As a psychotherapist, I can’t count how many times I have seen individuals and couples struggle with building healthy connections in their relationships.

The most common complaint has been that they feel unfulfilled, devalued or unappreciated in relationships with others. It is my professional experience that when we get caught up in what others can do to make us feel good about ourselves, we are likely to become angry and resentful.

So how do you avoid the resentment trap in your relationship?

Four Tips to Avoid the Resentment Trap

1. Ask yourself: Am I being realistic with my expectations?

Perhaps due to unmet needs, you project your disappointments onto people who are incapable of meeting your standards. No one person can meet all of your needs. If this describes you in relationships, you will ultimately set yourself up for feeling unfulfilled and empty. Friendships, work relationships, family and partners all participate in your life in meaningful ways. But in the end, it is up to you to love yourself the way you deserve to be loved.

One common theme of having unrealistic expectations is getting caught up in the fantasy of what a relationship is supposed to look like — for example, having expectations that your “Prince Charming” will sweep you off your feet and all of your troubles will slip magically away. Now if this isn’t a resentment waiting to happen, I’m not sure what is!

How many women have dreamed of having their lives turn out like the fairy tale endings of Cinderella and Sleeping Beauty? Realistically, how many women have had those fantasies fulfilled to their expectations?

2. Remind yourself: I am a valuable, lovable human being.

No one person can make you feel good all of the time. You can feel loved in another’s presence, but if you choose one person to define how you feel in a relationship, you will be setting yourself up for deep disappointment. If you don’t feel good about yourself, begin by acting as if you do by creating a loving mantra and reciting it each morning in front of the mirror before the day begins. Examples may include “I deserve love,” “I am lovable,” and “I am perfect just the way I am.” Recite a mantra often enough and you will begin to believe it!

3. Surround yourself with healthy people.

By healthy people, I mean people who accept you unconditionally. I am talking about people who don’t shame you or try to prevent you from making your own decisions. These are individuals who will support you with your day-to-day challenges, accept you for your “human-ness” and are okay with you making mistakes. Write a list of people you know who have these qualities and keep in contact with at least one of them on a daily basis. These are also individuals who you can give you a healthy reality check. If you struggle with an issue that keeps you feeling stuck, ask for their perspective.

4. Focus on self-care.

If you deplete yourself to the point of exhaustion, it is far more likely that you will be vulnerable to wanting your needs met by others. You may possibly go to a child-like place and demand that you get your needs met immediately. I see this sort of thing in my work with clients who are struggling in love-addicted or codependent relationships.

So what is the best remedy for healing the vulnerable child within? Replace your expectations with gentle guidance and nurture yourself through a walk, deep breathing, a yoga class, journaling or meditation. Get to know yourself better.

One exercise I recommend is making an inventory of your strengths and weaknesses. Think deeply about your interests and passions. How can you begin focusing more on the things that bring you joy? You deserve loving care — and who better than yourself to give it to you?

Then I was going to relate the story about how, in the summer of 2002, I chose to stop taking my medicine the way my doctor directed me to take it, and then I stopped taking my medicine at all.

This was a bad choice. As a result, my illness became an emergency.

Nine hours in the ICU, four days in a private room, and two more weeks of hospital care brought a bill that topped $95,000.

The cost of nine years of care was eaten up by just a few weeks of my irresponsibility. That was cost that the health care industry, including my insurance company, would not have had to bear if I had only taken my medicine as directed.

It then seemed easy for me to extend this argument to all patients with any chronic disease. Do what your doctor tells you and your condition should improve, or, at least, be far less likely to worsen. By patients only complying with their prescribed treatment regimens the cost of health care in the United States would go down.

How much? A lot. As a matter of fact, a New England Healthcare Institute study of health care costs in the United States pegged the added cost of care due to patient noncompliance at $290 billion. That’s 15 percent of the country’s total annual health care cost. And a Medco study found that only 50 to 65 percent of patients with chronic conditions adhere to the medication therapy prescribed for them.

It seemed clear. I am, for my lost summer, and everyone else who does not take responsibility for their own treatment, everyone who does not comply with their doctor’s orders, are responsible for the high cost of health care in the United States.

When noncompliant, a person does not take his or her medicine as directed. This often leads to their condition worsening and results in higher costs of doctor visits, emergency room visits, and hospitalizations. On the other hand, medication compliance can significantly reduce these costs.

According to Medco, for every dollar spent on diabetes medication medical cost savings are $7.00, for every dollar spent on high cholesterol medication medical cost savings are $5.10, and savings of $3.98 are found for every dollar spent on prescription medication for high blood pressure. Mental illness costs are surely similar.

So if simply taking one’s medicine can lead to lower total health care costs, why are so many patients not taking their medication as prescribed?

Reasons for noncompliance include side effects, lack of continuing symptoms, and, yes, irresponsibility. But cost may loom largest.

I have always had health insurance. The co-payment for my medicine is $49 per month when I’m stable (it was higher, but one drug went generic). It goes up during rough patches. I’m responsible. I pay it. I’m well. I thought, perhaps I adhere to my treatment regimen because I am so heavily invested in it.

Maybe if everyone paid a larger share of his own health care bill, compliance with treatment would increase. Maybe personal responsibility, sacrifice when necessary, and more participation by each individual in the cost of his or her care would improve compliance rates and reduce the overall cost of health care.

But the cost of medication to the individual must be considered. As costs increase, fewer can afford to pay them. A study from the National Bureau of Economic Research finds that an increase in medication co-payments from only $6 to $10 results in a 6.2 percent increase in noncompliance and a 9 percent reduction in the share of fully compliant persons. The same study finds that increases in coinsurance lead to even larger increases in noncompliance. As for the uninsured, the American Public Health Association has found that 89 percent have not filled a prescription due to cost.

What was lost on me was some very simple economics. If each individual pays less for his or her prescriptions, compliance increases and the nation and insurance companies pay less of a total health care bill. Unfortunately, the trend in health insurance is for each individual to pay higher co-pays or coinsurance. As these costs go up out-of-pocket expenses may exceed one’s ability to pay. The choice? Noncompliance or increased debt and possible bankruptcy.

So yes, compliance is a choice. And noncompliance greatly increases the nation’s health care bill. Every proposal on the table that makes an individual pay more for his medicine will increase noncompliance and add even more to the nation’s health care bill. High deductibles and higher co-payments charged by insurance companies against each individual will only make the problem worse. Paradoxically, as cost-driven noncompliance pushes total health care costs higher, these same insurance companies may find themselves less profitable over the long run as they face the higher cost of complications caused by medication noncompliance.

Perhaps if insurance companies lowered prescription co-payments more patients would take their medicine as directed and the insurance companies, with fewer complication-related charges against premiums, could actually increase profits. Pharmaceutical companies would benefit as well as more prescriptions would be filled. We should have no problem with health insurance and pharmaceutical companies making more money if the profits they earn come from lower total health care costs and healthier individuals.

As for my, and others’, idea that if people pay a larger percentage of their health care costs they will live healthier, more compliant, lives, the truth is that health and compliance can be expensive. Low-cost prescription benefits must be considered as we approach ideas to lower total healthcare costs. Higher costs to individuals for medication lead to higher rates of noncompliance, which lead to a higher national health care bill that, one way or another, we all must share.

References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326767/

http://www.hreonline.com/HRE/view/story.jhtml?id=5059249

http://www.nber.org/digest/apr05/w10738.html

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Jun/1408_Morgan_Prescription_drug_accessibility_US_intl_ib.pdf

Maybe they’re being secretive and have even stolen money from your wallet. Maybe their physical appearance has changed with rapid weight loss or red eyes. Maybe you’ve noticed a change in their sleep habits, energy level and mood. Maybe you’ve actually found marijuana or other drugs in their room.

Naturally, the thought and possible confirmation of your child using drugs trigger a rush and range of emotions: anger, frustration, disappointment, sadness, fear.

If you think your child is using drugs, how do you approach them? Where do you start?

Two parenting experts shared their insight below.

1. Be direct and calm.

“This issue is too serious for subtlety,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. He suggested readers approach their kids “directly and immediately.”

Avoid letting your anger and frustration spill over into the conversation. According to Lisa Kaplin, Psy.D, a psychologist and life coach who teaches parenting classes, “The best way to approach your child is with delicacy, not drama. If you approach them with panic, anger, aggression or accusations, you can be sure your child will tell you absolutely nothing.”

Yelling, threatening and lecturing your child typically leads them to withdraw, sneak around and lie, she said.

Duffy also suggested approaching your child “from an emotional space of genuine concern for well-being.” He understands that being calm and centered is a lot to ask of parents. “But it is, without a doubt, the approach that works best in my experience.”

It’s common for kids to deny their drug use, or to respond casually (e.g.,” It’s just pot, and I don’t smoke it that often, anyway”). If this happens, “give a brief response in which you tell them that you do not want them to use drugs of any kind,” Kaplin said. Reiterate your house rules about drugs and alcohol use and “the consequences that come with that behavior.”

2. Talk when your child is lucid.

Don’t try to have a serious conversation when your child is drunk or high, Duffy said. “This might seem like common sense, but I have worked with many parents who have attempted to lecture an inebriated teenager.”

3. Ask open-ended questions.

It’s more likely that your child will be honest, and talk about their drug use if you ask open-ended questions. According to Kaplin, these are several examples: “Can you tell me more about that?  How did you feel in that situation? What will you do if that happens again? How can I help you with this?”

If your child admits to using drugs, again, “ask them with open-ended, non-judgmental questions about what drugs they have used, how often, and if they plan on using again.” You also can ask “for their input on how to proceed.”

4. Don’t punish your child.

Avoid punishing your kids, Duffy said. It rarely works. For instance, “Taking a cell phone away will never keep a drug user away from using.”

5. Show your support.

If your child reveals their drug use, “Thank [them] for being honest with you,” Kaplin said. Let them know that you’re “here to help them. Tell them you love them.”

6. Get your child treatment.

It’s key to take your child to see a qualified therapist who specializes in working with teens and young adults. When talking about professional help, don’t negotiate with your child, or take “no” for an answer, Duffy said.

Instead be brief, firm and clear, he said. Duffy gave the following example of what you might say to your child: “It is clear to us that you have been using something, and we are really concerned for your safety. As your safety is our domain as Mom and Dad, we are going to pull rank here and schedule an appointment for someone for you, and all of us, to talk to about this issue.”

Depending on the situation, you can “give [your child] options regarding therapists or treatment centers,” Kaplin said.

Even if your child is over 18 years old, Duffy suggested having a similar conversation. While you can’t force your older child to attend therapy, you can leverage other things, such as your financial position, he said.

It’s also important to get clear on your limits, communicate them to your adult child and follow through, Kaplin said. For instance, “can your child still live with you if they’re using drugs? If not, when must they leave and will you help them with treatment or other living arrangements?”

Knowing your child is possibly using drugs is stressful, scary and painful. And it can be incredibly hard to have a calm conversation. If you feel yourself losing control, take a break, and return when you’ve cooled off. Whether your child admits to using drugs or not, having them see a qualified therapist is critical.

Further Reading

Here’s more on symptoms of teen substance abuse, what parents can do, and reasons your child might use drugs and how to help them.

Colleges and university are cutting back on their involvement with ADHD, primarily due to abuse of the psychiatric medications — stimulants like Ritalin — prescribed to treat the disorder. Students — whether they are malingering the symptoms or actually have it — are prescribed a drug to treat ADHD (sometimes from different providers in different states), then sell a few (or all the) pills on the side. Profit!

Now universities are becoming wise to the epidemic nature of the problem, as some studies have suggested up to a third of college students are illicitly taking ADHD stimulants.

This might help curb the abuse problem, but will it also make it harder for people with actual ADHD to receive treatment?

The short answer is, yes, of course. Students with a pre-existing diagnosis of attention deficit or attention deficit hyperactivity disorder will still often be able to get their prescriptions filled while at school. The university just doesn’t want to do the diagnosing of ADHD any longer.

I’ve long wondered at the wisdom of universities getting into the ADHD business in the first place. University counseling centers generally shrug off long-term treatment of serious mental illness. So it’s never been clear to me why they were comfortable prescribing medications for ADHD.

The New York Times notes — in a well-written take on this issue by Alan Schwarz — that the changes are sweeping campuses throughout the country:

Lisa Beach endured two months of testing and paperwork before the student health office at her college approved a diagnosis of attention deficit hyperactivity disorder. Then, to get a prescription for Vyvanse, a standard treatment for A.D.H.D., she had to sign a formal contract — promising to submit to drug testing, to see a mental health professional every month and to not share the pills. [...]

The University of Alabama and Marist College, like Fresno State, require students to sign contracts promising not to misuse pills or share them with classmates. Some schools, citing the rigor required to make a proper A.D.H.D. diagnosis, forbid their clinicians to make one (George Mason) or prescribe stimulants (William & Mary), and instead refer students to off-campus providers. Marquette requires students to sign releases allowing clinicians to phone their parents for full medical histories and to confirm the truth of the symptoms.

“We get complaints that you’re making it hard to get treatment,” said Dr. Jon Porter, director of medical, counseling and psychiatry services at the University of Vermont, which will not perform diagnostic evaluations for A.D.H.D. “There’s some truth to that. The counterweight is these prescriptions can be abused at a high rate, and we’re not willing to be a part of that and end up with kids sick or dead.”

Not everyone is convinced:

“If a university is very concerned about stimulant abuse, I would think the worst thing they could do is to relinquish this responsibility to unknown community practitioners,” Ms. Hughes [CEO of CHADD, an advocacy organization] said. “Nonprescribed use of stimulant medications on campus is a serious problem that can’t just be punted to someone else outside the school grounds.”

She has a point. The 2010 suicide death of Kyle Craig, who abused Adderall prescribed by his local physician at home and not by the university he attended, suggests the problem is more wide-ranging than perhaps some university officials understand.

However, this sort of effort on the part of Fresno State is amazing and should be applauded:

And in a rare policy among colleges, students receiving prescriptions to treat A.D.H.D. must see a Fresno State therapist regularly — not for a cursory five-minute “med check” but for at least one 50-minute session a month.

Psychotherapy required for ADHD treatment? Nice — finally an institution that listens to the research and understands that medications are, for most, not a life-long answer.

I think that, by and large, this is a measured response to a very serious problem of stimulant abuse among college students. Students have long enjoyed free healthcare on campus, with counseling an additional free service they receive. But student counseling centers mostly refer students with serious, ongoing mental health or mental illness to local providers in the community — they’re simply not well-equipped to treat people with such concerns. I see no reason why ADHD should be an exception.

What this does for the colleges that are mostly getting out of the ADHD business is to limit the overall amount of prescriptions floating around for these stimulant meds. That should drive down supply, drive up prices, and make it less attractive as a “study” option for students without ADHD.

As for the students who actually have attention deficit disorder? I think they will still be able to get the treatment they need. Having seen people at community mental health centers, I know that if there’s a will, people will find a way to pay for mental health services.

Read the full article: Colleges Tackle Illicit Use of A.D.H.D. Pills

Proper treatment doesn’t suppress emotions or dull a person’s ability to feel things deeply. It builds a protective layer — an emotional resilience — to safeguard a depressive from becoming overwhelmed and disabled by the difficulties of daily life.

However, the tools found in happiness research are those I practice in my recovery from depression and anxiety, even though, theoretically, I can be happy and depressed at the same time. I came up with my own recovery program that coincides with the steps toward happiness published in positive psychology studies.

1. Sleep

Sleep is crucial to sanity because sleep disturbances can contribute to, aggravate, and even cause mood disorders and a host of other illnesses. The link between sleep deprivation and psychosis was documented in a 2007 study at Harvard Medical School and the University of California at Berkeley. Using MRI scans, they found that sleep deprivation causes a person to become irrational because the brain can’t put an emotional event in proper prospective and is incapable of making an appropriate response. Chronic sleep deprivation, especially, is bad news. It often affects memory and concentration. And, according to one recent study, it can cause a decline in cognitive performance similar to the intoxicated brain.

2. Diet

My mouth and brain are in constant negotiation with each other because while one loves white bread, pasta, and chocolate, the other throws a hissy fit whenever they enter my blood stream. My diet has always been an important part of my recovery from depression, but two years ago — after working with the naturopath and reading Kathleen DesMaison’s “Potatoes Not Prozac” — I could more competently trace the path from my stomach to my limbic system. Moreover, I recognized with new clarity how directly everything that I put in my mouth affects my mood.

Here are the bad boys: nicotine, caffeine, alcohol, sugar, white flour, and processed food — you know, what you live on. Here are the good guys: protein; complex starches (whole grains, beans, potatoes); vegetables; vitamins (vitamin B-complex, vitamins C, D, and E, and a multivitamin); minerals (magnesium, calcium, and zinc); and omega-3 fatty acids. I’m religious about stocking up on omega-3 capsules because leading physicians at Harvard Medical School confirmed the positive effects of this natural, anti-inflammatory molecule on emotional health.

3. Exercise

Dr. James A. Blumenthal, a professor of medical psychology at Duke University, led a recent study in which he and his team discovered that, among the 202 depressed people randomly assigned to various treatments, three sessions of vigorous aerobic exercise were approximately as effective at treating depression as daily doses of Zoloft, when the treatment effects were measured after four months. A separate study showed that the depressives who improved with exercise were less likely to relapse after 10 months than those treated successfully with antidepressants, and the participants who continued to exercise beyond four months were half as likely to relapse months later compared to those who did not exercise.

Even as little as 20 minutes a week of physical activity can boost mental health. In a new Scottish study, reported in the British Journal of Sports Medicine, 20,000 people were asked about their state of mind and how much physical activity they do in a week. The results showed that the more physical activity a person engaged in — including housework, gardening, walking, and sports — the lower their risk of distress and anxiety.

Exercise relieves depression in several ways. First, cardiovascular workouts stimulate brain chemicals that foster growth of nerve cells. Second, exercise increases the activity of serotonin and/or norepinephrine. Third, a raised heart rate releases endorphins and a hormone known as ANP, which reduces pain, induces euphoria, and helps control the brain’s response to stress and anxiety. Other added benefits include improved sleep patterns, exposure to natural daylight (if you’re exercising outside), weight loss or maintenance, and psychological aids.

4. Relationships and Community

We are social creatures and are happiest when we are in relationship. One of the clearest findings in happiness research is that we need each other in order to thrive and be happy, that loving relationships are crucial to our well-being. Relationships create a space of safety where we can learn and explore. Belonging to a group or a community gives people a sense of identity. Studies indicate that social involvement can promote health, contribute toward faster recovery from trauma and illness, and lower the risk of stress-related health problems and mental illness.

Plenty of evidence indicates that support groups aid the recovery of persons struggling with depression and decrease rates of relapse. The New England Journal of Medicine published a study in December 2001 in which 158 women with metastatic breast cancer were assigned to a supportive-expressive therapy. These women showed greater improvement in psychological symptoms and reported less pain than the women with breast cancer who were assigned to the control group with no supportive therapy.

Another study in 2002, published in the American Journal of Psychiatry, followed a group of more than 100 persons with severe depression who joined online depression support groups. More than 95 percent of them said that their participation in the online support groups helped their symptoms. The online groups here on Psych Central are a great resource where you can find support from people going through similar struggles.

5. Purpose

The father of positive psychology, Martin Seligman, explains in his book, “Authentic Happiness,” that a critical element to happiness exists in using your signature strengths in the service of something you believe is larger than you. After collecting exhaustive questionnaires he found that the most satisfied people were those that had found a way to use their unique combination of strengths and talents to make a difference. Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, believes that a sense of purpose — committing oneself to a noble mission — and acts of altruism are strong antidotes to depression. And then there’s Gandhi, who wrote: “the best way to find yourself is to lose yourself in the service of others.”

6. Gratitude

Gratitude doesn’t come easily to me. When my girlfriend sees a half-full glass of fresh milk, I see a half-empty glass of cholesterol-rising, cardiac-arresting agents. And when the kids’ school is called off because some road somewhere in our county apparently accumulated a half of an inch of snow, she thanks God for an opportunity to build snowmen with she kids. I have a conversation with God, too, but it’s much different.

However, I train myself to say thank you more often than is natural for me because I know that gratitude is like broccoli — good for your health in more than one way. According to psychologists like Sonja Lyubomirsky at the University of California Riverside, keeping a gratitude journal — where you record once a week all the things you have to be grateful for — and other gratitude exercises can increase your energy, and relieve pain and fatigue.

Shameless plug! Join me at one of three private screenings of “Happy,” a film that explores what makes us happy, followed by a discussion on depression and happiness and a book signing. Click the following links for more information:

The focus for most treatment professionals is on a patient’s symptoms and the alleviation of symptoms. Few professionals delve into how a disorder — like bipolar disorder or clinical depression — changes our identity. Everything we know about ourselves.

Everything we thought we knew about ourselves.

That’s why this recent piece in the NYT Magazine by Linda Logan exploring this issue is so interesting and timely.

Our identities as unique individuals with well-worn and familiar roles in life — mother, confidante, partner, employee — are quickly stripped away when a new label takes over: patient. Inpatient. Psychiatric inpatient. In all of society, there is almost no worse label that could be applied.

The illness then takes precedent. Everything about you fades away. It’s all about treating the symptoms, bringing them “under control” — usually through a combination of medication and structured activities in an inpatient setting. It’s an unsettling and uniquely dehumanizing experience. In our society, I suspect only prisoners experience worse.

Linda tells the long and sad story of her grappling with her disorder — bipolar disorder — while a mother to three children and struggling to complete her doctoral studies in geography:

The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.

Linda writes, “I would try to talk to my doctors about my vanishing self, but they didn’t have much to say on the subject.”

While some medications affected my mood, others — especially mood stabilizers — turned my formerly agile mind into mush, leaving me so stupefied that if my brain could have drooled, it would have. Word retrieval was difficult and slow. It was as if the door to whatever part of the brain that housed creativity had locked. Clarity of thought, memory and concentration had all left me. I was slowly fading away.

Going back again and trying to regain your identity as a unique person with a number of roles in life can be just as hard.

Philip Yanos, an associate professor of psychology at John Jay College of Criminal Justice, in New York, studies the ways that a sense of self is affected by mental illness. [...] Yanos told me that reshaping your identity from “patient” to “person” takes time. For me, going from patient to person wasn’t so arduous. Once I understood I was not vermicelli, part of my personhood was restored. But reconstructing my self took longer.

Mental health professionals across all professions — psychiatry, psychology, social work, etc. — should be more aware that this loss of self identity is a very real component of some people’s mental illness and subsequent treatment. It should be addressed as a regular component of mental health treatment, especially when the loss is acutely felt.

Because across all of healthcare, we are quick to dehumanize patients and focus only on the treatment of symptoms. Maybe it’s a way some professionals seek to keep their patients at arm’s length — not to become too emotionally connected to them. But in doing so, it also sends a (perhaps unintentional) message to the patient — you are only a constellation of symptoms to me. That’s all we’ll focus on, that’s all we’ll treat.

As professionals and clinicians, we can do better. We should do better to not turn someone in emotional pain into a simple diagnosis or label. If we think of Linda as simply “Oh, the bipolar woman in room 213,” we’ve lost our humanity and our focus.

Linda is now 60, and has lived a life full of color and heartbreak. Her story is worth checking out below.

Read the full article: The Problem With How We Treat Bipolar Disorder

There’s something strangely comforting in looking at these lists and hoping that our life problems can be boiled down into five simple steps. I read them hoping for the answers, because I too want the secret to life, the universe, and everything.

However, I think the reality is this: As much as some lists offer interesting ideas, the majority mislead people about change. They offer false hope instead of facts. They generally encourage people to think their lives can be simpler if only they do those five secret things that may have worked for another person.

Come on, really? Life is so complex and the reasons why we feel and do what we do also are complex.

Take depression, for example. The reality is nobody really knows why people feel depressed; and nobody really knows what will cure each individual’s depression. When talking about cause and effect, there are so many factors to take into account: cognitive, environmental, social, biological.

What we do have is good empirical evidence that some therapies can help some people overcome depression. But that doesn’t mean everyone will overcome it through therapy. I’ve worked with many people and, for whatever reason, they remain depressed and sometimes become even more depressed. When that happens, the focus of therapy changes to learning to live with being depressed. No list is going to change that.

We know that medication can help. But it doesn’t help everyone. More often than not, medication is guesswork — an art more than a science. What works for one person can make another person sick. I’ve seen some people recover in a matter of weeks, and others poisoned to the point of hospitalization. Where’s the five-point list on that one?

Advances in neuroscience are helping us understand the brain and how it works. Yet, even super-intelligent scientists with the most sophisticated technology don’t fully understand what is causing depression. So, can a five-point list really tell us how to overcome it?

It’s clearly frustrating not knowing the secret to being well. As a therapist and coach, it’s my job to help somebody get well, so it’s easy to hope a list will provide me with the secrets that’ll help me and the person I’m working with.

But many lists just don’t cut it. I was reading a list on procrastination the other week and the first thing on the list was something like ‘just do it.’ I can imagine all the people who procrastinate reading that and thinking, “Wow, that’s amazing. Why didn’t I think of that?”

OK, I’m knocking these lists, so I must know all the answers, right? Nope. I wish I did but unfortunately I don’t (please don’t tell my wife I said that). With that being said, I will now counter everything I’ve just written and offer you my own secret five-point list to life, the universe and everything.

1. You are personally responsible for all that you think, do, and (mostly) feel.
2. Accept reality: Life doesn’t owe you a thing.
3. You are you. Nobody can ever know what it means to be you, so be kind to yourself and others.
4. Life is meaningless, except for the meaning that you give it — so use that power wisely.
5. Nobody has all the answers. We’re all just making stuff up as we go along, hoping for the best.

Over time, pent-up anger and resentment causes tiny problems to become big ones. Anger can become displaced or is expressed in a way that becomes problematic. Many people feel more upset when they realize that they overreact or explode with anger, especially if it causes hurt for themselves or someone else. Thus, it creates the terrible cycle of struggling with anger.

But there is help for anger that doesn’t require you to dig up your past, explore your thoughts, or send letters to a dead loved one. It’s called biofeedback, and it offers individuals readily-learned techniques that are safe and effective (based upon decades’ worth of research).

Unhealthy, inappropriate anger looks like this: You get home from a bad day at work, where everything seems to be going wrong. The house is a mess, and the kids are running around screaming. Your spouse is yelling to you from the kitchen to help.

You explode with a nasty remark about how you were busy working all day, and you do not have time to help. You say something hurtful in regard to your spouse not being a good parent. The kids hear you yell, and your spouse yells back or begins to cry. You then kick one of the toys on the floor and leave the house to go to a bar for a drink to unwind, leaving your family in disarray.

On the other hand, people also can internalize anger and it will manifest in different ways. Internalized anger can cause migraines, stomach problems, high blood pressure, depression, anxiety, and so on. The body expresses anger in maladaptive ways when people do not express it constructively.

Biofeedback and neurofeedback techniques offer individuals skills in how to effectively manage anger.

People can monitor their physiological responses and thus learn how to gain control over them. Neurofeedback also helps create a stronger connection between the emotional and executive areas of the brain, allowing people to gain a proper “checking” system. Anger is then expressed in a rational, appropriate, and conducive manner. Communication becomes clearer, and others are more likely to respond to your needs.

Children also can internalize anger and carry it with them, or express it with aggressive and problematic behaviors. Biofeedback, with the use of a video game program, helps build a stronger connection between the midbrain (emotional center) and forebrain (executive control center).

Here’s how it works. The child has sensors placed on certain areas of the head to read brain waves such as delta, beta, and hibeta waves. The video game will not advance if he or she is not keeping active and focused (increasing beta waves). If he or she becomes anxious or distracted (hibeta waves), or begins to feel tired or daydream (delta waves), the game will stop.

The child then learns to find the medium where he or she feels a calm focus and is in control of his or her brain functioning. A study conducted at Boston Children’s Hospital showed that the children who received biofeedback therapy had better control over their reactions to daily frustrations than they had prior to receiving the treatment.

“The connections between the brain’s executive control centers and emotional centers are weak in people with severe anger problems,” explains Joseph Gonzalez-Heydrich, chief of psychopharmacology at Boston Children’s and senior investigator of a recent biofeedback study conducted there.

Building a strong connection and balance between the midbrain and forebrain allows a child or adult to gain better control over their emotional responses and behaviors. Aggression and anger are then diffused in a healthy and appropriate manner.

Biofeedback also teaches breathing correctly as a relaxation technique. Breathing deeply through the diaphragm and focusing on each inhale and exhale will clear the mind and allow the frontal brain to keep the midbrain and emotional centers in check. It gives the mind a chance to step back from the situation and view it objectively instead of impulsively reacting off of intense emotions.

Biofeedback is a time- and research-tested technique to help people learn to better control responses that many believe are automatic or uncontrollable. If you or someone you love is having trouble with anger, consider biofeedback as one potential treatment to help with this concern.

Reference

Boston Children’s Hospital. (2012, October 24). Video game with biofeedback teaches children to curb their anger. ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2012/10/121024164731.htm

Therefore, the use of art and crafts in psychiatric settings has played a significant role in OT from the beginning. Furthermore, a core idea in the development of OT is that “occupation, or doing with the hands, can be seen as an integral part of experiencing a meaningful life” (Harris, 2008, p. 133).

Crafts have many potential therapeutic applications: motor control, sensory and perceptual stimulation, cognitive challenges, and enhanced self-esteem and sense of efficacy (Drake, 1999; Harris, 2008).

Crafts, too, are also often used to assess cognitive functioning: “Crafts were selected because they can be standardized to present new information that is meaningful to the disabled most of the time” (Allen, Reyner, Earhart, 2008 p. 3).

However, in recent OT literature the term “craft” appears to have acquired less worthy connotations. In addition, the emergence of art therapy as a psychoanalytic tool, as well as the use of arts and crafts in recreational therapy, questions the role of the arts in current OT practice with psychiatric patients.

In a study assessing the perspective of inpatient psychiatric clients on occupational therapy, it was found that arts and crafts were the most popular of sixteen activity groups offered. However, only a third of the participants in the arts and crafts group indicated that they found the activity to be helpful and beneficial (Lim, Morris, & Craik, 2007).

An earlier study revealed only a slightly higher than neutral rating of craft groups among psychiatric patients randomly assigned to various activities (Kremer, Nelson, & Duncombe, 1984).

In the course of my investigation of the use of art in occupational therapy in inpatient psychiatric settings, a recurring complaint in several articles was the lack of research on both subtopics: the current role of arts and crafts in OT, and the current role of OT with psychiatric patients.

Although the studies quoted offer only moderate support to the hypothesis that arts and crafts are beneficial to psychiatric patients, they are only two studies. Furthermore, rather than refute the use of arts and crafts altogether, they reinforce the doctrine common to occupational therapy that any treatment must be specifically tailored to fit the interests and needs of the client.

References

Allen, C. K., Reyner, A. & Earhart, C. A. (ed) (2008). How to Start Using the Allen Diagnostic Module: A Guide to Introducing Allen’s Theories Into Your Practice (9th ed.). Colchester, CT: S&S Worldwide.

Drake, M. (1999). Crafts in Therapy and Rehabilitation (2nd ed.). Thorofare, NJ: Slack Incorporated.

Harris, E. (2008). The meanings of craft to an occupational therapist. Australian Occupational Therapy Journal (55), 133-142.

Hussey, S. M., Sabonis-Chafee, B., & O’Brien, J. C. (2007). Introduction to Occupational Therapy (3rd ed.). St. Louis, MO: Mosby.

Kremer, E. R. H., Nelson, D. L., & Duncombe, L. W. (1984). Effects of selected activities on affective meaning in psychiatric patients. The American Journal of Occupational Therapy, 38(8), 522-528.

Lim, K. H., Morris, J., & Craik, C. (2007). Inpatients’ perspectives of occupational therapy in acute mental health. Australian Occupational Therapy Journal (54), 22–32.

One of those things was eat ice cream. A lot. So I gained a few pounds. It was time to buy new pants anyway. The only important thing was that my medicine was working and I was feeling good. I felt like participating in my life again. Feeling good and eating ice cream were natural.

But then I broke the couch.

Maybe it was a coincidence that I was the one whose bottom touched the couch and made it go POP and collapse. But it had occurred to me, in that moment I felt the couch break underneath me, that I had gained a lot of weight. And that was enough to tell me that all this weight gain was starting to bother me.

I finally realized that as my mood had gone up, so had my weight; maybe my medicine came with a trade-off. I’d never had a medicine that made me gain weight before or gave me cravings that led to weight gain. But here I was.

I’d always told people in the same situation that it didn’t matter if they gained weight. Obviously mental health is more important than gaining a few pounds.

But is there a line that can get crossed, where weight gain can make the scales tip in favor of switching meds? What’s the number? 15 pounds? 25 pounds? 30 pounds? 50 pounds? In what span of time? One month, three months, a year? What is OK and not OK?

Mental health is most important, but at what point does weight gain also affect health? It affects physical health, like blood pressure and risk factors that come with obesity (I am now technically obese), but I’m not even talking about the physical drawbacks of weight gain. What I’m irrationally worried about is the emotional toll that weight gain can cause.

I’m not satisfied with what the medicine is doing with my body. I don’t feel like myself. I feel like myself when I was pregnant, only without a baby, meaning I feel too big and tired and slow. That is affecting my mental health. Not in a serious, clinical way. But in a way that is still real.

Still, I would never stop a drug that’s working in favor of nothing, or one that didn’t work, to be able to lose weight. I’ve been in the dark hole that depression is, and there’s no way I would jeopardize my own quality of life or my family’s with my vanity. But it’s a little tempting, when I’m still on my meds and they’re working well, but there’s just this one side effect…. And I think, maybe I could stop. But I wouldn’t just stop; I would switch to something else, after talking with my doctor like I should. I’m more vain than I realized, but I’m also even more terrified of falling into depression again.

One of the most disconcerting things is the feeling that I don’t have power over my body. Even when I eat well, and exercise, and sweat off what feels like pounds of water, it turns out I have actually gained weight. I haven’t lost a single pound since I started my medicine several months ago. That unsettles me and makes me feel a tiny bit like I do in a depressed state: I am not in control of my body.

This doesn’t cause me to lose hope in general, to think that there won’t be a better time. But it does cause me to lose confidence in myself. I’m already on shaky ground, living with mental illness. Will I feel good today or bad? How am I feeling? But now, I add, How do I look? How much have I gained? to the daily evaluations. I can’t always depend on my mind; now I can’t depend on my body.

Having a mental illness throws new challenges at me at every turn. Even when I feel well, it still reminds me of its presence, in this case, through these extra pounds clinging to me. I believe that there might be side effects and trade-offs to medication, but I also believe they saved my life, or at least saved the quality of my life, and that it’s worth it. And I believe the perfect medication might be out there, waiting to still be discovered for me.

Maybe I’ll always have to make the decision between effective medicine and side effects like weight gain. But I have hope that someday I won’t have to.

Mindfulness meditation is currently all the rage, and it works. But I am wary of its proponents who claim it can treat (or even cure) mental illness by itself.

Meditation is a powerful tool when used to decrease stress and increase well-being. But if we are to maintain that mental illnesses are biochemical malfunctions of the brain and nervous system, then we must allow room in treatment for medicine. Therapy also has a long history of positive impact on the lives of those challenged by psychiatric disease. Meditation, when added to more traditional and well-tested methods of treatment, can help a patient successfully manage a challenging life. I, and so many others like me, am proof of that.

I am sure that there are people who face serious mental illness well using only meditation. Dan Siegel writes of one teenager who manages bipolar disorder with meditation alone in his excellent book Mindsight.

But the popularization of such case studies may lead people to stop taking medication and pick up meditation in a hope to finally be done with meds. Anyone who hopes for this and changes his own medication regimen without proper medical oversight is asking for relapse and worse.

Another book on the benefits of meditation, Transcendence, by Norman E. Rosenthal, clearly states that meditation for mental illnesses such as bipolar disorder and schizophrenia should only be administered in conjunction with medication and therapy and should be monitored by a physician. I believe this more balanced view will help more people manage the symptoms of mental illness successfully.

Since I have become a disciplined meditator I have had little difficulty with my bipolar disorder. It is only natural to wonder if I could manage as well if I continued to meditate and came off the drugs. In fact, it is very tempting.

But my doctor advises me not to and, after much reflection and concern for my family, I agree. Just as I couldn’t manage this well without the meditation, much research evidence supports the idea that I couldn’t manage without the medication either. I’m not willing to take the chance.

Every person with mental illness to whom I have taught meditation has asked me if I think serious mental illness can be cured. At this point, with what science has discovered, I don’t. But it can be managed, and managed well, if meditation is added to the medical model of drugs and therapy.

Just as the person with diabetes will take insulin indefinitely, I must continue to take my medicine. And just as one with diabetes must adopt a healthy lifestyle to best complement her medication, the person with mental illness must as well. What I am sure of is that meditation is one of the best complements available.

Then, I walk into the lab next door for a blood test and the line I hear is: “Oh, your blood pressure was high, let me see if I can draw your blood now.”

Wait, what? Do they actually think that these comments will make me feel more relaxed?

I’ve also experienced more direct unpleasantries from doctors who project an icy, or even a rude demeanor. A poor bedside manner does affect a patient’s emotional disposition; it does heighten any anxiety, and it certainly ensures difficulty in forming a positive bond with a professional who’s in a field that’s supposed to alleviate illness.

“A bedside manner refers most often to the way a medical professional interacts and communicates with patients,” a 2012 post on Wisegeek stated. The post stresses that a doctor with a good bedside manner demonstrates empathy,¹ and emits an aura of ease for the patients, while also involving them in health decisions. On the flip side, poor bedside manners reflect rudeness, cold attitudes, inadequate listening skills, and a complete disregard for the patient’s fears.

Why are such mannerisms prominent in the medical field?

Lorianna De Giorgio’s 2012 article in the Toronto Star discusses why positive relationships between patients and doctors may be lacking in the profession.

Adam Waytz, assistant professor of management and organizations at Northwestern University, explained that a process of “dehumanization” lies behind an unfortunate patient-doctor rapport. Dehumanization may occur due to psychological demands placed on practitioners, and from ongoing advances in technology as well. Waytz determined that a bulk of medical decision-making gives way to a very mechanical method of thinking; problems are often solved and issues are fixed without recognizing the patient’s feelings.

While many individuals enter the medical field for humane reasons, “they get into the system, and the system is so stressful that sometimes the humanity is just beaten out of them,” notes Marjorie Stanzler, senior director of programs at the Schwartz Center for Compassionate Healthcare.

Waytz and Stanzler advocate that a proper bedside manner would result in improved psychological and physical outcomes for the patients in treatment.

A 2008 blog post entitled What Bad Bedside Manners Really Mean reviews the negative impact and consequences of these adverse behaviors:

“Doctors are supposed to be in the line of work of helping people. With this profession comes a lot of responsibility. The medical field is not supposed to be simply diagnosing a problem, handing out a few pills, and moving onto the next patient. It means much more. It means being a physician, and a physician means being a healer.”

I could not agree more. Patients may feel naturally anxious, waiting on an impending prognosis (especially if the condition has the potential to be serious). Do they really need aloofness on top of that?

“If the doctor seems disinterested in what you are telling him, there are greater chances of him missing something that you said,” the post stated. “If he seems put-out or preoccupied, the patient might be more likely to leave out pertinent information.” Furthermore, if the doctor is disrespectful, it may discourage patients from seeking medical assistance altogether.

Due to a distressing environment and technological developments, I can understand why medical practitioners may harbor some poor bedside manners, but that doesn’t make their etiquette right or beneficial.

I think it’s important for them to remember why they’ve entered the field in the first place; if it’s because they sincerely want to help people, it’s crucial to know how to relate to patients on an emotional level.

1. l personally think medical schools should have official courses on being more empathetic

And while you’re getting treatment — whether through medication, psychotherapy or both — there are many ways you can manage your symptoms in the meantime.

In his valuable book Depression: A Guide for the Newly Diagnosed, clinical psychologist Lee H. Coleman, Ph.D, ABPP, provides tips on minimizing symptoms and getting better while you’re receiving professional help.

Here are five of his suggestions.

1. Chart your symptoms.

A chart that documents your symptoms is incredibly informative. For instance, a chart of your energy levels will let you know the time of day you have the most and least energy. A chart with your activities will let you know how each action affects your symptoms (for better or worse.)

Coleman suggests recording your energy, sleep, mood and activities every day. Specifically, rate your energy and mood from 1 to 10; record the number of hours you slept; and jot down the type of activities you did that day. Bring this chart to your provider so they can see your progress.

2. Keep a consistent schedule.

According to Coleman, “When you’re depressed is never a good time to ‘wing it’ or leave your days completely unstructured, because you run the risk of drifting aimlessly.” Be consistent about when you eat, go to bed and wake up, along with other routines.

3. Stay active.

Depression drains your energy, enthusiasm and motivation. That’s why it’s important not to wait until you feel like it to engage in activities. (It’s like Therese Borchard said in this piece on exercise: “I think sometimes we have to lead with the body, and the mind will follow.”) In fact, mood and motivation often improve by continuing to participate in activities. Coleman suggests creating a list of activities you’d like to do or did in the past.

For instance, your list might include inviting a friend over for coffee, walking around the block, preparing a meal for yourself, picking up a few things at the grocery store, and meditating. Consider how these activities affect your mood. Also, if some activities seem overwhelming, break them down into bite-sized steps. Encourage yourself to accomplish one step at a time.

4. Practice self-compassion.

Self-compassion is especially important when you’re depressed. Unfortunately, the very nature of depression makes it difficult to be kind and understanding with ourselves. Depression shrinks your self-image and self-esteem. It makes you feel worthless and guilty.

But think of it this way: “We don’t get mad at ourselves for having the flu or a kidney infection, because we know that we didn’t cause the problem and that our job is to get better, not to feel bad about ourselves. It’s no different with depression,” Coleman writes.

Some people still worry that if they’re kind, they’ll just become even more unmotivated. But, as Coleman notes, these types of beliefs only exacerbate depression. Plus, “drill sergeants rarely make effective therapists!” Remember you can’t shame or hate yourself to health.

(It also helps to consider how you’d treat a friend who was going through the same thing. It’s likely you’d lead with kindness and compassion. What does that look like for you?)

5. Adjust your expectations.

Depression tends to affect all areas of your life. It might be tougher to work, study, socialize and participate in any other activity, Coleman says. So it’s key to adjust your expectations. “It simply doesn’t make sense to expect yourself to be at 100 percent with the hundred-pound weight of depression on your back.” Coleman encourages people to ask for help and advocate for themselves. “Remember people won’t know what you need unless you let them know — so tell them!”

Depression is a serious illness. But with effective professional help, you can get better. And while you’re receiving treatment, the above strategies may help enhance your improvement.

It doesn’t matter that I wake up most mornings to swim 160 laps, am borderline obsessed with eating salads and whole grains, and that I haven’t drank a drop of alcohol in 24 years; that I do yoga twice a week, keep a mood journal, engage in cognitive behavioral therapy, and have a rich spiritual life; that I take omega-3 fish oil capsules, vitamin D, calcium, and other supplements with my extra-pulp juice in the morning; or that I work really hard at communicating anger, frustration, and disappointment so that the repression of feelings doesn’t end up as a tumor somewhere inside my body.

I can’t get an individual or family plan short of signing up for a $10,000 deductible.

Because I have a history of depression.

My illness falls under the ABCs of the non-insurable, the “preventable” illnesses that solicit the red flag of “no way in hell” she’s getting coverage:

A – Asthma (and, hell, let’s throw in Arthritis)
B – High Blood Pressure
C – Cardiovascular Disease (and Cancer, sometimes classified – I know – “preventable,” but which is surely a insurance-killer)
Double D (think bra size) – Diabetes and OF COURSE Depression

Now I’m not so naïve that I dismiss the economic toll these illnesses take on an already fragile economy. Here’s the chronic disease price tag, estimated annual direct medical expenditure, according to the Center for Disease Control, which used different methodologies in calculating costs:

Cardiovascular disease and stroke: $313.8 billion in 2009
Cancer: $89 billion in 2007
Smoking: $96 billion in 2004
Diabetes: $116 billion in 2007
Arthritis: $80.8 billion in 2003
Obesity: $61 billion in 2000

Not mentioned here is clinical depression, which, left untreated, is as costly as heart disease or AIDS to the U.S. economy, according to Mental Health America. It costs over $51 billion in absenteeism from work and lost productivity and $26 billion in direct treatment costs.

Depression tends to affect people in their prime working years and may last a lifetime if untreated. According the MHA:

• Depression ranks among the top three workplace problems for employee assistance professionals, following only family crisis and stress.
• Three percent of total short-term disability days are due to depressive disorders and in 76 percent of those cases, the employee was female.
• In a study of First Chicago Corporations, depressive disorders accounted for more than half of all medical plan dollars paid for mental health problems. The amount for treatment of these claims was close to the amount spent on treatment for heart disease.
• The annual economic cost of depression in 1995 was $600 per depressed worker. Nearly one-third of these costs are for treatment and 72 percent are costs related to absenteeism and lost productivity at work.

That’s not to mention the human toll: seven out of ten deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50 percent of all deaths each year. Almost 15 percent of those suffering from severe depression will die by suicide.

And there is much we can do to prevent it. Four culprits are responsible for much of the illness, the suffering, the costs, and the early death associated with chronic diseases:

• Lack of physical activity
• Poor nutrition
• Tobacco use
• Excessive alcohol consumption

But allow me to climb back onto my soapbox. It’s still not fair. It’s not fair to those of us who go to great lengths to pursue healthy living and do everything in our day in the name of recovery – those of us who get up every morning with a pair of boxing gloves on, ready to fight for our health. It’s just not fair and it’s wrong.

I look forward to my meetings with health insurance brokers less than I do my yearly Pap. As much as I try to mentally prepare myself for the blow – “Repeat to yourself: You’re not going to like what you hear. It’s going to be unfair. You need to stay calm” – I still leave infuriated, which then, of course, has me checking off two of the ABCs: depression AND high blood pressure. That would probably bring my deductible up to $12,000, God forbid.

Originally published on PsychCentral.com

I first decided to try it in 2010 to see if it would be able to help ease my lifelong sleeping issues.

Usually I put a lot of thought into the medical providers I work with. In this case, I did not do any research into which practitioner I wanted to use; I simply chose the acupuncturist located one block from my house. It was certainly convenient, and seemed like a good idea at the time.

I recall those sessions as being strange. In addition to needles being placed all over my body, my sessions also involved smoke and fire. Sometimes, an herb would be placed on top of the acupuncture needles, then set on fire. Smoke was used in a procedure called “cupping” where glass jars were suctioned all over my back.

Craniosacral therapy was also used on me. My acupuncturist would rub two bones on the back of my skull at a very specific point. All of this was supposed to make me sleep. When pressed as to how this would all work, my acupuncturist would sometimes use the word “magic.” Magic? Really?

I went to these sessions four times, as I was told this was how many visits were needed to assess if my treatment was working. I saw no difference after four visits and stopped going. My western mind told me the process was all a bit much for me. If I felt the magic was working, I could have gotten over it, but I saw no progress. Plus, acupuncture is not covered by health insurance and my visits were getting expensive.

A few months ago, I started to feel my inability to sleep was at a point where it was greatly affecting my life. I have a variety of sleeping pill prescriptions, but nothing seemed to be helping me as much as I hoped. I was starting to feel desperate and out of control. This is when I thought again of acupuncture.

I wondered if a different practitioner might be able to help me more than the first one had. I did a good amount of online research and settled on someone. I’ll admit, aside from good online reviews, part of the appeal of this new provider was that everyone in the office was from China. I thought that a practitioner of Chinese medicine who was actually from China may have different viewpoints and use an alternative approach. This supposition was really based on nothing, but it made sense to me at the time.

When I called to make an appointment, the person on the phone did not ask me any questions or tell me what to expect. She simply wanted to know when I would come to the office. When I went to the office at that specified time. I found a dark hallway and a locked door. When I called the office’s phone number, I could hear the phone ringing on the other side of the door. No one answered; no one was at the office. I had been stood up.

I soon received a call explaining there had been a scheduling error. I understand that these things happen, but decided not to make another appointment. I had a bad first impression of that acupuncturist’s office and did not want to move forward with them.

This led to more Internet research. I settled on a group of acupuncturists not far from my house. When I called to inquire, the person who answered the phone asked me a great number of questions about why I wanted to come and what my symptoms are. This made me feel comfortable.

I filled out a lot of paperwork before the first visit. The paperwork contained very personal questions about my body and health, with some of the questions being highly detailed. I answered to the best of my ability.

At my first appointment, I handed in my paperwork to the acupuncturist and we talked for a long time. She wanted to know more about my patterns of insomnia and anything else that was wrong with my well-being. We settled on insomnia as my primary issue, but also addressed headaches, nausea, and neck pain.

This acupuncturist did not use smoke, fire, or magic. She simply asked me to remove my shirt and lie face down on a table. She then placed needles all over my neck, shoulders, back, and calves. I lay like that for around 20 minutes, then the needles were removed. I replaced my shirt, then turned onto my back. The acupuncturist then placed needles in my forehead, arms, wrists, and legs.

The next two sessions proceeded much like the first, but with less interviewing. Each time I would go, we would check in on my sleep and other ailments, then I would lie still while needles were placed in various areas of my body. The needles would sometimes feel uncomfortable, but the sessions were, overall, relaxing.

At my third visit, I was given my assessment. I was informed I had imbalances in the Chinese medical organ systems of spleen/stomach, heart/small intestine, and liver/gall bladder. I was also told my blood needed additional nourishment. I did not understand what this meant, but went along with it.

To help my treatment of these problems, I was given a prescription of Chinese herbs. I was prescribed the herb blend of Suan Zao Ren Tang. This came in a powder and I was instructed to mix five scoops of granules with a cup of water. I was told to take it at night, two hours after eating dinner. It seemed imperative that I take the herbs on an empty stomach and with no other medicine.

The herb drink did not taste good, but it wasn’t terrible. The flavor reminded me of celery. I began drinking my prescribed dose every night.

When I started taking the Suan Zao Ren Tang, I began to feel like I was falling asleep with more ease and had less frequent headaches. I began feeling positive about the acupuncture treatments and my herbs. I felt like it was all working.

My acupuncturist soon added another herb blend to my routine. I started taking Si Wu Tang in the morning. This one came in pill form and I took seven of them as soon as I woke up. I found swallowing seven pills immediately upon waking to be strange.

This was followed by a bad couple weeks of sleep and I became discouraged. During that time period, I had an acupuncture treatment that did not seem to help. I couldn’t help but associate the downward turn with the addition of the Si Wu Tang pills. When the bottle ran out, I did not buy more.

I started to feel more negative about my acupuncture treatments. For the price I was paying, I wanted to be sure it was doing something. At my next session, I asked the acupuncturist what I could reasonably expect from the treatments. She said she did not understand my question. I found this vaguely annoying — if a health-related service is being provided, I think it is fair that a client understands how long interventions will take and how to assess if they are working.

The acupuncturist reviewed my paperwork with me and pointed out the areas in which I was making progress. She had a point on some of the issues. I was then given the unsatisfying answer that treatment takes time and everyone responds differently. Because we were trying to fix the underlying cause of my insomnia rather than mask its symptoms, it would take an undetermined amount of time. I understood what the acupuncturist was saying, but would have preferred to assign a time and price assessment to my treatment. The costs of the treatments and the herbs were quickly adding up.

At that same visit, my Si Wu Tang was officially discontinued. It was replaced by something called Free and Easy Wander Plus. This was in a pill and I was instructed to take five of them when I woke up in the morning. I started taking these the next day.

I have now had eight acupuncture sessions and have purchased three more. I am still unsure as to if this is working. I seem to be sleeping a little bit better, but I don’t know if this is because of the acupuncture or other factors. When all my acupuncture sessions are done, I will have spent $800, plus the cost of the Chinese herbs. I would like to know if this money has helped me with my insomnia, but how can I tell for sure? This makes me feel highly frustrated. I had hoped my results would be more concrete.

People seem to have strong pro or con opinions about acupuncture. I am still somewhere in the middle. I’m desperate to have help with my sleeping issues, but am unwilling to pump endless money into a practice that may not be doing much for me. The experience has left me feeling both confused and hopeful, a strange combination to figure out as it continues to unfold.