World of Psychology Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999. 2016-06-30T03:20:46Z Psych Central Staff http:// <![CDATA[Solitary Confinement Crushes Any Chance of True Recovery]]> 2016-06-27T18:29:29Z 2016-06-29T22:35:44Z jailbird

Solitary confinement is a torture device. In New York, an inmate can be sent to solitary for a nonviolent rules infraction like too many stamps or being in the wrong place.

For Maria, solitary confinement “made me want to use more.”

“I went from not caring to not giving a f–k,” Maria said.

The Queens native is currently serving time in one of New York state’s female prisons. Though she was already a drug user before she got locked up, Maria says that her addiction has only gotten worse since she’s been behind bars, where she started experimenting with more substances than the pot, alcohol and occasional pills she was doing on the outside.

Drugs felt like “a necessity” in the harsh world of prison, but eventually that “necessity” landed Maria in solitary confinement. That’s when, she says, she stopped “giving a f–k.”

Though the specifics vary from one prison system to the next, typically solitary confinement means being alone in a 6×9 or 8×10 cell for 22 to 24 hours a day. Sometimes, there’s an opportunity for outside recreation — but in some facilities, that just means going out into a tiny “dog cage,” alone and shackled. Meals and meds are pushed in through a slot in the door.

There are different types of isolated confinement, though they go by different names in different prison systems. There’s psychiatric and medical isolation, punitive isolation, protective custody, and administrative isolation for the “safety and security” of the facility.

Solitary confinement is a routinely used weapon in the prison guard’s arsenal. In New York — as in many other states — solitary sentences can be doled out for trivial, nonviolent rules violations. If you’re not familiar with the workings of the criminal justice system, you might assume that solitary is for the worst of the worst. But you would be wrong…

For a closer look at just how ineffective solitary confinement in prisons is when it comes to sobriety and recovery, check out the rest of the original feature article, How Solitary Confinement Destroys Any Hope of Sobriety, over at The Fix.

Peter <![CDATA[Bipolar: My Life on the North and South Poles]]> 2016-06-27T18:29:36Z 2016-06-29T18:35:14Z North Or South, Opposite SignsI was born in 1969, the flower power days.

School for me was difficult because I had dyslexia, and back then the word “dyslexia” wasn’t in the dictionary. Instead they said I was lazy and not working hard enough.

After school, I started a jewelry apprenticeship — you don’t need to read much when you are a jeweler, you see. I decided to work as a contractor. I realized it’s easy for your boss to kick you in the bum, but it’s hard to do it yourself.

I knew I needed a change, so I went to work at a lighting company where I met Roseanne. I had a seven-year relationship with Roseanne, but when we broke up the depression set in.

At the time, my daughter Ruby was on the way and the picket fence dream of having a relationship, a daughter, and a roof over our heads had gone out of the window. I had hit rock bottom. I was suicidal. I had major depression. People were spinning out. I’ve never been a fighter, I’ve never hit another human being, but now when I got upset and frustrated, I hit walls. And that was when I was diagnosed with bipolar.

I had been going through life basically unaware that I had bipolar. I was having mood swings all the time but not realizing why. It hadn’t clicked to me, or really to anyone.

When I was first diagnosed, it still wasn’t obvious to me that I was any different to anyone else. My attitude was very much, ‘I don’t need medication.’

But I agreed to treatment and took the medication, more out of curiosity than anything else. Since then, I’m a better person. The impulses I was having when I was frustrated were controlled, and my moods were stable.

The weight gain which came due to the meds I was on at the time, however, was bit of a shock to the system. “You’re going to gain a bit of weight,” the doctor said. I gained 88 pounds in six months! As you can imagine this was a bit of a downer, especially when I was in a depressive period. I’ve since swapped the meds, and I’m starting to see the weight drop off.

There are still moments in my life where bipolar sets in. Events can trigger it, major letdowns, or major excitements. If I have a blow, it can trigger depression, and if something cool is happening or if life’s really a breeze, I can be manic.

I now look at bipolar like the earth. I have my North Pole and South Pole. One is completely opposite to the other. I have my depressive side, and my manic wild times. In my depressive South Pole periods, I can be in bed for one, two or even three days at a time. And when I’m in a manic North Pole period, I’m shouting out to the world and going for days without sleep. But the treatment keeps me on the equator. I might go to the Tropic of Cancer and Capricorn maybe, but I won’t be going to each pole.

Keeping busy and active really is the thing to help keep the bipolar under control. I never find myself with nothing to do, really I don’t. I live life to the full.

Since being diagnosed, I got my Certificate III in Horticulture and Landscape Gardening, and now work at House with No Steps doing garden and property maintenance.

I’m also in a band called ‘Electric Grapefruit,’ formerly ‘Men with facial hair.’ I also love fishing with a sandwich, a can of drink, and some friends.

I am still having treatment, and have found a fantastic doctor who understands me and will call me out when needed.

My disabilities are hidden, both dyslexia and bipolar. It’s not something that’s often seen and is something I can often cover quite quickly and easily. Even so, I have had it rough in my life. Through my life I’ve gone through ups and downs and had different challenges, but I wouldn’t change who I am for anyone.

To my Mum: Mum, you’ve been there the whole time, through helping me learn at school, teaching me to read and do my homework, working out my dyslexia, seeing specialists, and throughout my bipolar journey. Mum, you’re the reason why I’m here.

igor stevanovic/Bigstock

Emma Lavoie <![CDATA[Separate and Unequal]]> 2016-06-27T18:29:42Z 2016-06-29T14:20:20Z Blue 3D Arrow Seperates Into Two Distinct PathYou have just fallen off your bike. You hit a rock and were thrown over the handlebars onto your back. Ouch.

What do you do now? You go to the doctor. X-rays are taken. Nothing is broken. You get some medicine, you go home.

The next day at work, you are having some trouble with the pain. Your peers ask what’s wrong. You reply that you fell off your bike. They say that’s too bad; hope you feel better. Move on. They don’t think too much of it.

Now, let’s pretend you had a different kind of health issue. Lately you’ve been feeling down. You can’t explain why, you just don’t feel like doing anything. You aren’t hungry, and are disinterested in things that usually excite you. So you go into work and your peers have noticed your mood shift.

They ask about it, wondering if you’re OK. You tell them you’ve been feeling sad and can’t really explain it. They tell you you’ll get over it. You’ll come out of this slump you’re in. Just try a little harder to be happy.

How would you respond if they told you to “just try a little harder” when you’ve got a broken bone? You can’t try a little harder. It takes as long as it takes to heal.

This is a common response when people are talking about depression, and many other mental illnesses. They think it’s your fault, and that you aren’t trying hard enough to get better. But that’s not how mental illnesses work. This opinion is rooted in misunderstanding and generalizations about the impact of mental illness.

This is a primary example of the stigma surrounding mental illness. Many see it as fake and easily overcome. For example, Dr. Michael Karson believes that sympathy given to people suffering from mental illness is detrimental to their getting better. He believes that some mental illnesses are behavioral, and when we excuse the actions of those people, we are reinforcing their behavior.

This only serves to worsen the stigma surrounding mental illness. It gives us the notion that serious mental illnesses are purposely made up by people seeking attention. While this does occur, many people who are faking a mental illness are more likely to also have a real mental illness, according to an article on WebMD.

In a study published in the U.S. National Library of Medicine, it was found that the knowledge of or suspicion of a mental illness can have a negative impact on a hospital stay. This thought held by some health professionals doesn’t bode well for those suffering from mental illness.

In fact, a recent study in the Health Affairs Journal found that doctors don’t follow up with patients suffering from depression as often as they should and are less likely to help these patients manage their illness. This same study also found that most primary care practices aren’t equipped to handle depression as a chronic illness. Although they are not mental health specialists, primary care doctors should be equipped to refer patients to therapists and psychiatrists.

According to Ranna Parekh, the director of the division of diversity and health equity for the American Psychiatric Association, there is a separation between mental and physical health.

She says that the longer we continue to refer to them as separate, the longer we will treat and view them differently. Health needs to be an all-inclusive term. This will reduce a separation in thinking that comes along with a separation of terms. When we refer to someone as being in poor health, we are usually talking about a broken arm, or having a harder time breathing, or being slow to get around. Being in poor health needs also to include mental health. Mental illnesses need to have the same amount of credibility and awareness as physical illnesses.

If physical and mental health were thought of as one entity, health, then there wouldn’t be such a separation in thinking about these two things. It would all be talked about in the same breath and making separations and comparisons would be harder to do. It would force us to think of health as a combination of mind and body, not a separation.

There are currently efforts to try to achieve parity in health. For example, The Mental Health Parity and Addiction Equity Act, passed in 2008, requires that financial requirements and treatment limitations be no more restricting than those applied to physical health care. This exemplifies the movement to end stigma and get to a point where mental and physical health are equals.

This movement needs to happen. There are many people around the world who are suffering from a mental illness. Their suffering is only made worse when they are treated differently and ostracized, and made to feel shameful about something that is normal. The world will be a happier and healthier place once health is an all-inclusive term.

Atthidej Nimmanhaemin/Bigstock


Vanessa Ruspoli, DPsych <![CDATA[Cognitive-Behavioral Therapy for Weight Management]]> 2016-06-27T18:26:09Z 2016-06-29T10:32:34Z Weight Scale.Countless people feel unhappy with their bodies. Some have eating disorders, and many others deal with issues surrounding weight management. They may have tried the standard self-help techniques, from exercise and dieting to grueling weight loss programs, without success.

Cognitive-behavioral therapy (CBT) is an effective and widely used therapeutic approach that can be applied to issues including self-esteem, body image, and weight management.


There is evidence that CBT can be effective for low self-esteem, which is often at the root of weight or eating issues, or can come as a result of them. Every person, through their life experiences (including early experiences), creates a bottom line — a particular appraisal of themselves. If that self-appraisal is negative, low self-esteem follows. The person then develops rules for living that allow them to avoid situations that trigger difficult aspects of that self-appraisal (e.g., “I am unacceptable as I am, so I need to hide my real self”).

CBT focuses on reevaluating a person’s bottom-line beliefs and rules for living through cognitive techniques and behavioral experiments, and working on enhancing self-acceptance and reducing self-criticism.

Behavioral experiments will vary depending on the issue. For instance, if the person’s low self-esteem is associated with the idea that “others find me unlikeable because I am too fat,” the person will need to test this assumption. They might directly confront the belief by talking about it with their therapist and trusted others, or challenge it by seeking evidence against it. A psychologist might also support the client to develop the associated skill of communication, which can help a client with low self-esteem to better express themselves, and to assert their rights and preferences.

Body Image

Body image refers to the attitudes and perceptions a person has in relation to their body. CBT has been found to be effective in addressing and adjusting a person’s body image, with body image improvements being maintained over significant periods of time. CBT work with body image uses a variety of cognitive and behavioral techniques, and often involves homework, using aspects like self-help books and self-directed exercises that are elaborated upon in therapy.

By way of example, the therapist might ask their client to challenge core beliefs that may be associated with their body image (e.g., “I need to be thin to be happy”). Homework tasks might involve encouraging a client to fill in the blanks for three things they really like about their appearance (such as their hands or their smile), or in the case of self-esteem, it might be to notice three positive things they have done this week that made them feel good about themselves. Worksheets that consider cognitive and behavioral elements also are useful.

Weight Management

CBT also is an effective strategy for weight management. It focuses on challenging unhealthy ideas and beliefs that support weight problems (both if the person is underweight or overweight). It also brings awareness to behaviors that lead to weight problems, such as bingeing.

Some modalities, such as enhanced CBT, also target external factors that might be associated with weight — not only low self-esteem and poor body image, but also interpersonal difficulties and high levels of perfectionism. CBT can address different issues by teaching the person new skills and working on testing their beliefs. It can also give clients the tools for learning new behaviors that are more adaptive and conducive to good weight management.

There are a variety of skills that might be associated with all these interrelated issues. One that frequently comes up is emotional expression and mood regulation. CBT supports clients to identify their emotions, and express them in a healthy manner with the help of their therapist. Another skill might be learning to respond appropriately to the body’s messages and needs (e.g., hunger and thirst), and to attend to and acknowledge other personal and interpersonal needs that eating or weight issues might have been masking or substituting. Additionally, CBT can help you become positively aware of your body, and to approach exercise and nutrition in a healthy way, gradually and in a realistic fashion, so that goals are achievable and easier to maintain.


Matthew Loeb <![CDATA[Checkmate]]> 2016-06-27T18:09:48Z 2016-06-28T22:35:02Z Chess MasterThe check. And here you thought I was talking about the dinner bill, didn’t you?

No, for those hearty souls battling obsessive-compulsive disorder, “the check” refers to something different than picking up the restaurant tab. For those afflicted with OCD, the check could mean ritualizing about the pedestrian they may have hit, sprinting to the restroom to scrub cracked hands, or fleeing a dinner date to check whether the garage door is shut.

OCD, popularly known as the doubting disorder, affects 1 in 40 Americans. On average, it takes nine years for the average OCD patient to receive the correct diagnosis. Medication alleviates the symptoms for a fortunate few. Exposure and response prevention (ERP) helps some. For others, the journey to acceptance continues.

As we gaze at our mind with bewilderment, awe, and a little dismay, here are some tips to manage the unmanageable.


Your mind playing its usual magic tricks on you? Are you bemoaning the latest and greatest OCD thought? I understand but, as Robin Williams commanded in “Good Will Hunting,” “It isn’t your fault.” You are more than the meaningless thoughts; you are a partner, a brother, and a friend.

As your mind pummels you with intrusive, nonsensical thoughts, reframing is a useful cognitive tool. Through reframing, you can challenge ingrained cognitive responses. When a repetitive thought accosts you, your mind’s instinctive response tightens OCD’s vise grip. Let’s examine your response.

The involuntary thought “Something is wrong with my mind” taunts you. Your typical response is to wallow in a pool of belittling statement and self-pity. Instead, reframe the intrusive thought into a more neutral statement. Here is a model response: “I am going through a challenging time and have the skills and tenacity to persevere.”

Baseball Box

People with OCD ritualize. For me, I put on a trench coat and do my best Forensic Files impression whenever I have an intrusive, repetitive thought. “Maybe it is true. What does this thought say about me? This must mean I am a horrible person,” my mind endlessly repeats. Now the only rituals I engage in are when I am doing my best Slammin’ Sammy Sosa impression during softball.

Mind over Matter

Some days I am a sweating, bubbling mess. The mind is winking and smiling devilishly at me. “Opposite day,” he cracks, or yells.

Slowly, I am learning to accept the false messages. The OCD radio may be cranked up but I can still compose emails and essays. The thoughts, the feelings, and that sinkhole pit in my stomach are brain tricks. Bring it on; I will thrive in spite of the tormenting thoughts and feelings.

Silence is (not) Golden

The buddy system isn’t reserved for overwhelmed summer camp counselors. Find an OCD friend. Attend an OCD support group. Join a mental health advocacy organization. As a mental health consumer, it is tempting to believe that we are the only ones enduring these horrific thoughts. We aren’t. There are confidantes and counselors sympathetic to your daily tug-of-war against the OCD thoughts.

OCD preys on self-doubt. As we seek reassurance and perfection, the self-doubt strangles life’s joy. Here’s a tip: analysis is paralysis. And another one: focus on the tip, not the check. You can’t overanalyze 20 percent.


Psych Central Staff http:// <![CDATA[Fostering Self-Actualization During Child Development]]> 2016-06-27T18:25:30Z 2016-06-28T18:30:34Z Smiling Children Outdoors

Finding out who we are meant to be can be a difficult task and most won’t take the time and energy involved in the journey. Perhaps, not that they won’t, more often than not they can’t.

Many people struggle daily with meeting other, more base needs, rendering them unable to direct their energy towards higher, more fulfilling needs. In no way am I a self-actualized person, in Rogerian terms I am self-actualizing, that is, I am tending towards my real self and this is necessary for proper and healthy development, and should start no later than once the child is born.

Abraham Maslow identified the hierarchy of needs, in which he proclaims that humans have five levels of need, each of varying significance. At the bottom of the hierarchy lie our very basic needs — the things we need in order to survive. The higher one progresses through the hierarchy the more advanced the needs become. At the very top of the hierarchy is self-actualization, which Rogers defines as the activation of your innermost capacities, the congruence between the perceived self and the ideal self.

These needs will only be met when the other needs have been satisfied. For instance, a homeless man who is constantly struggling to obtain food, water and shelter, will find himself locked in battle between the two bottom tiers of the hierarchy. It is only when these needs are satisfied that he will be able to seek out love, self-esteem and so on.

The first four levels are known as D-needs, and these alone are not motivating. When the needs are not met a person will feel an urge to satisfy them, and once they have been satisfied the individual will feel content.

A Positive Environment for Child Development

The hierarchy of needs can help us better understand child development, and the progression children go through in order to discover themselves. We will be focusing particularly on self-actualization in children, with regards to personality development and comparing how different living environments may affect development.

A child reared in a generally positive, and accommodating environment has more opportunity for growth than one that is reared in a generally negative environment.

A positive environment would be one with two parent-figures, who not only offer the child unconditional positive regard, but offer it to each other as well. The child should feel generally safe, secure and content within their environment, and should not fear either parent. Rather, they should respect their parents.

The Importance of Authority

The best way to create such an environment is to employ an authoritative parenting style. Diana Baumrind describes authoritative parenting as a combination of high demand and huge responsiveness. That is, the parent has firm rules but is willing to make exceptions when the situation warrants, the parents should also be responsive to the child’s needs, without being overly indulgent. This sort of parenting offers the child an environment in which they can flourish — it helps them to understand that they are required to act a certain way within society, but they are also able to develop high levels of self-esteem and self-efficacy due to their parents supportive and accepting demeanor.

A typical authoritative parent will reprimand their child for hitting another child, for example, but will also then follow up after the punishment of choice. For instance, after the child has been on time-out for an appropriate amount of time for his or her age, the parent will ask the child what led them to the decision to hit, why it was wrong, and what they would do in the future. The parent should also be sure to make sure the child knows they themselves are not bad, rather the behavior is harmful, and is generally not acceptable.

This way the child understands the parents reasoning behind their punishment, and less likely to repeat the behavior in the future. Further, the child is less likely to walk away from the situation harboring negative feelings towards themselves, or about their relationship with their parents. This is an essential part of child rearing, and without such a positive relationship with the parent, the child may foster negative feelings towards the self or others, which may promote the development of certain neuroses such as anxiety or depression.

The Importance of a Healthy & Safe Home

It is imperative that the child is offered a healthy and safe environment in which they can grow in order to develop the self. This way, the child will awake every day with the first three levels already fulfilled-meaning that throughout the day, the focus will be on achieving esteem, and self-actualization — two very similar and interrelated levels of the hierarchy.

With the fulfillment of level three — love and belonging — which will be achieved through a healthy family relationship, (both parents to the child, and the child’s understanding of their parents relationship with each other), the child will simultaneously fulfill esteem (to a degree). That is, by the parent offering the child love and a sense of belonging, they also build the child’s belief in his or her abilities — their self-efficacy — which strengthens their self-esteem.

For example, a parent who offers their child a warm and loving environment would also offer their child support in activities. A young boy is drawing and his mother tells him “that’s a beautiful picture, you’re good at drawing.” This statement encourages the boy to continue drawing because he believes he is good at it — and the more his parents support him, the more he believes in himself and his abilities.

A parent’s love and acceptance lays the groundwork for a child’s success in self-actualization, in that it allows the child to exert all their energy into developing their self, and understanding their self.

Consider the example above. The child is built up by his parents, and has an understanding of himself as being “good at art,” and he has the opportunity to continue with this talent, or to find and develop a new talent. Should he be told he is bad at drawing, and should not continue with it because he will never improve – this strips him of any esteem or sense of belonging provided by the parents. In the future he will vie for the parents positive attention and love, and will only be able to find esteem in others approval. This means that his energies will constantly be focused on the 3rd and 4th tier of Maslow’s hierarchy of needs, and will constantly be struggling to fulfill self-actualization.

This is not to say parents should coddle their children, and provide false praise — in fact the parent should not give praise where praise is not due. The parent should recognize the child’s successes as well as the child’s failures — the way the parent deals with the failures is what is important. In order to deal effectively with a child’s failure, the parent should address the situation with the idea of unconditional positive regard in mind. That is, accepting the child as they are, and not judging.

Being sure to address the failure as external from the child is imperative — the child should never be made to feel that a failure is directly correlated with who they are as a person. If the child is made to feel this way, we will have a similar scenario to the one cited above, where the child will constantly be trying to prove to himself and others, that he is in fact, not a failure. He will be constantly battling between belonging and esteem, and will find it tremendously difficult to self-actualize.

Thus, the importance of self-actualization at a young age is evident. This is not to say that children should self-actualize at a young age — it is very difficult for anyone to self-actualize, particularly because of the tremendous amount of energy required. However, if a child is offered the proper environment in which they may achieve esteem and belonging, they will be well primed to successfully fulfill their self-actualization need.


Baumrind, D. (1966). Effects of Authoritative Parental Control on Child Behavior Child Development, 37 (4) DOI: 10.2307/1126611

Boeree, C. (2006). Abraham Maslow. Accessed online 2015-10-15.

Maslow, A. (1943). A theory of human motivation. Psychological Review, 50 (4), 370-396 DOI: 10.1037/h0054346

Maslow, A. H. (1954). Motivation and personality. New York: Harper and Row.

Rogers, C. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable.

This guest article originally appeared on the award-winning health and science blog and brain-themed community, BrainBlogger: Child Development – Fostering Self-Actualization at a Young Age.

Gabe Howard <![CDATA[“Day-to-Day” Bipolar Disorder Before Diagnosis]]> 2016-06-30T03:20:46Z 2016-06-28T14:25:27Z  Living with Bipolar disorder before diagnosisThe internet is filled with articles about living with bipolar disorder. There are scientific articles written by medical professionals, but the most common examples are the “lived experience” articles, written by people living with the disorder — people like me.

The lived experience articles typically cover two viewpoints:

  1. After diagnosis, but before recovery. These are written by people who are aware they have bipolar disorder, but haven’t yet received the right combination of medication, coping skills, and experience to properly manage the disorder. In other words, they spend more time worrying about the disorder than they do on other pursuits.
  2. Life in recovery with bipolar disorder. These are written by people who are doing well managing the symptoms and essentially living a “normal” life. In other words, they spend more time living their lives than they do worrying about bipolar disorder.

But what about the experiences of people who are unknowingly living with bipolar disorder? There are some articles about this, but generally they focus on the extreme outcomes and/or crisis points. There is a lot writing about what it feels like to be suicidal or what mania feels like. These are all very important viewpoints, but they don’t answer the question of what it’s like to live day-to-day with bipolar disorder without knowing it.

I Was Unaware I Had Bipolar Disorder

Given society’s lack of knowledge surrounding mental illness, it isn’t a surprise that I didn’t know something was wrong. I suspected, a little, that I might have depression, but I assumed the treatment for that was to “man up” and get over it.

The idea that I could have a severe mental illness like bipolar disorder didn’t even cross my mind. People with mental illness were violent and spit on strangers. They rocked back and forth, screaming nonsense. I knew what crazy looked like. I had a television after all.

Realistically, there were days I acted almost as I described above. While I never laid my hands on another person, I was certainly angry. I yelled at people, especially those closest to me. I kicked and punched doors and walls, and I did so with a loss of control that still haunts me.

In my opinion, one of the cruelest things about bipolar disorder is that it exists on a spectrum. Some days I’d be “normal,” without a care in the world. I was intelligent, charismatic, and engaging. I had a great job, was married, and — from the outside looking in — was a regular guy.

Other days, though, I was wild. The highs of mania were intoxicating and I followed every rabbit I could down every rabbit hole. I was the real life Mad Hatter chasing Alice – who was always one step ahead. There was no limit to what I could accomplish during those episodes, and mania feels good, at least for the moment.

Other days, I wasn’t so lucky. Suicidal depression would grip my entire body. These episodes would take over every area of my life. I couldn’t move, couldn’t think, and just wanted to go to sleep and never, ever wake up. The numbness was horrific.

Most days, though, I was somewhere in between — not quite manic and not quite depressed, swinging back and forth like a pendulum. And, to complicate matters further, I had different friends for different moods. I never called my family when I was depressed or manic. I only called them when I was in the middle.

My family always thought I was moody, sure, but they never saw the extremes and therefore saw no reason for special worry. Besides, I had a job and a house. Mentally ill people don’t have jobs and houses. Crazy people can’t work. So life moved forward, each episode of depression or mania drawing me closer and closer to the edge.

And no one, not even me, was aware anything at all was wrong.

Talking About Bipolar Disorder Is a Good Thing

The reality is that I should have known something was wrong. To what extent I should have been aware is still something I struggle with. It’s frightening to me that I thought what I was going through was normal. If my circumstances had turned out even slightly differently, I could be homeless, dead, or still suffering the whiplash effects of a cruel disorder.

We must talk about bipolar disorder in its entirety. Yes, mania is interesting and depression has been romanticized into some twisted parody of what it is actually is, but in between, there are numerous symptoms we seldom hear about.

The problem with only teaching people about the extremes of illnesses such as bipolar disorder is that it is much harder to recover after a crisis. And there are some things a person can never recover from. The suicide rate for a person living with bipolar disorder is 15% — and that number is far too high.

Brandi-Ann Uyemura, M.A. <![CDATA[Best of Our Blogs: June 28, 2016]]> 2016-06-28T00:12:01Z 2016-06-28T10:30:19Z DiscomfortWe can start to fear discomfort. Trips, jobs and relationships can all be potential disappointments. Even superficial disappointments can remind us of deeper childhood pain or future goals we have yet to attain. Over time, comfort feels like safety, but prevents us from experiencing new things, which can later stunt our happiness and self-growth.

While the key isn’t to jump in the deep end right away, it helps to flirt with the idea of discomfort. Maybe it’s staying open when meeting new people. Maybe it’s experimenting with a new restaurant and being okay if it turns out to not be your favorite place.

As we get older, it’s tempting to want to control everything to avoid discomfort. But I think our purpose isn’t to build walls so we don’t feel. Instead what if challenges were created to help us grow?

Do you need help with disappointment? Dig into our posts this week. It may finally reveal where your inability to handle discomfort comes from.

You Don’t Outgrow the Effects of an Alcoholic Parent
(Happily Imperfect) – You left your painful past in childhood or so you thought. These nine struggles might still haunt you if you were raised by an alcoholic parent.

How to Spot a Child Molester
(The Recovery Expert) – Want to keep your kids safe? Look for these signs to tell if a person is a potential threat to your children.

How to Sort Your Thoughts From Your Feelings: And Why it Matters
(Childhood Emotional Neglect) – The greatest conflict you’re having isn’t with a friend or relative. It’s with yourself. If what you think (e.g. That guy is a jerk!) and how you feel (e.g. I feel attracted to him), keep running against each other, this will help.

Is Your View Skewed? (The Impact Of Abuse)
(One Day You Will Roar) – When you’ve been abused, your whole world turns upside down. Here’s how to shift your perspective so it’s not permanently tainted by that world view.

Sharing Our Shame
(Weightless) – If you feel alone in your shame, this post will heal you. Find out why the key to eliminating the darkness is through the light of sharing.

Psych Central Staff http:// <![CDATA[Why Using the Dreaded ‘D’ Word Could Sabotage Your Marriage]]> 2016-06-27T14:39:02Z 2016-06-27T22:55:08Z Divorce Concept

It’s a cheap shot!

Arguments or disagreements are a natural part of marriage. As much as we love our partner, we become annoyed or upset with one another probably more often than we would like to admit.

We may choose to ‘blow off steam’ toward our spouse exactly because our spouse is the one person who will love us ‘no matter what.’ However, it is never, ever appropriate to use the D-word when arguing with your spouse. And by D-word, I mean: the word ‘divorce.’

Do NOT Marry Someone Until You Can Honestly Answer These 20 Qs

Once a certain word is out of our mouths, we cannot take it back. And, using the highly-charged word ‘divorce’ can have a detrimental effect on your marriage, possibly causing irreparable harm. Let’s look at why that one word is so damaging to use during a heated argument:

1. It’s Manipulative.

Possibly you throw the word ‘divorce’ around in your arguments to get your spouse to just “shut-up!”

You toss that word out, hoping the argument will come to an end and you will get your way (and avoid further argument). This is pure manipulation on your part and may get you what you want in the moment, but the issue still exists and will come up again.

2. It Causes Stress and Anxiety.

The D-word feels like an ultimatum to your spouse. Let’s face it, no one likes ultimatums. They make you feel backed into a corner by the person who is supposed to love you more than anyone else in the world.

When you throw out the D-word, your spouse may figure he better give in or risk losing your love, and possibly the relationship itself. This causes your spouse stress and anxiety when it comes to the security and permanence of your marriage relationship.

20 Things You MUST Accept For Your Relationship To Succeed

3. It Makes Your Partner Actually Consider Divorce.

When your spouse hears the word ‘divorce’ used in your arguments, she may hear it as a threat. No matter how long you’ve been married, you should not speak about divorce unless that is exactly what you intend to do. Don’t use the word in the heat of an argument as a threat to secure a ‘win’ for yourself by getting your spouse to back down!

Threatening divorce is never the way to resolve issues in your relationship. If you use the word every time you argue with your spouse, your spouse may get to the point where she figures why not just “do it.” “Let’s just end the agony and get divorced.”

That may not have been your intent, but now it has become a reality that you didn’t think would actually happen.

4. It’s Just a Total Jerk Move.

Threatening divorce every time you fight is just mean and a textbook ‘jerk’ move. Maybe you use the word because you really want to plant the seeds of doubt and despair in your spouse’s head. Possibly you really do want a divorce, but want him to decide.

So, you go about trying to create a situation where he is so unhappy that he’ll cave and make it happen. Then he looks like the ‘bad guy’ by everyone and you’re the poor victim.

It is so important to understand that a marriage based on idle threats, manipulation, and intimidation can never be healthy and happy. As a couple, you must work together and learn how to deal with difficult issues in your relationship, even when doing so feels uncomfortable in the moment.

Stop using the D-word in your arguments and start working on your issues.

Sometimes even simple things can become huge issues when you avoid discussing them, when conversations become heated, or if you threaten to end the relationship if you don’t get your way. As long as the two of you are together in a relationship, there will be times when you don’t see eye to eye. Arguments will happen, but that does not mean you’ll get divorced.

Learn how to fight fairly and resolve conflict. If you need help, seek out a good counselor who can offer guidance and direction for a better and happier marriage.

This guest article originally appeared on If You Use THIS Word During A Fight, You’ll Damage Your Relationship.

Linda Sapadin, Ph.D <![CDATA[The Need to Struggle]]> 2016-06-27T14:38:49Z 2016-06-27T18:15:30Z Man pushing a giant, heavy stone, rock over the mountain. ConcepAre you tired of struggling? Do you want to reach your goals without having to work so hard? Do you yearn for the glamour without the grit? Achieve! Accomplish! Actualize yourself! Yes, you want to do all those things. But why does it have to be so hard?

It used to be fun. You were excited about stuff. As a kid, you wanted to do everything. You picked out a few notes on the piano, played a tune and poof, you were a pianist. You displayed a coin; let the coin drop into your pocket, disappearing from view and poof, you were a magician. You were enjoying yourself. You were having fun. You were not constrained by pesky problems such as rules and realities.

Now the years have passed. You’re an aspiring adult; wrinkle-free or weighted with wrinkles, it matters not. There’s much you need to learn, if you want to be a comeback kid. Your old enthusiasm needs to meet new requirements, restrictions and reprimands. Rather than letting these ridiculous realities whisk the energy right out of you, you must summon up the courage to continue ahead.

Continue ahead without flitting from one idea to the next. Continue ahead without diving into distractions of fresh sights and sounds. Continue ahead even if you’re not in the mood to do so. Continue ahead even when the only thing you feel inspired to do is watch another episode of your favorite reality show.

When seeking success, in whatever endeavor you choose, you must rely on:

  • Discipline, not feelings.
    Feelings are fickle and fleeting. You want to do something, then all of a sudden you don’t. You’re too tired. You’re uninspired. You’re discouraged. Tell those feelings to hush. Not now. You’ve got work to do. You are becoming a self-motivated person. You do what you need to do, even if you’re not in the mood to do it.
  • Discipline, not inspiration.
    Inspiration is great. Make use of it when it’s there. The work will be easier. But when it’s not there, don’t quit. Don’t keep questioning why. Instead, introduce “why” to “why not.” Then, get back to work. When you do, your inspiration will return. Rejoice. The work will now be so much easier.
  • Discipline, not perfection.
    Perfection may be the one thing that you think you want; yet, it will be the one thing that will kill your energy and enthusiasm. “It’s not perfect” quickly morphs into “it’s not good enough” and then “it’s not good at all; why even keep going?” You’ve worked so hard and now what do you have? A mountain of self-doubt and uncertainty.

How can you go on? And yet you must. But first, you must tell that need for perfection to get out of your way. It’s sabotaging your efforts. Yes, you can patch up your problems. Yes, you can tune up your thoughts. And yes, you can move on and accomplish what you want to accomplish, without it being perfect.

There’s no getting around it. To get to where you want to be, you need to struggle. So, whether you’re learning a new skill, returning to the job market, wanting to write your memoir, or looking to run for President, I hope you reach your goal.

It will be easy to continue your efforts on the good days when you feel inspired. It will be tough on the bad days when you feel discouraged. It will take Herculean effort on the horrible days when the worst has happened. But stay with it. Stay with it. Stay with it. Then one day, in the not too distant future, you will rejoice in your achievement.

Michal Bednarek/Bigstock


John M. Grohol, Psy.D. <![CDATA[Massachusetts: Third-World Mental Health Care?]]> 2016-06-27T15:39:55Z 2016-06-27T14:39:16Z There are few states that have a more broken mental health care system than Massachusetts. You’d probably think of poorer, more rural states when you think of low-quality healthcare. After all, Massachusetts is home to some of the nation’s best universities (Harvard, MIT) and renowned […]]]>

There are few states that have a more broken mental health care system than Massachusetts. You’d probably think of poorer, more rural states when you think of low-quality healthcare. After all, Massachusetts is home to some of the nation’s best universities (Harvard, MIT) and renowned hospital systems (Mass. General [Partners], Brigham & Women’s, Beth Israel).

Yet none of these local institutions, nor the state itself, appear to have given much thought to the mental health care of their most vulnerable citizens. Instead, I live in a state that appears to offer the equivalent of third-world care for those with chronic mental illness.

The Boston Globe’s Spotlight team published an in-depth piece on Sunday about the patchwork quilt of services that substitute for an actual system of care in Massachusetts. If you are seriously mentally ill in this state, chances are you’re just as likely to end up in prison, become homeless, or worse. And your chances of accessing any kind of regular, long-term, evidence-based treatment are minimal.

Sadly, the pessimistic, one-note (negative) article couches its entire argument in the threat of violence — something that only a tiny percentage of people with mental illness pose to others. In taking this perspective, the Spotlight Team of journalists does a great disservice to all of those with mental illness by posing the problem as primarily a public safety issue, rather than what it really is — a crisis due to a lack of services.

Fifty years ago, Lee Chiero might have been treated — and locked away — in one of the public psychiatric hospitals that once dotted Massachusetts.

Today, nearly all of those institutions have been bulldozed or boarded up — and many had to be, having evolved into inhumane asylums for people who are, in the great majority, no threat to anyone. But the hospitals were not replaced with anything resembling a coherent care system, leaving thousands of people with serious mental illness to navigate a fragmented network of community services that puts an extraordinary burden on them to find help and to make sure they continue getting it.

Even those beset by the most ferocious inner demons, such as Lee Chiero, are routinely pinwheeled from hospital to hospital, therapist to therapist, court to court, jail to jail, then sent off into the world with little more than a vial of antipsychotic medications and a reminder to take them. Chiero was hospitalized at least 10 times in a half-dozen hospitals over two decades before he killed his mother.

And that’s the real problem — there are little to no services for people who have chronic mental illness in Massachusetts. There is nothing approaching a comprehensive care system. This in one of the richest, most-educated states in America.

Who’s to Blame?

While we can blame “the state,” it’s actually the people of Massachusetts who are to blame. We elect our legislators, and they seem unable to take up and address the problem in any meaningful way. We don’t hold them to change this problem, because these people who are suffering aren’t us.

Until they are. One day we wake up and find our adult son or daughter needs help, needs to access the mental health care system in the state. That’s when we discover there’s really no such thing — the kind of care he or she will receive is less than they’d receive in many third-world countries.

Where would your adult son or daughter go? I don’t know the answer either, because as the article makes clear, it’s unlikely there’s any actual place for them to go.

How Can We Fix the Problem?

The state needs to reallocate the resources it has taken away from people with mental illness with the closing of nearly all of its state hospitals, and put them into new facilities (or tax credits and grants, to encourage new privately-run psychiatric hospitals to open) like the modern, successful Worcester Recovery Center and Hospital. One hospital for the entire state is clearly not enough.1

Articles like this one by the Spotlight Team illustrate that despite the advances we’ve made in being able to talk about mental health issues in America, we still have a long way to go in treating them on equal footing with physical health.


Read the full article: Spotlight: The mental health care system in Massachusetts is broken


  1. I was a little saddened to see the approach this article took to discussing the complexities of accessing mental health care in the state, with only a passing mention of the crown jewel of the state’s system, the Worcester Recovery Center and Hospital. I’m not sure why the journalists took such a slanted, one-sided perspective.
Margarita Tartakovsky, M.S. <![CDATA[3 Pointers for Prioritizing Your Self-Care]]> 2016-06-28T16:05:07Z 2016-06-27T10:45:55Z pointers for prioritizing self-careToday, self-care has become a buzzword. And when something becomes “trendy” or seems to show up everywhere, we tend to write it off. It becomes a kind of background noise. Maybe you think self-care is a hollow synonym for pampering yourself — and that doesn’t ring true for you. Maybe you think self-care is an indulgence. Something for people with plenty of time. And money. A luxury that doesn’t fit into your life.

While self-care can include pampering yourself, it’s so much bigger. It’s so much more meaningful and important. “Self-care is essential to our survival,” said Jessica Michaelson, Psy.D, a clinical psychologist and certified coach for adults and couples who want to find more joy and meaning in their busy lives.

She defined self-care as: “the practice of taking care of one’s own physical and emotional needs, with the goals of remaining healthy and resilient.” Consider a newborn who cries when they’re hungry. That is an example of self-care, Michaelson said. “That is sensing your inner state, and taking action to get your needs met.” Because when we ignore our needs, over time, we become sick, unhappy and overwhelmed, she said.

Many of us don’t know how to practice self-care. Many of us weren’t taught to pay attention to our inner states — or to trust them. “Instead, we are taught what we’re ‘supposed’ to think and feel, and try to ignore feelings that we think we ‘shouldn’t’ feel.”

Maybe you’re anxious about a certain situation. But you’re ashamed about your nervous feelings, so you pretend they don’t exist. Maybe you’re really upset about something. But you think you should be happy, so you stuff down your sadness. Maybe you really need 9 hours of sleep. But you believe you should be able to function just fine on 6 hours—so that’s what you try to do. Maybe your entire body is saying no to a commitment. But you don’t want to seem rude or impolite, so you say yes.

We also neglect taking care of ourselves because our culture values and glorifies self-sacrifice. According to Michaelson, we promote the employee who works 80-plus hours a week; we idolize the mom who never seems to need a break. “This belief that self-sacrifice is best creates a great deal of shame when we feel like we need something different. And we can label ourselves ‘lazy,’ ‘selfish’ or ‘weak.’” And because we don’t want to be lazy, selfish or weak, we ignore our body’s messages, which can easily turn into desperate pleas for our attention (possibly leading to burnout).

Even though you might be unfamiliar or uncomfortable with practicing self-care, you can learn. Below, Michaelson suggested three valuable strategies for prioritizing self-care in your life.

Rethink self-care.

The first step to prioritizing self-care is to revise your views on it—to realize how powerful and vital it is. Taking care of ourselves is a “basic human need, it’s not weakness,” Michaelson said.

It’s also not selfish. To the contrary, self-care makes us more available and open to others, she said. We have more to give when we’re not exhausted, sleep-deprived or overwhelmed. Plus, “self-care is an ongoing, daily practice, not an every-once-in-a-while splurge.” 

Learn to pay attention to your needs.  

This is a skill you can sharpen. Because, again, many of us weren’t taught to identify, acknowledge and respect our needs. Rather, unfortunately, we’re often taught to dismiss or judge them.

Michaelson suggested setting a timer to go off every hour to check in on how you’re feeling physically and emotionally. “Are you hungry? Are you stressed? What does hunger and stress feel like in your body? How are they different?”

Take small action.

Michaelson noted that self-care is taking small actions that serve our well-being. For instance, if you’re hungry, eat. If you’re tired, take a break. If you’re upset, talk to someone you trust. If you’re struggling with anxiety, see a therapist.

Self-care also is individual. It is “based on the specifics of what works for you to be well in your body and mind.” How do you know what that is? You experiment, she said.

Again, self-care isn’t some empty, meaningless term. It isn’t defined as spoiling yourself. “Self-care means paying attention to yourself, understanding how you work and taking action that serves your personal needs,” Michaelson said. It “means not living only to please others or fit into assumptions about what you’re supposed to think, feel and do.” Self-care is vital for each of us, and it is something we can learn to do.


Psych Central Staff http:// <![CDATA[Having Trouble Making Friends? Stop Obsessing Over Yourself]]> 2016-06-28T03:13:06Z 2016-06-26T21:45:38Z Three Female Friends Enjoying Breakfast At Home Together

It’s actually pretty simple. “If you want to be interesting, you have to be interested.” These are the famous words of my husband’s grandmother. She took conversation making seriously, and understood the golden rule of friendships — put into people what you want back.

When it comes to making friends, we all pretty much understand the same principle applies: to have a friend, we know we have to be a friend. But sometimes this isn’t so straightforward, and is harder than it seems.

Dear Grown Women: Let’s Stop Being So MEAN To Each Other

It’s not that you aren’t trying — focusing on your efforts can undermine your relationship-building. People pick up on your negativity and your self-focus…and it’s a turn off.

Healthy people are ultimately drawn to happiness, and people that are kind. If you don’t seem happy or able to give and take, you’re not attracting the best people around you.

Here are three ways thinking of others — instead of yourself — can help you turn the corner in developing more MEANINGFUL connections:

1. You Can Actually Trick Yourself Into Actively Seeking New Friends

For starters, it’s not like it used to be. Making friends is about putting in the effort, and at times it can feel a bit like networking — not something most people like to do, even if it’s something we all have to do if we want to cultivate resilient social networks.

New research from Harvard Business School suggests that taking the focus off of yourself entirely, and instead focusing on how you can help others or a valued cause can facilitate your willingness to participate.

2. You Can Deepen (or Renew) Your Connection With the Friends You Already Have

While this should go without saying, being kind to others is universally well received by them. Not only do people appreciate being shown attention and understanding, but these efforts make an impact, distinguishing you from others who may not show friendship.

Instead of tracking what you are getting out of a friendship, try instead to track what is going on with the people in your life and how they are doing. Try putting yourself in their shoes and reach out to them.

To have a friend, after all, is to be a friend.

3. You Can Benefit From Better Mental and Physical Health

Science shows that kindness is not only a great way to cultivate relationships, but is good for your physical and mental health. Compassion and kindness have been linked to better physical health and longevity.

Thinking about others is also good for our mental health, because when we are happier when we are kind, and we are kinder when we are happier.

25 Things Ambitious, Get-What-They-Want Women Do WAY Differently

Adopting a compassionate and caring mindset can have positive ripple effects on the people around you, the quality of your relationships, and most importantly, your physical and emotional health.

Thinking about others is not just a strategy for winning friends; it’s a strategy for nurturing the relationships we care about, as well as ourselves. Be more kind to the people around you and you might be surprised how full your social life will become.

This guest article originally appeared on If You Want To Make Friends, Stop Being SO Obsessed With YOURSELF.

Marcia Naomi Berger, MSW, LCSW <![CDATA[Falling in Love with Your Spouse — Again!]]> 2016-06-28T03:17:28Z 2016-06-26T15:45:11Z Middle-aged couple relaxing in sofa at home

A successful marriage means falling in love many times, always with the same person. — Mignon McLaughlin

Do you view marriage as a destination or a journey? If you view it as a journey, you’re infinitely more likely to succeed.

Those who view marriage as a destination are likely to become disillusioned. When the glow fades, they’ll wonder: “How could I have married this person who is so annoyingly different from me?!!!”

Actually that thought can easily surface in any marriage. Does this surprise you?

I remember meeting a widower, maybe about eighty, back when I was single and naïve enough to think a relationship had to be perfectly fine all the time or wasn’t worth keeping. This man had had a long and very happy marriage. I’d sensed that from his radiant expression as he described his feelings for his late wife: “Sometimes I thought she was the most awful person in the world,” he’d said. “Other times I thought she was the most wonderful one; I felt so fortunate to be with her.”

Spouses Can be Annoying

Sometime after I did marry, I liked hearing Rabbi Joseph Richards’ advice about how to choose a lifetime partner. He said, “People are annoying, so find the person who annoys you least and marry that one!

If you view marriage as a journey, you’ll understand that all marriages experience ups and downs. Our job is to learn, over and over, how to deal productively with relationship challenges as they arise, to approach them in ways that foster our growth as individuals and as a couple.

Marriage as Ultimate Growth Experiences

Viewing marriage as a journey means knowing it takes a daily investment of energy to keep the relationship emotionally and spiritually fulfilling. This is actually fairly easy to do, once we make it a habit by developing routines to keep reconnecting with our partner (1). When you do this, the glow will keep returning and you’ll find it hard to imagine life without your mate.

Approached this way, and with an ongoing quest for self-understanding, marriage is the ultimate growth experience. Learning to accept and appreciate differences, to communicate positively and constructively, to be responsible for behaving in ways do or do not bring out the best in ourselves and our partner — all these practices are part of the big marriage-as-a-journey picture.

Thriving in Ever Changing Reality

By behaving in these ways, we increase our ability to empathize with and support each other. We develop more sensitivity to our partner’s wants and needs, as well as our own. We are able to become “other-centered” without losing ourselves.

Certainly, it takes a degree of maturity to stay happily married. To succeed, we need to commit, not to the static moment of marrying as a destination, but to an ever changing reality, as life and our relationship evolve. The two of us as a couple become the constant that helps keep us balanced, or keeps us returning to a balanced state, again and again, as we experience the bumps, twists, and turns of our relationship and of life in all its aspects.

Choosing a partner wisely is the first step toward creating a fulfilling, lasting marriage. By treating marriage as a journey, we allow the glow to keep returning. We fall in love with our partner — again, and again, and again.     


(1) Marriage Meetings for Lasting Love: 30 Minutes a Week to the Relationship You’ve Always Wanted tells, step by step, how partners can hold a weekly gentle conversation that keeps them reconnecting frequently. Marriage meetings foster more romance, intimacy, teamwork; and smoother resolution of issues.

Neil Petersen <![CDATA[Video: Be Passionate, Not Just Content]]> 2016-06-14T17:25:20Z 2016-06-26T10:45:26Z Man Hand Writing Passion With Black Marker On Visual ScreenLet’s say for a minute that instead of a therapist you have a genie that will grant you three mental health wishes. Whatever’s getting in your way, bothering you, holding you back, poof, it’s gone, solved by the mental health genie.

OK. So now what? There’s nothing to make you unhappy anymore. Does that mean you’re happy?

At the very least, it probably means you’re content. Things are basically going well for you. Nothing to complain about.

After a while though, you might start to get a little restless. Bored even. You wonder: is this it?

Happiness isn’t just a lack of unhappiness. Even when things go our way, when we find ourselves in situations we basically feel good about, we aren’t really wired to stop there and settle for being content.

Instead, we look ahead to what’s next. When we get what we want, we set our sights a little higher. We make new goals and keep reaching.

That’s why we can’t simply become content and then stay content. We have to go further by looking for real meaning and for things we’re passionate about.

One way to do this is to make a point of trying new things and see what sticks. Volunteer. Work for a political campaign (just, for the love of all things good, please not Donald Trump’s political campaign). Look for something you can do that will make a difference for other people and will challenge you.

The idea is that when things go well and you find yourself actually feeling content, you should savor the good times, but you also shouldn’t be content with being content.

Why? Because contentment isn’t an emotion that’s built to last, and it can turn into boredom before you even realize what’s happening. Passion, on the other hand, and real meaning, are much more robust.

In this Ask the Therapist video, Marie Hartwell-Walker and Daniel J. Tomasulo address a letter asking about what to do when you really don’t have any problems at all. They talk about how to make the most of the times when things are going your way, and how to go beyond being content to being passionate.

Watch the video below, and visit the Psych Central YouTube channel for more Ask the Therapist videos.