Tag Archives: happiness

Too busy!

People brag about the strangest things.

Not getting enough sleep is one; are Americans in some sort of dysfunctional competition to see who can get by on the least possible sleep – regardless of the effect on their mental and physical health?

Another is being busy – so very, very busy – that one could not possibly do anything healthy, or creative, or refreshing in any way.

Is it real busy-ness? It’s hard to say, but I have my suspicions that it often comprises some combination of underestimating how much time is frittered away on time-wasters, taking on a lot of extra and unnecessary tasks, and, sometimes, more than a hint of pride. You know, the people who find out you actually read books in the evening or squeeze in a date night with your spouse and give that little smile and a hint of a sniff when they say, “Well, it must be nice…” Well, yes, actually, it is. Very nice.

Pride, or arrogance, aren’t necessarily obvious. Healthy humans have a normal, natural need to feel needed and wanted. This is a good, but the fear that somehow your absence will cause all of creation – or at least your workplace or the kitchen at home – to immediately crumble into dust is not good. Even Jesus and Moses sometimes sneaked off for some very necessary R&R, either to be alone with God or also with some of their most loved, trusted friends.

Some people are going through a stage of life that is very busy. People with school-aged kids who each  participate in one extra activity will indeed be temporarily overly busy, driving to practice or lessons. They check homework, look under the sofa for shin guards, and use their vacation time for pediatric appointments for yet another ear infection. This stage is transient. Even too-busy parents, though, often hide time-wasters into their day.

When someone asserts always being “too busy” to do things they claim they really want to do, then I suspect that perhaps they don’t actually want to do those things. It would be better to say, “Oh, no – last thing I want to do is be stuck in a gym five mornings a week,” then to dodge exercise by pretending they are just too, too busy. Once they are honest about the issue (apparently they would rather do something else than spend hours on the human version of a hamster wheel) they are free to figure out how to meet the essential need (enough exercise to stay healthy) and stop dodging reality with brag-worthy busy-ness.

It’s hard to give up the busy excuse to oneself. It might be a polite dodge to other people (but remember that “let your yes mean yes and your no mean no” admonition?) but it’s just pointless to lie to oneself.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

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.

Military Mental Health

It seems as if daily we are told how shamefully the military handles the problem of psychological distress and emotional pain for our men and women in uniform. In May, the USA Today newspaper empire asserted that the “Pentagon [is] perpetuating stigmas that hang over treatment, study finds.” (Zoroya, USA Today, May 6, 2016). The military is criticized because it takes mental health issues seriously enough to reconsider security clearances…unnecessarily “stigmatizing” those who have sought treatment.

This supposed stigmatization merits careful consideration. These include the depth and breadth of existing mental health services for active duty personnel and veterans; the conflicted American mindset on mental illness and emotional distress; and the logical outcome of this strange ambivalence.

A person not in the military or close to military personnel, may reasonably be under the carefully groomed media misimpression that the emotional well-being of our soldiers, sailors, airmen and marines is some sort of vague afterthought. Perhaps the general public is unaware that military mental health officers (people who are qualified to be licensed solo practitioners in the civilian world) are found in forward operating bases, combat outposts, and other deployment settings, providing critical incident debriefings, assessments, counseling, and referrals for more comprehensive care. When young men in harm’s way are despondent over a wife’s philandering, or are heartbroken over missing their child’s birth, the mental health officer is there. When there are incoming mortars, the mental health officer is there. When someone’s reaction to the weekly required malaria medication is extreme (malaria meds cause short-lived anxiety in about 1 in 10 people, and for some of that 10%, paranoia kicks in briefly, too), the mental health officer is the one who can figure out what’s going on and have the physician provide an alternative medication for the soldier – saving a military career from dissolving due to what looks like psychosis but is a transient medication side effect. In short, when crises occur, the “doc” or “shrink” or “combat stress lady” (quotes from military personnel) is there.

It is understandable that most civilians are unaware of mental health clinics on military bases, where military personnel and their families can receive counseling. Besides basic counseling services, mental health personnel provide services such as outreach before, during and after deployment, support while preparing for new babies, parent training, marriage counseling, couples’ retreat weekends, substance abuse education, and more. All these are part of the routine in military mental health clinics. Mental health officers are also able to veto a transfer if any member of the transferring family’s health or mental health needs cannot be adequately met at the new location. So…if Mom is being transferred to Base “A” and that area doesn’t have the specialized services that one child in the family needs, the transfer is nixed – possibly by a licensed clinical social worker at Lieutenant rank. The 2nd Lt. just overrode the entire command structure, in the military that is decried for not taking mental health needs seriously.

Then there are the VA system and the Vet Centers. Vet Centers are cousins of the VA. Unlike the VA, Vet Centers require only a DD 214 to provide free individual, couple or family therapy. It doesn’t have to be service-related…but if the problem seems to be service-related after all, the Vet Center personnel can help facilitate connection to the VA proper. These, too, are staffed by people licensed in their respective states as solo practitioners. There are no “not good enough to make it in private settings” amateurs serving in mental health positions.

Finally, there is the difference between benefits (think, Tricare, which is insurance for post-military service) versus service-connected health care (think, the VA system). A lot of veterans get that confused, and any of us who have tried to deal with health insurance and making sense of what is/is not covered, copays and coinsurance, and in and out of network…well, it’s understandable that almost anyone would find it confusing. Fortunately, the VA system and Tricare have professionals who do a lot of work (and get yelled at a lot) in trying to help people understand their benefits/insurance/service-connected health care, and connect them to the right services.

There are mental health services for military personnel and veterans. There could certainly be more, and the services available could be better marketed. In addition…there are stigmas.

Those stigmata comprise one more disgraceful example of too many Americans wanting to have their cake and eat it, too.

The regrettable medicalization of mental health has resulted in the mythology – happily embraced by many in the medical, pharmaceutical and professional-helper fields, as well as by many in the general public – that all mental disorder diagnoses are brain diseases. For example, many professionals will assure you that depression is strictly medical in nature; a brain disease, incurable but treatable by manipulating brain chemistry. Likewise, anxiety is (supposedly) purely a physical issue. People collect Social Security Disability, disability from their employers’ insurance, and other benefits, based upon having some sort of lifelong brain disease (according to psychiatry).

There are plenty of people eager to buy into this. We hear depression is epidemic (what else could we call something that apparently affects at least 20% of women and 10% of men each year, based on prescriptions for drugs?). Well, here is a recipe for depression:

  1. Maintain a sedentary lifestyle
  2. Eat a lot of junk food and assiduously avoid adequate portions of healthy foods
  3. Smoke cigarettes and/or abuse illegal or prescription drugs
  4. Drink more than one drink daily (females) or two drinks daily (males), or more than your physician recommends, given your particular health profile.
  5. Cultivate poor sleep habits. Watch television before bed; heck, watch television in bed, or use your smart phone, or tablet, etc. at bedtime. Drink caffeine less than six hours before bed. Wait until night time to argue with your spouse. Have a “nightcap,” which is a short word for “the alcoholic drink that will let you fall asleep more quickly and then wake up at 2 AM and have difficulty going back to sleep.” Eat salty foods before bed to activate your dopamine system and feel a little hyper.
  6. Avoid exposure to natural daylight.
  7. Watch lots and lots of television, or streaming video, or play video games, or surf the internet. The more the better. Strive for the national average of 6 hours or more daily (non-work related).
  8. Spend lots of time on social media. In particular, notice how much your life stinks compared to other people’s (supposed) lives.
  9. Shop for recreation. Spend money you don’t have on things you don’t need and then keep being surprised when, no matter how fancy the clothes or pricy the electronics, you are still, well, you.
  10. Be selfish.
  11. Don’t apologize, and don’t say thank you.
  12. Think a lot about how much other people are unkind, selfish, lazy, and how generally you are not getting your fair share.

Yes, I just described what an awful lot of people do, and yes, if you do enough of these things, you will probably feel depressed. Yet, as can be seen, every single one of these behaviors is optional for most people. Perhaps someone has physical challenges that prevent them from being active, but otherwise, these all represent choices made, choices which could be changed. If you were to do these things, and feel sluggish, unhappy, uninterested in life, helpless to make things better, etc., and reported this to your doctor, you could easily be diagnosed with depression.

The label depression, of course, is itself suspect. Within the mental health field, we are well aware of a dirty little secret. This secret is carefully hidden by pharmaceutical companies from the unsuspecting, suffering, and happiness-seeking public. That is, the criteria for almost every mental disorder diagnosis is a checklist. Committees review the research, argue about what should and should not be on the various checklists, have professional feuds, and publish the criteria. People are then diagnosed based off a checklist of symptoms or complaints. Those categories are fuzzy – a complaint I hear regularly from graduate students who, perhaps naively, expect pure, clear science. As soon as one set of criteria is published, the process starts all over again. This is how it came to be that, in the current diagnostic manual for the American Psychiatric Association, there is no such thing as bereavement. If you are still moping around after two weeks because someone you love has died, the American Psychiatric Association, in its infinite wisdom, has decided you meet criteria for Major Depressive Disorder. That’s the same Major Depressive Disorder diagnosis that many forces are pushing us to believe is simply a brain disease that requires lifelong treatment. I am not being sarcastic or flippant; it’s their decision, not mine. I was Hospice-trained and, even absent that, I am human and understand that bereavement is a long and painful process, even for the resilient among us.

The decision to eliminate the “bereavement exclusion” was supposedly made, in part, to allow people to use health insurance to pay for grief counseling. (At least, that’s the gossip I hear in mental health circles.) In other words, you are despondent. Someone has died. You go to a counselor. They diagnose you with depression, which is supposedly a brain disease, because you meet checklist criteria. You are now labelled with what many people assert is a lifelong condition due to your sick brain. You will now be able to have insurance cover your counseling (after your deductible has been met, of course). The diagnosis of a major mental disorder will last forever – long after you have forgotten whether you paid a copay or full fee for a handful of sessions, or went to a support group in a church conference room that a therapist facilitated as a volunteer.

Depression is worth discussing as one of the most common diagnoses. Psychiatrists and other physicians provide prescriptions for antidepressants, for example, to about 15% of the adult population annually – and many assert that depression is just a disease, like any other disease, and you have to face that you will be sick and need medication for the rest of your life. If that is the case, then why criticize the Pentagon for being concerned about someone whom psychiatrists assert has a lifelong brain disease having their finger on a trigger, or button, or sensitive data? Why should one person with a particular diagnosis be placed on perpetual disability and another maintain top secret clearance? Which do the people complaining about how the military stigmatizes mental health want?

To be clear, this is not unique to the military. People seek counseling, are unwittingly diagnosed, and discover later that they are deemed mentally ill and a high risk for suicide; perhaps their life insurance rates increase, or their health care premiums increase, and when the premium bills come in, they can’t remember having any mental problems except that time they saw a counselor after their grandparent passed away. The labelling can happen without any mental health treatment at all; if your physician lists a mental disorder as a possible diagnosis (fatigue, depressed mood, and poor sleep being symptoms of lots of problems, psychological and physical) while ordering blood tests (for what turns out to be something medical), that possible mental disorder diagnosis is in your health record, now part of your profile, even if you turned out to be anemic, not depressed.

Even if you are diagnosed with depression, the diagnostic categories don’t adequately describe what is happening, and they should. It is reasonable to expect that professionals, viewing the diagnosis on a chart, immediately discern the difference between these types of experiences:

“I’m depressed and exhausted because I’m having hideous nightmares ever since my buddy was blown up and died in my arms” versus,

“I’m depressed and exhausted because the 5 years I spent doing meth have caught up with me and my brain has been damaged,” or,

“I’m depressed and exhausted (and right now no one, including me, realizes it’s because I am among the one in 10 women who suffer depression as a side effect of chemical birth control).”

Right now, the label doesn’t differentiate. As you dig into the chart, yes, it’s there – but the most superficial record just shows the diagnosis code.

So, let us not pretend that the military is some big, horrid bully for treating serious mental disorder diagnoses as a possible risk factor for clearance. As long as those in power – throughout the medical, insurance, pharmaceutical and government arenas – are manipulating the definition of mental illness, one can hardly blame the military for being overly solicitous about the mental health of our men and women in uniform.

The conundrum of diagnoses and the risk of damage to one’s life explain why some military personnel are suspicious about seeking mental health treatment. We ought not to assume ignorance when they instead go to chaplains (who may be precisely who is needed) for wise and useful guidance. Similarly, they may choose to be self-paying for marriage counseling, stress management or other issues…off the record and off the base, their privacy is as sacred as mental health treatment ever was, before psychiatry yielded to intrusive insurance, and, as the big player in the mental health field, dragged most mental health professionals with it.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

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.

Avoidant Personality Disorder, Social Anxiety, or Just Shy?

Simple shyness? Social Anxiety Disorder? Avoidant Personality Disorder? What’s the difference? Are we just pathologizing normal behavior? Why so many labels?

Well, the labels exist to help professionals differentiate between constructs. That’s what most diagnoses are: categories put together by committee, identifying particular experiences or patterns of behavior, thinking and/or feeling that tend to co-occur. That’s an extreme simplification, but it’s a good jumping-off point for us.

Shyness is normal-people-speak. It’s the way we describe someone, or ourselves, when we are a little reluctant to “blow our own horn” or “put ourselves out there” (whatever THAT means). A little shyness means some mild worry about doing the right thing, not embarrassing ourselves, and wanting to avoid being a nuisance.

Social Anxiety Disorder (SAD) is a psychiatric label that covers a level of shyness that interferes with someone’s daily life. That’s the test: whether the person’s regular life is constricted by worry about saying/doing the wrong thing in social settings and a tendency to avoid social gatherings or work or school related activities. It’s anxiety: there are both physical symptoms of fight-or-flight (elevated heart rate, for example, or more perspiration) and psychological symptoms (worrisome ideas about being in the spotlight and doing something “stupid,” for example). People with SAD usually have close relationships and get through daily life pretty well, with bumps along the way when big events or unusual circumstances – public speaking at a work meeting, for example, or large gathering – looms.

Avoidant Personality Disorder (APD) is sometimes confused with SAD. ADP is markedly different, though, because it encompasses a global low self-esteem and fear of being judged and found wanting in just about every way. So, for example, the person with some social anxiety has close friendships but might feel a bit anxious about going to a wedding reception with a lot of people s/he doesn’t know. The avoidant person has few close relationships out of fear of people finding them just not good enough to be friends. The APD person suffers anguish before annual performance reviews, and even gentle constructive criticism is received as devastating evidence of how deficient they are.

The fear is not “just in their head.” Fear is always a full-body experience. When a situation seems to be a threat (for the person who suffers with APD) to be judged and found wanting, the body responds before the logical, higher brain has even identified what is happening. So the amygdala has sounded the general alarm – the endocrine system flies into action, and as a result logical assessment is curtailed. Telling someone whose heart is pounding, whose blood is full of adrenaline and a massive dose of glycogen and is primed to run away that they are just overreacting is not helpful. Learning how to manage this, how to recover from the old messages of being “less than” and “not good enough,” is a process, not an instant fix. It can be healed.

There’s much more to these labels and to the details of treatment, of course, but perhaps the useful take-away today is: help is available. A lot of people will find that solid self-help approaches based in cognitive-behavioral therapy research (David Burns, MD’s books are excellent examples of these) quite sufficient for mild to moderate social anxiety. When that anxiety is all-pervasive, and there are few relationships out of fear of being found wanting, and loneliness and fear of being judged rule one’s life, the additional support of a counselor might be more helpful than trying to struggle through alone. Ironically, group psychotherapy can be quite effective for these difficulties – but it’s hard to find them.

If you know someone who is struggling, try to help them get help.

 

Dr. Lori Puterbaugh

© 2016

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.

Oh, the drama!

It’s about 2/3 of the way through the spring term, so it’s time again for my intro psychology students to learn about the various personality disorders, as defined by the American Psychiatric Association. One interesting one – and not necessarily in a good way – is Histrionic Personality Disorder (HPD).

Traditionally, HPD was estimated to occur in perhaps 2-3% of the population. You know these folks; you’ve known them all your life. They’re exciting, intense, and fun; the life of the party, the center of attention…and they can’t turn it “off” when appropriate. It’s the “friend” who wears a very well-fitted white dress to your wedding; the family member who always has to make it “about them,” when it’s very, very much about someone else; the middle-aged parent who is trying to compete with a teenaged child to the point of embarrassment (for the child, that is). They lack empathy for anyone but themselves, but can emote with the best of them. Recent studies indicate that incidence of HPD is exploding – with some estimates as high as 27% of the young adult (under 35) population now meeting criteria for the psychiatric diagnosis. It’s thought that the two-generation long emphasis on having high self-esteem absent any achievement of good character or performance might be involved, as well as the current culture that elevates attention (any attention) as better than just chugging along, living your life happily with the people you love.

Which of our grandparents would ever, in million years, have imagined everyday people talking about how many “followers” they have, as if they were Jesus?

Like almost all psychiatric diagnoses, HPD is defined by a checklist; meet enough criteria according to the clinician holding the checklist, and you’ve earned the label. Of course, someone with HPD isn’t coming for therapy for help with HPD. Others may come for help with them, or it may become apparent within the context of counseling for some other issue: relationships, work conflicts, etc.   It’s sad, really, that it can be so difficult to realize one needs help, because at the root of this is a small child, still jumping up and down crying out, “Mommy! Watch this! Mommy – look at me!” and that small child in the unconscious just doesn’t realize that all the jumping up and down cannot make them feel “seen,” and they need to find other ways – more adult, meaningful ways – to feel connected and recognized. After all, everyone wants to be seen by eyes that love them; didn’t the film Avatar touch on that well, where the most intimate thing people could say to another living being was, “I see you”?

Like some of the other personality disorders, particularly Antisocial Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder, the person with Histrionic Personality Disorder will seem fine…in fact, better than fine. All four can be very charming, interesting, and fun. They can seem special and their attention can make the next victim caught in their vortex feel special until all heck breaks loose.

Be compassionate but beware. No matter how wonderful, loving and patient you are, healing the wounded heart under HPD is not a one-man or one-woman task.

Dr. Lori Puterbaugh

© 2016

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.

What are you waiting for?

The American Association for Marriage and Family Therapy asserts that the typical couple coming in for counseling has had difficulties for over five years…which makes me wonder, what are they waiting for?

There are a lot of seemingly perfectly sensible reasons to postpone counseling when things start to go awry:

“It’s expensive.” This is true; counseling does cost money and relationship counseling is an out-of-pocket expense. Still, most therapists are cheaper than two retainers, two divorce attorneys, a mediator, a parent coordinator, etc…

“I don’t want to be told what to do.” Well, a good therapist isn’t just going to tell you what to do. A therapist is going to be asking a lot of questions, having you fill out a lot of questionnaires, and trying to develop a very clear picture of your relationship’s specific strengths and the particular types of problems each of you identify. That way, research-recommended approaches can be matched to the problem(s) of the particular couple.

Fear. Don’t a lot of people fear that it’s going to be like that old Simpsons episode, where, after Marge vents for hours, the therapist turns to Homer and says something to the effect of, “I’ve never said this before, but it really is all your fault.” That’s not what happens in real life.

Shame. So many people suffer with shame over the difficulties they are having. Marital difficulties feel like a failure. Yet, if marital problems were some rare, shameful thing, why are there so many marital therapists? We have our own doctoral programs, professional licensure, and organizations. Beyond that, other non-specialists in the mental health professions also offer couples counseling.   Shame can be overcome by getting help and feeling less alone in the suffering.

The Ostrich. Just try to ignore it and hope it goes away: the addiction, the affair, the endless disputes about parenting or money or values and ethics. Some things, ignored, will go away: a minor cold, a pimple, a minor aggravation of the day. Other things, though, just fester and turn into a nasty emotional infection: resentment, trauma, guilt, hurt.

If your relationship is suffering from feelings of distance and disconnect, or seems to be a vortex of repetitive arguments, counseling could be very effective. Often, five or six appointments, spread out over four to six months, can make a world of difference when both parties are willing to work at changing patterns of behavior and experimenting with new ways of interacting.

It’s important to find a counselor who is a good fit. Call a few of us; talk for a few minutes; get a sense of style and see who seems like a good fit for the two of you.

Be bold. Push past shame and fear; challenge your inner ostrich. Then start to feel happy again.

 

Dr. Lori Puterbaugh

© 2016

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.

Toxic Myths, revisited

A lot of people ask about toxic myths: what does that mean? Why “myths?” (I’d like to say, well, buy the book, and sometimes do).

The toxic myths are examples of lies dressed up as truths. Our culture is seething with them, but in Toxic Mythology, I only addressed a few.

For example, consider the myth that people can compartmentalize their lives. Someone can, within this myth, be an absolute scoundrel in their personal life but supposedly be capable of being completely trustworthy and honorable in their public/vocational role.   Conversely, they can (per the myth, at least) be a sociopath in their professional life but be kind, tender and good in private.

So…if you buy this myth, you have to be willing to:

Vote for someone who swears to uphold a particular principle while having a personal and/or professional life littered with betrayals and a habit of acting on expediency, not principle;

Believe your child who promises she didn’t really cheat on that exam or plagiarize on the paper (despite the software evidence) after same child was grounded for “borrowing” money out of your wallet without permission.

Keep on an employee whom you overhear lie to customers because you haven’t caught that employee lying to you.

Convince yourself that your gossipy acquaintance never, ever would talk about YOU behind your back.

Does any of that sound reasonable? Of course not; these are, however, the toxic myth in action. Our culture tells us that it’s perfectly reasonable to believe that compartmentalization of character is possible and (further) that we should be “judgmental.” That’s another myth for another day.

 

Dr. Lori Puterbaugh

© 2016

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.

Mental Health, Well-Being, and Responsibility

More about personal responsibility in regards to mental health and well-being…

Have you noticed how often people talk about things they do as if they were events that happened. It’s as if “stuff happened,” and they were just hapless victims of circumstances. Note, I am talking about the things people actually DO – not things that really do happen to them.

“I got to work (or class, or church, or wherever) late.” A more accurate description would be, “I decided to do (some category of activity) rather than leave on time.” Maybe it was staying in bed, maybe it was “one more chore,” but the person decided to do something and thus the lateness.

Someone complains, “I woke up with a hangover,” when, of course, the reality is, “I decided to drink to a point where I knew I would feel lousy today but last night it seemed like a really good idea.”

“The (whatever task – homework, a chore, etc.) didn’t get done.” What really happened? The person decided to do something else, or a whole bunch of something elses, rather than that pesky task.

So, one way to improve one’s well-being is to simply start taking responsibility for choices. I might decide to have a brownie ice cream sundae for breakfast, and if so, I should say I am deciding to have this instead of scrambled egg whites with cheese. The brownie sundae, in all its wonderful deliciousness, will not just happen to me by accident, without warning.

I can decide to sit and stew about something that bothers me or I can decide to try to focus on some other activity and decide that I will figure out what to do about a particular problem when I’m in a better frame of mind. I get to decide; an hour spent stewing is something I can choose, or maybe I can choose to do something else instead.

You can decide to be in a relationship with someone who is toxic and mean, or not.

You can decide whether to seek help in parenting strategies, or throw up your hands in despair, or try the consequence-of-the-week approach except for when you’re too tired to argue.

You can decide whether to join a grief support group or suffer in silence and loneliness.

The act of owning a decision gives a greater sense of control, because if you decided one thing today, you might decide something else in five minutes, or tomorrow, or next week. If stuff just happens to you, you have no control, and thus must sit around being helpless, hoping for better luck next time.

Luck is an iffy plan.

It would be better to decide.

 

 

Dr. Lori Puterbaugh

© 2016

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.

Personal Responsibility and Mental Health

This is another reflection on the Florida Adlerian Society’s annual conference last Friday. One of the primary speakers emphasized the role of personal responsibility in mental health. I can imagine, taken out of context, how brutal that might sound. “Are we now blaming victims and ill people for their woes?” the person exposed to just that sound bite might wonder. “Is that what mental health professionals believe?”

The short answer is no, that’s not what we believe.

Embracing free will and the dignity of each person, however, ineluctably leads one to emphasize the role of personal responsibility in how one deals with what happens in life. This isn’t something new: it is ancient philosophy dressed up in psychotherapy clothes. So, while someone may suffer terrible misfortunes outside of their control, the impetus to decide what to do about it is within them. Seek help, or sink into despair? Reach up to grasp a hand, or reach out for a bottle, or needle, or some other vial of trouble?

Sometimes people do have some personal responsibility for what happens, and indulge in magical thinking in which bad things just randomly happen to them. I recall a person I met many years ago who got into trouble for buying drugs. He complained about the injustice of the level of trouble; he didn’t mean to do it. It just happened. (I’m pretty much quoting here.) I asked, how do you buy drugs by accident? How do you take a peaceful stroll around your neighborhood and accidentally end up lurking behind a shopping center chatting with the type of entrepreneurs who set up shop near dumpsters and concrete walls? Acting like there is no personal responsibility means that there is no effort to make things better. It’s just a lot of bad luck, from his perspective; no reason to change because you can’t change “luck.”

Often, though, human suffering is due to others’ actions. Just the same, an adult has some power to effect change. The responsibility is not for others’ bad actions, but to take some sort of action to help oneself. Sometimes people evade taking responsibility to make change because it will be uncomfortable, or embarrassing, or mean that they have to admit that at some earlier point they were wrong. Breaking off a destructive friendship or leaving a toxic work environment can be very challenging for a host of reasons, and leaving an abusive relationship can be dangerous. Reach out and get help. If the first, or second, or third person you go to for help is clueless – keep looking for the right help.

Typically, people do things that undercut happiness and health in some way and evade responsibility. People have habits that cause insomnia, for example, and complain, as if poor sleep side-tackled them in the hallway due to no fault of their own. We take on extra activities and complain about being too busy. People fail to set limits with their kids and then yell and throw consequences around when their children are irresponsible, disrespectful and unpleasant to be around. People make choices all day, often on auto-pilot, and a great many of us are prone to griping about all sorts of situations that result, as if stuff just happens without cause. Yes, of course, sometimes, stuff does happen…but, if you’re always five minutes late…that’s you. Not the traffic, not the cat, not the dog…it’s you. If your friends are inconsiderate, that’s not your fault, but it is your problem if you keep tolerating it. If you do tolerate it, then take responsibility for it and stop complaining. “Yes, good old Joe is always late but that’s just him; it’s not personal.” You’ve decided to accept it. Stop griping. If you can’t stop griping, you haven’t accepted it. If you can’t accept it, then do something: leave when he’s late. Put your foot down. Tell him off. Lie about what time you’re meeting and get there late yourself (it might work, once). Whatever; if you’re not prepared to do something about it then face that you have decided to let Joe be chronically late without regard for your preferences or schedule because you have decided tolerating it beats the alternatives you’ve identified of annoying Joe or losing his friendship.

Narrowing it down to mental health, whatever a person is suffering, help is available. How one lives is always part of healing. Proper amounts of exercise, sleep and nutrition are part of it, and things for which most people can take some responsibility. Seeking right guidance requires making choices. Unless you belong to a professional mental health association, your friends might not be the best source of professional advice on the specific strategies, to, for example, use mindfulness training, exercise and specific cognitive therapy techniques to rewire your brain and reduce obsessive-compulsive symptoms. You get to choose. That’s not blaming you for your suffering, but it is saying that you have the freedom, responsibility, and capacity to move towards healing.

 

Dr. Lori Puterbaugh

© 2016

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.

Well…something’s crazy (but it’s probably not us)

Yesterday I attended the Florida Adlerian Society’s annual conference; it runs for three days but I was only able to commit to one. It was a great day: wonderful speakers, challenging information, and, of course, the warm and friendly Adlerians in attendance.

Adler is one of the great founders of psychotherapy, but often is relegated to a corner with a few remarks about birth order and maybe credit for starting the child guidance movement. He’s much more than that, and if you’re curious, visit www.alfredadler.org.

An interesting point made during yesterday’s talks was the evolution of bereavement in psychiatry over the past few decades.   The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s published list of descriptions of various patterns of symptoms. The intention, back in the early 1980s and DSM-III, was to provide a structure for shared dialogue and research for the identified hypothesized mental disorders. No one was pretending these were all clearly identifiable and diagnosable, discrete brain diseases. In the DSM-III days, bereavement, as a category, covered up to a two year long period. If a grieving person was still sad more often than not, still struggling with aspects of grief and getting back to a (new) normal life, mental health professionals figured, depending on the relationship, two years was a reasonable time frame. Of course, some losses never heal – but people somehow figure out how to go on, just the same. The point is, no sensible person thought it was pathological to still have some regular bouts of tearfulness a year or more after your most beloved person died.

In 1994, the next edition of the DSM came along, DSM-IV. It gave people two months – not two years – to get over it and move on. If not – if the person was still crying, or numb, or having appetite and/or sleep disturbances, or otherwise met the minimum criteria for depression…well, that meant that bereavement was over and the person was now diagnosable with a major mental disorder – depression – which was now sometimes described as a permanent brain disease.

In 2013, the DSM-5 was published (note that the change from Roman numerals to integers was done by the APA – it’s not a typo on my part). The DSM-5 got rid of the bereavement issue entirely: now you get two weeks of being sad more days than not, plus the other possible symptoms, and you’re mentally ill with depression (according to the APA). There is no exception for bereavement, although it ought to be noted on the chart. One rationale provided, about which I’ve written in the past, is that this way people can get their health insurer to cover their grief counseling. Whether this makes it worthwhile to pathologize normal grief, I leave each reader to consider.

Are you mentally ill if you have trouble eating or sleeping, or burst into tears almost daily, two weeks after someone you dearly love passes away? I don’t know anyone who thinks so, but the manual that has become the healthcare provider’s and insurer’s standard frames it so.

 

Dr. Lori Puterbaugh

© 2016

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.

Cognitive Behavioral Therapy: So Much More than Positive Thinking

It’s more than just positive thinking

A smart, thoughtful person mentioned the other day, in conversation, that Cognitive Behavioral Therapy (CBT) seems to be just “the power of positive thinking.” That’s probably what it sounds like when it gets boiled down to a sound bite…but in reality, it’s so much more. There are many excellent resources out there, so I won’t attempt to tackle the whole topic here. A brief example, though, on the difference between CBT and simple positive thinking, might help.

In CBT, we are indeed looking for patterns of negative thinking. These are identified, and then we dig down to the underlying thoughts. From there, the challenging and reforming of particular thoughts begins. Then comes the hard work of rehearsing those new thoughts.

Consider, for example, an adult who is very anxious about grades in college. This student is up late studying, preoccupied with grades, and anxious to the point of headaches and nausea before tests. The student feels terrible, of course. The top layer of thinking probably includes themes such as, “I have to do well,” or, “This is too important to fail.” The level of distress the client feels, though, seems out of proportion; the client is sick and nauseated over A- or B+ grades. Digging deeper, the client turns out to have buried beliefs such as, “Perfect or failure – no in-between,” or, “Hero or zero,” or, “No one loves a loser.” Thus, the A- feels like a failure and even a threat to love and security. Those aren’t conscious thoughts: no reasonable grownup thinks, “Oh, no one can love me because I got an A-!” It’s more of a personal belief, often acquired early in life, which became the background to many experiences.

You can see that trying to be “positive” about the top layer thoughts might seem silly: “Oh, it’s fine to fail,” or, “It’s OK for me to not do well.” The client cannot buy into that. However, a deeply held belief – that one is either perfect or a complete and utter failure – merits serious attention, and probably underlies many difficulties for this client. Thus CBT starts it work – which is much more complex than presented here – by seeking the foundational troubling beliefs that are leading to the negative thinking.

As I noted – this is a cursory glance at one aspect of CBT. It is a well-researched method of treating anxiety, OCD, depression, and other difficulties. If it seems as if it might be helpful for you, please see appropriate professional guidance.

Dr. Lori Puterbaugh

© 2016

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.