Tag Archives: counseling

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.

If this were my kid…

Advice-giving:  some therapists claim it should never be done; therapists-in-training are eager to leap in with advice before they know enough about a situation to offer it.  The stance on advice-giving has its roots in various philosophical approaches to therapy.

For those of a more psychoanalytic bent, it is the role of the therapist to push for deeper self-exploration and understanding, with that “a-ha!” process leading to more responsible, better-informed decision making.  Insight leading to action is a vital part of maturation; the alternative is an adulthood of adolescent reactivity and self-absorption.

Psychoanalytic insight may not do a frustrated parent any good at the moment they are figuring out how to handle the upside-bowl of cranberry sauce on the floor. Again.

In solution-focused brief therapy, the emphasis is on searching for times when a problem is absent or much reduced and breaking down the details of those situations, especially in regard to clients’ behaviors. This process empowers the client to realize that s/he is already equipped to deal with much of the situation(s) at hand and develop plans to do more of what already works.

This is a very helpful process, but sometimes people want a little more guidance.

Psychoeducation – teaching, basically – is different than telling a client specifically what to do. It provides information, refers to scientific data, often linking particular actions to help with problems.  Education is part of holistic counseling approaches to many concerns, including depression, anxiety, eating disorders, and problematic insomnia.

All of which brings us back to the question of advice.  I am not a new therapist, and people are not coming to see a therapist with 25+ years’ experience and some white hair so I can look vaguely concerned and steeple my fingers and murmur, “Hmmm, how do you feel about that?” when they express anger and shame over their inability to get a five year old to comply with bath and bed routines.

So, I am, at least for the moment, breaking the invisible fourth wall – the wall first broken in literature by Charlotte Bronte in the final chapter of Jane Eyre – and say, straight out, “If this were my kid…

“I would take away all electronics for at least six weeks.  Maybe longer.  Not even any television/movies unless a responsible adult is with them.”

Yes, they are going to be bored. They will be angry. If they have been playing video games, they may become aggressive and destructive – be prepared for this.  If they have been using pornography, it could be even worse. Fists and feet have gone through drywall over losing access to video games and phones.  If your child becomes hostile and aggressive (not just normally angry), it is evidence you are doing this late in a problematic process.  What are they going to do?  Play other games. Make art. Play the instrument that is gathering dust. Exercise. Do chores.  Read.  Libraries offer books, puzzles and games to borrow: no cost, little effort.  Try a family book club to introduce them to a broader range of reading.  Help them learn how to have a conversation in full sentences, complete with eye contact. The possibilities are boundless.

If they need a device for school, it can be carefully monitored and programs to limit access (such as Covenant Eyes) are available to try to control what is going on. 

“I would have them do chores.  No, ‘school is their job’ is not a good idea.  Do you want to be married to someone who goes to work, comes home, and expects to be waited on, because they did their job?”

By 13, an average, healthy child should be competent at all the basic skills of housekeeping. That means, able to clean any room without having to call in HazMat; sorting, washing, appropriately drying (read the tags), folding and putting away laundry (I give everyone a pass on fitted sheets, and yes, that reflects on my clumsiness); plan, execute, cheerfully serve and thoroughly clean up simple and nutritious meals; do most of the tasks of pet care; be able to handle trash, recycling and compost duties.  Would you want to be roommates or married to someone who can’t do these things as a young adult?  Your future daughter- or son-in-law will appreciate it.

“I would have them get an hour or two more of sleep, every night.”

According to the CDC, children age 6 to 12 need 9 to 12 hours of sleep per night. Teens need 8 to 10.  Odds are, your child is not getting enough sleep and you are already saying this is ridiculous and impossible; how are you supposed to do this?

Insufficient sleep has an almost immediate detrimental effect on brain structures and functions critical for focus, memory and mood:  factors that teachers and parents spend a lot of time complaining are deficient in children.  You know what you’re like when you don’t get enough sleep; foggy-brained, irritable and looking around for caffeine and sugar.  Your children are like that, too, except you are probably keeping the little ones away from triple-shot lattes.  If your teen has to be up for school by 6 AM, then they have to be in their room without electronics sometime between 8 and 10 pm.  The math is easy; accepting that something has to give is the hard part.  Make it an experiment to accompany the electronics question and see what child you meet after a few weeks.

“I would have them learn to use a planner.”

Unlike the early years of school, and even a lot of secondary classes, real life – adult life – requires strategic planning.  By middle school, students should be learning how to break down tasks into manageable, realistic chunks and follow those plans, adjusting as necessary.  That means writing down “Social studies test tomorrow” Thursday night is not good enough.  It means figuring out how much review needs to be done each night of the week to be adequately prepared, and adding that to Monday through Wednesday’s plans.  Even outside of school, the skill of planning is useful.

For example, many people get into power struggles/arguments/endless debates over dinner. The frequency with which this particular power struggle erupts in therapy would astound non-therapists.  I do not understand the surprise that dinner must be had.  Name a date in the future – any date – and if I am not deceased, unconscious or doing colonoscopy prep, I will expect to eat.  The need for a meal at night will never catch me by surprise.  Yet this recurring surprise is apparently part of the annoying texture of life for many families. Model the benefits of planning.  Get the week’s meals worked out, and streamline evenings.  There is an immediate benefit: instead of arguing about “what to do” and wasting two hours around it, have a quick, planned meal and then have time to do something fun, like watch a parent-approved movie together, fold that pesky laundry, and push around more pieces on the 2000-piece puzzle of a Tiffany window that seemed like such a great idea at the time.

I’d make some good memories, I’d say, if this were my kid.

COVID-19: Surviving and Thriving

We’re worried about our loved ones, our own health, our school work or livelihood and what the months ahead will hold for our families, our communities, and our world. Being separated from one another makes it harder. Here are some strategies that can help:
1. Establish a daily routine and keep regular hours. Get up at your usual time; go to bed as usual. Use a checklist, a schedule or whatever structure helps you stay focused on positive, constructive actions.
2. Pray! Pray alone; pray on video-conferencing with friends and family; pray while watching livestream worship services. Include in this: daily periods of silence – not just telling God what you want done; instead, begin learning to sit quietly, observe your zigzagging thoughts, and not immediately take all your ideas so seriously.
3. Physical activity: an hour or more of physical activity, if you have medical clearance to do so, will help reduce the physical and mental effects of chronic stress. If you are able to be outdoors without being in danger of infection – enjoy a walk in nature. If not, seek opportunities indoors: walk in place; dance with your kids; be creative!
4. Reach out to someone who needs encouragement every day. Call, email, text, video chat, or send a note in the mail – be a light for someone who is alone and discouraged.
5. Check for news updates twice a day – more than that and you are often reinfecting yourself with the same negative news. Even if your logical brain recognizes it as last hour’s news, your emotional brain is again jolted with a bit of fight-or-flight about the pandemic and its consequences.
6. Odds are, you have more time on your hands than usual. Why not pick something to learn about on your own, with family, or with friends as an online/videochat study group? Can you practice a new skill, start a book club (hello, e-reader plus video chat!), or study a long-neglected area of interest? If you ever purchased arts and crafts supplies for “someday,” bought and neglected a language-learning app or fondly recall an elective course you’d wished was your major – it’s time to bring those interests into the light of day.
7. Take some time each day to journal about the experiences you are having during these strange weeks. Writing things out may help you clarify your emotions and thoughts, and help you see your experiences from a slightly “outside” perspective. Close your daily journal entry with a few things for which you are grateful.
There are lots of other ways to survive and thrive as people maintain social distance, self-isolate, and shelter in place…while we can’t control everything, we can exert control over our responses. Pick the story you want to be able to tell yourself, and others, about how you handled the COVID-19 crisis. Are you going to be able to tell a story of faith, compassion and grace under pressure – the year you became passable in Portuguese, started a book club via Skype or Facetime, and became a hula hoop expert? Or will it be the year you zoned out in front of 24/7 news for untold days, slowly becoming more burdened with ennui and inertia?
Choose to persist in faith, maintain your healthy habits, nurture others and grow in wisdom.
Choose life!

That’s Confabulous!

That’s Confabulous!

Your favorite uncle entertains every family gathering with the same stories.
His listeners realize they are not the same stories. The tales shift…small flourishes are added, details are lost and later denied (“Uncle, what about the cow? You mentioned the cow in the marsh last time.” “No, no – there wasn’t a cow. It was a goat. It’s always been a goat. Why would there be a cow in the marsh?”) Emotions intensify, diminish, and intensify again; the who, when and even the where are wobbly.
Is your uncle a pathological liar?
Well, he might be.
More likely, he’s a normal human being.
Memory is not a video recorder from an omniscient position. Our memories are constructed. Because it’s imperfect – and our brains want things to make sense – we fill in the blanks. There’s a little of filling-in-the-blanks in almost every memory, and in extreme cases, it is called confabulation.
Karl Bonhoeffer, German psychiatrist and father of martyred pastor Dietrich Bonhoeffer, coined the term. Confabulation, properly used, is the unconscious attempt to fill in the blanks in memory with made-up details, identified most with alcohol-related forms of dementia. The speaker believes it’s all true – but it’s not. Brain damage causes inevitable errors in processing and storing memories, and the brain valiantly attempts to weave a story out of scraps.
Related to confabulation is the tendency to “fill in the blanks” where there is no dementia and no logical reason to do so. People make up stories about other people, ruminate on them, discuss them with their companions. Later, when the subject comes up, the remembered imaginings are woven into whatever sparse facts were originally available. Electronic media has speeded up a process that used to require substantially more time and effort. The possibility of interrupting the downward spiral is much diminished.
A nearly harmless example: last year I moved my office from the high rise where I’d been for 19 years to two parish-based offices. My old office furniture was not needed in either location, so I gave it away to my parish, where it is apparently very popular with the youth group at their Sunday night meetings. Imagine my surprise when I heard from various sources that I had closed my practice, semi-retired, stopped working…you see the drift. People took one fact (she gave away her old couches and tables) and built a story around it (she retired). I have no idea how many referrals have not come my way due to someone’s – or several someones’ – confabulous storytelling regarding my work.
Less benign are the tendencies of unhappy people to ruminate and stir in speculations, scraps of other unhappy memories, fears and grudges, creating a new and often sinister narrative about a situation or people. This seems to be most effective when done in dyads or slightly larger groups. My observation, at least, is that the more shared memories, the more believable the confabulous concoction of “truth” that emerges from the co-rumination. Motivations are attributed with no evidence; “facts” are mutually invented and, since someone else believes or remembers the same exact thing – why, clearly, it must be true.
If this has ever happened to you, often in the context of perpetually unhappy coworkers, family members or friends, you know how useless it is to fight against the creative power of two or more brains that have mind-melded a mutual mural about…you. The only useful thing one can extract from the misery is a warning against being part of that type of dismal discussion.
Even with honorable intentions, memories shape-shift over time.
Emotion tints memories. Next time you are in a generally happy mood, pull up an old memory, perhaps a time shared with a loved one who has passed. In contentment, reflect on the events of the day and the joy you felt with that loved one. Really sink into the memory. Next time you evoke that memory, it will have shifted a bit to emphasize the joyful aspects – the smile, the warmth of heart – whereas if the same memory came up when you were sad, somehow it would be tinted. You might notice that other memories that feel the same way easily come to the surface: that’s another aspect of memory. Our memories are linked by emotional flavor, not just content. That’s why someone who is angry at you seems to have a boundless recall for every stupid and disappointing thing you have ever done.
Words also shape how memories are shaped and stored. A car comes up from behind, passes you, enters your lane and, a half-mile later, ends up in the ditch. You pull over to call 911 and see if you can be of assistance. Later you are questioned about your observations. How much did the car swerve? If asked, how much did the car fishtail…your memory will subtly adjust. The next time you recall it, the film may contain a touch more veering about.
Personal beliefs and biases enter the picture, too, and help form “memories” that are less than precise. It might be as subtle as “assuming” that someone meant something and then sliding into believing that they implied it, and subsequently taking offense by something that was unsaid as if it had been a slap. It could take the form of filling in the blank in someone’s appearance or comportment based on biases. Alternately, beliefs or entire cosmologies are attributed to someone based on scraps of “evidence” and then merrily embraced as “truth.”
It’s an interesting dilemma, encompassing the Commandments (Thou shalt not bear false witness) and Pilate’s coyly avoidant, “What is truth?” False witness, after all, is not just perjury. It comprises gossip and unnecessary tale-telling, both inevitably not the whole truth, as any elementary school teacher can attest. It’s all the ways in which we might fill in the blanks, perhaps consciously but, I suspect, as often reflexively, justifying our own emotional wallow with imagined and projected details.
Isn’t that confabulous?

Meet Them Where They Are

Three times each year, our parish runs Alpha, an eleven week program for people who are open to exploring the basics of Christianity, starting with elemental questions such as, Is there more to life than this?, or Why should I believe in God? The chair of the committee running this, and our other evangelization programs, was accosted by a fellow parishioner after Mass one morning. The parishioner had a list of grievances, particularly that the program wasn’t “Catholic,” citing various deficits, in the complainant’s mind, such as a lack of Marian theology. Besides her apparently unchristian behavior, she had missed the point of meeting people where they are. Many people are skeptical about the existence of God because they have been sold a bill of goods about faith and science being incompatible; it is hardly useful to wrestle them into a dialogue about the Blessed Mother and the Virgin Birth, or Transubstantiation. We must meet them where they are. They are wondering if there is a reason to believe in anything or any One, and rushing somewhere else won’t help; it simply truncates the conversation before it begins.
Just so, in our daily lives, we must meet people where they are…
It may well be that the child you permitted to walk all over you is now grown, or nearly so, and the rudeness and demanding behaviors that you thought were funny at age 2, and tolerable at age 4, are grinding you down now that the child is 18 or 21 or 30. It does little good to beat yourself up because you were not willing to foresee this problem; you need to deal with the situation as it exists, or choose not to (and continue to be ground down by caustic, toxic offspring). Attempting to have what you think is a perfectly reasonable conversation about your expectations and anticipating you will receive thoughtful, considerate responses is, well, sad and silly. You will have to meet them where they are: as a very large toddler who needs clear rules and near-immediate consequences. You will also have to have a plan as to how you will cope with an adult having a temper tantrum. There will be displeasure about any limits you set:
“We are no longer going to pay for your cell phone. You can come with me to [provider’s storefront] after work on [specify date] to switch the number to a new account in your name, or I will simply close that number.” You will hear how unfair this is, how unreasonable – you know how much their student loan payments are, right? – and how ridiculous and selfish it is for you to bring up their prodigious spending on entertainment and other technology.
“You are an adult, and this is our home. No more overnight guests.” Well, this is unfair, too; how are they supposed to, well, whatever? Other people’s parents are reasonable. Besides, it’s the 21st century; what’s next, bundling?
…and so it goes. You will get pushback and you will either stay firm – something apparently quite difficult, because if it came naturally, you would have put a stop to this behavior, oh, say, 20 or 25 years ago.
Many people are unhappy about the state of their marriages, and there, too, is a problem that is best met where it is. The typical couple puts their relationship almost entirely aside when children come along, neglecting it sorely, and then are surprised, dismayed and resentful at the state of things. They barely speak; they have nothing in common; each wonders, how could I have chosen such a miserable person? The relationship is anemic, neglected, and easily startled; like a once-beloved pet banished to the back yard pen for months or years, it hardly knows how to behave in the house. Treat it with gentleness, patience, and consistency. The friendship must be rebuilt; meet that process with good will rather than sarcasm and cynicism. Use Gottman’s research and books; use Chapman’s 5 Love Languages; use a good therapist: do something, be consistent, and begin at the beginning, with careful nurturing of the abandoned friendship. Perpetual complaints about what it “should” be like are worse than useless; just meet the marriage where it is.
You may need to meet yourself where you are, too.
You might like the idea of being physically fit, self-disciplined: the sort who enjoys vegetables and exercise. That’s all very nice…and, if it is not true, you will have to meet yourself where you are and begin teaching the actual you – not the imaginary, idealized version of you in your head – how to be self-disciplined, how to gradually become physically fit, and how to appreciate the subtle flavors of vegetables after assaulting your senses with however many years of packaged and fast foods.
Perhaps your vision for yourself is more spiritual. You might like the idea of yourself as a truly good person, the kind of person who enjoys engaging in loving service, doing without for others, and understands what it is people are talking about when they discuss having a “prayer life.” Meanwhile, you are stuck with a few rote prayers and still think Job and Jonah are supposed to be historical reports. Well, you must meet yourself where you are. If your spiritual training ended at 7, or after your Confirmation, Bat Mitzvah or Bar Mitzvah, your stunted spiritual age is where you begin.
Meeting ourselves, and others, where they are doesn’t mean “settling” unless you are content to stay there. It can mean having a real conversation, and a real chance for positive change. Flashes of insight are not change; they are the precedent of change. Change happens only where we are.

Every parent’s nightmare

All good parents – and most not-very-good-at-it parents – want what is good for their children. They would like them to grow up happy and healthy, to have a comfortable life, stay out of jail, etc. A few grandchildren and regular calls and visits would be nice.
Often unspoken, but definitely there, is the desire that their child not be what they might call “crazy.” It’s not my word – I’d use depressed or anxious, or having a psychotic episode – but for parents, one of the greatest fears of all is that their child grows up to be mentally ill, with hallucinations and delusional beliefs – to be out of touch with reality, to be, in short, psychotic.
Psychotic doesn’t mean “violent and crazy,” as it is so often misused. It means to be out of touch with reality, often with some sort of hallucination (hearing voices, seeing things that aren’t there, or some other sensory misinformation) and/or delusional beliefs (paranoia, which may mean being persecuted or it may mean an unrealistic arrogance, belief in one’s special powers, or that one is in fact someone of great power and importance).
And, it turns out, psychotic symptoms are a risk factor for two common substances in the lives of young people: methylphenidate, a commonly prescribed drug for ADD/ADHD, and cannabis.
The research on methylphenidate has been ongoing, in some cases for decades, and while you cannot do experiments to “prove it” (who would volunteer to try to have their child rendered psychotic just to see about a drug’s effects?), researchers scour multiple studies following up on children and teens prescribed methylphenidate, and find that 1 to 2.5% develop psychotic symptoms. That’s up to more than one in 50. The latest meta-analysis was published this summer in the Scandinavian Journal of Child Psychiatry and Psychology, using multiple studies with over 77,000 young people in all.
The link between cannabis and later psychotic symptoms, as well as anxiety, for young people has been known for years, but often studies began in the mid- to late-teen years and it was difficult to determine if those who were prone to mental disturbances were more attracted to cannabis than healthy teens, or if otherwise healthy teens were developing psychosis as a result of cannabis use. With studies beginning earlier – in 7th grade – researchers feel confident asserting there is an increased risk for psychotic symptoms within a year after a teen begins using cannabis. This is for all teens, not just those with family histories of psychotic illnesses such as schizophrenia.
What should parents and other caregivers do?
If your child is being treated with methylphenidate, work closely with the prescribing physician to monitor side effects, be honest about what you observe, and do not panic. Remember that counseling and neurofeedback, provided by experts, can help someone diagnosed with attention deficits develop skills and neurological adaptations to reduce symptoms. Seek a referral from your child’s physician.
In terms of illegal drug use…assume no “safe” amount of an illegal substance. The fact that many states have legalized or decriminalized marijuana has misled many people to believe it is “safe.” It is not. The American Medical Association and the American Psychiatric Association both have published strong positions warning about the use of marijuana.
Parents and caregivers also need to be mindful that the drugs used for ADD/ADHD, and methylphenidate as an illegal substance, are popularly misused, sold, or shared among young people. According to studies published as recently as last autumn, 5 to 10% of high school students and 5 to 35% of college students use, or have used, prescriptions for ADD/ADHD illegally as “smart” or “study” drugs. This may be regular use, or may be occasional to get through end-of-term crunches with minimal sleep. Side effects include sleeplessness, agitation, anxiety, dizziness, headache, sweating, appetite loss, elevated blood pressure, and psychosis.
Be alert for subtle changes in behavior and do not be afraid to be assertive about this. Your child’s physical and mental health may depend upon it.

Go and Do, for Me and You

Verbs, like “go” and “do”
In a recent on-air segment, Jamie and I (he’s the afternoon radio talent for Spirit FM, the local Catholic radio station/Christian pop music station where I’ve been volunteering since 2009) were discussing various social protests. He had asked me how to handle the flood of social media, with people posting/re-posting/re-re-posting, and the pressure to have some sort of opinion/assert some stand on perpetually protesting celebrity.
I try, but don’t always succeed, in preferring action verbs. Like, “go” and “do.” I don’t much care for meetings. I don’t like sitting around talking about how we can help the homeless and severely mentally ill. I went and did (full time work, almost 5 years). Jesus didn’t say, sit around and have lots of committee meetings. He said, pretty much, Go… (He also had something to say about babbling on and on, so I will move along.) I would rather teach than talk about teaching, do art than sit around talking about art…you get the idea.
So my thoughts are, go and do. It would be far more helpful – if, for example, we are talking about the real and obvious pain in poor neighborhoods – to go and do. Mentor a kid. Be a Big Brother/Big Sister. Organize a community watch organization. Do pro bono work in your field. Provide free tutoring. Be a Guardian ad Litem. Etc., etc. Go and do. Standing around getting attention for taking a public position that costs nothing seems a little self-serving.
It reminds me of the time a woman I knew criticized me for failing to wear red on some arbitrary date publicly announced to be the day to wear red to support women’s heart health. The only woman whose heart I have much influence over is my own. I had already exercised, gone to church, had good conversation with my husband, eaten a healthy breakfast – in other words, it was 8 AM and I had done all I could for THIS woman’s heart health. Nothing I was going to do, besides pray and try to set a half-decent example, would help anyone else.
It also brings to mind the big test for reports of visions of the Blessed Virgin Mary. Such a report requires much evidence, but a primary benchmark requires that Mary points towards Jesus. There is no credibility if the reported vision does not direct people towards Jesus. Such an experience is not something from the Good side. It might be a well-intentioned, innocent delusion, but it is not Mary. Mary doesn’t showboat.
So…if terrible injustice moves you, go and do something concrete, specific and clearly helpful for one particular person. Keep the meme to yourself.
…and more on “Go” and “Do”
Teen and young adult mental health took a drastic, terrifying turn for the worse beginning in 2007 – and the stats keep worsening, especially since 2012. This, according to a lot of research, can be traced back to the smart phone, according to San Diego State University professor, researcher and author Jean Twenge. Her recent book, “iGen: Why Today’s Super-connected Kids are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood – and What that Means for the Rest of Us,” provides the results of not just her original research but meta-analysis of generations of data on the pattern of mental health and activity for youth.
It seems like constant connectivity has led to less “go” and “do” and more detachment and isolation. It’s a double-dose of negative: the ineluctable distance created by screen-based communication and a deficit of direct experiences. We were not designed to sit and click; we are made to go and do.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

Posts are for entertainment and not meant to be construed as treatment or professional recommendations. If you need mental health assistance, please contact a licensed professional in your area.

Duck, Duck, Goose

Muscovy ducks are ugly.

There’s simply no getting around it. Perhaps some find them in the category of, “So ugly, they’re cute,” the befuddling phrase used to describe certain regrettable-looking breeds of dog with what seems to be a permanent, long drip of slime on their maws. I don’t see it, in either the dog or the duck.

Muscovy are also an invasive species here in west-central Florida, driving out our adorable and good-natured native ducks. Thus, they are unwelcome both in, and by, appearance.

During an Emmaus retreat at the Franciscan Center in Tampa, I was able to observe a female Muscovy along the river last weekend. She was waddling along, looking into the river on her right and then to the ground on her left, seeking food. She was followed closely by one, then two, then four, large, ugly and showy Muscovy males. She seemed oblivious. They were posturing: just short of chest-bumping one another, fluffing up their feathers, strutting in circles and then, realizing she had waddled on further ahead, scuttling up closer to the object of their desire before devolving into posturing observed only by one another, and me.

Ms. Muscovy did not feel obliged to wear shorter feathers in her nether region or walk on her webbed toes to gain their attention, and indeed, it was apparently unnecessary. She had the power of her femininity, and that was sufficient. God knows how large the flock of males out-strutting each other got before she made her selection; the bells rang and I hurried off to join my fellow retreatants for Morning Prayer.

Flash back to the 1980s, when wearing brassieres over one’s clothing, instead of under, was all the rage for a few unfortunate years. During a lunch conversation, a male colleague (middle-aged, recently divorced and apparently adjusting with difficulty) mentioned his amazement at seeing this while out in a nightclub. A few of the females opined we would never do such a thing. If we weren’t married, he said, and had to be out there, competing for male attention…whoa, whoa, WHOA. A man, I said, for whom I was to “compete” by wearing my underwear over my clothes would not be the man for me. My female cohorts agreed. Divorced-dude was amazed.

Alas, times have, apparently, changed. Somehow the power to vote, own property, and be paid the same for the same work (let’s not go to where we compare part-time clerical staff with chemical engineers and whine about salary differences, okay?) seems cast aside for the “power” to wear vagina-hats in public, insist that tights are business trousers, and gain fame by posting indecent pictures of oneself to (anti)social media.

In our little yard, I cannot, from a respectful distance, tell Mrs. Bunny from Mr. Bunny, but apparently they can, and so things work just fine. Mrs. Cardinal is subtle compared to her (to human eyes) flashy husband, but trust me, when the six or seven species of birds – almost all larger – are sharing the seeds I have flung onto the front yard, it’s little, softly hued Mrs. Cardinal who commands attention and sets the rules. Mr. Cardinal does not seem to have any objections about being partnered up with his gently-toned, energetic little mate. Likewise the pair of black snakes, the ever-expanding clan of blue jays, or our resident crows, Poe and Annabelle Lee, and their hapless but fun-to-watch adolescent offspring: all seem content without the females doing strange and torturous things in a craven attempt for male attention.

Why are humans so singularly dysfunctional when it comes to male-female relationships? Can we blame it simply on the Fall and the impact of a long history of bad choices that have turned us slowly away from what we could have, and might still be, towards this strange situation in which much of our culture finds itself?

For almost three decades now, mental health professionals have dealt with body-image and sexuality issues created by a pornographic culture so pervasive that too many young women believe they should engage in sexual activity whether they feel like it or not, and many young males have incurred physical damage on themselves due to excessive masturbation with porn as the stimulant. Conditioned to images on electronic devices, a normal, living female is just not as attractive and too much trouble. We’ve all, no doubt, heard of the teen magazine that explained sodomy in how-to terms. In my work, this isn’t some abstract issue; I listen to young women wrestle with their discomfort and shame over what they feel obliged to do and the fear that their hesitancy to engage in impersonal sexual acts means there is something “wrong” with them. I help couples whose relationship has been torn apart by the husband’s pornography addiction and disengagement from his wife.

I used to pity my male college students, assuming the heterosexuals had their ability to focus on psychology (endlessly interesting to me but, I realize, not to all) cruelly challenged because, for a healthy straight young male, the proximity of female peers would normally be distracting. Now the female peers are often dressed in revealing clothing. I assumed (naively) that this placed an unfair, even uncharitable, if you will, burden on the males. Now I wonder. I wonder if, drowned since childhood in a flood of hypersexualized images, the presence in the next seat of a young woman with her breasts pushed up to her collar bone is…nothing. Now I feel sad about that; they are both missing something about the joy of being human: they have lost the capacity to appreciate one another.

He may be sentenced, until he works to change it, to a life of seeking ever-more extreme forms of sexual stimulation, and she will be reduced to claiming that her power comes from the right to have sex indiscriminately and wear unflattering pink hats in parades.

Meanwhile, Ms. Muscovy is enjoying the riverbank and may eventually pick some posturing, squawking, ugly drake from among her admirers.

The ducks have it figured out. Guess who gets to be the silly, sad goose?

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Not So Complicated

I channeled Mary Poppins: resplendent with unwavering decisiveness and spit-spot, lickety-split efficiency, two of us turned the spare-bedroom/storage-room into comfy guest quarters in less than 45 minutes. Easy-peasy…

…because it was not MY spare bedroom. No emotional investment, no weariness at once again facing the task at hand, it was, actually, fun. Change is refreshingly simple when it doesn’t cost you a thing.

When it costs something, change seems complicated and hard, even impossible.

Almost everyone I know has argued, in vain, with newspaper articles, the radio or television newscasts. As if briefly overcome with psychoses, they shout at the television and argue with the radio in their car. (Me, too). Whatever their position – progressive or conservative, libertarian or statist – they are frustrated and amazed, over and over, at officials’ protestations of how hard it is to make change happen.

Everyone has ideas on how to make change happen. Some are terrifying; others are naïve. Many, however, have the ring of common sense, and it makes one wonder, why are these officials, whether elected or snugly sinecured, acting as if everything is so complicated?

There are many different government programs aimed at moving people from one place to another. Why many? Who knows? Could it be simplified? Yes, and probably elegantly. Everyone on Medicare, for whatever reason, use service A; everyone who meets whatever clearly established criteria (such as Medicaid) for need, use service B. Give every participant a chipped card to use, require photo ID (or put it on the card) to be sure the cards don’t turn into underground currency like food stamps sometimes do, and then the details entered into the program (A or B) for that individual will determine: medical taxi, van assistance, reduced or free bus fare? A bright STEM high school senior could write the bulk of the program in a day or so. If you immediately imagined the most complicated possible situations just to pick a fight with me: sure, those exist. If someone needs a wheelchair-accessible van, then that goes into the electronic info on their card; if they merely need a cab for doctor appointments, that’s on the card. As circumstances change, someone in a remote office can input the update. When Mr. X no longer needs a wheelchair van to get to his appointments, his account can (spit-spot, lickety-split) be adjusted to provide for the appropriate transportation benefit. Plus, with GPS it won’t be hard to figure out if the beneficiary had the cab drop them at Dr. K’s or at K-Mart: auditing for abuse becomes simple. Ta-da: not easy, but simple.

If the object was to make sure poor people had good quality healthcare, one might wonder, why not simply work with what we have? One, we have a public health department system and two, we have a VA system to serve as a model for comprehensive (albeit labyrinthine) healthcare. What makes it so complicated to appropriately expand the one, based on what we know from the other? Doctors are leaving, or not going into, private practice and instead signing on as employees in the private sector, so a nice government job with benefits and a pension seems like a tempting offer for many D.O.s, MDs, ARNPs, RNs, dentists, and other healthcare providers angling to be someone’s employee. Yes, we’d need more buildings and more staff, and probably some specialty services would be outsourced (the VA knows all about that, too). Who uses them? How about anyone who meets criteria for transportation assistance, as above? They already have the ID card; add that info. Outsourcing so little of it will lead to much less fraud, the latter a cause of handwringing for the same politicians who resist change.

Oh, I know. I can’t possibly understand. It’s far more complicated than that. Well, no, it’s not. It’s not going to be easy, but that is not the same as complicated. From out here, it is very clear that sometimes what is explained as “complicated” really means “not easy.” These are different things.

A marathon is not complicated. It is a matter of stepping forward and repeating that action for 26.2 miles. I know; I ran 79 of them. They were not easy. They were simple and hard. So are lots of things. It is just easier to see “simple and hard” from the outside than from the inside.

“Complicated” is a euphemism for something along the lines of, “Well, we don’t want to change anything; some people will be unhappy, and maybe we’ll lose some votes, so somehow we must give the appearance of changing things without actually changing anything.” The best we seem to get sometimes is the legislative version of buying storage containers during the January sales. It’s the same pile of junk, but it’s temporarily neat. If the object is to pretend to change, then, yes, everything we shout at the newspaper and radio about is quite complicated. I have no idea how to run AND not run at the same time, so how could a bunch of bureaucrats figure out how to simplify programs while simultaneously avoiding any changes?

Our ambivalent relationship with change makes it simple, and enjoyable, to help other people organize their stuff. The books were not MY books, the stuff was not MY stuff. People who have enough money and stuff hire people to come in and bully them into getting rid of stuff. The theory is that someone else, who is not emotionally invested, will be able to confront me. I can imagine the process:

Professional organizer: “Now, Lori, how many CS Lewis books do you really need?”

Me: “I dunno. How many ARE there? Ought I leave room for more?”

It goes downhill from there.

The analogy ought to fail because the people we elect should not be emotionally attached to ineffective programs. They behave like people suffering the deep heartache that leads to hoarding behavior, but I suspect the attachment is less suffering and more sinister: each entanglement serves a gratifying purpose or two.

Imagine members of Congress clinging, weeping, to the thousands of pages of regulations that describe the several programs to provide fuel (or rather, money for fuel) to poor people in winter. Why would they fret about merging these into one, clear, program? Where is the burning enthusiasm to ensure that the funds to help people stay warm are used prudently and effectively? I don’t want to read about one person collecting fuel benefits from multiple funds and using some of it for frills, while someone else freezes to death. I want everyone to be warm and cozy. If there were one program, would people find a way to abuse it? Surely; but simplicity reduces the camouflage.

I suspect we will all be shouting at the news for a long time. Meanwhile, I have to go pretend to be someone else so that I can impose some order on my stuff: a process that will be simple and hard.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.