavior that would explain what happened. They feel compelled to continue replaying the event in their minds in an effort to figure out exactly what they did wrong. I imagine the people who do this are people who have a pre-existing tendency to blame themselves when things go wrong; the drive to blame oneself in the absence of any evidence seems to suggest this.

These are just theories...

Avoidance as a Coping Strategy

2014-01-22T07:46:00.000-05:00

It's easy to understand why we tend to avoid certain situations, activities, people, or tasks that stress us out, make us uncomfortable, or otherwise generate negative emotions. Nobody wants to feel bad, especially if there is some way to avoid it.  Thus, if there is a particular situation that creates anxiety we will most likely avoid that situation whenever possible. It makes sense.  There's no reason to deliberately cause ourselves suffering.

Similarly, we are sometimes faced with problems that create distress whenever we think about them.  To avoid distress we simply avoid thinking about the problem. Of course we are typically unable to do this indefinitely, but we can always put things off until the last possible moment.

Avoiding things that cause us discomfort can be an effective strategy. If there is a certain person who always manages to get under our skin it is best to deal with said person as little as possible. If we are under a lot of stress and feeling overwhelmed, waiting until later to deal with certain problems could be the best way to preserve our emotional and psychological well being. We have to prioritize. If certain places make us uncomfortable and we don't have to go there then avoiding these places is completely logical. If talking about certain topics upsets us and there is no compelling reason to do so then it makes perfect sense to avoid conversations about said topics. If there are certain memories that are unpleasant to recall it can be beneficial not to recall them.

There are also times when avoidance is a very ineffective strategy.  A coping mechanism is ineffective when it creates more problems than it solves. Avoidance has the potential to become this kind of strategy. Because avoidance is so effective at alleviating distress we can inadvertantly begin to rely too heavily on it as a coping mechanism. Anything that alleviates distress is inherently reinforcing. We feel distress, we avoid, the distress is gone. We feel better. We avoid more.

So when is avoidance detrimental? What follows are a few examples. This list is by no means exhaustive.

*When avoiding discomfort or distress becomes the primary factor you consider when deciding whether or not to do something. (Avoiding distress becomes your primary motivation; everything else takes a back seat).
*When the list of things you won't do because they cause distress grows so long that the list of things you will do is actually shorter. (The end result is that you spend most of your time at home and only leave when there's something you absolutely have to do).
*When you put off dealing with a problem or conflict for so long that you end up simply not dealing with it at all. (The problem doesn't go away, of course. It probably gets worse while you are busy not dealing with it).
*When you avoid doing things you need to do or dealing with things you need to deal with, despite significant negative consequences for doing so.
*When avoiding starts to cause conflict in significant interpersonal relationships.

Conflict, Argument, and Who's to Blame

2014-01-14T07:28:00.000-05:00

A few weeks ago my husband and I had an argument.  Things got kind of ugly and both of us ended up saying some not very nice things. After taking a few hours to regroup, we sat down to talk about what happened. I've mentioned before that my husband has a tendency to blame me when there's conflict in our relationship. In this particular instance, I'd clearly said and done some things that were hurtful. I was angry over what I felt were legitimate grievances but that didn't make my behavior okay. (Unfortunately, this was a conclusion I reached only in hindsight).

So when my husband sat down to talk things out the first thing I did was apologize.  I admitted that my actions were inexcusable. My husband immediately agreed. He then proceeded to list a number of grievances he had with me. He concluded by asserting that anything he said or did that was upsetting to me was simply a natural reaction to having to deal with my bad behavior.  He went on to say that if I would stop being so difficult to deal with then everything would be fine and we would get along perfectly.

I cannot completely capture how it feels to try to resolve a conflict with someone I love, to humble myself enough to admit I was wrong and to apologize for it, only to be told that I am the root of the problem.  The most immediate emotion is anger. It feels like a slap in the face. I become defensive, like I have to justify myself or somehow prove my intentions are good. I feel frustrated. Sometimes I feel hopeless. "What's the point of trying to fix things?" I ask myself. "We never solve anything. He just ends up blaming me. Nothing changes." On several occasions I have ended the conversation at this point. I get pissed off and walk away. It doesn't solve anything but sometimes walking away seems like the only good option.

In this particular instance, however, walking away would have made things worse. So I told him it wasn't fair for him to place all the blame on me. "So you're saying that every argument is always both people's fault?" my husband asked.

I actually had to stop and think about this for a minute. In any given argument, are both parties at fault? Is this a rule that applies in all cases? Or are there arguments where one person is clearly to blame?

"Yes," I finally decided. "Because a disagreement doesn't have to turn into an argument," I explained. "And it always takes two people to argue. If one person refuses to engage then you can't have an argument," I added. I went on to qualify my statement. "I don't think both people are always equally to blame," I said. "There are times when one person clearly initiates an argument. The initiator would probably bear more responsibility in that case. But still, it takes two people to argue. If someone tries to start an argument and the other person won't take the bait then there's no argument. It's just one person acting like an asshole."

It is a tricky question though. I think most of us are inclinced to blame the other party when we get into any sort of conflict. This isn't always a bad thing. People are motivated to fight for something when they believe in the rightness of their cause.

It's different when the conflict is with someone you love. The best approach is probably just to agree to disagree, whenever possible. When this isn't possible compromise is the next best option. Of course this means that neither party gets everything they want and that both parties have to give something up. People are not always willing to do this.

I also think there is something to be said for acceptance. For example, I'm (begrudgingly) learning to accept that my husband is not going to actively participate in keeping our house neat and clean, no matter how often I ask him to help with these tasks. And he is (slowly) learning to accept that I become irritable when I'm stressed out and that unfortunately, I get stressed out pretty easily. Our tendency has been to get upset about these things again and again, to demand that the other change, and then to feel frustrated and disappointed when this doesn't happen. For me, it is extremely difficult to accept that my husband won't do something I think he should do. It makes me angry but not as much as it used to. I try to recognize the other ways he contributes to our lives. This is a work in progress.