Being assertive is starkly different from being passive or aggressive. Paterson has a helpful analogy that distinguishes the differences. He explained:

In the passive style, all the world is allowed on stage but for you — your role is to be the audience and supporter for everyone else. In the aggressive style, you’re allowed on stage but you spend most of your time shoving the others off, like in a lifelong sumo match. With the assertive style, everyone is welcome onstage. You are entitled to be a full person, including your uniqueness, and so are others.

“Assertiveness involves advocating for yourself in a way that is positive and proactive,” said Joyce Marter, LCPC, psychotherapist and owner of Urban Balance, LLC. It also means being clear, direct and honest, she said.

For instance, if you’re upset with your boss over your performance review, you’re able to express your opinion in a diplomatic and professional way, she said. Again, this is very different from the other styles. If you’re passive, you might swallow your feelings and become resentful, which can chip away at your self-esteem and boost stress and anxiety, she said. If you’re aggressive, you might curse out your boss and quit. If you’re passive-aggressive, you might call in sick and give your boss the silent treatment, she said.

Why Some People Aren’t Assertive

Why are some people assertive while others aren’t? Many factors may contribute. Stress is one. “The fight-or-flight response is an evolutionary adaptation that pulls us toward aggression or avoidance, and away from calm, relaxed assertiveness,” Paterson said.

A person’s belief system also plays a role. According to Paterson, these assertive-sabotaging stances include: “Being nice means going along with others” or “It doesn’t matter if I’m assertive, no one will pay attention anyway” or “He’ll leave me!” That’s why it’s so important to become aware of these beliefs. “[This way you] can examine them clearly and rationally and decide what to do,” he said.

People with low self-esteem may feel inadequate and have a hard time finding their voice, Marter said. Others might fear conflict, losing a relationship, criticism or rejection, she said.

If you’re a woman, you might’ve been raised to set aside your needs and opinions and support and agree with others, Paterson said. If you’re a man, you might’ve been raised to react aggressively with a “my way or the highway” view, he said. Or just the opposite, you might want to be completely different. “[These individuals may be] fearful of provoking aggression when they are present in relationships, or of being ‘a jerk like my father was.’”

How to Be Assertive

Assertiveness is a skill that takes practice. It may always be easier for you to swallow your feelings, scream at someone or give them the silent treatment. But assertiveness is a better strategy. It works because it respects you and others.

“Triggered: A Memoir of Obsessive-Compulsive Disorder” is for anyone who is or knows someone who is suffering from mental illness of any type.  While Wortmann wrestles with OCD, he is more than sympathetic regarding all types of mental illness. In addition to making us understand the problems and loss of so much of his life due to his problems, it’s important to him that mental health professionals try to understand things that they may not have personally experienced. If they can’t feel what the patient feels, it is important that they are careful when trying to help and not make light of things. (His well-meaning social worker decided to call his deepest depression “crumping” because she felt it would be easier for him to call it this when he had too much trouble asking for help.  This did not end well.)

Even as a boy, Wortmann tended to use irony in order to survive his disorder.  While it may seem better than complaining and constantly feeling unhappy with the help provided, to the reader it is obvious that this is exactly what kept Wortmann from really asking for help when needed most. 

His fixations — whether they be the perfection seemingly demanded by Jesus in his religion; his obsession with perfection in school and at home; or his very normal embarrassment by a parent picking him up from school — are not unfamiliar to the average person. But the OCD causes Wortmann to have an extreme, painful and almost fatal reaction to such things. 

It is difficult to judge this book because it is well-written by a man who could be writing fiction and making you laugh or cry depending on the moment.  He admits to trying to kill himself more than once. He can’t be sure that he won’t do so at some point in his life, because no matter how much help he gets, no one can take away what he’s been given — which seems to be an overabundance of guilt and worry. Think of the adolescent fear of dating. Then imagine the impossibility of setting this fear aside long enough to understand that a “no” isn’t the end of the world and asking is the only way to get a “yes.”  This is just a small portion of his life.

I think this book will bring many people to a new understanding of OCD because it is filled with interesting anecdotes and compelling sadness along with hopeful events.

To write anything negative about this book would be difficult since I have suffered my own type of mental illness.  I have suffered physical pain, as have most people at one time or another, but mental pain far surpasses this. Wortmann’s pain hurts me as he says “Does it sound embarrassing, trite, if I claim that I feel a kinship between us?”  This, I am sure, means everyone with mental pain.  It feels as though Wortmann “feels” too much, which is probably due to a lifetime of pain that is difficult to pinpoint and difficult for others to comprehend. It doesn’t sound embarrassing or trite to me, because feeling the pain I felt — and knowing there are people like Wortmann who will live with this pain forever and have never known real peace — is painful to me.

Triggered: A Memoir of Obsessive-Compulsive Disorder
By Fletcher Wortmann
Thomas Dunne Books: March 27, 2012
Hardcover, 272 pages
$24.99

At one point during the chat, I connected with a distraught young woman who had been seeing a therapist for quite some time, but her OCD was getting worse, not better. “Is the ERP therapy too difficult for you to do?” I asked her. “ERP therapy?” she responded. “What’s that?”

I was stunned, though in retrospect I’m not sure why. Our family had floundered and then fought our way through a disorienting maze of treatments and programs, desperately trying to find the best help possible for Dan. But I had thought Dan was the only one who had been steered in the wrong direction, sent to the wrong therapists, and put on the wrong medications. It was then and there that I became an advocate for OCD awareness.

Exposure Response Prevention Therapy (ERP therapy) is a type of cognitive-behavioral therapy (CBT) and, in my son’s case, a very effective treatment for OCD. In a nutshell, this therapy involves the person with OCD facing his or her fears and then refraining from ritualizing. This is extremely anxiety-provoking initially, but eventually the anxiety starts to wane and can sometimes even disappear. A concrete example of ERP therapy in action would involve someone with OCD who has issues with germs. They might be asked to touch a toilet seat and then refrain from washing their hands. Treating OCD with ERP therapy has even been the topic of some reality shows over the past few years. So why do so many therapists remain in the dark?

When Dan diagnosed himself (with the help of the Internet) at the age of 17, he was referred to a well-respected clinical psychologist in our area. This therapist employed traditional talk therapy, which included examining underlying issues. This form of therapy is usually ineffective in treating OCD. In fact, talk therapy often exacerbates OCD. Repeatedly talking about their fears and reassuring OCD sufferers only adds fuel to the fire. OCD is not something rational that can be discussed. It is a neurologically-based anxiety disorder. In fact, a study done in 2007 showed that OCD sufferers had less gray matter in the areas of the brain associated with suppressing responses. Telling someone with OCD not to worry is like telling someone with asthma to stop having trouble breathing. It isn’t possible.

And so Dan spent months in therapy, getting worse. He ended up spending nine weeks at a world-renowned residential program for OCD, and that was his, and our, first introduction to ERP therapy.

You don’t have to go to a residential program to get the right help for OCD, but you do need to find a properly trained therapist who specializes in the disorder. What works for one OCD sufferer may not always work for another. You and your therapist will work together to find the right balance of therapy, medications, and stress management techniques that will give you the best chance of success. The best resource out there for finding these competent therapists is the International OCD Foundation. Not only do they list health care providers by state, they give you tips on what questions to ask when interviewing a prospective therapist.

ERP therapy is difficult, but with hard work the OCD sufferer can improve dramatically. Three years ago Dan was so debilitated by severe OCD that he could not even eat. ERP therapy literally saved his life and today he is a rising senior in college with a wonderful life ahead of him. ERP therapy often is very effective for those with OCD. Having OCD is tough — getting the right help shouldn’t be.

The mom and I started to chat about the symptoms the sick girls were exhibiting. But the mother was either distracted by the clicking or felt the girls were being rude, and she soon made the two sick teens turn their phones off.

The pair grudgingly obeyed, sticking the devices in their purses, but not before whining, “Why doesn’t she have to stop?” “Because she’s not the one with the doctor’s visit,” Mom replied. “But she’s the one who’s texting us!” the girls protested in unison.

I was speechless. Here were three sisters in a room together communicating with their thumbs. That encounter really hammered home to me just how plugged in we have all become. We are suffused daily in a multitude of digital communication options.

According to a recent Pew research study, one in three teens sends or receives over 100 text messages a day. It’s not that texting is inherently bad. Like many other forms of communication, it has the potential to keep us connected. But Sherry Turkle, MIT professor and author of Alone Together: Why We Expect More From Technology and Less From Each Other suggests that while constant texting may give the appearance of increased connectedness, these technologies may actually be keeping us isolated from each other. She argues that “Facebooking” is not socializing. “Thumbs up or thumbs down on a web site is not a conversation.”

Texting can also be dangerous. Texting while driving can be so deadly that it is banned in many states. When I’m at the gym, I cringe watching folks text while walking down stairs or running on treadmills. They look like accidents waiting to happen, like that poor woman whose YouTube video went viral when she fell into a fountain texting while she walked at a mall.

Children should be taught to turn off their cell phone when engaged in any activity that requires their full attention: school, homework, babysitting. Children also need to understand that some forms of texting—like sexting (sending nude or inappropriate photos in a text message) or cyber-bullying (sending mean, taunting or embarrassing text messages)—can have disciplinary consequences at school and even legal ramifications.

Another new issue being raised about texting is its effect on teens’ sleep. We are learning more and more about teens who bring their cell phones into their bedrooms and text long into the night.

Technology is developing at a rate that may be faster than our ability to monitor it and ensure its safe use. Parents should have frank conversations with their children about the dangers of texting and driving and the negative emotional and sometimes legal consequences of sexting and cyberbullying. Parents should review their children’s text logs to see who is texting them, when and how often. Limits can be placed on the number of texts sent and received as well as the hours texting is allowed. And parents can certainly confiscate phones after a reasonable hour, if necessary.

We need to be good role models for our children as well. While many parents take their kids’ cell phones away from them during our office visits so we can have face-to-face conversations, I have just as many parents who themselves text during our visits. We have to be careful what kind of example we set. My heart breaks whenever I see a mom or dad texting in the bleachers of their kid’s big game instead of watching their child play. If we are disengaged from our children, can it be long before they’ll disengage from us?

Kids texting photo available from Shutterstock

With no time clock to punch and no boss monitoring your comings and goings, starting the day can be difficult, according to Deborah Serani, PsyD, a clinical psychologist and author of Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing. Or, just the opposite, you might work through your days and even on weekends, she said.

Working from home is tricky because it “requires a person to shift…from personal to professional mode,” Serani said. And that means a lot of self-discipline, which is regularly tested with piles of laundry and dirty dishes, she said.

Other sights and sounds also can pilfer productivity, she said. For Therese Borchard, author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes, those distractions are her two lab-chow mutts, who ferociously bark at passersby, and a barrage of phone calls.

In addition to struggling with the same concerns, individuals managing a mental illness also grapple with unique challenges. Below, Borchard and Serani, who both live with mental illness, provide productivity pointers and share what works for them.

1. Create structure. Structure helps to create boundaries around work, home and play, which boosts productivity. Serani has been a self-employed psychologist and work-at-homer for almost 20 years, so she’s developed a good rhythm that keeps her productive. “I awaken the same time every day, and give myself two hours to get as much chore work and personal work done as I can.” Any tasks that are left get done after work.

2. Set realistic goals. Be sensible about what you can accomplish in a workday and at home, Serani said. “Living with a mental illness requires us to strive for well being each and every day,” she said. So it’s key to avoid overextending or overcommitting yourself to either home or work projects.

3. Map out your day. Productivity also requires a specific plan. For instance, Borchard writes down a task she needs to accomplish and approximately how much time it’ll take. Again, keep these goals reasonable. “I would give myself two to three hours to write a blog post. Some took longer, and others were easier,” said Borchard, who also writes the widely popular blog Beyond Blue.

4. Identify what you need to work well. “The best advice I have is for readers to learn what they need to be at their best — and then try to create that structure as your own blueprint for work,” Serani said. For instance, she doesn’t mix work and play, even on her computer. “My work computer doesn’t have my personal email address or any of the fun sites, games or social networks bookmarked.” She also keeps her phone away from the office and has a mini-fridge near her workspace so she doesn’t break her concentration when needing a drink or snack.

With the help of her doctor, Serani also adjusted the time of day she takes her medication. Taking it in the morning made her tired during the workday, so she started taking it at night instead.

Borchard found that headphones and Pandora, a personalized Internet radio service, help to block out her barking dogs and other distractions. She also turns the ringer off on her office phone.

“When you live with mental illness you need to create an environment that enables you to reach your potential. Look at what is working well, pat yourself on the back and keep that momentum going,” Serani said. If something isn’t working — like Serani’s previous medication schedule — brainstorm ways you can make changes.

5. Work ahead. On the days you’re feeling well, accomplish projects ahead of schedule, so you can take time off when you need it, Borchard said. “I always tried to have a few blog posts ready to publish in case I couldn’t write for a couple of days,” she said.

6. Keep stress at bay. “Research tells us that stress overload not only intensifies symptoms of mental illness, but can trigger relapses in individuals who are symptom-free,” Serani said. Not surprisingly, this also affects your ability to work.

Keeping stress at bay means taking extra good care of yourself, Serani said. She pays particular attention to stress-inducing events, tries to minimize their impact and schedules time to decompress. “I generally take breaks out of the house — like a short walk, eating lunch on the patio or just resting in a pool of sunshine on the sofa in my office.” She also schedules dates with friends and family.

7. Make time for healthy practices. “I make sure that I eat well, sleep well and exercise often to help keep my mind, body and soul in synch,” Serani said. Borchard wakes up at 5 a.m. every day to swim and goes to bed at 9 p.m. Healthy habits aren’t just critical for well-being; they also help to prevent relapse.

8. Accept that you’ll have a bad day — or week. “Research shows that those who have the daily struggle of living with mental illness are prone to more self-criticism than non-mentally ill age peers,” Serani said.

Without even knowing it, you might be playing disparaging tapes in your head, which only make you feel worse. “’I can’t believe I can’t get out of bed and start my work day!’ is not only self-critical, it places undue shame and guilt into the mix,” she said.

Instead, according to Serani, you might say, “Some days are harder than others. And today I’m going to need some extra time to get out of bed — and get my mind into work mode.”

“It’s important to build a soft cushion of acceptance in the margins of your work life when you have a chronic illness, where you can regroup without guilt or shame if you’re having a particularly tough day, or as you’re bouncing back to a more grounded state,” she said. For Serani, that means not comparing her professional or personal life to anyone else’s, knowing what she needs when she’s having a rough day and staying positive about her illness.

Again, chronic mental illness is taxing. And while it’s frustrating when you can’t be as productive as you’d like, try to take it easy on yourself.

“When I was in the midst of my most severe depression, I couldn’t write at all. For almost a year,” Borchard said. “I try to remember that when I have a bad day where my brain feels like silly putty and I am not able to string two words together. I try to remember that courage isn’t doing a heroic thing, but getting up day after day and trying again.”

In her book, The 11 Laws of Likability: Relationship Networking . . . Because People Do Business with People They Like, she proves her method simply by the way she writes.  She is realistic about her advice, constantly explaining her thought processes and personal situations, and she understands everyday struggles.  She doesn’t pretend that she is in a constant state of perfect happiness and she doesn’t try to convince her readers that they need to be either.  She simply offers her readers a way to strengthen and maintain relationships, both personally and professionally, as she is a businesswoman and a professor of business at NYU’S Stern School of Business.

I instantly found myself connecting with her as a narrator and I was engaged by her advice and her stories.  I was worried this book wouldn’t tell me anything new, but Lederman finds a way of repurposing natural advice, like “you have to like you first.”  She breaks it down into how to realistically achieve this feeling, pointing out the places where you can easily get tripped up. In this example, she explains that when you assume that you cannot do something or do not deserve something, it helps to ask yourself “Do I want to be right about this?” She goes on to say, “if your answer is “No,” then you need to change your reality.” So, even the advice that you thought you knew becomes fresh and more tangible.

This book thrives on logical, straightforward advice and the setup follows the same format.  Lederman divides her book into eleven chapters, not including the short introduction and conclusion, and each chapter explains one of the “laws.”  Each chapter is introduced with an inspirational quote, establishing a root for where the law came from, and then she expands to include personal stories of either herself or of someone she knows and how this particular law has affected them.  Sporadically throughout the book she includes “live the law” sections that give you a quick way to self-assess and stay active in the process.  She divvies up each chapter with large section headings to guide you and finishes with a memory refreshing section to review her key points.  There is no set formula to each chapter, but they all include these features, which help you to make notable connections that you will remember in the future.

In addition to her sections being divided by “law,” Lederman divides the eleven laws into three sections.  The sections revolve around the center of relationships and connections, which she calls the conversation. The first section is “before the conversation,” which helps you look at yourself through the laws of authenticity, self-image, perception and energy.  The next section is the conversation itself, and she guides you through it with the laws of curiosity, listening, similarity and mood memory (becoming aware of the moods we carry with us and how that might affect the conversation).  Finally, her last section is a guide to what to do after the conversation, explaining this through the laws of familiarity, giving, and patience.  I found this to be the most helpful, as it focuses on how to maintain long-term relationships, with acquaintances and business associates alike, in sensible ways.

The introduction gives you a nice taste of who she seems to be as a person.  She explains the personal situation that turned her on to studying likability.  Most importantly, she admits that this book is very much the opposite of how she used to think about things, and that it is different than how many people still think about things.  By explaining the context surrounding the book, Lederman makes it easier to become immersed in it and helps you to trust her as your narrator.  Her ideas are easier to understand, absorb and practice when you know how she arrived at them.

Lederman’s personal stories are engaging. She often intertwines them along with her key points, so it is easy to get caught up in a few different stories.  It certainly helped to keep my attention and it also proved that she designed her “laws” to work in everyday experiences.  This book is the result of practice, not theory.  The stories are not simply about Lederman herself, but also about people in her life: students, coworkers, old friends, etc.  She explains both her connection to them and her ability to assess and understand them in the particular situation they are in.  She guides you through her thought process, e.g., how she tried to find the good in a coworker with whom she simply did not enjoy working. If she had just trashed him, neither would have benefited; instead; she tried to discover some of his positive attributes.  This resulted in a positive talk where they mutually decided to find him a job elsewhere in the company.  He thrived in his new spot and she felt better about herself as a supervisor. 

Lederman does not suggest her methods are an end to all your sleepless nights. Nor does it mean you’ll never frown again. But it is a realistic way to find and establish something positive in your life, rather than trying to endure the negative.

At the end, Lederman explains that this book is not meant to be linear, nor is it meant to be your only resource—it is a part of a network. She encourages you to absorb the parts of the books that you gravitate toward or to look to specific sections if you have a particular problem.  Because she makes the book so accessible and malleable, I liked it more than I thought I would.  Mostly, I found it helpful for how to govern relationships in the professional world, as they don’t always develop as naturally. The workplace can be a place of tension and Lederman’s book gives you a way to start finding relief.

The 11 Laws of Likability: Relationship Networking … Because People Do Business with People They Like
By Michelle Tillis Lederman
AMACOM, September 15, 2011
Paperback, 240 pages
$16.95

The topic was brought to mind because my wife, Ellen, and I are about to be honored by the Jewish Community Centers of Greater Boston at their annual gala for twenty years of significant personal and financial contributions. We have never been recognized for our community service or our charitable gifts before, even though it has been an important part of our lives for many years. This led to many conversations, including the question of how our children (ages 37 and 40) would participate in the event.

In turn, it made us realize that we have never really talked to our children about their views on charity and what role it plays in their lives. That realization caught me by surprise because I have always viewed myself as having a very close relationship to my sons and thought that over the years we have discussed most issues of importance. On the flip side of that, while our children are aware of our community activities, I don’t think we have had a meaningful conversation with them about why this is so important to us.

Neither Ellen nor I came from charitable families. While Ellen was actively involved with community service in her early adult years, as her career blossomed, she became much less involved on a personal level but always remained committed on a financial level. Recently, she has been significantly increasing her personal involvement again. I, on the other hand, was a latecomer to the world of community service, entering actively in my 40s.

This raised a few questions. How did two people who were not taught the value of community service during their formative years become so committed to it as adults? Had we ever installed those values in our children? Why haven’t we talked to our children about this topic?

As with any other personality characteristic or set of values, one quickly realizes that it is not simply about teachings but also about inborn tendencies. You quickly recognize the nature-nurture conflict. Clearly both contribute as we look at siblings and often see dramatic differences in behavior or beliefs. But if we leave out the teaching part, then we are letting others have a greater influence or, perhaps, just leaving it to chance. Certainly, as parents, we want to find ways to provide guidelines for our children.

This is, of course, a timely issue. For many years, there has been a growing dissatisfaction with the materialism of the holidays of Christmas and Chanukah. Meanwhile, children’s birthday parties, confirmations, Bar/Bat Mitzvahs, kindergarten graduations and numerous other child-oriented events have become grossly out of control in terms of the money spent and the loss of the real purpose and meaning of these events. Meanwhile, charitable giving is down and volunteerism has diminished (largely because the traditional resource of at-home mothers has greatly diminished). Yet I have also observed a couple of generations of teenagers becoming active in walks for hunger and cancer and other similar events, something that was a rarity for teens in the more distant past.

So the data on the current role of charity in families seems to be mixed. There has been much publicity about families volunteering to serve meals at homeless shelters on Thanksgiving and Christmas. While this is an excellent step, my limited conversations with families doing this suggests it is too often an isolated aspect of family life rather than reflective of a deeper, year-round commitment. Of course, most families, understandably, complain they don’t have enough time for each other, no less others outside the home. It is well-documented that today’s families are much more isolated from one another and their communities than those of earlier generations.

As Robert Putnam described in his excellent book, Bowling Alone,

“For the first two-thirds of the twentieth century a powerful tide bore Americans into ever deeper engagement in the life of their communities, but a few decades ago — silently, without warning — that tide reversed and we were overtaken by a treacherous rip current. Without at first noticing, we have been pulled apart from one another and from our communities over the last third of the century.” (p. 27)

It is no coincidence that we appear to be living through a period of time when those responsible to provide leadership and model desired behaviors, whether politicians, clergy, corporate executives or athletes, have been an exaggerated source of constant disappointment, leaving a trail of criminal, immoral, unethical, and uncaring behavior that is slowly but surely creating a groundswell of anger among the people. I hope a level of excess has been reached that begins to signal a turn of that tide before we become a morally bankrupt society. And there is no better place to start that groundswell than in our own homes, by our own behavior as parents, and the messages that we not only share with our children but demonstrate by our own actions.

So while the holidays provide an excellent opportunity to demonstrate caring for others and involvement with the community, it needs to be part of a larger commitment to move away from the “I want… I need… I’m first” mentality and find simple, basic ways to show a genuine concern for the needs of others without tabulating the return on your investment. Turn birthday parties back into simple celebrations of a new year of your child’s life and focus at least some of the activities and gift-giving toward charitable causes.

Do the same for the other celebratory events in your children’s lives but, as I noted, you also need to do it in your lives, as the parents, if you expect it of your children. Discuss community service in your family and come up with ideas about how it can be expressed as part of your family’s life: instead of having yard sales, how about donating still-usable items to charity; consider having the entire family commit to a walk for hunger or a medical problem; choose a community organization or a particular group within the community (the elderly or people with special needs) that everyone in the family can agree upon as a focus for the family and then figure out how each member will be involved.

A few years back, as I was researching ways to keep my counseling techniques fresh, I came across several articles that covered the most recent discoveries in neuroscience. That research is what ignited my current love affair with the most complex organ in the universe, the human brain, and helped me to understand how people really change their behaviors.

Let’s take a moment and ponder this question: What really causes an individual to change his or her behavior? You may answer this question many ways depending on your theoretical perspective and on your specific observations and experiences with dissecting human behavior. However you answer this question, though, one known fact is that change must first occur at the neurological level before we will see it at the behavioral level.

The understanding of the biology of the human brain can assist clinicians with understanding the questions of how and why people change. A clinician is successful at her craft when she can produce a physical change in her client’s brain. Obviously, she cannot get inside and rewire a brain, but she can set up conditions that favor this rewiring and create an environment that nurtures it (Zull, 2002). This article will explore how individuals change their behavior neurologically as well as examine some therapeutic techniques to stimulate this fascinating process.

Neural Networks

The brain is made up of tiny nerve cells called neurons. These neurons have tiny branches that reach toward and connect with other neurons to form a neural network or a neural net. The brain is constructed of a vast amount of these neural nets that form every thought or experience people have in their lives. The human brain literally has millions of these neural nets because they begin to form in utero. So the experiences mental health professionals have in regards to their therapy techniques are based on the specific neural networks they have developed in this area. Neuroscientists have found that these networks are interconnected as an intricate web of memories, thoughts and experiences.

Hearing a special song can kickstart a flurry of recollections; a particular scent can toss an individual toward a memory of a particular person or place. This phenomenon can describe how the brain is circuited for memory. When the word ‘teacher’ is mentioned, each person has a specific neural net that was created based on their experience with the various teachers in their lives. Another way to look at this is as a type of associative memory. Thoughts, ideas and feelings are constructed and interconnected in a neural net that may also have a potential relationship with another network of neurons. So one individual may be picturing in their mind their lovely fifth grade teacher and another may be thinking about their difficult college math instructor.

Feelings and emotions also are entangled within neural networks. For example, the word ‘love’ is stored in a vast neural net that is based on an individual’s experience with that term. Subsequently, the concept of love is also created from many other ideas. For some people, love may be connected to the memory of disappointment, pain, and anger. Anger may be linked to hurt, which may be linked to a specific person, which then is connected back to love (Arntz et al., 2005). Therefore, when a person thinks of ‘love,’ she may remember that person who broke her heart and may still be angry about it. In essence, the enormous number of neural nets each person has colors all of their perceptions and interactions with other people.

It makes sense if you think about it. Our little ones, even when not so little anymore, live in our hearts. We want them to know it. Valentine’s Day gives us a reason to show it.

That’s why parents of young children not only buy cards but do things like put a red tablecloth on the table, serve heart-shaped pancakes at breakfast, slip little notes into lunch boxes or present a heart-shaped cake at dinner. For tweens and teens, parents often send a Valentine’s text message or an e-card as a low-key way to convey love without inducing embarrassment. For adult children, many of us send a card or flowers or at least make a phone call to let them know we carry them in our hearts no matter how far away they’ve flown. Celebrating a day dedicated to love makes us all smile.

To nurture the heart and warmth of a family, the rituals around Valentine’s Day — actually saying and doing loving things for those we love — is something that we parents can and should do regularly. Little ones need a daily dose. Grown kids need reminders of our love less often but with just as much heartfelt emotion.

Yes, February 14 gives us all a special day to do things up in a big way. But kids who get daily deposits in their emotional bank accounts are kids who develop and sustain the resilience to manage the stresses of life. They are the kids most likely to have the emotional vocabulary necessary to make good romantic choices of their own someday. They become the adults who work through the rough spots in a good relationship and whose self-esteem in strong enough to avoid or get out of a bad one.

For many parents, actively loving kids is second nature. For others, especially for those who weren’t well-loved themselves, it’s sometimes more challenging. I’m sure this has been done before, but I’m going to weigh in with my own version of what L-O-V-E stands for as a friendly reminder of the basics for parenting well:

L is for setting loving limits. Both the loving and the limits are important. Love without limits doesn’t give children the training they need to manage the world. Love without limits teaches them the world owes them a living. They feel entitled to get what they want without respecting the rights of others. Limits without love does control kids’ behavior but it doesn’t teach them self-control or self-respect. Limits that are arbitrary and harsh teach the kids to be scared of their parents, not to respect them.

Done well, limits do provide safety and show kids what is and isn’t acceptable behavior. Love is the ingredient that determines whether limits are about teaching our kids or only about controlling them. Limits that are said and done in a loving way let a child know we’re on their side, that we’re there to help, that we understand they need our guidance. Limits that lovingly adjust with a child’s growing sense of responsibility help our children grow into responsible adults.

O is for observing. The most frequently repeated phrase of normal childhood is “Look at me. Look at me.” Children are always checking for the grownups’ reactions. They want us to see their successes. They want and need our approval. They want us to really, really see them for who they are.

Kids who feel invisible to their parents either become withdrawn in discouragement or act up in order to be seen. Neither strategy works well in the family or in the world. Kids who are watched with love and approval keep trying to master new things and become confident that being their best selves is the way to get attention and inclusion.

V is for verbalizing our love. What makes Valentine’s Day so special is that it gives people the opportunity and permission to say what they feel. Kids do need this kind of affirmation every day. They need to be able to rest in the assurance that they are worthwhile and worthy of our love. They especially need to hear they are loved when they aren’t doing very lovable things. When they are regularly shown and told they are lovable and loved, kids and teens can accept correction and redirection without needing to be defensive. Kids who receive regular “I love yous” are kids who grow up knowing how to express love to their family members, and eventually, their own partners and children.

E is for enjoying our children. Kids need us to enjoy them as well as to care for them. They need us to play with them, joke with them, and generally be delighted with their efforts and little successes. They need us to want to spend time with them and to spend a little of life on their terms. That means reading the same story for the hundredth evening in a row with enthusiasm. That means getting out in the sandbox or down on the floor with the blocks and getting into the game. That means listening to our teen’s music with interest instead of criticism.

When kids feel like a burden or a disappointment or a major inconvenience in adult lives, they start to see themselves as defective and unworthy of love. Such children are vulnerable to depression. Some live down to the expectations of their parents and become unlovable by getting in trouble or being rebellious and difficult to manage. Kids who are enjoyed, however, are more likely to develop a strong self-esteem and self-confidence in the social world. Being a joy to parents feels good so they are more likely to be enjoyable.

By all means, make Valentine’s Day special. Any excuse to celebrate our families is fine with me. But let’s not forget that we can make valentine-ing into a verb; an action word for the many ways we provide L-O-V-E to our children every day. When we do, we both nurture them and draw more love, warmth, and affection into the family as a whole.

Paranormality: Why We See What Isn’t There does not discuss if the phenomena are real (and Wiseman is very firm in stating that they are not), but rather why we and our brains have evolved to experience them.  This fascinating perspective, which the author presents clearly and entertainingly, is applied to many different aspects of the paranormal, coming to a similar conclusion each time: that our senses and our minds are incredible in what they perceive, and that investigation into the supernatural leads directly back to the very grounded realm of scientific discovery.

Paranormality’s chapters are organized according to various mystical realms. For example, Chapter 1’s focus is fortune telling.  Psychics mainly use “cold readings,” in which the psychic has not previously met the person seeking a reading.  While many people are very impressed with what these practitioners can “see,” Wiseman explains that six empirically proven psychological techniques are the basis of a psychic’s power.  These include flattery, selective memory, the illusion of uniqueness, etc.   To further drive home the point that anyone can learn to be a psychic, the author provides a set of exercises so the reader can amaze and astound her friends with her new “powers.”

Out-of-body and near-death experiences (OBEs) are the most common encounter people have with the paranormal.  Rather than having touched heaven or the astral plane, however, Wiseman notes that after examination:

“…people who experience OBEs are much better than others at naturally generating the type of imagery associated with the experience, and struggle to tell the difference between reality and imagination.  Put these people in a situation where their bodies receive only a small amount of unchanging information about where they actually are and […] they can end up believing that they are no longer located inside their bodies.” (p. 88)

In fact, according to the end of Chapter 2, with training, anyone can learn to fly around the world while lying in bed!

Chapter 3 delves deeper into psychic deception, which is what makes the majority of all paranormal phenomena possible to experience.

“The first four principles of psychic deception […] ensure that people do not figure out the solution to the tricks that are happening right in front of their eyes.  The fifth principle […] ensures that they are unable to accurately remember what happened.” (p. 126)

This chapter also presents the first of the many scientific conclusions that investigation into these principles has drawn:  among other real-life effects, selective memory undermines the reliability of eyewitness testimony (p. 130).

The following sections on talking with the dead and ghost hunting expand upon this premise, with Wiseman detailing how reports of these occurrences have led directly to discoveries of the unconscious, ideomotor actions (actions performed without conscious intention), the power of suggestion, and sleep psychology. Even cult brainwashing has provided a lens into hazing and the power of self-justification.  In probably the most direct cause and effect example, the famous case of Clever Hans (the mathematical horse) made abundantly clear the need for double-blind experimentation.

The final phenomenon that Wiseman explains is prophecy.  He specifically asks why we have evolved to believe in the impossible, namely that one can predict the future through dreams or other divination.  His answer is that this tendency to attribute other-worldly revelations dates back to primitive pattern-finding skills.  Humanity has developed a “…built-in tendency to find connections between completely unrelated events.  In doing so, you can easily convince yourself that you have experienced the impossible (p. 306).”

With its clear, step-by-step explanations and scientific rationales, even the most intense believer will have second thoughts after reading Paranormality.  And if you’re already fairly skeptical, Wiseman provides a fascinating look at how it all ties together.  Not only is the author obviously very knowledgeable and experienced, he also is able to present his research in a humorous, tongue-in-cheek manner.

Paranormality is also a practical work, with real-world applications and lessons included in every chapter (as well as an “Instant Superhero Kit” in the appendix to tie it all together).  In this way, it’s not only a psychological tome, but a ‘how-to’ on learning mind reading, making objects float, talking to the dead, having an out-of-body experience, etc.  Smartphone tags are scattered throughout for related video and audio content, which are especially interesting when used to expand upon anecdotes presented in the text, and suggestions for further reading are included in the Notes.  Not on the list, but a related work that readers who enjoy this book will love, is Sleights of Mind: What the Neuroscience of Magic Reveals About Our Everyday Deceptions (see review here).

Wiseman isn’t only about ruining the magic of the supernatural with his insistent disproving of any otherworldly phenomena, though.  His view is that knowing how these instances are experienced doesn’t decrease the wonder of phenomena, but rather that “seen in this way, rotating pencils and bending spoons are not proof of the impossible, but are instead vivid reminders of how sophisticated your eyes and brain really are (p. 132).” 

Between this observation and the numerous advances in science resulting from the paranormal, Paranormality leaves the reader with an appreciation of what ghosts and psychics can teach us about ourselves—but through neuroscience, not mystical means.

Paranormality: Why We See What Isn’t There
By Richard Wiseman
Spin Solutions Ltd: August 17, 2011
Paperback, 198 pages
$15.00

These individuals may have treatment-resistant depression or refractory depression. While there’s some debate over the precise definition, treatment-resistant depression is typically thought of as failing to achieve remission after two treatments or two antidepressants, according to George Papakostas, M.D., director of Treatment-Resistant Depression Studies in the Department of Psychiatry at Massachusetts General Hospital.

Why Some People Have Treatment-Resistant Depression

People develop treatment-resistant depression for many reasons. Some struggle with severe depression, which is difficult to treat. Medical illness and comorbid psychological disorders — such as drug or alcohol abuse or eating disorders — also complicate treatment response, according to Dr. Papakostas and Yvette Sheline, M.D., professor of psychiatry and the director for the Center for Depression Stress & Neuroimaging
 at the Washington University in St. Louis. Severe stress also can impact improvement, Dr. Sheline said.

A variety of genetic, neuroimaging and electrophysiological studies have investigated the underlying causes of treatment-resistant depression. And researchers know one thing for sure: Refractory depression is not the result of one brain region or neurotransmitter system.

Preliminary research suggests that individuals with depression may have abnormalities in the frontal and temporal regions in the brain and dysfunction in serotonin modulation. Also, the subgenual cingulate (Cg25), which is located under the cortex along the midline of the brain, may play a role. Cg25 is activated when an individual experiences sadness. It also connects to other regions involved in mood, motivation and sleep. When antidepressants are effective, this area is less active. Some researchers have hypothesized that in refractory depression, Cg25 doesn’t turn off. In general, according to Papakostas, there isn’t enough evidence to show a consistent or unifying theory.

Other individuals may not have refractory depression after all. For instance, according to Sheline, a thyroid problem may mimic depression. Individuals may have bipolar disorder — though there’s recent evidence that bipolar disorder may be overdiagnosed in patients who appear to have treatment-resistant depression — or a long-term low-grade depression called dysthymia. If a treatment isn’t working, it’s critical that your physician re-evaluate your diagnosis.

Treatment Options for Refractory Depression

According to Sheline, there’s disagreement about the number of medication trials a person needs to try before moving onto more invasive interventions. While physicians determine this on an individual basis, it’s important for patients to have an adequate dose of medication for an adequate amount of time, Sheline said. “Each antidepressant has different therapeutic dose ranges, and these also vary according to individual factors, such as age,” she said. An adequate duration of treatment is usually six weeks. If there’s partial improvement, doctors may recommend patients stay on the medication for six to 12 weeks, Papakostas said.

This is why it’s especially important to take medication as prescribed. Many patients stop taking their medication after a week if they don’t get better, Sheline said. But this isn’t enough time to see improvement. Skipping or forgetting a dose can decrease a medication’s efficacy and make it look like it’s not the right medication for you. Also critical is practicing healthy habits, such as engaging in physical activities and getting enough sleep, and managing stress. Exercise boosts mood, while stress and lack of sleep exacerbate depression.

If one antidepressant truly doesn’t work, physicians will typically prescribe an antidepressant from a different drug class. Or they’ll prescribe an augmenting agent, such as lithium or an atypical antipsychotic medication to boost the effectiveness of the antidepressant.

If medication and psychotherapy are unsuccessful, these are other options:

Electroconvulsive therapy (ECT). ECT involves placing electrodes on a patient’s scalp, which sends a specific current that induces a short seizure in the brain. In the 1950s, ECT developed a bad reputation because it was administered without anesthesia and with a high voltage, Sheline said. But today, it’s a completely different treatment, she said.

ECT is administered with general anesthesia and the voltage is carefully controlled. In fact, Sheline noted that there is ongoing work to decrease the pulses to minimize side effects. There’s also been concern that ECT is involuntary, Papakostas said. He clarified that ECT is voluntary and requires a patient’s informed consent.

ECT does have various bothersome side effects, including memory loss and headaches. It’s understandable why patients would hesitate to try it, Papakostas said. However, both Papakostas and Sheline agree that a large body of research substantiates ECT’s efficacy. When compared with medication and psychotherapy, ECT appears to work faster and has a higher chance of success, according to Papakostas. It also has the most efficacy data of all the more invasive interventions.

Transcranial magnetic stimulation (rTMS). According to Papakostas, this treatment is second to ECT in quality of data. Transcranial magnetic stimulation doesn’t require anesthesia or induce a seizure like ECT. Instead it creates a magnetic field that produces an electric current in a specific area of the brain. It’s typically used for mild to moderate depression. The Food and Drug Administration has approved one device called the NeuroStar TMS to treat depression, which may be used after one antidepressant has failed.

Vagus nerve stimulation (VNS). In 2005, the FDA approved vagus nerve stimulation for treating treatment-resistant depression. The device is surgically implanted onto the vagus nerve on the left side of the neck and delivers mild electrical impulses. Think of it as a cardiac pacemaker. According to the University of Maryland Medical Center, it sends 30-second impulses to the vagus nerve every five minutes.

For over a decade, VNS has been used to treat patients with epilepsy. Researchers began studying VNS for refractory depression when they noticed that some patients’ moods improved. Whether VNS is an effective treatment for refractory depression is unclear. It appears to help some people tremendously but not others. To date, “the data [on VNS] just isn’t on par with ECT or rTMS,” Papakostas said.

Not finding a treatment that lifts your depression can be utterly frustrating and make you feel hopeless. But while it may take more time and effort, together with your physician, you can find a treatment that works for you. Remaining optimistic is important. “Being able to maintain a positive, hopeful attitude is as critical as [getting the right treatment], Papakostas said.

Through its holistic, compassionate approach, this valuable guide empowers with knowledge, instills with confidence and gives women a direction for finding doctors who are truly knowledgeable about their disorders and able to treat their pain.  As is read in its introduction, “This book is the product of our passionate belief that all women with sexual pain need both physical and emotional support.” 

Deborah Coady and Nancy Fish provide a detailed, empathic guide that that offers a wealth of physical and emotional suppport. I highly recommend Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain.

Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed or not diagnosed at all.  Because of the multidisciplinary nature of sexual pain, which falls between the disciplines of experts, women have often been told that pain is “all in your head”  or that nothing can be done to help them.  As Coady and Fish point out, “We’re here to tell you that none of that is true.  Sexual pain is almost always caused by an identifiable, verifiable medical condition; it can be treated and is not in your head.” 

Nancy Fish had suffered from severe pelvic pain and had seen seven specialists before visiting Deborah Coady.  Coady, while having years of experience with women suffering from sexual pain, nonetheless took some time to uncover all of Fish’s difficulties.  Fish, like most women suffering from sexual pain, through inadequate treatment had several conditions that had compounded and spread.  A licensed certified social worker specializing in chronic illness, Fish found great hope in Coady’s insistence that she never give up on herself. She was inspired to form a partnership with Coady to help those with the chronic illness of sexual pain. 

Deborah Coady, through her personally developed teams of colleagues in neurology, dermatology, orthopedics, pain management, gastroenterology, urology, peripheral nerve surgery, physical therapy and psychotherapists, demonstrates in Healing Painful Sex how fruitful their holistic approach can be. As they write, “Even in your most difficult situations, you can experience a significant reduction in your pain and can find help for reintroducing sex as a joyous and nourishing part of your life.  We promise:  Things can get better.”

The book is organized into three parts. Part 1: Naming the Problem begins with the difficult situation of talking about sexual pain.  It helps the reader learn how to share her situation with one or two other people who can then help make medical decisions.  The book then discusses the often arrogant, uninformed or downright abusive physicians who exist.  As stated in the book, “The degree of incompetence, insensitivity, and indifference among gynecologists, other specialists, and general practitioners is hard to overstate.”  Hoping to aid their emotional healing along the way to ending their sexual pain, Coady and Fish outline the ways in which the reader can understand what to do when the doctors get it wrong. 

The first section of the book ends with a chapter dedicated to finding a doctor who will offer effective treatment and provides a detailed holistic guide on beginning one’s healing by following guidelines on pain, sleep hygiene, diet and supplements, exercise and relaxation techniques and learning of how to be gentle with oneself.

Part 2: Understanding the Problem, provides the reader nine chapters of detailed information covering the symptoms and conditions of pelvic floor dysfunction, vulvodynia, pudendal nerve pain, clitorodynia, pelvic organ problems, endometriosis, painful bladder, and irritable bowel syndrome, skin disorders, such as lichen sclerosis, and hormonal, surgical, and post-cancer causes of pain.  Interwoven with detailed explanations of the causes of sexual pain, the book contains full-page anatomical illustrations, checklists for particular disorders, and details on the types of tests needed as well as lists of the common misdiagnoses given for a disorder and ways to rule it out.  It contains details on how the various conditions can co-occur and affect one another.  It tells the potential patient of what to expect during an examination and offers guidance based on the doctor’s performance and recommendations.

Part 3: Overcoming the Problem presents valuable information and guidance devoted to fulfilling one’s life with the joys often taken away in sexual pain.  Coady and Fish hope to return libido, desire, partner intimacy, healthy relationships with friends and families to women undergoing sexual pain.  Their many personal case studies validate and underscore the valuable guidance they provide.  The book closes with excellent resources, including recommended books, helpful websites, psychotherapists, as well as relevant organizations and associations.

Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain
By Deborah Coady, MD & Nancy Fish, MSW, MPH
Seal Press: November 1, 2011
Paperback, 400 pages
$18

Whether it’s your first or fourth child, your relationship still sees a jolt. As Marter said, “The first child most often brings about the greatest life and relationship change, but each subsequent child affects a couple almost exponentially, widening the scope of responsibilities and compounding family and relationship dynamics.”

Having children can bring couples closer. But it also can chip away at a relationship if you’re unprepared for the potential pitfalls. Take this surprising statistic: Within three years of their child’s birth, about 70 percent of couples experience a significant slump in their relationship quality, according to the Gottman Relationship Institute.

The key in keeping a relationship happy and fulfilling is knowing what these pitfalls are, having realistic expectations and staying committed to each other. Below are three of the most common pitfalls and pointers to help.

Pitfall 1: Sleep deprivation

Everyone knows that having kids is exhausting. But you might not fully appreciate the fatigue. According to Marter, “the chronic and cumulative nature of sleep deprivation during the newborn phase is perhaps one of the most commonly underestimated challenges of new parenthood.”

Sleep deprivation sinks your mood, makes it harder to cope effectively with stress and exacerbates mood swings and anxiety. And that’s just what it does to each person.

Lack of sleep strains the relationship in various ways: Couples may fight about who’s doing more and sleeping less. Because couples are extra agitated and stressed, they might squabble more in general. And the primary caregiver may feel unsupported and alone and eventually resent their spouse, Marter said.

Pointers: Sleep when your baby sleeps, Marter said. “This may mean letting the laundry or scrapbooks wait and forcing yourself to nap. It might mean going to bed at 8 p.m., so that you can sleep during your baby’s longest stretch.”

What if your baby isn’t really sleeping? Marter suggested working with your pediatrician and reading other resources such as Healthy Sleep Habits, Healthy Child by Dr. Marc Weissbluth. If feedings are the reason your family isn’t getting much sleep, she also suggested checking out the La Leche League, and figuring out a feeding schedule that works best.

Ask loved ones for support and, if it’s financially feasible, hire help for household chores, a babysitter so you can take daytime naps or a night nanny, Marter said.

And work as a team. For instance, moms who are breastfeeding can pump so their partners or loved ones take turns doing the feedings.

Pitfall 2: Lack of intimacy

Sexual intimacy declines after having a baby, and not surprisingly, this can negatively affect your relationship. “Because sexuality is intensely personal and sexual connection is a major component of romantic relationships, sexual dysfunction or disconnection can become a significant problem for many couples,” Marter said.

The decline happens for many reasons. Physicians typically suggest that women abstain from intercourse for 4 to 6 weeks after childbirth. Even after that time, “women may experience or fear pain from intercourse due to the effects of delivery, an episiotomy, perineal tearing, and/or vaginal dryness due to hormone fluctuations,” Marter said. Couples also experience a decline in desire because of busy schedules, body image issues, fatigue and other concerns.

Pointers: Expect that intimacy will decline after childbirth. This is normal considering the sleep deprivation, new responsibilities and need for the woman’s body to heal, Marter said. Avoid viewing lack of sex as rejection or a sign of trouble in your relationship.

Be close and intimate in other ways, such as kissing, touching, snuggling or spooning, Marter said. Make time to physically connect with each other. Staying home and watching a movie is one way, she said.

“Good sex requires good communication.” Marter suggested talking openly about your needs, preferences and fantasies with your partner. These are some questions she suggested raising: “What is good about [your sex life]? When was it the best and why? What do you each desire? What schedule seems to work best for you? What gets in the way of having more sex?”

Also, work on your emotional connection. For instance, “Create at least 20 minutes per day to connect and talk about things other than the responsibilities with household and baby,” Marter said.

Pitfall 3: Responsibilities

In Marter’s practice, the most prevalent problem for couples is division of labor. Resentments inevitably peak when one partner feels like they’re tackling more tasks and working harder. “They may compare and become competitive or defensive about their responsibilities, schedules or the pros and cons of their work or role,” she said.

They also might glorify each other’s positions, Marter said. A stay-at-home dad might think his wife’s day at work is filled with swanky business lunches, interesting projects and a quiet commute, while he’s dealing with temper tantrums and dirty diapers. His wife might imagine him playing, cuddling and connecting with their child, while she deals with a difficult boss, endless deadlines and concerns over job security. “Then, when an issue like who is going to do the laundry comes up, the misunderstandings have created an environment ripe for conflict,” she said.

One of the problems is that couples usually don’t have a plan for how they’re going to divvy up responsibilities. Marter finds that many couples make assumptions about who’ll do what — often based on how their parents did things — which typically leads to confusion and conflict.

Pointers: Map out what your routine and responsibilities will look like, Marter said. And make sure it’s fair to both partners. Again, couples get into trouble when responsibilities are vague. One of Marter’s clients wanted her husband to help out in the mornings, but the couple ended up bickering instead. “By sitting down and reviewing the mornings tasks, the husband was able to select several items that his wife agreed would be helpful for him to manage,” she said.

When you’re figuring out fairness, remember that a relationship requires give and take. “For example, the husband of a client who is a teacher really steps it up during her grading periods and she picks up the slack when he travels for work,” Marter said.

Also, lower your standards, and let some things go. Another client of Marter’s, who was super stressed and worn out, used to iron all her baby’s clothes. Of course, getting enough sleep supersedes ironing. “Focus on the big things and let the small stuff go,” Marter said.

“The transition to family is simultaneously joyous, miraculous and wondrous and one of the most challenging life experiences and opportunities for growth,” Marter said. It helps for couples to have realistic expectations about parenthood and their relationship and to remain committed to working as a team.

Drawing on her own experiences and her observations of others, Schoen explains exactly what a “gentle self” is.  This type of narcissist puts others ahead of themselves because the narcissist feels that he or she is unworthy of love or respect.  I can definitely relate to the gentle self.  Schoen spends half the book comparing and contrasting the two types of narcissist.  You may be thinking, “How can someone who puts others first be a narcissist?  Isn’t that the exact opposite of what a narcissist is?”  Schoen addresses this very question.  She explains that a narcissist is anyone who is self-absorbed.  The gentle self is self-absorbed in the sense that they are constantly thinking about how they don’t feel like they belong, how they aren’t worthy of love, etc.

The second half of The Gentle Self is about how to overcome depression, anxiety, shyness, and low self-esteem.  Schoen offers such advice as, “If you feel strong anxiety or pain or even a nervous breakdown approaching, the first rule to remember is: leave yourself alone.”  She goes on to say, “We often tend to put more pressure on ourselves in the form of ‘I can’t possibly burst into tears right now,’ ‘what’s wrong with me,’ or ‘I hate myself,’” and suggests trying to “be your own friend” when others are being negative toward you.

In romantic relationships, Schoen recommends bringing the spontaneity that we crave into the relationship instead of waiting for our partners to do so.  If we sit around waiting for our partners to read our minds and do what we want them to do, our relationships will end in failure.  Affairs are a not uncommon problem in relationships with gentle narcissists.  In friendships, Schoen says that gentle narcissists should get out and meet people.  Since it’s human nature to crave connection, meeting strangers on the street can feel refreshing and give the gentle self the confidence he or she needs to feel good the rest of the day.

Some other practical methods that Schoen provides for dealing with personal issues are the typical options: psychotherapy, meditation, and growing up.  The phrase “growing up” means something different to everyone.  In the context of The Gentle Self, growing up can be explained with three ideas:

• Leave yourself alone.
• Stay involved with other people.
• Take care of somebody else such as a child, grandparent, or pet.

If you, or any other gentle self, can get your mind off of how you feel about yourself, you get out with friends or meet new people regularly, and you have someone you can pour your affection into, your life might just start to look a little bit brighter.

All in all, I’m not too sure how effective Schoen’s methods are.  I’ve tried meditation before with little success.  Though I do feel a little better when I’m interacting with people, when that interaction has ended, I’m back to feeling how I did before—worthless and unimportant.  There are a lot of things that I agree with in The Gentle Self.  As I read, I could see so many parallels with my life.  Everything from distant parents trying to live through me to my fear of intimacy in romantic relationships—Gerti Schoen covered it all.  I have yet to try psychotherapy, but it is something I’ve been looking into.  As for taking care of someone else, I don’t know what I would do without my pets.  The only way I can explain how I feel about my pets is how a parent feels for a child.  They mean everything to me and I would be lost without them.

On the whole, The Gentle Self was a slow read.  There are a few grammatical and spelling errors, but nothing that the average mind would notice unless it was looking for them.  Schoen offers sound advice.  Her methods work more often than not.  Ultimately, I would have to say that The Gentle Self is definitely a book I would recommend to anyone who suffers from major depression or bipolar disorder.  You may see yourself in the pages.

The Gentle Self: How to Overcome Your Difficulties with Depression, Anxiety, Shyness, and Low Self-Esteem
By Gerti Schoen
CreateSpace: August 25, 2011
Paperback, 136 pages
$7.20

Dr. Ann Masten from the University of Minnesota wrote in the journal American Psychologist (2001) about resilience as “ordinary magic.” That is, given normal protective factors, most children will be able to cope, recover, and be fine after witnessing or experiencing a traumatic event.

Some children and adolescents may develop symptoms following a disaster, especially if they have experienced traumatic events earlier such as losses or other difficult situations. The symptoms related to trauma may appear as difficult behaviors or emotions shown at home or school. It is important for parents to know that children’s behaviors and emotions can become dysregulated, where they demonstrate more aggressive or withdrawn behaviors such as sadness or anger, and even “numbing” or little emotion as a way of coping with trauma.

Some of the “red flag” behaviors of concern when seen in children of different ages include:

• For children under 5 years of age: returning to earlier behaviors such as thumbsucking, bedwetting, fear of darkness, separation anxiety or excessive clinging
• For 6-11-year-olds: disruptive behaviors, extreme withdrawal, inability to pay attention, sleep problems and nightmares, school problems, psychosomatic complaints
  including stomachaches and headaches or changes in usual behaviors
• For 12-17-year-olds: sleep problems and nightmares, school problems including changes in performance and truancy, risk-taking behavior, problems with peers, changes in usual behaviors, psychosomatic complaints including stomachaches and headaches, depression or suicidal thoughts

Parents need to be able to recognize these “red flag” behaviors and identify when their child may be experiencing so much distress that he needs help. Parents may also need help in providing support to their child after traumatic events that may also traumatize the parents. Brief support and being able to talk to someone who can be more objective may be helpful to both parents and child after a traumatic event.

When they experience traumatic events, children can be protected most by support from their parents or trusted caregivers, being able to talk to them and have them listen, and if they are younger, being able to play freely. Younger children often play out what they have seen or experienced which, at times, may be difficult and upsetting for parents to observe but is important in helping the child recover from the event.

Returning to routines is also very important for children after they’ve experienced trauma, even if the routines are different from what they experienced before the traumatic event. If the children are older, then being able to go to school and be with friends will help in their recovery. Life needs to be predictable for children (and adults) and traumatic experiences disrupt that predictability. Reinstating routines help make life predictable again.

Guidelines for Parents to Help Their Child Cope with Trauma Include

1. Offer to listen to your child and help her, but don’t overwhelm her if she is not ready to talk. Don’t pressure your child to think or talk about what has happened beyond her willingness and readiness to do so. Children need answers to their questions that are age-appropriate and truthful, but it is not in their best interest to be flooded with more information than they ask for or need.

2. Talk about what has happened or is happening but in tolerable doses. It is wise to respect your child’s need to break off the discussion and to respect his wish to not talk further about the trauma for a while. He or you can ask to talk again at another time.

3. Do not underestimate a young child’s awareness or understanding of what has happened or may be happening. Answer your young child’s questions about injury or death truthfully, but in language she can understand without offering her
more than is necessary for her to hear.

Different age groups have different needs. For example, very young children need to be protected from exposure to too much television or other media; they are likely to have either seen or heard too much already.

Children need to be helped not only with their anxiety and confusion, but also with their anger. They may react to the traumatic event with anger and need to learn ways to express their feelings in healthy ways. Here are a few age-appropriate, healthy ways to help children express their confusion or anger about a traumatic event:

• It is often helpful for young children to have the opportunity to draw pictures of what has happened, perhaps depending on the traumatic event, including rescue vehicles coming to aid. Children who are a little older may want to play out the event with toys.

• Older children may find it helpful to use heroic action figures for their play or toy soldiers or military equipment to show danger as well as rescue.
• School-age children may want to use these less verbal forms of expression but they also might be able to be more direct and verbal about their feelings and concerns; they are more likely to also talk to teachers, relatives, and other adults in addition to parents.
• Teenagers may find it helpful to talk as part of a small group of peers their own age rather than talk by themselves. After disasters, teenagers can play a major role in helping others in recovery work at school and in their community and also help younger children. It is important to recognize and support prosocial activities for teenagers, which can also decrease the likelihood of higher-risk behaviors.

As I shared with one parent whose young child was very upset after experiencing a traumatic event that would impact both of their lives for some time, “Life will return to normal, however, after trauma, it may be a ‘new normal.’”

Flipped car photo available from Shutterstock