Category Archives: counseling

I could tell you, but you’re not going to like it: Anxious Youth

As you know, this column isn’t intended as psychotherapy or professional advice. It’s information and entertainment, and, I hope, the spark for some conversation with someone who can help with a problem. The problem here is anxiety in all its forms.

According to the Anxiety and Depression Association of America, about 31.9% of youth have some sort of anxiety disorder.  This would include diagnoses such as generalized anxiety, separation anxiety, panic disorder, and trauma disorders. It’s hard to believe this is accurate; if it is, then as a culture, things have gone horribly wrong. 

We know a lot about what works, and what doesn’t work for anxiety.  Isolation, the vortex of doom the internet can be, the misguided or malevolent support of random strangers online, endless social networking, and a sedentary, sleep-starved, junk-fed existence don’t work.  Overscheduling doesn’t work. Avoidance doesn’t work. Irresponsibility doesn’t work. So do the opposite.

Get off the devices except for schoolwork.

Get enough sleep. Go to bed at a set time, get up at a set time. Every day, even weekends.

Cut down on activities.

Read real books. Learn about other people’s interior lives via good fiction (that’s a primary reason that we read classic literature in school; to understand more about how other people think, feel, and respond to life’s events). Then talk about them. That means parents should read them, too.

Get physical activity.  A healthy young person needs at least two hours of activity a day, and ought to be standing, moving around, and active a big chunk of the rest of the time.  

Learn useful skills.  For example, everything it will take to manage one’s own money, car and home.

Socialize in person, often while doing something purposeful (whether that’s a sport, volunteering, or other activity).

Spend a lot of time in nature. If it can’t happen just about every day, plan a four- or five-hour chunk on the weekend.

Have chores and responsibilities for young people.  No, “school is not their job” and therefore nothing else is to be done around the house. How are they going to learn necessary life skills? Plus, who wants a spouse or roommate who thinks going to work covers them for any contribution to home and family life?

Learn mindfulness meditation skills, to slow down the stress response and “step back” from anxiety-provoking thoughts. This facilitates the cognitive restructuring of cognitive-behavioral therapy, in which new ways of thinking and behaving are identified and rehearsed.

…and try cognitive behavioral therapy (CBT), preferably with at least one parent learning, too, to be coach and to help the parent. Anxious parents tend to teach their children fear-fueled ways of thinking and behaving, and anxious parents are apt to facilitate avoidance.  Avoidance is like jet fuel for anxiety. Find a licensed mental health professional who will work with you as a family to teach the skills. Keep in mind that CBT will work much better if the other parts of life are in healthy, working order – proper sleep, nutrition, exercise, etc.

To expand on an earlier point: parents, often your anxiety feeds your child’s anxiety. If you are behaving as if the world is a terrible, dangerous place, do not be surprised if your child responds the same way.  Making changes together to have a healthier, less anxious lifestyle will help the whole family.

I could tell you, but you’re not going to like it: Why doesn’t she leave?

Hint: whatever the reason is, odds are, she’s not “codependent.”

Your much-loved friend, your sister, your cousin – someone precious to you – is in a hellish relationship. Not a call-the-police violent relationship, but something similar: a toxic, gaslighting, crazy-making mess of a relationship that whirls up and down and around like a psychological roller coaster from Hell.  One day she’s fine, the next she’s a weepy, shaky, self-doubting shadow of her usual self. Over the days, weeks, or months, you’ve watched her change from confident, funny and insightful to anxious, depressed, maybe even physically ill. You can tell the problem is her partner; everyone can. Why can’t she?

I’m using the female pronouns because, although the torment can flow in either direction, research and the experts in the field indicate the pattern tends towards the victims being female and the dark-triad partner being male. 

Dark triad types – more often male, with antisocial, narcissistic, and Machiavellian traits, and often sadism thrown in – prey on victims. They assess the prey and find the way to quickly gain her trust.  The typical prey makes this easy, because it is her positive personality traits that will now make her vulnerable to this predator. The relationship started out fast – intense, a burst of attraction and an amazing number of similarities. In retrospect, you think, too amazing. The “too good to be true” turned out to be, well, untrue.  The cycle of drama – accusations, fights, threats of abandonment, and, ironically, your friend seeking forgiveness sometimes – keeps her off balance, on the ropes, without enough peace to think things through.

Very often, the women who find themselves in relationship with manipulative, emotionally and psychologically abusive, and often financially exploitative and sexually manipulative men, are the people you’d love to have for a good friend. They are high in the personality traits comprising the primary traits of Agreeableness and Conscientiousness.  Agreeableness includes traits such as friendliness, honesty, a willingness to put others first, and nurturing.  Conscientiousness includes loyalty, perseverance, and dedication. These people are often great parents and wonderful friends. These traits bite them in the butt when a predator exploits those very strengths to draw the woman into, and keep her in, a chaotic relationship that never settles down enough for her to have time to reflect and figure out what might be going on. Sometimes, her best hope is that she starts feeling like she’s going crazy and seeks therapy…and finds a therapist who sees, not codependence and a victim’s participation in the dysfunction to meet some unhealthy psychological need, but a person whose strengths have, in this unusual situation, become a trap.

Maybe you wonder, reading this, how good traits can be a trap…just think about your own history. Were you ever the team-member, at school or work, who dutifully did your share and more, while others slacked off and still got the shared credit? Has your loyalty been exploited by a “friend?”  Have you loaned money to a friend or family member on a word and a handshake – only to be avoided, and unpaid, later?

Part of the trap for your friend will be, ironically, compassion for the predatory partner, who has probably included in his story a carefully curated tale portraying him as a noble and heroic victim.  Her compassion, nurturing and desire to be helpful (those great-mom, great-friend characteristics) now propel her into fix-him mode.  His anger at her can all too easily be interpreted through the lens of his pain and frustration. Out of care for what she believes is a suffering fellow human being, she gets tangled in self-blaming, guilt and confusion. She easily believes his supposed distrust of her that seems to erupt out of nowhere is due to his attachment wounds, and buys into a notion that patient endurance and reassurance will heal him. And yet…sometimes he just lashes out, apropos nothing, and then denies anything even happened.  He berates her and tells her later she’s exaggerating, overreacting, imagining things. Stop making up lies about me, he rages.

So, if she wonders, half-rhetorically, on the few times you manage to see her alone, if she’s “going crazy,” don’t agree. Don’t accuse her of being codependent.  Listen, actively.  Gently question her: is it okay that he keeps texting while the two of you, who have known each other forever, have a cup of coffee? Does he do this a lot? Share your observations and concern for her (not criticism or blaming). Ask what keeps her in the relationship and, if she admits to feeling trapped, be kind and firm in your assurance that she has people to help her. She is not trapped, no matter how stuck she might feel.

The manipulative partner creates so much emotional turmoil and distress that it becomes almost impossible for the victim to think clearly.  Part of this is because of the cognitive dissonance the victim feels: the confusion and distress of holding conflicting thoughts of this magnitude: On one side are the “good” beliefs about the partner because of their seemingly perfect match and on the other, the anguished, distrustful, terrified thoughts because of the confusion of demands, accusations and threatened abandonment.  Your friend probably can’t think straight – for now – but, again, it isn’t because there is something “wrong” with her.  She is in the midst of a prolonged trauma.

Thus, the most obvious (to you) parts of a solution may seem overwhelming or impossible.  Moving the abuser out of her place? Not impossible.  Moving her out of the abuser’s place? Not impossible. While she may feel unable to cope with the finances, her pet rabbit/dog/cat/bird, and the task of moving possessions, her concerned friends and family can easily help slice this problem into manageable pieces.  Someone has a guest room or garage apartment or mother-in-law suite; someone can foster her pet at their home while the dust settles; someone has a truck for everyone to gather and load up so she doesn’t have to face the process alone; someone can coach her through changing all her passwords and un-merging her phone, etc., from the partner.

This situation is heartbreaking to endure. Keep reaching out; do not give up on your friend/family member/cousin.  Maybe it’s even worth having a little movie night – without her partner – to watch the classic film, Gaslight, starring Charles Boyer and Ingrid Bergman.

I could tell you: Bryce Canyon Therapy

I could tell you, but you’re not going to like it…there’s no way to defeat fear without going through it

I am afraid of heights.

Not, “Eew, a little squeamish standing on the observation deck at the Empire State Building” afraid of heights. I mean, heart-pounding, sweaty-handed angst when faced with the open stairs in your typical outdoor, three-story-ish observation tower. I come by it honestly; I apparently took a few hard tumbles down long flights of stairs as a toddler. Hence the reality that “falling can and does happen, and it’s bad,” is hardwired in.

The thing of it is, avoidance works perfectly if by works you mean, never feel that afraid. It also means missing out on things, standing around at the bottom of things feeling slightly foolish when everyone else goes up and looks out over scenic vistas that I will see as a thumbprint on their cell phone screens.  The only way to reduce it, or at least have the experience that fear will not be what kills me, is to go through it.

Enter our long-planned, long-saved for vacation earlier this year to Utah, where we joined a small group tour hiking and camping and taking in five of the national parks: Arches, Bryce Canyon, Capital Reef, Canyon Lands and Zion.  The first day, we set up camp nearby and drove over to Bryce Canyon to see the canyon at sunset and see the trail we would take on the next morning just past sunrise – a narrow path down the cliff walls, through the varying terrain of the bottom, and back up the narrow path along the cliff walls.  I spent half the night in turmoil, crying with fear, and woke up knowing if I did not do that hike, I would regret it for the rest of my life. Meanwhile, of course, my amygdala were trying to convince me that the rest of my life would be short because I would certainly fall off a cliff and die.

I did hike the trail, sometimes in tears, sometimes trying to melt into the cliff face away from the edge (sorry, everyone who had to pass me; I disobeyed the rules of foot traffic on that).  By the end of vacation, I was navigating through elevations with much less fear. I am not a fan of heights, and probably never will be, but I know I can feel afraid and still do reasonable things.

Sharing this tale with friends, one shared that he, too, is afraid of heights and that’s why he decided to apply to and go through jump school in the military (as in, jump out of perfectly good airplanes). He didn’t expect it to cure his fear of heights – it didn’t – but it did do what he hoped, which was convince him he could handle scary things, something he wanted in his pocket before being deployed to war.

The purpose of this rambling set of tales is to illustrate what’s happening when we therapists annoyingly insist people face their fears, even one small step at a time, if the fear is keeping them from doing the normal, necessary things of life and/or barring them from their goals. Whether it’s elevators, public speaking, or driving over bridges, only taking the small, often agonizing steps forward works. Thinking about it, waiting until you’re magically not afraid, or postponing only convince your emotional, instinctive brain parts that the situation in question merits that level of fear. In other words, avoidance doesn’t reduce fear, it increases it. Every time I started up an observation tower, freaked out and sat down on the steps and then crept back down before reaching the top, I didn’t accomplish anything except making my fear worse.

So when, as the therapist, I encourage you to plan out, with me, and begin taking small steps towards conquering the fears that block you from living as enthusiastically as you’d like, I am not being mean or insensitive. I am not failing to understand how gut-wrenching fear can be. I get it. Really. As in fear-sweat drenched, heart-pounding, climbing that narrow path in and out of Bryce Canyon on a hot day getting it. 

(Un)Social Drinking

4th in a series: I could tell you but you’re not going to like it: Social Drinking often isn’t.

Yet again, I am stepping into the fray to offer the kind of information that can be helpful but feel quite unwelcome. In this case, it’s the raw fact that, for many people, Social Drinking…isn’t.

Social drinking is one of the terms for the use of alcoholic beverages in disciplined moderation, with others: the glass of wine at dinner, the single drink at happy hour.  It means the person is not an alcoholic, and everything’s under control…but as the term is used, perhaps not.  The American Psychiatric Association has established a low bar to meet the criteria for mild Alcohol Use Disorder: these are two of the many criteria, and perhaps these two will resonate with some social drinkers:

“Alcohol is often taken in larger amounts or over a longer period than was intended” and

“Continued alcohol use despite persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of alcohol.”

In other words, if someone often drinks three glasses of wine when they meant to have just one, or plans to have “a drink” with a friend that turns into a three-hour hangout with multiple drinks, that is a marker of a potential problem. If someone uses alcohol, and then becomes argumentative with friends and/or family, or zones out in front of the television and, yet again, neglects chores or short-changes the dog’s evening walk, the so-called social drinking isn’t just social drinking. Stir in failing to get up on time for work due to a hangover, or having the alcohol cause headaches, belly aches, acid reflux or blood sugar issues, and there is a storm coming.

So, perhaps, unless your physician advises otherwise, you might do a bit of an experiment if you are a social drinker. The experiment is, no alcohol for a month; six weeks would be better. Fighting a habit takes time. Then see what happens.  If you discuss alcohol with your physician, please be honest: the health professionals’ unofficial guideline when people tell us about alcohol use is, double it, or perhaps even triple what the person tells you.

Evening alcohol use disrupts sleep; people may fall asleep more quickly but will often have sleep problems a few hours into the night.  Alcohol impacts the brain in a host of ways: it impairs balance and spatial judgment, slows physical reaction time, weakens impulse control, and interferes with cognitive functioning. It also interacts dangerously with a host of common medications, including but not limited to medications for pain, anxiety, depression, OCD, ADHD, allergies, and more; if you are on any medications, over the counter or prescription, check with your pharmacist about using alcohol with these medications.  Mixing alcohol and medication can be deadly. Perhaps during your alcohol-free weeks, you will find yourself more motivated to get up and get that morning walk or workout in; perhaps you will have fewer unproductive arguments with the people you love. At that point, it may seem that social drinking may not be social, after all.

I could tell you #3: Screening the Screens

#3 in a series: I can tell you, but you’re not going to like it.

Once again, I’m the fun-killer, offering information for your recreational purposes that you might not like hearing.

Thus far, I’ve discussed getting more sleep and more physical activity as ways to help children who seem restless, unhappy, unable to focus (except for electronics, usually).  If you have been experimenting with those changes – perhaps for your children, perhaps for yourself – and a few weeks have gone by, I suspect you have noticed a few changes.

You may be sleeping better and waking up more rested and alert. You may be naturally less reliant on caffeine and high-sugar foods to wake up or to get through your day.  If you were tracking it, you might also notice that you are spending less recreational time with electronics. If you were managing these changes for a child, you experienced some degree of pushback, possibly to the level of an addict being denied their drug of choice, because the brain becomes addicted to the rewards of social media, video games, etc., and it will take time to replace that addiction with healthy patterns.  If you were able to persist, within a few weeks you probably noticed positive changes in mood and behavior.

Some studies have supported the approach of adding positive changes before taking things away. For example, if a person needs to quit smoking, eat healthier and exercise, success is most likely to accrue if exercise is added first. This becomes an additional reward and incentive, and can help buffer the withdrawal from nicotine as well as withdrawal from addictive, highly processed foods. In that spirit, it seems it could be easier to have begun helping a child heal from the cultural damages that contribute to anxiety, depression, attentional problems, etc. by adding positive things (sleep, exercise and play) before directly taking away negative things (specifically, the largely unsupervised world of the online universe).

If your child has any unsupervised screen time, it is almost guaranteed they are seeing things you do not know they are seeing or want them to see. End of story. You think you have adequate controls, and firewalls; and somewhere far away, people with far more expertise in technology than most of us are busily creating pathways to circumvent parental controls.

As I have shared in other columns, one of my little escapes in a long work day may be a two to four-minute clip off the internet of some old movie: a dance scene from Mary Poppins, a short scene from Much Ado About Nothing, a few moments of Branagh’s Henry V, the latter not cheery but stunningly well done and quite grounding, as examples. These are my typical fare: dancing penguins, singing suffragettes and Shakespeare, but sometimes up will come next some horrible thing – R-rated, violent, hideous – so terrible that even shutting it down immediately is too much exposure.  From this I hypothesize that if you think your kiddo is happily watching perfectly clean children’s videos and do not supervise, you don’t know. You do not know whether some horror or corruption that was carefully created and marked with the right key words to intrude on that corner of the market is slipping into the stream.

Under the best of circumstances, if it were an hour or two of tap-dancing penguins, it is on too much time to surrender to passive entertainment without being selective. Most people will not just absent-mindedly pick up any book and read it for a couple of hours and then look up, surprised and resentful, when interrupted for food or water or homework. The internet, however, is something else: the endless parade of “talking” kittens, so-called “influencers” and worse contrive to steal time every day from many people. It’s not all bad, of course; I listen to educational lectures when I’m on the stationary bicycle six days a week. I’ve encouraged people to watch “The Chosen.” I’m in favor of well-researched educational programming. I’ve done car repairs under the tutelage of a mechanic on Youtube and am still stumbling through beginner Spanish with the internet, too.

If you are unconvinced about the use of the internet, watch the documentary, “The Social Dilemma.”

Cutting back on tech time is hard. You’re probably not, initially, going to like it, and odds are your child will fight you – hard.  We’re talking about your child’s well-being: their physical health, mental health, intellectual development and social skills. It’s worth the trouble. Try adding the deliberate reduction of entertainment with electronics to the improved sleep and physical activity habits.  Then see what happens.

My child is “hyperactive” Part 2: Move it!

Post 2 in a series: I COULD TELL YOU, BUT YOU AREN’T GOING TO LIKE IT © 2023

Once again, for purely entertainment purposes, I foray into the world of possible changes to be made to your, and perhaps your child’s, routine to maximize well-being. Be sure to consult a health professional before undertaking new activities.

My child is hyperactive, part 2:  Move it!

I am using “hyperactive” in quotation marks because, over the past 25+ years, many parents have offered this as their diagnosis of their children. When asked to describe the behaviors, they talk about poor attention, disorganization, disobedience, moodiness, lost homework and missing sports equipment, etc. It is this type of description, not the medical diagnosis per se, that I address here.

Human beings are designed to move: to walk, bend, stretch, jump, hop, climb, and more. We are able to throw things, build things, swim, dance, and then, when weary, sit and rest.  Follow a healthy preschooler around for a few hours and you’ll get the idea:  explore, play hard, stop when you’re ready to rest. Modern life seems to have it backwards:  most people’s lives involve a preponderance of sitting and far too little standing and moving. This is unhealthy for most people (of course, some people have serious health limitations) and even worse for healthy children. To expect children to sit still for many hours is a recipe for attention and behavior issues as well as developmental challenges.

My paperwork for new clients includes questions on sleep, exercise, and basic health, because these habits help shape mental health, too. These also can highlight if mental health care needs to be coordinated with their physician due to physical conditions that can impact mental health.  Obviously, we function best when our habits encourage physical and mental well-being.

In my last post, I challenged parents to take a hard look at their family’s sleep habits and work towards healthy changes. Perhaps by now you and your child have been experimenting with getting adequate sleep.  A second step towards a healthier, happier child with better focus, memory and mood is physical activity.  The American Heart Association recommends at least one hour per day of moderate to vigrous physical activity for children and teens. That means running, jumping, playing games, riding a bicycle, dancing, etc. It doesn’t mean a two-hour practice in which they spend 30 minutes on the field and 90 on the bench, waiting their turn.  Ideally, it includes plenty of free interactive play with other children and some with parents. It is this play, which requires physical activity and complex social skills, that enhances brain development the best and prepares children for the increasingly complex world of the workplace.  It includes the kind of rough-and-tumble play children traditionally have had primarily with fathers, in which the father would model how to pause and calm down before things get out of hand. Rough and tumble play without limits becomes “The Lord of the Flies” and grotesque gang violence. Life without play leads to passivity, poor social skills, poor physical health and higher risk for anxiety, depression, insomnia, and loneliness.

If your family pediatrician has cleared your child for physical activity, it is imperative to get moving. Your next task will be to find ways for your child or children to have more unstructured play time with children, and more outdoor activities with you, too. That will seem inconvenient, especially if you have your children overscheduled and accustomed to being moved from place to place and activity to activity, their entire lives carefully curated to keep them under the direct management of adults.

Go to the park and get on the swings, use the jungle gym, the climbing wall, the workout stands around the periphery. You might have to participate at first, just to show them how it’s done.  Take nature walks. Put the phones away; have yours along to take pictures of interesting animals and plants to look up together later, after you’re home.

Like the change to the sleep routine, expect push-back. Be consistent and see what happens. I suspect that, once your child is on a normal sleep schedule for a few weeks, and has adequate active play, you will see some interesting changes in behavior.   As a side benefit, screen time naturally is reduced:  children who are active outdoors and getting enough sleep have less time to be drugged by their screens.

Have fun playing!

Not Signing On

My professional associations fought for years to become approved Medicare providers, and, in January 2024, this will come to pass.

I won’t be signing on.

The primary reason, and one that is sufficient unto itself, is that I do not work with any insurance. Having a vast bureaucracy wedge itself between my clients and me, forcing me to diagnose grief as a mental disorder (for example), and to pathologize the search for meaning as life takes its confusing twists and turns, is against the principles under which I trained for this profession. To be alive entails suffering; to help those who suffer is not necessarily something that can be reduced to diagnostic and intervention codes. I can do cognitive-behavioral therapy and other science-based work without reducing the client and the heartache to a series of codes.

There are other reasons, which, if the simple fact of not working with insurance were not sufficient, would add weight to the argument.

It would limit my clients’ options. Some people want to self-pay for services, and if they have Medicare, and I have contracted with Medicare, I can no longer offer them that option. The rules would impose limits around what I can and cannot do, even when it does not cost Medicare anything.

Second, it would complicate my practice. As with all insurance companies, an online billing process for electronic submission would be necessary. My simple process of recording of payment and making a bank deposit would be replaced by electronically keeping track of what was paid, what is outstanding, what requires additional documentation or some other time-consuming and frustrating process, copays and coinsurance and deductibles.  A conservative guess would be an additional five hours a week spent in this process, five hours that I believe would be better spent with a client or two, a professional training, a walk in the park.

Finally, there is the issue of insult. I am presuming that the Medicare per-session reimbursement for either of my professions, Mental Health Counseling and Marriage & Family Therapy, will be the same as Clinical Social Workers. It is my understanding this is the case with third party payors. With this as the expectation, then, by accepting the terms of Medicare, I would be acquiescing to the bizarre notion that my work as a psychotherapist is only about three-quarters the value of a clinical psychologist’s work. Of course, there are many clinical psychologists far more skilled than I; on the other hand, after many years in the field, I do not agree that any randomly selected clinical psychologist is necessarily my superior as a psychotherapist.

It is not the money; I work on a sliding scale, based on household income, and, as you might imagine, a number of my clients pay considerably less than Medicare would.  However, the arrangements I have with God give me a sense of peace, not injustice.  A client who pays me less because she is in poverty is part of my relationship with the Lord; an insurance company that pays me less because people who do not understand my profession have, via a dart board or an indolent board room debate or perhaps a roll of the die, have decided thus is tyrannical injustice; “Because we said so.”

So, while many in my profession are exuberant, feeling validated that our profession has achieved recognition on par with other mental health professionals, I shrug. If this makes them happy, I am glad for them. I hope that the process is fair and that my misgivings will turn out to be unwarranted.

But I won’t be signing on.

Using the Right Tool for the Job

When painting, the particular tools have to suit the purpose at hand.  Pastels, my favorite medium, range from hard to very soft. The degree of hardness impacts the way they make marks and interact with the painting surface. Thus, they are used in ways appropriate to the task at hand. Softly blended colors – the distant trees, faintly blued by atmospheric effect – call out for soft pastels. The graceful lines of bare branches glimpsed through foliage are served better by a harder pastel.  Use the wrong tool for the job and it is an exercise in frustration.

Just so, the various ways in which we communicate with one another have their preferred and best-suited purposes. I write letters in long hand to some family and friends; email has its role. The humble text message is an absolute delight in its place.  Its place is best described as the brief sharing of simple data:

Writing out Christmas cards, can’t find Uncle Lew’s new address

123 Orchard Street, Apt. A, S______, STATE, ZIP.

Thanks.

Or,

At the rest stop at US 19 and I-10, should be there in about 3 hours.

Great! See you then!

Or, perhaps, sharing a quick photo: a hummingbird, frozen in flight; a child in her sports uniform, a lovely sunset.

Text messages, on the other hand, are wretchedly inadequate for important conversations and emotional expressions beyond, “Love you! Have a good day!” sort of messages. They are inadequate for many reasons.

For one, they are brief.  Unless you have the ability to reduce complex ideas to simple, yet not simplistic, expression with the elegance of C.S. Lewis, the affective concision of Yeats and the incisive observational skills of Shakespeare, give up the notion of effectively resolving complex interpersonal issues via text.  We are, none of us, up to the task.

Worse, when we misstep, believing ourselves to be abundantly clear, we cannot see, or hear, the nuances of small muscle movements, pupil changes, swallowing, breathing, voice tone and volume, that alert us to make corrective efforts. Instead, our misstep is enshrined in visible form, to be reviewed and the misunderstanding (or all-too-clear awfulness) revisited and engraved into the heart and mind of the recipient, as well as anyone with whom they share it in an attempt to justify themselves in their rage and hurt.

You might say, well, the same can be said for email (right) and for the older, handwritten letter. For the latter, until fairly recently, writing was laborious: a pen to be perpetually sharpened and wiped; liquid ink to let dry. Even now, the arm and hand movements of script engage more of the brain, slow the process, and thus allow time to reflect before dashing off a reactive and possibly toxic response.

Many clients have explored in session the dilemma of family members demanding a text message interaction to address – now! – some emotionally rich and complex issue.  I urge them, and everyone, to resist giving in to the juvenile and narcissistic insistence that something of apparent critical import be reduced to text messages.  It is quite common for people to demand immediate exchange via text, repeatedly insisting you explain yourself (or whatever it is they require). If it cannot be face to face, at least do so via voice when both people are rested, sober and have time. Audible clues of tone, volume, steadiness and rhythm can help you assess how the conversation is going. If you are dealing with a reasonable person, refuse to have serious dialogue via text. If you are dealing with someone who is unpredictably volatile, irrational, or substance-using, potentially violent, seek appropriate safety and guidance.

So, what to do? There are multiple right answers here, of course; feel free to enter into a text message discussion of why you dislike your sibling’s fiancé, or don’t want your in-laws at the birthday party, or are upset about your child’s fifth undergraduate major in three years. I’d recommend against it. I offer, as a starter set, a few options to firmly, and lovingly, employ as you refuse to play the “text message” game.

“I love you too much to have a conversation about something clearly this important to you by text. Let’s figure a time when we can both be well-rested and ready to talk.”

“This sounds like a topic best discussed face to face. When would be a good time for you?”

“I’m glad you let me know this is something we need to address. When can we discuss?”

The possibility exists that you are dealing with someone, including someone you love, who is emotionally immature. Perhaps they demand, imagining they need, immediate gratification in terms of “resolution”. By resolution, they may mean getting you to agree they are right or bullying you into capitulating in some other way. At worst, they may be willing to cancel you if you stumble through an awkward and unexpected conversation. If you love someone this immature, whether friend or partner or family member, it is a sad state of affairs.  Still, giving in and trying to have emotionally complex conversations by text message (or email) will ineluctably lead to misunderstandings that can be read and reinforced in perpetuity. Just refuse.

Because, of course, you love them too much to reduce their concerns to a mere text message.

Take a Break: A Shabbat Habit

I was asked to give a talk to a women’s faith group about finding peace in this busy, stressful world. The direction I chose was to invite each person to consider how they keep Sabbath. Beyond attending worship, Sabbath includes truly connecting with God, with family and friends, with creation, and a deliberate disconnection from the usual routine of life. Perhaps you don’t practice a religion and feel that some sort of mandatory day of sitting around doing nothing sounds boring and stupid.  “Sitting around doing nothing” is a corruption of what the day of rest was meant to be; think of it as a day to step away from your usual routine and focus on what is most important. If you’re having trouble figuring out what that might be, think about the people you’ve known who were dying, or what you focused on most when you lost someone you love.  The great existential crises of life tend to make some things stunningly clear.

There are entire books written about the importance of Sabbath time, of that weekly stepping back from rushing, overstimulation and noisiness.  This short column is just a little memo, to me as much as to anyone who might happen to read it and could use the reminder.

So why should anyone consistently and deliberately take a break from the routine? Here are a handful of the many reasons.

It gives you time to recuperate from overdoing. My car’s tachometer goes much higher than the engine is meant to run to function well.  It’s the same for us. We are not meant to run at “100%” 24/7.  Taking a step back from overdoing gives your body a chance to begin to recuperate from an overstressed state. A lot of people like to think they do their best work under pressure, but at a certain point, the nervous and endocrine systems will conspire to have you functioning in a way that reduces your access to your logical, analytic brain.  You probably won’t notice it’s happening, but other people will.

It gives you time to begin to take a different perspective.  Much of modern life is designed to keep us distracted and in an artificial sense of urgency.  This interferes with reflection, the deeper thinking about what is going on, where our actions are taking us, and what does and does not really matter. Put another way, it can help you figure out what is important, versus what feels urgent but is not as important.

It gives you time to focus on relationships. Whether it’s online contact with family far away, time for a walk with your loved one, a meal with family or friends, or a ruthless, hours-long game of Monopoly, a Sabbath mindset puts aside clocks and schedules and savors the time with the people we love.

It provides time for play, rest, and creative pursuits. These are all important. They are not accessories, nor does their value derive from their contributions to work performance the rest of the week.  They are part of being human and have inherent value without having to be subordinate to our work roles.

…and I, definitely, and you too, perhaps, are far nicer to be around when there’s been enough rest, fresh air, laughter, and time with people who love us.  Sabbath time helps make us whole.

That wholeness is part of holiness.  People who are too rushed and focused on work, on the “next thing,” on the next ping of an electronic device, are not able to tune into other people, to themselves, or to God.  Doing what people most associate with Sabbath – going to worship services – loses something if I show up with a rushed, preoccupied, “Yeah, okay, but what’s next?” mindset.  We need a break, a prolonged pause that lets what is important float to the surface of our attention.

If you think this sounds crazy…try it anyway.  Try to take one day a week and carve it out as a day set apart. Spend time with the people you love.  Read a book; take a nap, play games or work on a puzzle. Savor the music you’ve diligently collected. Make art. Write a poem. Go for a nature walk. Cook and enjoy a meal together.  Put your devices away except for purposeful connection with people not physically present.  Then try it the next week. Try it for four or five weeks, and see what you find.

Shalom. Peace.

The Serotonin Story

Unless your newsfeed features obscure psychiatry and psychology news, UK news, or the very limited US news coverage of the July 2022 publication of “The serotonin theory of depression: A systemic umbrella review of the evidence,” in the Journal of Molecular Psychiatry, you might not have heard this news. In a sweeping meta-analysis addressing six serotonin-based hypotheses and multiple studies, one of over 150,000 people, the conclusion has been drawn that, verifying what the senior author of the article, Dr. Mark Horowitz, noted is “known in academic circles, that no good evidence has ever been found of low serotonin in depression (Medscape, July 22, 2022).”  The evidence does indicate, in some studies, that long-term use of some antidepressants can lead to lower serotonin levels, just as long-term use of drugs that boost dopamine (amphetamines, for example) can ultimately lead to depletion and insufficiency of that neurotransmitter.

To repeat, in the academic world, it has long known there is really no substantive evidence linking low serotonin levels to depression. This is similar to the academic knowledge that marijuana, especially in its modern, heightened THC formulas, is a dangerous road to sometimes unrelenting anxiety or even psychosis.  However, since science is hard and so often inconvenient, these particular unpopular truths have usually been ignored. About one in six Americans, and about one in six English adults, are on antidepressants.  Yet the science says the rationale for these drugs – that they will fix a chemical imbalance in the brain – does not stand.  The science does seem to indicate a placebo effect, as well as some people experiencing a numbing of emotional pain, which might be sufficient to begin the work of the changes necessary to heal from depression. The researchers are quick to note that no one should stop these medications quickly; cessation ought to be done slowly, with medical supervision, because of the risk of physical and psychological ill effects during withdrawal.

Depression, as Dr. Horowitz’ team and countless other researchers and clinicians have long asserted, is a complex experience of physical, emotional, cognitive and social aspects.  It is also a rather fluid diagnosis, encompassing, as it does now in the current diagnostic manual, almost any two-week period in which sufficient symptoms are met, even when life’s events make it a completely normal response.  As I have noted in other articles, the grief exclusion for depression has been eliminated, for example. Are we, therefore, to believe that, once someone you love dies, you develop a potentially lifelong brain disease in which one neurotransmitter (among many) suddenly goes haywire?  Or is it feasible that death, or profound injury, or the loss of a job or home or friendship, etc., could cause sadness, physical pain and fatigue, and a tendency to withdraw from the very activities and relationships that could bolster recovery?

One of the interesting aspects of this study was its analysis of the very popular genetic explanation, a sort of, “It runs in my family,” explanation for depression.  Besides the scientific analysis of the large body of research indicating that that while a very small, initial study hinted this may be the case, the much larger research studies indicate it is not.  Of course, there is more to “running in the family” than genes. Some of this may be impacted prenatally via epigenetics, which helps tell which genes to turn “up” or “down” (a grotesque oversimplification; sorry) depending on environmental stressors such as severe poverty and want of food.  Then our families teach us whether the world is a safe place or not, and whether to take risks or not. Optimally, families teach us we are worthwhile, and how to make connections and corrections in relationships.  They set a life pattern in place that may ses us up for long-term healthy habits, or inflict a neglected or violent childhood that results in shortened telomeres and the prospect of an unhealthy and too-short adulthood. If the family fights dirty, abuses substances and one another, is rejected by the community via being fired repeatedly from jobs, ostracized by neighbors, and disliked by peers, the children will grow up to be unlikeable, rejected, angry and depressed adults.  There need not be any genetic component for this to be the case.

This type of adult will need to learn to heal wounds, how to develop a sense of purpose and meaning, and the cognitive skills to overcome depression. The latter includes developing the skill of interrupting and redirecting rumination, challenging and changing unhealthy thought and behavior patterns and thus changing emotions, and improving the skill of being in the moment, or, as Dr. Stephen Hayes has written, “Get out of your head and into your life.”

There are biological factors at play; anyone who believes they are suffering from depression ought to have a full physical exam, including bloodwork, to rule out medical causes for many of the symptoms of depression.  Good guidance on nutrition, sleep, exercise and natural light exposure are all in the physical realm of helping, and deficiencies in any of these areas may be sufficient to trigger the low mood, lack of energy, erratic eating and sleeping identified with depression.

There is, as can be seen, nothing here that is so complex that it is beyond the average person’s ability to understand and do.  For most of human history, the rhythm of sleep, hard work, natural light, meaningful connections with others and a strong accession to the transcendent provided a milieu in which profound suffering had both meaning and support. Our lives were designed for mental health.  This, alone, is so reassuring and empowering that one would think that this simple, ancient recipe for mental health would have never been relegated to a supporting role. Unlike the message that your brain is broken and there is nothing to be done except take this pill – which may make you suicidal, or homicidal, or cause tremendous weight gain, sexual difficulties, apathy, or moments of mania – the message of the Horowitz et al research is a hopeful and inspiring one: that it is possible to overcome the depression that threatens to crush your spirit.