Sensitivity

I am reading The Secret Life of Bees for book club, and I love it! I know it's old, but in our last meeting we discussed which books made us wish we could spend more time with the characters, and one of the members mentioned this one. I can see why. I love all of the characters, too. Well, maybe not June so much. She's a little too guarded for me. Although I wish I could be more like August, the matriarch of the sisters, I am actually more like May--the fragile one who feels other people's pain too deeply. Not as deeply as she did, thank goodness. But more so than I would like sometimes.

On the one hand, I recognize that it is a gift to have such a keen sense of empathy. I know I have helped a lot of people because of it. But I am also easily thrown off balance when the people I care about are in pain--especially since I am also prone to depression and anxiety. I have always assumed this meant that I was weak. Fragile. Too sensitive.

I spent time with my brother this weekend--the only one of the four siblings who does not have a mood disorder. In talking to him, it was clear that he does not experience his feelings as intensely as I do. He does not get his feelings hurt very often. He is better able to maintain distance from family drama, and his advice really is to tell them to suck it up.

I envy him for this, but I cannot be him. I can only be me. I feel things intensely. My feelings get hurt easily. And when someone is in pain, I feel what they feel and try to help them, even if it hurts me.

But rather than berate myself for it, I am learning to accept that this is who I am. We all have different vulnerabilities. Some people may be prone to heart disease. Other people have diabetes. I am a hyperempath with depression and anxiety. Therefore, I have to be sure to take care of myself in certain ways: make alone time a priority, set boundaries, and be more selective about who I spend time with.

I used to joke that I'm not trying to save the world--just the people that I meet. But perhaps I will have to narrow down my scope in my life-saving efforts, too.

Darkness and Light, Part 2

I am deeply saddened by Robin Williams' death. I love the roles he chose as an actor. He was a comedic genius. And he was full of life--a light that seemed to shine a little brighter than the average star.

As a psychologist, I don't have any special knowledge about why Robin Williams committed suicide. I wasn't there. I didn't know him personally. I wasn't his therapist. I do know that, no matter how well you think you know someone, it is difficult to fathom the depths of the darkness they live in. Because who wants to share that with other people? Who wants to burden other people with additional darkness? It's hard enough to deal with our own.

I also know what it's like to have multiple depressive episodes. My psychiatrist compared relapses to breaking your leg in the same place multiple times: with every break you become more vulnerable to injury; it takes a little longer to recover each time. 

My dad had 3 major depressive episodes. His last episode hit when he was 69 and lasted for almost 4 years. It was a tremendous amount of work for him--and my mom--to recover again. I know sometimes he didn't want to try. And I know he felt that way more often than he let on but tried to be strong for my benefit. 

In my last depressive episode, there were times when I wanted to give up, too. Well, it's not so much that I wanted to give up. It's more like the depression told me that I should. And in my weakened state of mind, it was hard to fight back. I am thankful that I was able to do so in the end. That was my 2nd major depressive episode. I'm trying to do everything within my power to prevent a third. 

What if Robin Williams had 5 or 6 depressive episodes? What if the demons of depression never took a break unless he threw himself into something like acting or drugs or alcohol? I don't drink and I have never used drugs, but if I had to live my life feeling the way I did at my worst, maybe I would. I don't know that I would have been any stronger. So I don't think it's fair to accuse Robin Williams of being weak. Clearly, based on his body of work, he was anything but weak. He was fighting it all the time.

I was also taken aback by the anger that some people felt about his suicide. But I don't judge them for it. I can understand why, if you have been personally affected by suicide, you would identify more with the people who are left behind and have to make sense of this loss for the rest of their lives. Fortunately, I have never been there, but if my dad had ever given in to his demons, I know I would have been devastated.

I think that people who see mental illness as a weakness, an excuse, or a nonexistent entity fear the darkness in themselves. They try to deny it in themselves and in others as vehemently as possible, lest it find a way to escape. But some of us don't have that luxury. We can't lock our depression in a closet and throw away the key; it is too powerful. It does not obey our will.

One positive outcome of having known that kind of pain is that it has deepened my compassion for others. It motivates me to alleviate whatever suffering I can in others. In my opinion, the people who know what it's like to live in darkness are the ones who are the most motivated to enlighten others. So if Robin Williams inspired more people to become light bearers, then that is at least one good thing that can come from this loss.

The Battle Against Depression

I really wish that so much of my existence did not revolve around obsessing about sleep. I'm tired of writing about it, and I'm sure you're sick of reading about it. But this is the reality of my existence at the moment, and I am committed to being honest about my current state of mind.

Today was another day that was filled with sleep. It makes me feel like such a failure. My colleagues don't struggle to make it to work because they can't get out of bed. The physicians in my family never even take a sick day. Some depressed people manage to take care of their families. I can barely take care of myself. What is my excuse for my weakness?

Then I thought of physical conditions that leave people debilitated. Migraine headaches. Chronic Fatigue Syndrome. Lyme disease. Do the people who suffer from these conditions feel paralyzed with guilt and shame when they can't get out of bed? Or do they accept their fatigue as being part of their illness rather than a personal failing?

I think about the recommendations I give to clients who are depressed. Exercise. Get sunlight. Be social. Regulate your sleep cycle. If someone had the flu, you would tell them to rest. Listen to your body. But with depression, we tell people to ignore what their bodies and minds are telling them and to do the opposite. Fight it! Don't give in!

Don't get me wrong. I do all of these things when I can, and they work. After sleeping most of the day, I forced myself to do laundry, get some lunch, wave at my neighbors, put together my tennis schedule for the new league, and play tennis for 3 hours to make up for my lack of steps from yesterday. And I'm writing this blog post now. 

Because if I gave in to the desire to do nothing, I wouldn't really be trying to get better. I wouldn't be taking responsibility for my illness. But I don't think it's fair to hold it against someone if their depression is so severe that it's too much effort to go outside and get sunlight. Because sometimes I'm that person, too.

When I have a client who cannot will themselves to follow these recommendations, I don't judge them for it. But I tell them to keep trying to do them. And no mental health professional that I know would tell a client that if they felt like they need to sleep they should listen to their bodies and rest.

There is an article circulating on the internet about how for some depressed people, positive reframing doesn't work. Telling the person to be positive actually makes them feel worse. That it's better to support them by expressing empathy for their feelings. 

Perhaps someday, researchers are going to find that listening to your body when you are depressed is sometimes more effective than fighting it with wakeful activities like forced exercise and socialization--two things that can be difficult to do even when you're not depressed.

I'm going to do my own case study to see if this works.

Liebster Award

I would like to thank Somber Scribbler for nominating me for the Liebster Award. I am new to blogging so I always wondered how people got these awards. What a great way to find out! In the words of Sally Field, "You like me! You really like me!"

What is the Liebster Award?

Liebster is a German word that means lovely or valued. It's an award for relatively new bloggers with less than 200 followers. Nominating someone's blog is a way of letting them know that you like their work and a way to interact with other bloggers. 

Liebster Rules

In order to participate, Liebster nominees must:

1.  Thank the person who nominated you. (Thanks again to Somber Scribbler, who writes one of my favorite blogs.)

2. Answer the 11 questions given to you.

3. Nominate at least 5 blogs with less than 200 followers (approximately).

4.  Post 11 questions for your nominees to answer.

5.  Post a comment on your nominees' blogs to let them know that they've been nominated.

Questions from Somber Scribbler

1.  Why did you start blogging?

About 2 years ago I started writing a self-help book on self-acceptance, but I thought it was so terrible, I was embarrassed to let anyone read it. I had to figure out some way to let other people read about my ideas, so last September I decided to start a blog, even though I barely even knew what a blog was. It turns out blogging is perfect for my writing style.

2.  If you could describe yourself with one word, what would it be?

At the moment, I would say "hopeful." That's why I'm a therapist, why I continue to try to get better at tennis, and why I think I can write a book.

3.  If you could be famous for one thing, what would it be?

That's a tough one. I'd like to be famous for just about anything, as long as it's positive. But I'll say writing a best seller.

4.  What advice would you give to fellow mental health sufferers?

Listen to that voice that tells you to believe in yourself, regardless of how small it may be at the moment.

5.  If you could only eat one thing for the rest of your life, what would it be and why?

Another tough one. I will interpret "thing" as "ingredient" and say anything with sugar, for obvious reasons.

6.  Which fictional character do you relate to the most and why?

Ellen O'Farrell in "The Hypnotist's Love Story," by Liane Moriarty. She falls in love with a man whose ex is stalking her and becomes obsessed with her stalker because she has so much compassion for her suffering. That would totally be me. 

7.  What did you want to be when you grew up?

The first thing I remember wanting to be was a cashier when I was 5 because they had access to all that money. But then my parents told me that money wasn't theirs. So then I wanted to be a bank teller, but my parents said that money wasn't theirs, either. After that I clearly gave up on any attempt to make money.

8.  What is your greatest strength and your biggest weakness?

I would have to say that my greatest strength is my biggest weakness, which is my empathy and compassion for other people's suffering. It helps me to help people, but having too much empathy can be overwhelming at times.

9.  What is your dream vacation?

Maui is one of the few places that has lived up to all of my expectations, so that's where I would go for my dream vacation. With Roger Federer.

10.  Which of the many quotes about mental health speaks to you the most?

My favorite quote is from Kung Fu Panda (although I'm sure it's originally from somewhere else):

Yesterday is history,
Tomorrow a mystery.
But today is a gift.
That's why they call it the present.

I have a lot of trouble living in the moment, which is why in my blog I often start sentences with "In this moment...." A lot of suffering can be minimized with the practice of mindfulness.

11.  What is the most positive thing about today?

Today I got to spend time with my niece, Sadie, which is always a gift.

My Nominees

I'm going to interpret "new blogger" loosely so that I can nominate some of my favorite bloggers. So in no particular order, I nominate:

1.  Amy Purdy, who writes Bipolarly. Her blog on bipolar disorder is informative, personal, and from the heart.

2.  Matt Fried, who writes Fried's Blog, because he is committed to honesty and to eradicating stigma against mental illness.

3.  Tim Clark, who writes Life, Explained, because he rooted for UVA to win the NCAA championship in basketball after his team was eliminated.

4.  Joy Page Manuel, who writes Catharsis, because she is a fellow Filipino and we think alike.

5.  Somber Scribbler, which is probably cheating, but we think alike, she also writes about mental illness, she also includes doodles in her blog, and she would have been my first nominee, had she not nominated me first.

My Questions

1.  What job would make you say, "I can't believe I get paid to do this!"

2.  What's the last dream that you remember?

3.  Who was your favorite character on "The Brady Bunch" and why?

4.  What was your New Year's Resolution this year? 

5.  What do you want to be remembered for? 

6.  What advice would you give to someone who is thinking about starting a blog?

7.  How many jumping jacks can you do in a minute?

8.  If you could put 3 things into a time capsule, what would they be?

9.  Who is your favorite superhero? 

10.  What song best describes you?

11.  What's the last book that you couldn't put down?


Here is a random picture of Sadie and me in Legoland.

2014 Blog for Mental Health Project

“I pledge my commitment to the Blog for Mental Health 2014 Project. I will blog about mental health topics not only for myself, but for others. By displaying this badge, I show my pride, dedication, and acceptance for mental health. I use this to promote mental health education in the struggle to erase stigma.”  
A Canvas of the Minds

Sometimes we make the most important decisions in our lives without consciously knowing why we made them at the time.

I knew that I wanted to become a psychologist since I was in high school. At the time I wasn't fully aware of being depressed in the clinical sense. Being anxious was so much a part of my personality that I didn't think I had an anxiety disorder. And I definitely wasn't aware of any mental illness in my family. I had no idea at the time that depression, bipolar disorder, and anxiety would impact every aspect of my life--in both positive and negative ways.

It's probably not surprising that I have been negatively affected by mental illness. But as I write this post, I realize that there have been positive things about it, too. I have learned the most important lessons in life through suffering and loss.

Even as a therapist, when I heard clients make comments about how they had a bad week, it didn't fully register how horrible that week was for them. In part because clients don't elaborate unless you ask them to. Unless they are certain that you really want to know. And because they are embarrassed about it. Ashamed, even. But after going through my worst depression 5 years ago, I have much more compassion when clients make these offhanded comments.

I admit, during that period there were times when suicide would cross my mind. But there were two things that kept me from seriously entertaining it. One is that my dad would be devastated, and I feared he would never recover if I went through with it. 

The other reason is that if I took my own life, it would undermine everything I ever said to my clients about how pain passes. That one day when they look back they will realize how strong they were at the time. That they will learn lessons from their suffering that it takes some people a lifetime to learn. How can you believe anything your therapist said if she committed suicide? That would be the ultimate betrayal.

So I spent months willing myself to get better.  I went back to therapy, started meds again, meditated and prayed, and forced myself to play tennis and spend time with friends. And I did get better. And everything I said about realizing my strength, becoming more compassionate, and acquiring wisdom were all true. I would have never chosen depression, but we usually don't choose the experiences that teach us the most about life.

People often ask me how I can listen to client's problems all day long. In all honesty, I can't imagine what else I would do for a living. It feels more like psychology chose me.  And when I hear a client's story, I always have hope that together we can change the plot for the better. After all, I always root for the underdog. I am the eternal optimist. And I never back down from a challenge.

There was a time when I would never have told this story about my struggles with depression and anxiety to my students or clients. Or even friends and family. But now I want to share it with the world, because every act of courage benefits someone else. My blog is proof of that.

Let it Go

I love Disney movies. And Disney's latest, Frozen, is one of my favorites, not only because the music is awesome, but also because it is a story about self-acceptance and love between two sisters.

Elsa is the heir to the throne in the kingdom of Arendale. She has spent her life locked in her room, afraid of her power to create ice and snow, because she accidentally injured her sister Anna when they were children. At her coronation, Elsa's powers are revealed when she sets off an eternal winter. When she sings the theme song, she is exhilarated that she no longer has to hide her secret. She creates her own palace of ice and snow on an isolated mountain top.

Although Elsa is free from her secret, she still doesn't want to let her sister into her life. And ironically, in her effort to protect her sister, she accidentally freezes Anna's heart, which almost kills her. But even then, she still tries to push Anna away, for fear that her powers will do even more damage.

It is not until the end of the movie, when Anna sacrifices her life to save her sister, that Elsa understands that surrendering to love is the answer to controlling her power. She is then able to unfreeze the kingdom and open the doors to the palace.

Tonight my brother called me because he has been depressed and struggling to make it to work. For the first time I shared with him how I had gone through the same thing 5 years ago in an effort to convince him to get on meds and to reassure him that this is not a sign of weakness. He was surprised that I had suffered as he had and that he had not known about it. But it wasn't his fault, because I didn't tell any of my brothers about it.

Although I had been on and off meds for several years, this episode forced me to accept that they would have to be a permanent part of my life. As humbling as this was to acknowledge, it was also freeing. But even after I felt better, I still remained in my kingdom of isolation, afraid to let people know.

Writing this blog is the first time I have been completely honest about how dark my depression was. And perhaps sharing my story will save someone else. But in this moment, the most important thing to me is that it saves my brother's life.

We all have the power to create barriers to keep our loved ones away from the darkness inside us. Yet the real answer is to let go and to bring that darkness into the light.

Meds

The first time I started anti-depressants I was 30. By this time I had been depressed for at least 15 years on and off and anxious non-stop for about 30 years.

Obviously, it would have made more sense to start them sooner, and people told me that, but I was anti-meds up until this time. I was in a research program that strongly favored psychological interventions. Meds were just a product of the money-making pharmaceutical industry and were over-prescribed. People were more likely to relapse when they stopped taking meds. Blah blah blah.

Most of my resistance was really because I was stubborn. No one could have talked me into taking them any sooner.

I finally decided to try them after my husband and I had moved again after a year. Before we finished unpacking, he was already obsessing about buying a house. I knew at some level that we weren't going to make it, which triggered a depressive episode.

I started on Paxil and sure enough, I felt better immediately. So much better that I wondered why I had allowed myself to suffer for decades when I could have just put myself out of my misery by taking the freaking pill.

Still, after being on them for a year and a half, I stopped taking them--with my doctor's approval. And I was OK for awhile. But then we bought a house and my husband wanted to find another one a year later. My marriage was moving closer to its sad conclusion.

This time I took Lexapro and stayed on it for much longer. When my life finally seemed stable, I tried going off them again. As soon as the meds were completely out of my system, I felt the depression slowly creeping back. I was a little more irritable. It was a little harder to tolerate stress. My thoughts were a little more negative. Occasionally I was emotionally explosive. And finally, I was barely able to get out of bed.

It turned out to be the most severe episode I had ever experienced. It seemed out of the blue at the time, but now I know that it was because my dad was also experiencing his most severe depressive episode. Even though I didn't talk to him much, I felt it. That whole super-empath thing. Damn empathy. So annoying sometimes.

I can honestly say that this time the meds saved my life. The depression and anxiety were so debilitating that I spent most of my time lying on the couch, willing myself to keep living, counting the days until the drugs kicked in.  And when they did, I was immensely grateful for the pharmaceutical companies that came up with drugs that allowed me to be myself again.

All clients want to try therapy without drugs, and we always do.  And sometimes that's enough.  But sometimes it's not.  And the process of going on and staying on meds for as long as necessary--which might not be for life--is long and arduous.  But when they finally take them, they are thankful that they did and wonder why it took them so long.

But they still want to go off them.

I don't criticize them for this, because my path to acceptance was longer than theirs.  I used to beat myself up over my stubbornness, but the reality is, you can't be ready until you're ready.

It takes a long time before we are willing to give up suffering.

No Good Reason

Most people who come to therapy for depression berate themselves for not having an excuse for their feelings.  Even when they can identify the stressors that led to their depression, they claim that these aren't good enough reasons to be depressed.
 
Sometimes people try to make them feel better with the "count your blessings" approach.  This usually makes them feel worse, because now they don't deserve to be depressed since they have so much going for them.

In cognitive-behavior therapy (CBT), therapists challenge irrational beliefs as a way to help clients see that their depression isn't logical.  Sometimes this works.  But sometimes they know their depression isn't logical, and pointing this out makes them feel even more ashamed for not being able to control their feelings.

For clients with the "no good reason" problem, I have found that the most useful strategy is to debunk their myths about feelings.  Since you probably believe these myths, too, I thought I would go through my whole therapy spiel.

1.  Feelings don't have to be rational.  That's why philosophers make such a big deal about distinguishing reason from emotion.  Sometimes they coincide, and it feels better when they do.  It feels better when we can say I'm sad because I'm sick of winter versus I'm sad and I have no idea why.  But we don't have to know the reason why for our feelings to be valid.

2.  There is no right or wrong way to feel.  We have a lot of implicit rules for what we should be feeling in a given situation.  Take my Ph.D. example in my post on self-worth.  I thought I would feel ecstatic after defending my dissertation.  Instead I got depressed.  Positive events don't always lead to positive feelings. 

3.  We can experience positive and negative feelings at once.  Researchers say that we can't do this, but I think they're wrong for reasons that are too complex to explain in this blog.  But I'll give you an example to prove that I'm right.  People cry at weddings because they are both happy and sad at the same time. 

4.  Your feelings aren't your fault.  We like to believe that we have more control over our feelings than we actually do because...well, because it makes us feel more in control.  But this illusion comes at a cost.  Which is why I wrote the posts on blame and free will.  You didn't choose to be depressed, and it's not your fault that you can't stop the depression.

 5.  If you try to make yourself stop feeling, you'll just make things worse.  Because this will involve some level of deception, like denying or suppressing or minimizing your feelings.  And at some point, this will blow up in your face when you least expect it.  Plus it will make you less empathic when other people tell you how they feel, which will lead to relationship problems.

Although I can write logically about these myths, I still fall prey to them, because feelings aren't always logical.  Knowing isn't enough to solve the problem; you still have to practice.  Which is why I practice mindfulness and self-acceptance.  And I encourage you to do the same.

So the next time you catch yourself saying that you have no good reason for your feelings, remind yourself that you don't need one. 



Fear of Sadness

Most people find it difficult to tolerate negative feelings like sadness.  This task is even more difficult when you suffer from depression, because any time your sadness feels too intense or lasts too long, you worry that the depression is coming back.  And if you've ever been depressed, you know how terrifying the prospect is of going back to that dark place.

Your loved ones also become hypersensitive to your sadness, which just exacerbates your fears.  If you're feeling down, they ask you if you're taking your meds, or if maybe your meds need to be adjusted.  Don't get me wrong--I'm all for meds.  I've tried to go off them several times, and each time I got depressed again.  But it's unfortunate that once you've been depressed, every feeling has to be scrutinized for potential pathology.

There's also this added sense of failure associated with relapse.  Like you should have been able to prevent it this time, since you've been there before.  And even though you recovered before, you fear that if it happens again, you won't be so lucky the next time.

And even if you do recover, you fear that the wait will be agony.  I fear depression much more than anxiety because when I'm anxious I can take an Ativan and I feel better immediately.  But antidepressants don't work that way, so there's not much I can do to feel better right away when I'm depressed.

Whenever I am afraid I'm becoming depressed, I journal about my fears, my sense of failure, and my pain.  And when I look back at these entries, I realize how strong I am.  There are a lot of things that suck about depression, but I have no doubt that it has made me a stronger person, even while it tries to convince me that I'm weak.

But how do I know when I'm sad versus depressed?  To be honest, I don't always know.  Sometimes I feel depressed for a day.  Sometimes I feel sad for what feels like an eternity.  The line is not as clear-cut as we'd like to think.  But regardless of whether it's sadness or depression, the best I can do is to control what I can control.  This includes therapy, meds, stress management, and self-care. 

And most importantly, for me, it means practicing self-acceptance--of my sadness, my depression, and everything else that makes me who I am, for better or worse. 

How to Save a Life

A few years ago a client told me that I saved his life.  Well, he didn't tell me directly.  He told my colleague when he was drunk at a gala. But he told her to tell me.  Although I'm not sure he remembers doing so.  Still, I was humbled by this.  I knew therapy was important to him, but I didn't think his life was in danger.  But then again, even when clients are in therapy, they don't always tell you the full story.

Once I had to cancel a session with this client and he stopped coming in for about a month.  Apparently he got depressed because he felt like I had abandoned him.  A professor contacted him because he had also stopped going to class.  When he came back to therapy, he told me that his professor saved his life.  That was the first time I really understood how much therapy means to some clients, even when they say they're not sure they want to be there. 

Last week I went to a threat assessment training, and the first case that the presenter discussed was a student who had to go to the police department because she told her roommate she was suicidal.  While she was there, she asked for a piece of paper and a pen.  She drew what appeared to be a bunch of random doodles.  But later when they looked at the drawing, they saw that she had embedded the word help three times.

This, too, reminded me that people may say they don't want help but their actions tell you otherwise.

Before I started blogging, I thought blogs were just another example of our narcissistic culture in that journaling, which is supposed to be a private experience, was turned into something that you shared with the world and everyone was free to comment.   But now I realize that blogs can be a way for people who have never had a voice to connect with people like themselves.

My favorite blog is by Nelly N.  She writes passionately and honestly about her struggles with obsessive-compulsive disorder, among other things.  She shares her most painful experiences so that other people who suffer in silence will realize that they are not alone.  And it works.

A few days ago the student group that I advise had their annual eating disorder panel.  It consists of students in recovery who are brave enough to share their story.  On our campus, people with eating disorders are blamed and judged more harshly than any other disorder.  Not surprisingly, no one wants to admit to having one publicly.

Every year, at least one student seeks treatment after attending the panel.  And the next year, those students volunteer to speak on the panel so that they can help someone else who is alone with their eating disorder.  Sometimes they use the opportunity to speak as motivation to get better.

We don't have to be able to leap tall buildings to save someone's life.  Sometimes heroes are ordinary people who take action when someone needs help.

                    

Free Will

When I was in college, one of my fellow psychology majors asked me if learning about psychological theories made me question whether we had free will.  It did not.  Although his question did make me read through the theories again, just to make sure I understood them correctly.  But I was still convinced of my free will.

In my last post I used the example of an alcoholic father to illustrate how difficult it is to sort out blame and responsibility.  If alcoholism is genetic, and his parents were alcoholics, and all of his friends drink, what chance does he have of living a sober life?  How much of his behavior is in his control?

What if you have someone who is depressed with no family history of depression and no apparent cause, and she can't get out of bed to make it to class.  Is her depression real?  Does she deserve to fail?  What about if she refused to go to therapy and start meds?

I mentioned in my last post that these problems require forgiveness.  We have to forgive ourselves for having the disorder.  We may have to ask for forgiveness from people whom we have harmed.  And we may have to forgive people who have added to our suffering. 

When I'm depressed, I think everything is my fault.  In the midst of an episode, I am angry at myself for not being able to function.  I don't think I have an excuse to be depressed.  In those moments, it's hard to forgive myself for not being able to control everything.

I also mentioned that there is always some part of the problem that we can take responsibility for.  It may not be the alcoholic dad's fault that he is prone to addiction, but he can join AA.  He can stay away from friends who pressure him to drink.  He can see a therapist.

I believe that knowing our limitations allows us to have more freedom.  In my work, clients often try to convince other people that their suffering is real.  I tell them that they have limited control over what other people think about their disorder.  However, they don't have to blame themselves.  They can take control of what they can control.

Some people think that going to therapy is a sign of weakness.  In reality, therapy increases your degrees of freedom.  And I want to make sure I capitalize on all the freedom I can get.

Whose Fault is It?

I love playing games.  One of my favorites is the Blame Game.  Even though any couples therapist will tell you that you're not supposed to do this, I'll use every piece of evidence of every argument I can remember to prove that it's not my fault.  I have no doubt this has contributed in part to the demise of some of my relationships. 

However, even though I don't like being at fault, I also blame myself for everything.  I'm one of those people who takes too much responsibility for problems.  Maybe that's why I am also willing to do more than half of the work to try to "fix" the relationship.

The whole blame and responsibility thing is even harder to sort out when you throw in mental illness.  Lets say, for example, that you have an abusive alcoholic father.  Is it his fault if he hits you while he's black out drunk?  Is it his fault that he has an addiction-prone brain and can't just have one drink?  What if he had been sober for a year but relapsed because a buddy guilt-tripped him into going to a bar to celebrate his new job?  What parts of the alcoholism are his responsibility?

In my work, the Blame Game is the most problematic in a sexual assault.  It is often the case that both parties were drinking.  However, when friends are assigning blame, the perpetrator is seen as being less responsible because he was black out drunk.  The victim is seen as being more responsible for allowing herself to get that drunk. 

And when the victim comes to therapy, she also believes it was her fault because she had been drinking.  The perpetrator usually doesn't come to therapy.  In rare cases, the victim will bring the sexual assault to our judicial system to get the perpetrator to take responsibility for his behavior.  And the victim almost never wins.

The two most common disorders we see in the Counseling Center are depression and anxiety.  These are disorders where the person takes too much responsibility for their problems.  If they can't will themselves to get out of bed and go to class, it's their fault for being lazy.  When I suggest that a client try meds for her panic attacks, she often says no.  That's a cop out. She should be able to do it on her own.

I don't claim to know the answers for how much blame a person should assume.  I do know that the split in assigning blame is rarely 100% to 0%.  There is always some part of the problem that we can take responsibility for.  And when we take responsibility for our part, it usually makes things better.

Sometimes no one is to blame.  This one is really hard for people to accept.  How can you play the Blame Game if it's no one's fault?  But let's say a typhoon hits the Philippines and causes mass destruction.  Whose fault is it?  There is power in blame because it gives us the illusion of control. 

But there is also power in forgiveness.  We can forgive the other person for wrongdoing, even if they haven't accepted any responsibility.  And we can forgive ourselves for our role in the problem.  And forgiveness is much more freeing than blame, regardless of whose fault it is.

Wants and Needs

The other day I had a session where I was talking to a client about wants and needs.  She said that she knows that she needs to allow herself to be taken care of, but she doesn't want to do it.  I thought that was interesting.  How can you not want what you need?  But then after I thought about it some more, I realized that there are all kinds of things that people don't want to need.  They are usually the things that bring people to therapy.

Most people don't want to need other people.  That would make them dependent, and dependency is bad.  It's a sign of weakness.  There is even a diagnosis called dependent personality disorder.  Excessive independence, however, is not considered a problem.  In our culture, you can never be too self-reliant.

While I have certainly seen clients who depend too much on others, more frequently I see people who are afraid to rely on anyone, like this client.  Which is strange, because in the animal kingdom, humans have the longest period of dependence on their parents.  And even as independent adults, we still need other people to have babies, to have jobs, and to survive.  Even hunters and gatherers relied on one another.  I don't think anyone would consider them weak.

Despite this knowledge, I have to admit, I don't like to rely on other people, either.  I don't ask for help unless absolutely necessary.  And the flaw that I am most of ashamed of is my need to be in a relationship.  That's why I'm so proud of myself right now for being alone.  But the truth is, while I'm not in a romantic relationship, I'm not really alone.

The other thing that people don't want is to feel.  Usually they come to therapy with the hope that I can help them stop feeling.  This includes the feelings that accompany disorders like anxiety and depression, as well as normal feelings like sadness after a breakup or loneliness--because that makes you weak.

Like dependency, feelings are also necessary for survival.  Without feelings, we would have no signal to figure out what is causing us pain.  Without feelings, we aren't able to empathize with other people.  Without feelings, we would be classified as reptiles in the animal kingdom. 

I don't want to be a reptile, but I do get frustrated with the intensity of my feelings.  Sometimes they reach the level of depression and anxiety.  And then I feel other people's feelings, too.  That's a lot of feeling for one person to tolerate.  And some people do find my feelings overwhelming.  I'm too needy. Too sensitive. Too much. 

Or maybe they were too reptilian to be able to empathize with me.

I often have to tell clients up front that if what they want is to stop needing and feeling, I can't help them.  Sometimes they transfer to other therapists, which I understand.  Who wants to be told that they have to accept being human?  But most people stay.  When I point out that only robots have the luxury of not needing or feeling, they acknowledge that they don't want to be a robot.

But it's surprisingly hard work, this being human stuff.  It requires a lot of self-compassion, self-acceptance.

Which is why I started this blog.

Judgment

There are certain personality types that are sensitive to being judged, and I have one of them.  It takes very little criticism for me to feel ashamed that I have done something wrong.  Sometimes I interpret neutral comments as criticism.  And in some cases, I've even interpreted positive feedback as criticism.

Once my first husband was talking about a picture of Alicia Keys and commented on how she had big hips.  I replied with, Are you calling me fat?  Which really annoyed him.  I kind of thought it was funny but true.  Even if I get what is intended to be a compliment about having an athletic build, I take this to mean that I look fat.  This is why it's better to refrain from comments about women's bodies in general. 

Although I have never had an eating disorder, I can relate to being obsessed about my body.  I also have a similar personality to the types of people who develop anorexia.  I am prone to anxiety and depression.  I am perfectionistic.  I am highly motivated to avoid harming others, even if it means hurting myself.  And I am so sensitive to criticism that I never forget a mistake.

This is why I am drawn to Buddhism--especially the practices of mindfulness and compassion.  I find comfort in the idea of letting go of what I "should" be thinking, feeling, and doing.  That I can accept whatever is true of myself at this point in time, without judgment or criticism--even if it's something that I hope to change. 

I often point out to clients when they are using judgment words to describe their feelings.  For example, if you say I feel pathetic, the word pathetic is not a feeling.  There is no emoticon for pathetic.  Sometimes it's actually hard to come up with a feeling word.  Usually when you can't think of one, you're probably feeling ashamed.

Even when we're successful in describing our feelings, we often get judged for them.  For example, if I say I feel depressed, someone might say You shouldn't feel that way.  You should be happy because you have so much going for you.  This is meant to make me feel better about myself, and perhaps it works for some people, but it never works for me. 

Sometimes I have tried to point out to the person that they are judging me, but people who judge others are often sensitive to being judged.  So they usually get defensive and say they were just trying to be helpful--that I'm being too sensitive.  So then I judge myself for being too sensitive.

But I am all about controlling what I can control.  Today, I realized that I can't control whether someone else chooses to practice nonjudgmental acceptance of my feelings.  I can only control what I say to myself. 

I can also choose not to share my feelings with people who judge me.  I think I'm going to start doing that, too.

Addiction

I've been thinking a lot about addictions lately.  Even before Phillip Seymour Hoffman's death.  I have never been the addictive type.  My history is so clean I would have made a great political candidate, if I didn't dislike politics so much.  But Richard Rohr, my spiritual guru, says that everyone is addicted to something.  So I'm trying to be honest with myself about what that might be.

At times my hobbies have been like addictions.  When I first started knitting, I would crank out so much stuff that I made all my Christmas gifts in a month and still had scarves to give away.  Same thing with making jewelry.  I sold a lot of what I made, but all my profits went towards buying more beads.   And I can sing Karaoke for hours.  I hosted a small Karaoke party over the summer and we sang for 6 hours straight. 

But knitters tend to be fanatical bunch.  Jewelry makers can be, too.  And for a Filipino, my Karaoke usage is average, at best.  Plus these hobbies tend to go in phases.  I'm in a knitting phase now.  I would describe my interest in these activities as obsessive rather than addictive.

The next addiction candidates would be tennis and sugar.  These two things are a consistent presence in my day-to-day life, and I cannot imagine living without either of them indefinitely.  Giving them up would require some kind of intensive inpatient treatment program, and even then the probability of relapse would be high. 

But playing tennis and consuming desserts has not significantly impaired my functioning, and I've been able to cut back.  I am only playing 3-4 times a week to prevent injury.  And I don't eat 3-4 desserts a day any more.  So I would classify myself as a heavy user but not an addict. 

As I was thinking about this post, one of my FB friends messaged me and asked me to write something about codependence.  And that's when it hit me:  I am addicted to unhealthy relationships.  Ostensibly because I want to help people, but needing to be needed is a form of addiction, too.   In the post on solitude I talked about how ashamed I feel for tolerating so much crappiness to avoid being alone.

Based on my experience as a therapist, I know that many people have the same problem.  Often clients come in for a relationship addiction.  Their friends and family are sick of listening to them.  They know they should break it off, but they can't.  They live in secrecy because they're still in contact with the other person.  If someone came up with a detox program for unhealthy relationships, they could probably make a fortune.

I guess in a way I have completed my own self-imposed detox program.  And for the first time in 30 years, I did not use another relationship to ease the pain.  I rank this accomplishment right up there with defending my dissertation.  Maybe even higher.  Because after my dissertation I got depressed because there was nothing left for me to accomplish.  But as far as relationships are concerned, it's all up from here.

Interestingly, I started this blog right before the breakup.  It wasn't conscious, but I guess at some level I decided that the energy I was investing in my relationship would be better spent writing.  And blogging helped me tremendously during the breakup process.  I don't think I could have made it this far without it.

So until someone comes up with a detox program for unhealthy relationships, I would highly recommend intensive blogging as a treatment strategy.

Listen Carefully

Last night I gave a presentation to some students about how to provide support to those who have been affected by the accident last November.  My advice is simple yet difficult to do:  listen carefully.

Most of the time we're too focused on ourselves to listen to what others are saying.  We're thinking about what we want to say, what we don't want to say, whether the other person is listening to what we're saying, what we're going to do once this conversation ends.  You get the idea.

As I got better at listening, I noticed that people put out feelers about important aspects of themselves, just to test the waters--to see if anyone notices.

Once I was watching my ex play in a basketball tournament, and I had to sit with a bunch of wives I didn't know who were also watching their spouses play.  I was having the usual conversation when I meet someone new.  What do you do for a living?  I'm a psychologist.  Oh, I bet you're psychoanalyzing me right now!  Yup.  I've got you all figured out. 

This was not the response she expected.  But she still asked more questions.  Do you specialize in anything?  Eating disorders, multicultural identity, positive psychology.  Interesting!  I had an eating disorder once.

Of course this got my attention.  It was my turn to ask questions.  At first I worried that she would be offended by my prying into her mental health history, but it was the exact opposite.   She had never told her story to anyone.  Back then no one talked about eating disorders.  Bulimia wasn't even a diagnosis.  She wanted someone to hear what she went through.

This is always the response I get when I follow up on those feelers that people throw out there.

There's nothing magical about being a good listener.  Anyone can do it.  The best way to get better at it is to pay closer attention to yourself.  We spend so much time trying to will ourselves to think, feel, and do what we think we should think, feel, and do that we don't really know ourselves.  This is often what I do therapy:  teach people how to observe themselves without judgment.

It's not easy to do.  It takes practice.  This blog is one of the ways that I practice listening to myself, and you can see how hard it is for me to do so in a nonjudgmental way.  But I am trying to treat myself the way I would treat anyone who I care about deeply, and I suggest that you do the same.

Because hopefully you are someone who you care about deeply.

Winter

Today the temperature is supposed to be in the 50's, and many people are happy about this.  A lot of people don't like winter--particularly this winter, since it's been unseasonably cold.  But I don't mind it. 

I'm not that good at small talk, so it's nice to have something to say if I'm forced to talk to someone I don't know that well.  I know this is true for a lot of those winter haters, too, even if they don't admit it.  And I've worn all the sweaters that I bought while I lived in Ohio and Pennsylvania, so I've had more wardrobe options.

Winter is usually a time when people feel more depressed because of the cold and lack of sunlight.  Even though I was depressed in December, I've been surprisingly cheerful since the beginning of the year.  I really like living alone.  I like sleeping alone.  So much so that I wonder if I will ever invite someone over again.  I like knitting, making jewelry, watching sports, or writing a blog post without distractions. 

Adapting to changes in the weather is a good example of how we can get used to just about anything.  Before the first cold spell, I thought I was going to freeze to death when the temperature dropped to 24 degrees.  Now it takes single digits before I think it's unbearably cold.  The other day one of my friends commented on how last week, when we had a day in the 40's, it felt so warm she could have played tennis outside. 

The same is true about living alone.  When you live with someone, they may annoy you, but it seems like it would be worse if you had to come home to an empty house every day.  That's what I said not too long ago in my post on solitude.  And when you're used to living alone, you think it would be unbearable to have to deal with all the annoying things about another person, which is how I feel now.  But I'm sure if I started dating again, I'd get used to having someone in my space and it would seem worth it.  Hopefully.

In therapy, I often use the weather as a metaphor for feelings.  I tell them to observe what they're feeling at any particular moment, like Weather on the 8's.  Sadness with a chance of happiness later in the late afternoon.  Fifty percent chance of an anger outburst tomorrow.   Maybe we don't like the weather when it's 7 degrees outside, but it will change eventually.  Maybe even later that day. 

Ordinarily this is not the way we think about feelings.  We dread when the other shoe will drop and our good mood will be ripped away from us unceremoniously.  But when we're in a bad mood, we fear that we will be stuck in depression or anxiety for the rest of our lives.  The reality is, you can count on your mood changing, positive or negative, just like the weather.

We can also look at the weather in a more impersonal manner.  We don't blame ourselves if the weather is cold; we didn't do anything wrong.  And we don't really have to understand the reason why it is unseasonably cold.  I don't particularly care about understanding the polar vortex.  But if we feel sad for no reason and we can't make it go away, we must be weak.  Irrational.  Crazy.

The other message I give to clients is that even when we feel sad or anxious, there is still something positive about that moment.  And I don't mean this in a think happy thoughts kind of way.  When I feel depressed and can't motivate myself to do anything, I have more compassion when a client says they spent the whole weekend in bed, feeling crappy about themselves.  I have a better understanding of how much pain they are in.  And it helps me to be a better therapist.

There is beauty in everything, even in the things we don't like, but sometimes we have to look for it. 



Photo Courtesy of Allison Szuba

Self-Worth

For the first 35 years of my life, my self-esteem was primarily based on grades.  I made good grades, so you would think that meant I had high self-esteem, but I didn't.  This is true of any external measure of worth: the positive feeling you get from an accomplishment is short-lived.  But I didn't know that at the time. 

I remember when I was in my first year of grad school, another student had just defended his dissertation.  He rented a limo and decorated it as though he had just gotten married and was driving around town, honking his horn.  I thought that was a great idea and that I would do the same thing to celebrate once I got my Ph.D.

But that wasn't what it was like at all.  I thought that I would feel smarter or whole or something.  Instead I felt...exactly the same.  Maybe even worse.  Because by this point, I realized that there was no goal I could accomplish that was going to make me feel better about myself.  I had reached all my goals; there was nowhere else to go.  So I got depressed instead.

These days I don't talk about self-esteem at all in therapy.  Instead I try to convince clients that they are inherently worthwhile, regardless of their accomplishments.  This is a tough sell in our culture.  Initially they say they don't believe in inherent worth.  They see themselves as a stock whose value rises and falls depending on their performance.

But like I said in my last post, for an agreeable person, I'm pretty good at arguing.  And this is one of those arguments where I know I'm right.  So I use whatever it takes to convince them of their worth.

Many of them do start to believe it, not so much because of my compelling arguments, but because I believe in them.  Deep down we all know that we are inherently worthwhile; we just need someone to tell us that we can trust that part of ourselves.

So if you didn't have anyone to tell you to trust that part of yourself before, you do now.

In Need

I don't like the word needy. I much prefer the word crazy to needy.  Crazy can have many meanings, and not all of them are negative.  Sometimes crazy can be a compliment.  At least that's how I interpret it when I'm feeling good about myself.  Neediness, on the other hand, is never a compliment.

I admit I am sensitive to the word because I have been accused of being too needy, too demanding.  I have tried to correct for this, but I don't know how to distinguish my unreasonable demands from my needs. 

I've tried to deal with it by giving my partner the benefit of the doubt.  If he couldn't give me what I needed, then perhaps it was a demand that I mistook for a need.  How important is meaningful conversation anyway, really?  How much contact is actually necessary for the survival of the relationship? 

This approach hasn't gotten me very far.  I seem to have overshot my mark.  My therapist tells me that I cannot disavow my needs in order to make my relationships work.  Sounds good to me.  But how do you separate the needs that are necessary for survival from the ones that make people accuse you of being needy? 

Let's say that you came across a boy who you met in the woods while hiking one day, like the wild boy of Aveyron.  You feel bad for him so you invite him over for dinner.  But he's really hungry, so he eats all the food in your house and still wants more.  Obviously, you wouldn't blame the kid for this.  You wouldn't accuse him of being too hungry, because it's not his fault he was abandoned in the woods to fend for himself. 

Psychological needs are no different.  Neediness is the product of prolonged emotional starvation.  You may not be able to give the person what they need to feel satisfied, but that's not their fault.  It's not yours, either.

But it feels like it should be someone's fault, doesn't it?  Someone should take the blame!

I prefer to reframe a needy person as someone who is in need.  Perhaps their needs are so great that I can't help them.  That's OK; I don't have to be able to help everyone--although I do still try. 

I am trying to think of myself as someone in need, too.  I am just learning what these needs are, because I've spent my life focusing on other people.  There are a lot of them, and they have gone unfulfilled for a long time.  I'm not blaming anyone for this, but I'm trying not to blame myself, either. 

I'm just trying to make my way out of the woods.

46 Lessons Learned from Blogging

Since the original intent of my blog was to help other people, I thought I'd provide a cheat sheet of the lesson in each post (except for the random ones).  That way, you don't have to go back and read the whole blog if you don't want to.  But hopefully you will!

1.  Night Owl Syndrome:  Prejudice against night owls is a form of discrimination that has been perpetuated in part by Ben Franklin.

2.  Massages:  Massages are not as relaxing when you obsess the entire time about how much they cost.

3.  Knitting and Relationships:  Challenge yourself every now and then, but you don't have to knit a dress.

4.  Positive and Negative Feedback:  It's easier to believe erroneous negative feedback than it is to accept legitimate positive feedback.

5.  Karaoke Pusher:  Singing in front of other people is a good way to let go of fear.

6.  You Know You're Filipino If...:  Things that embarrassed you as a kid will make great anecdotes when you get older.

7.  The Courage to be Vulnerable:  Sharing your vulnerabilities with others makes people feel closer to you.

8.  The Unathletic Athlete:  Even if you were picked last in gym class, you can still grow up to be an athlete.

9.  Tennis Courtships:  Someone needs to come up with a website that can help tennis players find a doubles partner.

10.  The Uses of Prayer:  Sometimes God answers your prayers by giving you opportunities rather than results.

11.  Boundaries:  Being Asian makes setting boundaries even more difficult than it already is.

12.  Massages, Part 2:  Don't drink coffee before a massage--even decaf.

13.  Boundaries, Part 2:  Blogging is a good way to let people know that you don't want to be told that you're fat.

14.  Children:  Play with your inner child every now and then.

15.  Can Love Conquer All?  No, but it's still worth the risk.

16.  Body Image:  Small gains are better than nothing.

17.  Hard Core Fan:  It takes dedication to root for a losing team.

18.  Warriorism:  When things get tough, channel your inner warrior.

19.  Self-Portrait:  You can learn a lot about yourself from doodles.

20.  Solitude:  Sometimes when you think you're alone, you're really not.

21.  Self-Acceptance:  We all have different parts of ourselves, many of whom don't get along.

22.  Meet the Drill Sergeant:  Save your inner drill sergeant for emergencies.

23.  The Inner Critic:  Defy your inner critic every change you get.

24.  Thanksgiving:  Miracles really do happen.

25.  Perfectionism:  Blogging about mistakes can help you accept them.

26.  Stress Management:  Sometimes stress management can be stressful.

27. Self-Care:  Blogging is a good way to put yourself first.

28. Grief:  The best thing we can do for someone who is grieving is to be willing to listen to them talk about their pain.

29.  Yes and No:  Learn to say yes to what you want and no to what you don't want.

30.  Blogging is My New Boyfriend:  You can't fail if you never stop trying.

31.  Friendship:  Don't be afraid to ask for help when you need it.

32.  Empathy:  If you're high in empathy, choose your friends and partners wisely.

33.  Breakups:  If you're relationship is ending, try to leave with love rather than hate.

34.  In Times of War:  Make choices you can live with, regardless of the outcome.

35.  Angels:  If you ask people to send you angels when you're struggling, they will--and it works.

36.  Forgiveness:  For people with a harsh inner critic like me, self-forgiveness is the hardest part.

37.  Gratitude:  Practicing gratitude may not turn your depression into happiness, but do it, anyway.

38.  Love:  Our love may never be perfect, but I think God is OK with that.

39.  Forgetting:  Forgiveness is a process.

40.  Moms:  Moms are often unsung heroes, so thank them every chance you get.

41.  New Year's Resolutions:  Restating your resolutions every year is not a sign of failure; it demonstrates that you are choosing to live intentionally.

42.  In My Head:  I thought I was weird for thinking so much, but it turns out that it means I'm a writer!

43.  Bipolar and Brilliant:  You can be brilliant and mentally ill, but you can also be dumb and refuse to take your medication.

44.  Night Owl Syndrome, Part 2:  It takes practice to let go of unnecessary guilt.

45.  Competitive Latch-Hooking:  Sometimes the sibling that was your mortal enemy in childhood becomes your most loyal blog follower as an adult.

46.  Honesty and Trust:  Surround yourself with honest people; it takes less energy than being paranoid.