Category Archives: psychotherapy

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!

On Being “Beyond”

I’ve been thinking a lot lately on being beyond. Beyond what, you might ask, and I’m sorting that out. Basically, though, it started with realizing that I am now in that great blob of the population described so often as “beyond.” As in the headlines on the covers of women’s magazines,

“Get glowing skin! Customized tips for your thirties, forties, fifties and beyond!”

“Walking for Fitness at Any Age! Belly-busting strategies for your thirties, forties, fifties, and beyond!”

I don’t know the extent to which men are burdened with this. I can imagine, though:

“Get ripped! Washboard abs workouts for your thirties, forties, fifties and beyond!”

Yeah, I’m beyond.

It sounds sort of like a super hero, as if at 60 – when we enter into Beyond – we ought to get a cape. I have a cape – Irish wool, very warm. If you think that sounds more cozy than conquering, you haven’t met enough Irish women. (Note to would-be inventors of Beyond Woman action figures: spare us the wasp waist. We have the usual age-related spinal compression plus hormonally driven fat redistribution. Keep it real, that’s all we’re asking.  Because we are fine, better than fine, and in fact, beyond – just the way we are.)

It’s quite comical that the apparently youngish people who write so much media content put the newly 60s, the 60-year-olds’ mothers, their aunts, and centenarians all into one category, while the decades earlier are carefully delineated as if the difference between, say, 39 and 41 comprises dramatically more difference than between a 60-year-old and any given 80-year-old woman, and between that woman and a centenarian. It seems to reflect a silly and self-absorbed presumption about the nuances of midlife compared to the daily warfare of old age.

The implication is that, well, now you’re old and one old person is the same as the other. That is clearly ridiculous; there is far more difference between any two senior citizens than between any two 20-year-olds.  How could there not be? Life has been unfolding, every day full of experiences that compound the differences.  Every decision about habits, relationships, effort, sloth, etc., multiplies and intersects into complex and unintended consequences.  If you are 30 and reading this, consider how different you are from the people who were your best friends in high school, just 12 years ago. Wait another 30 years of daily choices and the ramifications of those choices, plus the unexpected and random events of life, and the differences between you will be inestimable.  

So, what does it mean, being beyond?  Well, the ones I speak with are beyond thinking they are in some sort of competition with the whole world.  They are beyond equally valuing everyone’s opinions; they stop craving indiscriminate approval. They are beyond getting aggravated about the minor speed bumps of daily life and getting tangled up in knots over every bit of bad news.  They are beyond thinking that social media alerts outweigh the person we’re talking with now. They have long been beyond pretending that cynicism is the same as wisdom.

All this means freedom: freedom to play freely with children without worrying about our dignity, sing in our cars, and ask questions without worrying we’ll look stupid. We adapt to what our bodies can and can’t do today. We can be creative because it doesn’t matter if other people don’t like what we paint or draw or bake or build. And, out of that freedom, we can offer encouragement and hope to people who are still trapped in the completely voluntary constrictions of being not-yet-beyond.

And so, here’s to being beyond, with all its freedom, challenges and gifts. 

What about you? What does being beyond mean – and will you wait until a magazine editor says you’re there to enjoy it?

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.

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.

Prodigal and in your face

The holy days of fall and winter have begun, with Rosh Hashanah and Yom Kippur behind us and Thanksgiving, Hannukah, Advent and the Christmas holidays closing in fast. The stores overflow with all things green, red and peppermint. This means that one of the dreaded markers of the season is also upon us. You might be thinking about the price of turkeys, or heating bills, or navigating the dynamics of family and politics, but I am thinking in particular of the seasonal outbreak of atheism and related forms of cynicism among adolescents and young adults. Except for the power to disrupt other people’s good times, I’m not sure why so many families experience the angry outburst, arrogant smirks or sullen refusal to participate in the traditional prayers and rituals of life just when it is most likely to hurt.  Other than the week of Passover and Easter, there is no time more likely to cause suffering, than the fall and winter holidays: the season seems to be a favorite target for unleashing pent-up bitterness over having been raised in a tradition of faith and culture.

So, if this has happened to your family, you’re not alone.  Over a quarter-century in the mental health field, I have had to see many families distressed at the verbal attacks, the rebellion, and the apparent determination to be hurtful. Fighting with the young person about it is, of course, useless.  Trying to listen calmly, refusing to participate in conversations that are disrespectful, and suggesting the conversation continue later (and then following up to be sure “later” can happen) are potentially helpful.  Give yourself time to calm down, seek guidance from other people, consider the direction being taken.  If the young person has decided that belief in God is a superstition, something incompatible with science, perhaps they are willing to explore this, including the substantial number of scientists who are convinced that there is a God. Perhaps they are willing to learn about intelligent design from non-biased sources.   When the attitude is not mere cynicism but actual anger, it is very painful. Sometimes the rage is about the perceived lack of choice, the complaint is that they didn’t want to participate in the faith from childhood and that the introduction into the faith, whether bris or baptism, was abusive and unfair.

A rabbi whom I consulted echoed the mental health professional’s perspective: look at what else is going on, what other issues are at hand.  Someone who has found clarity (as they see it) should be more peaceful, not angry. An adolescent or young adult who has decided that religion is just superstition might be annoyed at being expected to participate, but will not be enraged. Anger is the sign that the presenting assertion is merely the top layer. What else is going on? Why the sudden rage?  Is someone smart enough – smarter than Fr. Georges le Maitre, the Jesuit priest and physicist who developed the theory now called the “big bang theory,” apparently, by their own reckoning – simultaneously naïve enough to believe something just because some people who sound convincing said so on some internet platform? What other indoctrination have they absorbed with unquestioning readiness?

Of course, you won’t have this conversation at Thanksgiving, right after the young person drops the bomb of their atheism, or rejection of religion, or rage at you about their Baptism, Bar or Bat Mitzvah, or Confirmation. That’s the time to somehow find the patience to be, or pretend to be, calm, politely curious and willing to discuss this later.  The conversation may happen over weeks, months, or years; it may involve some third party – a religious advisor, a therapist, a wise friend who has been on the same road.

It won’t be a fun conversation, and we can’t control the outcome. By being calm, listening carefully, asking sincere questions and verifying that you understand, you leave the door open for further dialogue as well as for the possibility of a change of heart.

Changes of heart are hard to admit, and even more so in the world of social media.  If a young person adopts a position, there will be a host of online encouragers.  If the young person reports pushback from adults, there will be more voices, criticizing the adults, urging cutting off the relationship, etc.  But, if the young person announces a change of heart, some of these voices of encouragement can become accusing, vindictive, cruel. Backing out of a decision can always be hard; imagine telling your parents you’ve decided to drop out of med school to be a professional surfer.  Consider the people who go through with weddings because they don’t want to disappoint people. Even smart, competent adults foolishly move forward into situations they know are wrong because they don’t want the transient embarrassment and miserable, but also transient, short-term effects. How much harder it is for young people who haven’t finished developing a mature brain.

This means our first job, as adults, is to listen with compassion and find a way to keep the door of communication open.  This way, when the young person is ready to reconsider, or be less vitriolic, or simply have a real dialogue, it will not require they have the desperation of the Prodigal Son to take the first steps. Whenever the child takes those first steps towards dialogue and reconciliation, remember the father in the parable, who ran to meet the returning child.

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.

Gorillas in the Mix

People who do not believe in God, or are afraid to believe in God, often make predictable assertions to support their position.  They will often start with a mocking supposition about an old wizard or some such image who sits on a throne in the sky.  Well, duh.  No mature believer takes those images literally any more than they still believe that their doll’s hair will grow back overnight, or that wishing their stuffed bunny is real will make it so.  No, we have outgrown childish things, thank you very much.

Another argument points to how badly people behave who claim to believe in God.  Well, again, no surprise.  Of course, humans behave badly; that is a big part of the whole story. Have you read our sacred books? Good grief, it’s nothing but lying and murder, greed and adultery and every sort of mischief, about from the beginning.  Adam screws up and blames both Eve and God! Before long, our partner in conversation points to the sexual abuse horrors of the modern age. There are no excuses for this. Religion, of course, isn’t the only arena with a flawed priestly class. The fact that scientific experiments often lead to no useful knowledge doesn’t keep people from vigorously asserting we must follow the science.  Some scientists torture beagle puppies and other ones discover how to vaccinate against polio and rubella.  We do not throw out the world of “science” because some of its clergy are pretty terrible.

Doesn’t all this magical God stuff just give us an excuse to not learn things? This intriguing question seems rooted in the confusion between parable, history, poetry, wisdom texts, and other types of books in the Bible.  Nowhere in Scripture are people charged with staying as dumb as possible, and many scientists will admit that the more they learn, the more apparent it is that what comprises the material world does not seem to be mathematically possible as a random series of events.  What is obvious, perhaps, to a physicist like the late Father le Maitre, the Belgium priest who first came up with what is now known as the Big Bang Theory, is a bit harder sell to regular people.

This leads to a particularly interesting argument: if God really exists, it would be obvious, and not just to Jesuit scientists.  How obvious, you might ask, and so would I.  As obvious as a Marvel Comics super hero?  Would God look like a Durer woodcut, wearing what were called JC leather sandals, and making a peace sign? Would the bad people be punished, instantly and with schadenfreude-gratifying anguish by a lightning-wielding Viking in the sky?  Despite the childish imagery, our non-believer wants to pin believers down on the issue of God’s supposed invisibility.  To believers, though, God’s existence is clear as day, although sometimes it is recognized on reflection and not in the moment. Still, God is obvious, as obvious as a gorilla in the middle of a basketball game. 

Of course, I am referring to the famous and oft-replicated experiment designed by Chabris and Simons in 1999.  Given the task of counting how often the basketball was passed between one team’s players, almost 60% of the subjects failed to see the person in a gorilla suit walk through the basketball court.

Yes, perfectly bright people stared at a short film clip, diligently counting basketball passes and bounces, and failed to see the obvious. Other scientists, around the world, have replicated this experiment with much the same outcome.  People focused on a task will ignore the obvious, even a person in a gorilla suit strolling through a basketball game. How much of a stretch is it that we miss other remarkably obvious things in our environments?

I imagine most people think they would be in the 40% or so that would notice the gorilla, but statistically, that’s unlikely.  We can’t all be above average.  More likely we all ignore, or fail to attend to, amazing things every day, selectively riveting our attention and discounting other stimuli as irrelevant or interference.  One listener’s static is another’s radio transmission.

The non-believer, and perhaps, at times, almost all believers, have some confusion about what is, and is not, God’s job.  I know I suffer with this one, too: don’t we all ask for things and view the apparent “no” or “not yet” as rejection, like when Mom or Dad once again says “no” to ice cream for dessert? Sometimes it takes a long time to see the utility of experiences, because a believer has to learn to see things, to the extent possible, through a different perspective – a God perspective. 

We will die.  That’s inevitable, and death seems to be easier for people who have made peace with the people in their lives, with God, and with at least most of the processes of aging.  It must be easier to let go of this life without too much reservation, when one has, often slowly and painfully, surrendered so much: health, beauty, quickness of body and mind, social power, loved ones, valued roles in our relationships.  Every loving mother (I am not a father and cannot speak to this) knows that our children move on from each level of parenting before we are ready to let go, and those practices of having part of life that is important to us peeled away is preparation for eternal life. Imagine how painful it must be for young people who are terminally ill or terribly injured and facing mortality, who have not had the practice of surrendering, over and over, to the losses of life.  A believer looks back over this pattern and can see, very clearly, where God was present (all through it) and how the love and compassion of God was extant in some people around them, the coincidences that were not coincidences at all, the seemingly random moments of pure, abandoned joy.

If you are preoccupied with the tasks of the day, riveted on a to-do list and the self-created commands of your bullet journal, do not be surprised if you miss the obvious, even something as obvious as a gorilla in the mix.