Psych Central Original articles in mental health, psychology, relationships and more, published weekly.2015-10-07T17:35:03Z Sandra Wartski, Psy.D <![CDATA[Get REALL about Stress and Stress Management]]> 2015-10-06T17:08:34Z 2015-10-07T17:35:03Z ]]> Notions about stress and stress management are sprinkled fairly liberally throughout our American headlines these days. On one hand, this allows the experiences to be talked about more openly and hopefully allows more expedient resolution. On the other hand, however, it is possible to miss some of the basic truths and simpler solutions.

Stress Defined

Stress can cover lots of areas and is talked about very broadly. There may be short-term or acute stress situations, like running late for a meeting or being overcommitted with too many responsibilities, and there can be long-term or more serious situations, such dealing with relationship problems or a chronic illness.

Stress is also quite different for each person. What is stressful for one person may or may not be stressful for another. Some people get very stressed out and worried about making a public speech. Others look forward to them. Some people like the idea of having visitors. Others worry tremendously about others being in their home. Each person is in charge of subjectively deciding for themselves whether something is stressful for them.

What’s Wrong with Stress?

The problem with stress, no matter how each person defines it, is that it interferes with your ability to live a normal life. It can even be dangerous if maintained at high levels for extended periods. Having a few days of feeling tired, unable to concentrate or feeling irritable is not abnormal, but this sort of reaction becoming the norm is worrisome. Stress can cause people to feel overwhelmed or pushed to the limit of their capacity to cope. This sometimes leads to some of the less healthy coping tools, such as using substances, thinking about suicide or engaging in interpersonal violence.

Not only is stress problematic from an emotional standpoint, it can also affect physical health. Chronic, long-term or poorly managed stress can contribute to a variety of medical problems, including fatigue, gastrointestinal upset, skin conditions, and even heart disease.

The American Psychological Association did a survey several years back entitled “Stress in America” and found that one-third of people in the U.S. report experiencing extreme levels of stress. About one-fifth reported that they were experiencing high levels of stress 15 or more days per month. Given these rather alarming figures and all of the accompanying difficulties which can arise, it is key to know how to recognize high stress levels and handle it in healthy ways.

Is Stress Always Bad?

Stress is normal. Some level of stress is helpful for living, such as helping us to meet a work deadline or pushing us to clean up the house before guests arrive. Low to moderate levels of stress can be beneficial for you if it’s managed in healthy ways and if it’s not for extensive periods of time. Stress can help you to run from danger or complete a project by a deadline. Stress can also add a bit of excitement and energy to life, such as when we are riding a roller coaster or getting ready for an exciting night out. Short-term, acute or episodic stress can be exciting and even helpful in small doses. Mismanaged stress or stress which is not being coped with in healthy ways can have many negative side effects.

Paying attention to minor symptoms of stress, such as headaches or sleep difficulty, can be early warning signals letting you know that something is out of balance. Use it as a wake-up call to find ways of better managing stress.

What Are the Best Ways to Relieve Stress?

Each person’s stressful situation is naturally unique, and so each person must create his or her plan and life goals to manage his or her stress effectively. Knowing your own patterns and what sorts of things stress you out can be helpful for potential prevention. We all have different lives with different situations and different personal reactions to stress. No one can tell you what works best for you in terms of stress-relieving methods, we can just tell you that it is important to find your own methods. Like comfortable clothing, you need to have a goodness of fit. The bottom line is: if it restores you in truly positive ways, then it works.

There are no universally effective stress reduction techniques; however, there are some key steps for assisting in general approaches to stress. Research supports attending to some basics of stress management and tweaking them to fit your individual lifestyle. Because being able to control stress is a learned behavior, we can also learn ways to change behaviors which, in turn, can allow us to more effectively manage the stress as well.


As a way of remembering basic elements for relieving stress, I have put together an acronym to help remind us of five key areas: REALL. Each of the letters stands for specific ideas, of course, but the overall concept of getting real also hopefully conjures up the reminder to get back to the basics. Stress management doesn’t generally require anything fancy or complex but rather more authentic, down to earth self-care. Let’s review each letter of REALL in turn:

R is for Rest

When there is lots going on in someone’s life, it is often difficult to rest or sleep — whether due to higher demand of activities which interfere with sleep, ongoing anxiety affecting abilities to calm down or a combination of both. It is critical to take breaks, especially during times of higher distress when adrenalin is likely heightened and is causing more impact on the body. Someone may be overwhelmed when they are stressed and feel that they can’t rest because there is simply too much to do; however, we humans need to work more effectively with time rather than struggling against it. Taking short, scheduled breaks also helps in preventing burnout or overload.

Taking breaks and resting is important, but getting regular intervals of sleep is an important way to rest as well. Muscles can relax any time we sit still — the brain, however, is hard at work whenever we are awake. It is not uncommon for those struggling with stress to be sleeping less well; however, poor sleep then unfortunately can lead to more negative interference. With too little sleep, the body does accumulate a “sleep debt” which must be eventually paid off. Under times of stress, getting good sleep is especially critical as the body and brain’s way to recharge its battery. Sleep accomplishes much that we don’t necessarily see, such as repairing tissues and organs, growing more neurons, improving immune function, fighting infection and regulating appetite. Keeping up with – or getting back to – regular sleep-wake routines during stressful times in particular is critical.

E is for Eating

We naturally all need to eat, every day, multiple times per day. It is interesting to note, however, that individuals under stress often do not attend to this basic need as effectively as would be ideal. Keeping up regular meals, even if appetite if affected, is critical. The moderate approach which holds true as a key for day-to-day living is even more critical during times of stress. Our bodies need nutrients in order to perform daily functions and stay healthy; under stress, our bodies really need the energy and nutrients even more.

The usual pleasure in eating may be temporarily diminished or even artificially increased (which some people refer to as stress eating), but attending to regular, mindful eating will have far-reaching benefit. No single food can provide all the nutrients that the body needs, so it’s important to have varied and well-balanced meals. Rejecting the dieting mentality is especially important under stress, as obsessing about “good” and “bad” foods or being preoccupied about being a certain weight will not be helpful. Aim to focus more on food for nourishment & enjoyment, not for coping with stress or feelings.

A is for Air

This may sound obvious, but attention to proper breathing is especially critical during times of stress. Attending to better breathing and air intake patterns can absolutely assist in diminishing the impact of stress. Those who study yoga or meditation may be well-versed in the concept of attending to breathing patterns, but one doesn’t have to do anything fancy or use any special tools. Inhaling good air is about mindfully attending to breathing in and out, slowly and surely on a regular basis.

Breathing well is a natural tranquilizer for the nervous system. By practicing calming breaths, you are activating the parasympathetic nervous system. This is highly effective in helping to regulate and calm heart rates, the whole nervous system, and the mind. Breathing well not only helps during the day but also is the key to sleeping well and waking up feeling rested.

As poet, author and Buddhist monk Thich Nhat Hanh said, “Feelings come and go like clouds in a windy sky. Conscious breathing is my anchor.”

L is for Letting Go

We can’t change the fact that highly stressful events have happened or are happening, but we can change how we interpret and respond to events. We know that change and difficulties are a part of life. There can absolutely be value in processing and validating distress. Some people find it very helpful to engage in writing, talking or meditating about their thoughts and feelings related to stressful events in their life. Worrying excessively or obsessing about things keeps us stuck, however.

There may be strong, intense emotional reactions which emerge during stressful times, and this is very normal. It is also normal that such intense feelings will typically lessen over time. It’s important to avoid blowing the event out of proportion by considering the stressful situation in a broader context and keeping a long-term perspective.

Accepting circumstances that cannot be changed can help to focus on circumstances that can change. Part of letting go can involve looking beyond the present and looking forward to future circumstances which may be a little better, even if we aren’t sure how or when this might unfold. It is true that certain goals may no longer be possible due to certain adverse situations or after some particular stressors, but we can make new goals.

Finding ways to turn away from the negative thoughts and feelings related to stress can be helpful, such as through positive distractions of taking a hike in the woods, watching a funny movie or meeting a friend for dinner. Letting go is part of the journey of handling stress. It may be easier said than done, but keeping an optimistic orientation towards this is key.

L is for Leaning In

I am not suggesting dwelling on the stress. Instead, leaning in refers to the process of taking decisive action to move forward. This is naturally a broad concept which means different things for each individual, but the basic idea is that being active instead of passive helps people more effectively manage stress. Taking decisive actions has been shown to be much more helpful in the long run than detaching from problems, ignoring stresses or simply wishing they would just go away. In some circumstances, this may mean thinking about possible solutions to the current problems and deciding on realistic goals to achieve.

Rather than focusing on seemingly unachievable tasks, ask yourself, “What’s one thing I know I can accomplish today that helps me move toward an important goal for me?” Some people find it helpful to track their progress by making a record of any accomplishment that moves them toward their goals. Action can be even a small accomplishment in the midst of stress, such as doing a load of laundry, paying a bill or taking one baby step toward a massive cleanup project. Actions can be physical (engaging in regular physical activity and drinking plenty of water) or cognitive (actively thinking about how to take on a more optimistic outlook or making to-do lists).

It’s often helpful to visualize what you want, rather than worry about what you fear. Sometimes the leaning in might mean getting back to doing something regularly — like showering regularly or walking the dog again; other times, taking action can involve doing something different to shake up the routines and change the scenery. Driving a new route to work or trying a new recipe can be a way to engage the brain differently and create a change. Leaning in and leaning on loved ones also can be helpful, as having caring and supportive relationships within and outside the family is often so helpful during times of stress. Engaging actively in activities that you enjoy, that you find relaxing and that contribute to well-being are immeasurably important.

Part of getting REALL about managing stress is about tapping into our resilience. Resilience is officially defined as a phenomenon whereby individuals show positive adaptation in spite of significant life adversities, trauma or significant stress. Another way to think about it is that resilience is like our “bounce back” muscle. We all have these muscles, but some people have had more time and experience in building them up.

Being resilient does not mean a person does not experience difficulty or distress; instead, it involves behaviors, thoughts, and actions that anyone can learn and develop. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with adversity, loss or stress — such as people reporting that, over time, they have better relationships, greater sense of internal strength, improved self-worth, and heightened appreciation for life. Keeping your mind and body primed to deal with situations that require resilience is part of staying REALL about positive stress management.

Deep breathing photo available from Shutterstock

Marie Hartwell-Walker, Ed.D. <![CDATA[Four Fundamentals for Raising Competent Kids]]> 2015-10-05T19:48:18Z 2015-10-06T17:45:50Z ]]> My four adult kids joke that the reason we had a large family was to ensure that we had free labor around the house. They goodnaturedly complain that by the time they were 6, they were involved in household chores and work in the yard. They’re right. Guilty as charged! Yes, we did put them to work early and often. The end result is that they also brag that they know how to do things that many of their friends are clueless about.

They know their way around a toolbox, a fuse box and a hardware store. They aren’t flummoxed by badly written instructions for putting together anything that needs putting together. They know how to jumpstart a car without starting a fire (as a couple of their friends did). By the time they left home, all four of them could cook basic meals, do laundry, clean a bathroom, tend a garden, paint a room and fix things around the house. Oh, now that they are out on their own, they may choose not to do such things. (Neither of my daughters voluntarily cooks. My sons often let cleaning go until expecting company.) But they know how and there is pride in the knowing.

I’m sure we’ve made many mistakes as parents (as I’m equally sure my kids would be glad to attest). But my husband and I are pleased that we’ve raised young adults who have the skills needed to take care of themselves and the satisfaction that goes with it. They are competent and confident — attributes that help them be successful in any relationship or activity that matters.

Studies confirm our instincts that doing chores while they were growing up mattered. (I love when that happens.) In a long-term study of men by Harvard University researchers, it was found that “childhood industriousness” (having tasks outside and in the home) is an important factor in predicting a successful adulthood. In his studies, Dr. Marty Rossman, a professor of family education at the University of Minnesota, has determined that being expected (and taught) to do chores from an early age has a direct impact on becoming a well-adjusted adult.

Why? I think it’s because kids who’ve been raised with experience in successfully managing household chores develop a fundamental belief in themselves as capable human beings. As the kids develop skill in doing increasingly challenging tasks, their competence and self-confidence can spread to managing money, time and stuff; maintaining relationships with family, friends, and partners; and generally making good choices and decisions. Problems, whether with objects or with people, are seen as issues to solve, not as an assault on their self-worth.

Competence isn’t one of those inborn traits. It’s learned. It requires us as parents to model and teach the skills children need to grow up feeling, and being, capable of handling life’s many challenges. Here are some ideas gleaned from our efforts to raise competent kids:

  1. Promote a can-do spirit.
    Parenting competent kids requires modeling that setbacks are not reason to fuss, swear, or give up. They are problems to be solved. Oh, OK. Everyone is allowed a little fussing and maybe even a little cussing when things don’t go our way. The inclination to throw up our hands and want to give up is only human. But after we’ve done all that, the problem is still there.

    It’s important to show our kids the tremendous satisfaction, even joy, that comes with overcoming an obstacle or mastering a new skill. Teach your kids to take a deep breath, to analyze the situation and to think of ways to approach it. Most problems can be managed, either by working at them or by finding appropriate help.

  2. Take time for training.
    You’ve probably heard the proverbial expression: “Give a person a fish, and you feed him for a day. Show him how to catch fish and you feed him for a lifetime.” It’s true. Fixing our children’s problems for them may relieve the immediate stress, but it doesn’t help them learn to handle things on their own.

    Yes, it’s often quicker and easier to just do it. But that approach does not foster a sense of competence (except competence in getting mom or dad to do something). Whenever possible, it’s important that we take the time to patiently, calmly teach whatever skills are age-appropriate so the next time whatever it is happens, the kids can do it (or at least more of it) themselves.

  3. Provide lots of practice.
    Most skills of daily living aren’t learned at one go. Whether it’s setting the table, doing the laundry, saving for much-wanted and expensive new sneakers, fixing a broken toy or mending a relationship after a fight, kids need us to break the issue down into learnable steps and to encourage them to do pieces of it on their own. A useful teaching model is “Watch me, assist me, do” with as many repetitions as a kid needs.
  4. Model asking for help.
    Sometimes we can fix an appliance, recover from a loss, illness or an addiction or repair a huge mistake on our own. Sometimes we need a mechanic, doctor, or therapist to help. Competent people do their best but also acknowledge when their best isn’t good enough. Their pride doesn’t get in the way of asking for some instruction or assistance when a problem is beyond their own skills. Raising competent children requires making such decisions a visible process. It means trying our best but also explaining how to know when it’s wiser to admit our incompetence and call in some help.

Gardening photo available from Shutterstock

Eric Bakker <![CDATA[The Gut-Stress Connection]]> 2015-10-01T19:01:15Z 2015-10-03T17:35:36Z ]]> We’ve all heard that stress can make you physically sick, and the mounting evidence yielded by reputable scientific studies continues to reinforce that claim. Specifically, the gastrointestinal (GI) system — or gut — has a direct interaction with the brain and emotional health.

Terms like “gut-wrenching” and “butterflies in your stomach” are our attempts to describe the physiological reactions of our natural gut microflora to these alarm signals sent from the brain when facing stressful situations. The brain says “React!” and the gut responds with “OK!” When gut microflora is thrown out of balance for any reason, a domino effect of health problems begins to occur, and stress is usually a major culprit in this scenario.

The accumulation of even low-level stress over time can tip the balance of the gut microflora, ultimately throwing various body systems into disorder. Some of the resulting health issues stemming from stress-triggered microflora imbalances include irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Candida overgrowth/yeast infections, food allergies and intolerances, and chronic autoimmune disorders like Crohn’s disease, Grave’s disease and others. All of these conditions are at minimum quite unpleasant, and when left untreated can lead to catastrophic health problems.

Does stress cause gut problems? Or do gut problems cause stress? The answer is both. Stress leads to illness, and illness causes stress. Until that cycle is interrupted, feeling good again can seem out of reach for those stuck in the stress-illness-stress quagmire.

Stress has existed since the dawn of humanity as a necessary function for survival. In prehistoric times, stress — especially fight or flight response – was an important life-saving mechanism to help people avoid being eaten by predatory animals.

Modern life, however, has ushered in a plethora of new stressors. While some are still survival-related, the stresses we experience today have less to do with succumbing to animal attacks and more to do with surviving the faster pace of 21st-century life.

Just a few decades ago, who could have imagined the emotional impact that being “unfriended” on Facebook could have? Equally, the thought of having every tragic event broadcast live at your fingertips was unfathomable. Even people who remain disconnected from the electronic universe find themselves in a world fraught with perceived fears and urgencies at almost every turn. Sometimes it’s enough to “turn your stomach.” You see the connection?

Although it’s hardly a new issue, some of the biggest stresses we face involve other people. Extra stress can be generated by interpersonal relationships, whether it’s family, loved ones, friends, co-workers, a cranky neighbor, or even a difficult person online. The stresses created by these relationships can range from very mild and occasional to severe and often. Whatever the severity, the stomachache you experience after an argument is no coincidence.

The faster pace of life today can leave very little free time for relaxing, spending quality time with loved ones, or cooking. Consequently, fast food has become the norm for millions of people, though the convenience of these quick bites has a price beyond dollars. Most fast food is highly processed and unhealthy in various ways, thus leading to gut imbalances much more quickly.

Too often we’re also rushed to devour our meals quickly so we can get back to the demands of life. Your digestive system is programmed to react aggressively, so when the gas, bloating or stomach pains hit you, they shouldn’t come as a surprise. Your gut is in battle mode, and battles are never pleasant.

Multitasking is now the norm. Completing several jobs at once is often required in work environments due to economic pressures and downsizing. Many have said “I’m doing the work of 10 people,” and many are not exaggerating. While technology has streamlined some processes, most overtasked people experience high stress over racing the clock to finish all of that work before they can take a break. Consequently, many people end up eating at their desk while working, which is no break at all. Again, the gut reacts and the dominoes continue to tumble.

Like speed-eating, stressful eating is equally harmful to gut health. For many people, quality time at the dining table has become a rarity due of busy schedules, so eating on the run is not uncommon.

It’s quite surprising how many people – especially working women with kids – skip breakfast. By the time they do have a meal, whether it be lunch or dinner, they are starving and tend to overeat. People who skip breakfast are also more likely to consume more sugary drinks, processed snack foods and chocolate, looking for an energy boost. The digestive system races back into red alert mode, sending distress signals to the brain.

People who eat later at night are forcing their bodies to work when their systems have already begun preparing to rest. Imagine being in bed ready to drift off to sleep, only to be rudely jolted back to full consciousness by a fire alarm. Similarly, your gut is naturally stressed by the incoming-food-after-hours alarm, and is not likely to react well to such an event.

Many people rely on caffeine to keep them going throughout the day. On the other end, many people also rely on alcoholic beverages to escape the stresses of the day. Both scenarios can wreak havoc with our nervous and digestive systems, ultimately resulting in an imbalance of the HPA (hypothalamic-pituitary-adrenal) axis. As the HPA axis becomes increasingly compromised, our immune system becomes incrementally compromised, as well. This open the doors to a host of other health problems exacerbated by weakened immunity, including infectious diseases, autoimmune disorders, and even some types of cancer.

As conscious humans, we cannot completely eliminate every shred of stress from our lives. However, we can take effective measures to reduce our stress levels to a manageable point, which can bring surprisingly rapid relief from many of the physiological symptoms caused by mental stress.

  • Devote at least 20 minutes daily to a relaxation exercise.
  • Reduce caffeine and alcohol consumption.
  • Resolve personal issues with those causing you upset.
  • Make time for proper meals and quality time with loved ones.
  • Modify your diet to eliminate highly processed food products.
  • Certain herbs, minerals and supplements may help you relieve stress. Amino acids, chamomile, green tea and valerian root, among others, have shown to be helpful in stress reduction.
  • Exercise.
  • Step away from the devices whenever possible.
  • Consider counseling or stress management training.

Stomach ache photo available from Shutterstock

Margarita Tartakovsky, M.S. <![CDATA[Clinicians on the Couch: 10 Questions with Therapist Joy Malek]]> 2015-10-01T19:00:04Z 2015-10-02T17:35:44Z ]]> Joy Malek
Every month for the last few years we take a rare behind-the-scenes look at how therapists do what they do. Rare because how often do we get to peek inside a therapist’s office and personal life?

In this series, clinicians reveal everything from what they love about working with clients to the most challenging part about being a therapist. They also reveal if they’d take the same professional path again, and how they personally cope with stress. They share the biggest obstacle for clients, along with the one thing they wish they knew — and much more.

This October we’re pleased to present our interview with Joy Malek, M.S., a licensed marriage and family therapist in Pasadena, Calif. Malek is the founder of SoulFull: Psychotherapy, Life Coaching & Creative Workshops.

She specializes in working with Deep Feelers — people who are intuitive, empathic, creative, deeply sensitive, and singularly able to mine even their most painful experiences for the gold of wisdom.

Learn more about Malek at her website

1. What’s surprised you the most about being a therapist?

The biggest surprise has also been the biggest gift — that pursuing the practice of helping others has paved a path to my own healing. I remember the moment, as an undergraduate, when one of my professors announced to the class, “If you want to be a good therapist, you’re going to need to be in your own therapy.”

I was 21 years old, and I’d chosen this field because helping others seemed to be what I was born to do, but I took her statement as gospel and got myself into therapy. I’ve received a lot of incredible and indispensable clinical training, but the heart of what I have to give comes from my own wounds and my own healing.

The best way to have something meaningful to offer as a therapist is to pay attention when our own raw spots are activated, and to do the hard work that we ask of our clients.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

Hold Me Tight, a guide for couples to establishing secure connection with each other. The author, Sue Johnson, challenges the belief that maturity means outgrowing the need for others. It turns out that an emotionally safe connection with someone else is exactly what we need to become confident, resilient and secure!

3. What’s the biggest myth about therapy?

It’s no wonder to me that many people feel reluctant to try therapy, since it’s been popularly defined as a treatment for mental disorders. How awful to be in the depths of your pain, and feel that the only way to get help is to label yourself in such a way that just creates more shame.

Psychotherapy is simply a contemporary path to personal growth, in a long line of healing traditions that span history. Its potential for facilitating transformation is profound. For myself, and many of the clients I’ve worked with, therapy is a space in which we can finally understand the most challenging parts of ourselves, understand the value of these parts, and begin to work with them instead of against them.

4. What seems to be the biggest obstacle for clients in therapy?

Probably shame. We tend to believe that our most vulnerable places of need are the most undesirable to others. So, we understandably try to avoid showing these qualities to others, and even avoid looking at them in therapy.

It’s just too painful, and we’re too sure of rejection. The truth is that when we hold our naked vulnerability out to someone who cares about us, without defending, blaming, or otherwise pushing that person away, we are at our most lovable.

5. What’s the most challenging part about being a therapist?

Right now the most challenging part is modeling the vulnerability that I want my clients to treasure in themselves. We therapists can get caught up in feeling like we need to be the “exception” to the rule — we need to appear strong, poised and put-together no matter what is happening.

The truth is, that sometimes we are tired, ill, or unsure. Without burdening our clients, there can be something powerful about a therapist acknowledging when she’s less than at her best — instead of pretending — and inviting a more authentic exchange.

6. What do you love about being a therapist?

I am a Deep Feeler, and I love my work with other Deep Feelers, who tend to be intuitive, empathic, creative, and deeply sensitive. Life often hits us hard, but we’re also uniquely equipped to emerge from even our most painful experiences with insight and wisdom. Deep Feelers commonly feel wired differently from others and rather alone.

So, there is a privilege to being trusted to walk with someone during their deepest moments of pain and confusion, and to help them see the exquisite beauty in the way they’re wired. When I know I’ve connected — this person senses that what they’re feeling as real to me as it is to them — it’s a sacred moment.

7. What’s the best advice you can offer to readers on leading a meaningful life?

Honor your wounds. It’s probably one of the hardest things one can do. But it makes the difference between a life acted out unconsciously — running from the parts of ourselves that are hard to bear — and living a conscious life, in healing relationship with all our parts.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

I wish I could remember the author of a wonderful article I read several years ago about career paths. He was a psychologist and a former engineer, and he applied the so-called “Drunkard’s Walk” of mathematics to his own unexpected sojourn into psychology. He concluded that those with the happiest careers usually stumble quite randomly upon them. This rings 100 percent true for me.

I was pursuing an entirely different major in college, with a vague sense of unease, when I came across information about a counseling-track Bachelor’s degree. Within 48 hours, I’d made the decision to switch schools, change majors, and adopt a completely different vocation.

But it was right. Were I to start from scratch pursuing this career path today, I’d pick a different school, simply because I’m not the same person I was when I was 21. But it was that college, and then that graduate program, and then those training sites, etc., that led me to a life’s work that resonates on the deepest level.

9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be?

That the deepest healing in therapy happens within the therapy relationship. Paradoxically, it’s those moments of feeling that the therapist doesn’t get it, doesn’t care, or isn’t there for you that hold the greatest potential. Often clients try to ignore those moments, not rock the boat, and keep going, but it’s the process of having a wound repaired that can be most transformative.

10. What personally do you do to cope with stress in your life?

I swim; hike; read; call my nearest and dearest; cuddle with my cats; watch TV (I know that’s out of fashion to admit, but let’s be real!); work on something I care about; and most recently, watch video lessons by my favorite business coaches on Periscope.

Marie Hartwell-Walker, Ed.D. <![CDATA[How Many Friends Do You Need?]]> 2015-09-28T23:52:50Z 2015-09-29T17:45:31Z ]]> Among the most poignant letters I receive as an advice columnist are those from lonely people. Here are some typical samples. The letters are real but I’ve changed names to protect privacy.

From May, a 14-year-old girl in middle school: “I used to have tons of friends in elementary school but now I only have three friends I’m close to. What’s wrong with me?”

From a new mom, let’s call her Angela: “I’m the first one in my group to have a baby. I can’t go out partying anymore. Actually, I don’t want to. But I’m losing my friends. My husband is terrific but he’s gone all day. The baby isn’t much of a conversationalist yet. What do you suggest?”

From a high school guy, Ron: “I know a lot of people but I don’t think I have a real friend. I mean, I help people out when I can and I’m on several teams but I don’t think there is anyone who would help me. Why can’t I connect?”

From Harvey, an 80-year-old man: “Most of my good friends have died. I never thought I’d be the last one standing. My kids are all too busy to want to come over very much. If it weren’t for the guy I play chess with, the only people I’d talk to all week would be the paperboy and the guy who gives me coffee when I go to the drive-through window. How does a person my age find new friends?”

Why are these people longing for connection when they are plenty busy? Because it’s a fact: People are social creatures. We need other people in our lives to feel most ourselves, to be happy and even to be healthy.

It’s no wonder that advice columnists like those of us on PsychCentral get so many letters asking what to do to find friends, keep friends and make better friends. People want more than just to get along. They want to feel connected — at least to a few people they can feel close to and with whom to share the events of their lives and their confidences.

Robin Dunbar, an evolutionary anthropologist in England, has made a study of how many people the average person knows. He and other researchers have found that on average people are connected in a variety of ways to a total of about 148 others. He rounds it to 150 for simplicity’s sake. It doesn’t matter if we’re talking about hunter-gatherer societies, businesses or Facebook, people seem to be able to connect with no more than about 150. Even those who claim to have 1,400 followers on Twitter or Facebook actually only consistently interact with about 150. (Dunbar theorizes it has something to do with our brain’s capacity, but that has yet to be tested.)

Dunbar isn’t suggesting we all need 150 friends. That’s the total number of all the different kinds of people with different levels of connection that we generally recognize as being somehow involved in our lives. Within that number are levels of connection that are important in different ways.

Imagine Dunbar’s theory as a target. You are in the bullseye. In the next circle out are the people who are most dear to you. On average, people have three to five close, personal relationships. That’s all. Those of you who worry that you only have a few close friends can relax. You are well within normal. Of course, an average is the midpoint of any group. So some people have more than three, some have fewer.

As you move out from the center, each concentric circle has more people but with less meaningful connection. After the close friend group, the next ring generally has about 15 people who matter — usually relatives, mentors, and friends who don’t quite make the inner circle but still mean a lot. We see them less often than those in the center group but the relationships are warm and reciprocal in some way. They are the kind of people who seem to be in ongoing conversations with us that are interrupted by long periods of silence. When we get together again, it’s as if we never left off.

The next ring has about 50 people, typically friends of friends we’ve gotten to know a bit and people we see regularly but don’t count as our own friends. Perhaps you’ve met them multiple times at a mutual friend’s parties. Maybe you’ve served on a committee with them but never followed up to get to know them better. Or perhaps they are the people we see regularly at our kids’ soccer games.

Finally, there’s an outer ring of other people we recognize by sight as part of our community but we don’t relate to much, if at all. They are the people we recognize when we see them in a crowded mall or say hi to when we bump into them at a concert. If you are at all active in your school or community, you may have more acquaintances than you think you do — probably a number that will bring your total of all the rings to about 150.

All of the rings in the circle are important. Feeling that we are at least recognized by a substantial number of people in our community or school (whether the paperboy, the barista at the coffee shop, the cafeteria lady or the school crossing guard, for example) is part of what makes us feel at home. Having a few folks in that innermost circle of intimacy is what makes us feel valued and loved. I’m betting that, if pressed, Ron, Harvey and Angela can identify a number of people in most of the outer circles. Their problem is the lack of enough people in that first circle.

Feeling lonely when the population in the inner circle dips below two or three is normal and appropriate. That feeling of loneliness is a signal from our inner wise self that we need to do something to reconnect to feel good. We don’t need a ton of friends but we do need a few. We don’t need to sit at the metaphorical popular table but we do need to have connections within our community or school.

Fortunately, other people need friends too. The trick is finding each other. That inner group of people isn’t going to come knocking on the door. The key to getting connected is getting active.

Sometimes all it takes is making the time to bring people from one of the outer circles inward. An invitation to have coffee, to attend a community event or to go for a walk is all that’s required to set things in motion.

Sometimes connecting requires us to actively, purposefully set out to meet new people by doing new things. Sometimes it takes the willingness to risk rejection by trying to get to know a particular person better.

Let’s go back to our letter-writers. Harvey, for example, could expand his circle through his passion for chess. He might ask his chess partner to be sure to introduce him to some other chess players he knows. Or maybe he could volunteer to start or help with a local chess club.

Angela needs other new moms to talk to. If she asks around, she might find that there is already a social group for young mothers in her town. If not, she could start one. She’ll quickly find that she’s not alone. Most new mothers are hungry for the support that comes with connecting to others whose kids are in the same life stage. What starts as a support group of strangers often evolves into a group of lifelong friends.

Ron has plenty of people in outer circles. He needs to take some steps to bring some people in closer. He already has much in common with other guys so he could reach out to those he likes best. He could ask teammates to go for a soda after a game, or to watch an important game on TV. He could ask someone whose skills he admires to stay after practice to give him some pointers. It would be a start.

As for May, she needs to relax. Kids change as they mature so it’s not at all unusual for some elementary school friends to drop away. Now in middle school, she already has three important friends. If she wants more, she could encourage her group to get involved with activities at school. That would add people to Dunbar’s outer circles – the very people who might naturally become part of her inner group.

By gathering up a bit of courage and daring to take action, acquaintances can become friends and new people can be added to our friendship circle. As poet William Butler Yeats said, “There are no strangers here; only friends you haven’t yet met.”

For more detailed advice about how to make new connections, see Dr. Marie’s book, Unlocking the Secrets of Self-Esteem.

Chess player photo available from Shutterstock

Stan Rockwell, PsyD <![CDATA[How to Live Well with Chronic Pain & Illness: A Mindful Guide]]> 2015-09-17T16:39:19Z 2015-09-28T18:38:56Z I have been drawn to Toni Bernhard’s work because of the history of chronic illness in my family and because of the Eastern tradition she brings. This time, in her […]]]>

I have been drawn to Toni Bernhard’s work because of the history of chronic illness in my family and because of the Eastern tradition she brings. This time, in her third book, How to Live Well with Chronic Pain and Illness, “mindful guide” has replaced “Buddhist-inspired” in the subtitle, but much of the techniques and flow recall her previous publications. Still, although this newest book does go over some territory she has covered before, it is also in many ways more personal than the first two books in the trilogy, so makes a good addition for those who have been following her work. How to Live Well can also stand on its own.

Filled with experiences from Bernhard’s own life and the lives of those who have contacted her since her first book, this latest text offers a broad range of solid practical advice.
Bernhard has talked about her frustration with the medical system before, and how those with Chronic Fatigue Syndrome (CFS) are too often not taken seriously. She wishes for a better label, one that is a more fitting description of the illness. There is a proposal to change the name to systemic exertion intolerance disease — and CFS is sometimes now referred to as myalgic encephalomyelitis. But those names don’t solve everything, because labels don’t capture suffering well.

Plus, as Bernhard writes, many of us are quick to judge. Those with chronic illness too often have to put up with well meaning comments that totally miss the mark. People say things like, “I get fatigued, too. Wish I could stay home all day!” Even comments like, “You look great, how could you be sick,” can sting hard.

Meanwhile, when it comes to doctors, other issues arise. Physicians are trained to heal, but chronic disease is often about maintenance — no big change for the better. A victory is holding your own. Some doctors can’t handle the fact that there is no quick fix for their patients.

Bernhard and those who have shared their stories with her call for empathy. It is extremely difficult for folks to feel helpless, both those who are ill and those who want to help. You do not know what to say or do. The stories here give a guide to what to say and do or not say and not do, and how we can help — but Bernhard acknowledges that it can be a balancing act that takes practice and adaptation to change. Even she has times when she doesn’t remember “how to be sick.” Two feelings that come through again and again in her work, then, are compassion and respect for yourself and others.

And there is wisdom in this book for everyone, even apart from those dealing with illness at the moment. For instance, it is easy to get wrapped up in regret and guilt about the past or worry about the future. Bernhard provides an exercise inspired by Thich Nhat Hanh that she calls “drop it.” If you find yourself presently stuck in regret about the past or worry about the future, you tell yourself, “Drop it.” But you don’t stop there. If you did, those worries and regrets would try harder to come back.

Once you drop it, she writes, you can immediately begin to ground yourself in the present by paying attention to what you are currently seeing, hearing, feeling, and to whatever else is in your awareness. It is a simple exercise that is quite powerful, but it does take practice. I have already recommended it to clients I work with, and I use it myself.

Other areas Bernhard covers include longing for the good old days, loneliness, issues faced by young people with chronic illness, complaining, embarrassment, dealing with the change in your identity, and setting limits. She gives extensive resources and guidance for caregivers as well.

She also mentions a couple of Buddhist practices by name. Tonglen is the breathing in of suffering and breathing out of compassion. If the former is difficult, you can focus on breathing out compassion. Mudita is taking joy in the happiness and success of others — as opposed to feeling envy and resentment. Both are powerful meditation and mindfulness practices that anyone can use to bring more serenity into their lives and increase their feeling of connectedness in this world.

Bernard has a friendly writing style. The chapters are short and focused, and she speaks to you almost as if you are sitting across the table from her. She talks about living skillfully, and her writing is skillful. I appreciate her work very much and her courage to share her struggle with the rest of us.

How to Live Well with Chronic Pain and Illness: A Mindful Guide
Wisdom Publications, October 2015
Paperback, 352 pages

Bella DePaulo <![CDATA[The Odd Woman & the City: A Memoir]]> 2015-09-17T16:36:10Z 2015-09-27T18:35:43Z Vivian Gornick’s The Odd Woman and the City is a brief, beautifully rendered memoir by one of the premier writers of our time. Odd Woman is about solitude and friendship, […]]]>

Vivian Gornick’s The Odd Woman and the City is a brief, beautifully rendered memoir by one of the premier writers of our time. Odd Woman is about solitude and friendship, and the sustenance, meaningfulness, and connection Gornick has found while walking among strangers in the streets of New York. Day after day she walked, up to six miles at a time, “to clear my head, experience street life, dispel afternoon depression.” For three decades, she kept notes, then threaded them into this, her twelfth book.

There are no chapters in Odd Woman. The book is an unfurling of brief vignettes, conversations, observations, insights, and ruminations on literature and art, places and spaces, feminism and friendship. Readers can pick it up when they have just a few spare moments, or savor the whole thing in one luxurious sitting. The structure of the book mimics the experience Gornick describes: traversing the streets of the lively, cacophonous city, stopping now and then to engage or just observe, or walking dreamily for long stretches, more attuned to the fantasies within than to the life out on the sidewalk.

As a social scientist with a scholarly interest in friendship, I like to learn from rigorous research studies. Some of the best ideas for research, though, come not (just) from theory but also from the personal stories and glistening observations that enliven memoirs such as Gornick’s

The most important friendship in Odd Woman is with Leonard, a gay man with whom Gornick has rendezvoused once a week for decades, to walk and talk. How she describes her relationship with him offers potential insights about all of our closest friendships. For example:

  • “It’s the way we feel about ourselves when we are talking that draws us so strongly to each other.”
  • “The self-image each of us projects to the other is the one we carry around in our heads: the one that makes us feel coherent.”
  • “We walk on together, side by side; silent; mirror-image witnesses, each of us, to the other’s formative experience.”

With Emma, a woman different from Gornick in many ways, yet with whom she sustains an intense friendship, Gornick experiences another blessing bestowed by friendship. “The more we explored the immediate in service to the theoretical — a chance encounter on the bus, a book just begun or just finished, a dinner party gone bad — the larger the world seemed to grow.”

You won’t find Gornick effusing about the safe place friendship provides for the disclosure of our most shameful secrets. She prefers the model of friendship that prevailed long ago. “For centuries,” she writes, “this was the key concept behind any essential definition of friendship: that one’s friend is a virtuous being who speaks to the virtue in oneself.”

Gornick believes that friendship is vital to romantic relationships: without it, even the most passionate sexual connections will never be enough. She believes, too, that meaningful conversation is essential to friendship — and, really, to life. But she is not sentimental about friendship or anything else. She notes that her friendship with Leonard is powered by their shared sense of grievance, and a little of that goes a long way. In addition to describing a long lost friendship that resumes with new intensity, and a fraught friendship that heals itself over time, she also relates the unexpected shattering of that cherished friendship with Emma.

Gornick has been married twice, for just for two and a half years each time. Her memoir has the sensibility of the single person that she has been for nearly all of her life. I had expected it might. In one of her essay collections, The End of the Novel of Love, Gornick decries the smallness of novels that lean too heavily on a characters belief in the transformative power of romantic love. In Odd Woman, she places herself among the feminists of her time (odd women who, as she puts it in a recent interview, “can’t make our peace with the world as it is“) who raged against the prevailing mandates to marry and have children. She tells the stories of neglected women of letters who stayed single for life. When she describes her mother’s experience of marrying her father — “a cloud of obscurity lifted from her soul” — Gornick is critiquing that mindset, not praising it.

At its core, Odd Woman is about the city that nourishes the author, in all of its gritty and sublime manifestations. Gornick prefers the “crowded, filthy, volatile West Side” to the “calmer, cleaner, more spacious” East Side. Wherever she roams, though, she returns to her one personal truth: “>I was never less alone than alone in the crowded street.”

The Odd Woman and the City: A Memoir
Farrar, Straus and Giroux, May 2015
Hardcover, 192 pages

K.M. McCann, PhD <![CDATA[A View From a Lake: Buddha, Mind & Future]]> 2015-09-17T16:31:18Z 2015-09-26T18:39:50Z It is rare to read manuscript that cuts through expectation and forces the calibrated critical eye to step aside. But that is precisely what Neil Hayes’s A View From a Lake did […]]]>

It is rare to read manuscript that cuts through expectation and forces the calibrated critical eye to step aside. But that is precisely what Neil Hayes’s A View From a Lake did for me. Rarely have I been so moved — and, dare I say, inspired — by a book.

Hayes, who holds a doctorate in psychology from Oxford and who has meditated for many years and studied with Buddhist monks, offers up a buffet. He brings in philosophy, psychology, physics, theology, history, and even computer science. There are no quick fixes or marketed programs within this book that promise to lead the reader to equanimity and peace of mind.

What Hayes does offer is a robust look at Buddhist psychology and how it differs dramatically from the Western notion of the mind. He provides the historical framework of how our Western notions originated, how they have persisted through the years, and, most importantly, how they have led to pain, suffering, and general unhappiness. But his is a book that does not judge; it merely paints a picture and invites the reader to see for herself.

There are far too many important points to cover in such a short review, so I will focus, primarily, on Hayes’s suggestions for proper handling of low mood. The main research that he draws upon here is how rumination fans the fires of depression and anxiety, and how the simple act of smiling, whether genuine or not, can lead to a noticeable elevation of mood.

The rumination factor, sometimes referred to as brooding, is, Hayes writes, an example of how the thinking mind runs rampant and leads the experiencer toward the depths of despair. No one is served from obsessively focusing on the past, nor is anyone served by living for the future. The only moment we have is the present one, Hayes writes. Although there will be times of pain, sorrow, or other distressing emotion, the key to managing those feelings is to set aside attachment, resist the urge to ruminate and problem-solve, and simply view these feelings for what they are — sensations within the body.

Part of the flaw in Western thinking is the belief that our mental styles happen to us, Hayes writes, when, in reality, they are created by us. “When a feeling of, say, sadness enters your body,” he explains, “your mind will seize upon it and add a thought such as ‘I failed to achieve such-and-such,’ or ‘I am worthless.’ Before you know it, your thinking mind will have summoned up despair, or worse, and you cannot break the escalating cycle.”

The belief of happening to is so deeply engrained in our culture that our language tacitly supports it. For example, we say that we are “under stress” rather than that we are “doing stress.”

Instead, Hayes writes, we can choose to look at feelings as just feelings. And becoming aware that they are just that, and distancing ourselves from our emotions, “may even be sufficient to prevent you falling into the emotional state at all.” Not only are thoughts, and therefore emotional responses to those thoughts, within our control, he writes, but it is our responsibility to manage them. And it is only by managing them, through mindfulness, that we can liberate ourselves from the ego mind, harmful attachment to selfhood, and suffering.

The thinking mind, says Hayes, presents us with the conundrum of “constantly measuring the gap between how things are and how it desires them to be.” We compare and compare, and we are usually not happy with what we find. As Hayes puts it, “people suffer according to the extent to which they live their lives experiencing this gap.”

The solution is to cultivate mindfulness, or, if you like, the practice of being aware of how our emotions and thoughts directly influence our moods and therefore our response to the world.

Much has been written on the practice of mindfulness, and Hayes also offers guidance on the subject. His guidance, however, is not layered in jargon surrounding a proper technique; instead, his is a straightforward method of breath focus, awareness, and the art of simply letting go. The intent of A View From a Lake is not to instruct the reader on the fine points of meditation and Buddhist psychology, but to translate the inherent value of those practices into terms that are both understandable and perhaps palatable to our otherwise reductionist Cartesian-based approach. Hayes’s book is a practical glimpse, though a thorough one, into the history, science, philosophy, and psychology of mindfulness — and, indeed, a must-read for anyone interested in liberating the mind from suffering.

This is, by far, the most profound and important book that I’ve had the pleasure to review in many months. To call it self-help is absurd, especially since the point of the book is to release selfhood and find peace in the equanimity of no-self. That is a complicated concept, I know, but it is a concept that, after reading A View From a Lake, any serious reader will appreciate and, hopefully, put into practice.

A View From a Lake: Buddha, Mind and Future
Troubador Publishing, April 2015
Paperback, 408 pages

Claire Nana <![CDATA[Clearing the Haze: Helping Families Face Teen Addiction]]> 2015-09-17T16:24:01Z 2015-09-25T18:28:43Z I once read that the national cost of addiction and all of its related effects is second only to the money we spend on national defense. With this in mind, […]]]>

I once read that the national cost of addiction and all of its related effects is second only to the money we spend on national defense. With this in mind, Christian Thurstone and Christine Tatum’s new book, Clearing the Haze: Helping Families Face Teen Addiction, is both timely and relevant.

The book zooms in on the many dynamics that can either contribute to a teen’s substance abuse problem or help them recover from it. And as a psychotherapist who has spent years working in the field of addiction, I found it to be a refreshing read. Packed with interviews from those who have recovered from teen addiction as well as from treatment providers who specialize in it, the book addresses both the larger, more troubling questions about addiction — such as how to know if your child is using — as well as the often vague and equivocal subject of just what to say to your teen about drugs.

Beginning with a look at why teen substance abuse is such a big deal, Thurstone and Tatum draw on biological science to help us understand how the premature reward circuit in a teen’s brain, coupled with the delayed development of the prefrontal cortex, sets up an adolescent to respond favorably to the impulse gratification drugs offer.

The authors point to recent data, writing that “the lifetime odds of alcohol dependence decrease by 14 percent for each year the onset of alcohol use is delayed.” Likewise, when people start to have a dependence in their younger years, it’s serious.

Thurstone and Tatum then further explore the effects of a variety of drugs on adolescents. Among these effects, they suggest, are academic problems, such as the fact that youth who use marijuana by the age of fifteen are four times less likely to complete high school.

Once we understand the enormity of the problem, Thurstone and Tatum then present the tools parents need to go about addressing it. Among them: the appropriate amount of vigilance.

Here, the authors encourage parents to be aware of a teen’s access to substances, the social acceptance that they themselves as parents have of substance use, and the perceived risk of harm they associate with using drugs. Parents should “be inquisitive and not accusatory,” Thurstone and Tatum write. They should also act proactively with their teen to discuss difficult situations ahead of time. And when it comes to the dicey subject of whether or not to drug test your own kids, the authors give us pros and cons, ultimately reminding parents that they “will need to decide what works best for their family.”

Should a drug test come back positive, Thurstone and Tatum address how a parent should handle it. Attacking the common errors parents make in communicating, such as lecturing, storytelling, and placating, the authors present us with the three C’s of effective communication about drug use. That is, you didn’t cause it, you can’t control it, and you can’t cure it. With that in mind, Thurstone and Tatum explain the nuts and bolts of “Attachment Communication Training,” which includes first establishing ground rules for communication, understanding the difference between effective and destructive communication, practicing listening skills, and removing the common blocks to communication.

When it comes to treatment, the authors offer sound advice about what to look for in treatment providers, what to expect during treatment, and how to handle family sessions. And they walk parents through the spectrum of mild to much larger problems with drug use, as well as how to differentiate between them. The book draws on the National Institutes of Drug Abuse guidelines to help parents understand the five key questions to ask a treatment provider. For instance, is the duration of treatment sufficient?

Most addicted people, Thurstone and Tatum write, “need at least three months in treatment to really reduce or stop their drug use.” And, they write, longer treatment times are associated with better outcomes. Therefore, one of the more important skills a parent can have is patience.

Still, according to the authors, a parent should also adopt an authoritative stance, though avoid “falling into the traps of being too authoritarian, passive or neglectful.” Parents should be realistic, too. They should, according to the authors, seek to maintain “behavioral control, and not psychological control,” set realistic goals for treatment, be healthy role models, communicate clear expectations about substance use, and maintain appropriate self-care and boundaries.

Substance abuse is a chronic condition, Thurstone and Tatum remind us: one for which parents should have a “recovery protection plan,” and one that requires that parents have appropriate self-care themselves.

Clearing the Haze: Helping Families Face Teen Addiction
Rowman & Littlefield, July 2015
Hardcover, 182 pages

Caroline Comeaux Lee <![CDATA[Shades of Blue: Writers on Depression, Suicide & Feeling Blue]]> 2015-09-17T16:29:16Z 2015-09-24T18:34:11Z Blue comes in many shades, just like sadness and depression. There is the muddled color known as queen blue that casts a disorienting fog over life. This hue can slip dangerously into shadow […]]]>

Blue comes in many shades, just like sadness and depression. There is the muddled color known as queen blue that casts a disorienting fog over life. This hue can slip dangerously into shadow blue, a color that swallows you into the murk. Then, there is Yankees blue, made famous by the baseball team. Sure, the name sounds patriotic, even possibly celebratory. But this is one of the darkest shades of blue, a blue that borders on black. Here is where the precipice lies: Do you fall over and succumb to the black, or hang on to the shred of blue that perhaps supplies some level of hope?

These hues are described in Shades of Blue: Writers on Depression, Suicide, and Feeling Blue, a collection of essays edited by Amy Ferris. Ferris is an author, screenwriter, editor, and playwright who, in her introduction, recounts her own battle with depression. The essays she has gathered are a way of saying “I know how you feel” and “You’re not alone” to readers who suffer from depression or suicidal thoughts. And, they provide insight for those who don’t have a firsthand understanding of this level of despair and loneliness.

The contributors artfully elaborate on hidden details. One writer unfolds the movement of pulling a trigger to reveal the excruciating moments just before, the sobs that tore through the night, the despair that left someone paralyzed in their bed. Another unpacks the treasured moment of holding a child to show the blinding heartache of being unable to hold that child as a baby while trying to recover from a near-death delivery. These stories provide the voice, the cry, and sometimes, the scream that is within many individuals.

Not every essay talks about a desperate person’s suicide attempt, though some stories do look at suicide from the perspective of the person desiring it or the viewpoint of those whose lives are indirectly affected by it. Some of the writers tackle AIDS, cancer, and grief. There are happy endings, and there are not-so-happy endings. Each writer provides an empathetic voice to those who have been in the pit without a ladder, and each paints with words a picture that holds the depth and richness of Van Gogh’s “Starry Night.”

Some of the lines I read spoke directly to thoughts I have had, while others were just such beautifully coined phrases that I wanted to underline and remember. I could not help but think of the ones I have lost to suicide — people who maybe, just maybe, would have found some comfort in the pages of this book (though perhaps that is just a bit of survivor’s guilt talking). The essays are raw, realistic.

“What is wrong with me is not a bump in the road,” one contributor writes, “or a case of the blues, and it is not something that can be addressed by the right herbal tea. It is not a pot hole, it is a fucking canyon — one I can only navigate with help.”

This quote stayed with me as well: “Pain isn’t a constant. There’s an ebb and flow. Looking out a train window there can be a gorgeous view you want to hold onto but darn, you whiz past it. Then there’s an ugly sight out the window you don’t want to see. The train whizzes past that too.”

Books, though, however wonderful and honest, are not always enough. If you are having suicidal thoughts or think you might need help, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Shades of Blue: Writers on Depression, Suicide, and Feeling Blue
Seal Press, September 2015
Paperback, 256 pages

Marie Hartwell-Walker, Ed.D. <![CDATA[When a Loved One Becomes Disabled]]> 2015-09-22T16:24:54Z 2015-09-23T17:45:06Z ]]> When my friend’s 25-year-old son suffered a head injury in a major car accident, death seemed like a certain outcome. Instead, he recovered. But medications caused him to gain 50 pounds and he suffered from cognitive delays that might, or might not, resolve.

He didn’t look or act at all like the athletic young man I had watched grow up. “I was prepared for his death,” said his mother. “I wasn’t prepared for this. My job is to figure out how to love him now.”

How to love him “now:” In that phrase, my friend captured the essence of our challenge when someone we love suffers a major change in physical or mental health status. The child or adult who is chronically ill or injured or the elder who is declining into dementia may bear little resemblance to the person pre-illness. The relationship between the person and people in the family, the friend network and the community may change drastically.

I’ve learned much about caregiving in the last 40 years — partly from taking care of my grandmother into her 90s, partly from talking to clients who have been in that role, and partly from supporting friends who were supporting loved ones. I’ve found that we all have much in common. Whether the change came about due to illness, accident, abuse, combat, or aging, the challenges for caregivers are much the same. Here are some thoughts about self-care while caring for someone else.

  • Grieve in your own way, on your own timeline.
    Don’t put pressure on yourself to “get over it” on some artificial timeline. Everyone grieves in their own time and in their own way. The contrast between “before” and now may be overwhelming and sad. There needs to be room for owning and going through the feelings.

    The process identified by Kubler-Ross (denial, anger, bargaining, depression, acceptance) isn’t linear. Most people move among those processes in different orders or different days, often many times, until they can accept the loss of what could have been. The continued presence of a person who is but isn’t the person from “before” makes it all the more difficult.

    In the early 1960s, Simon Olshansky coined the term “chronic sorrow” to describe this ongoing sense of loss. It is a normal response to the repeated realization of the reality that the illness or disability will never go away. Each expected life milestone can trigger renewed grieving. Birthdays come and go. Peers marry, have children, get jobs, move up or at least on in the world while the injured or chronically ill person remains relatively static. Older people with dementia stop being the parent or grandparent everyone enjoyed. We don’t really get over it. We do learn to live with it.

  • Find meaning.
    Chronic sorrow may be a constant undercurrent but it isn’t the whole story. As my friend so aptly put it, the focus is on how to love the person in the now. That means identifying what you love about the person and finding meaning in the relationship. Caregivers often say that they themselves grew and change in important ways through knowing and loving the person in their care. Some become effective advocates for the cause of their loved one’s losses. Some focus on the moment to moment of each day. There’s no “right” meaning except what is right for you.
  • Adjust expectations.
    Comparisons to other people’s normal is a setup for disappointment. It’s more helpful to talk to professionals about what is reasonable to expect for your person on his or her particular timeline. Your loved one may never go to Harvard or explore the moon, but he or she will achieve things that matter. It’s something to celebrate when a person who has been terribly injured starts to take interest in life again or when someone who has been unintelligible gains some speech. I do think it’s fine to support an elderly person in poor health in her desire to eat two desserts. As my grandmother, age 90 at the time, said, “At my age, I’d rather have more ice cream than another year!”
  • Adjust your home.
    One mother I talked to said that she wished she’d known sooner what equipment was available to make her paraplegic son’s life — and hers — easier. A lift for the tub let him have his bath in relative privacy. A tool for reaching and grabbing things he dropped let him be more independent.

    When my grandmother came to live with us, we found that grab bars positioned strategically around the house made it much safer for her to get around — which meant she was more willing to move. A commode next to her bed made dangerous trips to the bathroom unnecessary. Sometimes something as simple as a special spoon can make all the difference. Search the Internet and talk to an occupational therapist about what would be helpful.

  • Accept help.
    Services vary by community. Talk to your doctor about how to access what’s available. My friend with the son with a head injury was able to access an excellent day program that he enjoyed. A state agency was able to provide respite workers one weekend a month to allow her and her husband to get a break. A weekly visit by a senior companion was a welcome change of pace for my grandmother — and some time off from being the focus of her attention for me.

    When family and friends offer to help, take them up on it. Let them be the kind of friend you would be if the situation were reversed. People who care about your family are often willing to run errands, visit now and then, or do some caregiving.

    Depending on cognitive ability, therapy for the injured person may help him or her accept losses and find strengths. Therapy for other family members provides support for managing conflicting emotions and for sorting through the myriad difficult decisions that often have to be made when supporting and loving someone whose life has taken an unexpected and difficult turn.

  • Accept that loving “now” is an on-going process.
    When someone’s life isn’t going as we hoped and expected, we are regularly challenged to adjust to a new “now.” Disabled children grow even through their skills may not — or not enough. Adults who have become disabled remain dependent. Elders continue to decline. They get frustrated at times. So do we. The antidote is our love and commitment and the capacity to see the person before we see the disability.

Woman in a wheelchair photo available from Shutterstock

Niki Hilsabeck <![CDATA[Your Survival Instinct is Killing You: Retrain Your Brain to Conquer Fear & Build Resilience]]> 2015-09-17T16:21:52Z 2015-09-22T18:21:28Z Despite our our access to instant gratification, despite our country’s abundance of conveniences, many of us walk around in an elevated state of agitation. Why? In Your Survival Instinct is Killing […]]]>

Despite our our access to instant gratification, despite our country’s abundance of conveniences, many of us walk around in an elevated state of agitation. Why?

In Your Survival Instinct is Killing You: Retrain Your Brain to Conquer Fear and Build Resilience, Marc Schoen argues that as we continue to meet our comfort needs, our tolerance for discomfort decreases.

Schoen, an assistant clinical professor at UCLA’s Geffen School of Medicine, has collaborated with Kristin Loberg on the writing of the book. He tells us that our limbic system has a much stronger pull than our cerebral system, making it difficult for us to “turn off” our responses to threats, no matter how unlikely those threats truly are. In other words, although we humans no longer need a highly sensitive survival instinct to protect us from the threat of being attacked, our survival system is still on the constant lookout for threats to our well-being. Something as simple as a pang of hunger or an unanswered text message can set off our body’s survival instincts, causing a physical reaction that’s difficult to avoid.

Schoen gives many examples from his own clinical practice, and from his specialty in using hypnosis to handle patients’ experiences with discomfort. We as a culture, he writes, have evolved to have a low tolerance for any sort of discomfort, and now constantly seek external ways of managing such feelings instead of using them to our own advantage.

And so, in an attempt to help us manage them, Schoen spends the latter half of the book describing tools. He encourages us to view discomfort as an opportunity to empower ourselves rather than an opportunity to run and hide behind our bad behaviors.

Overall, the book gave me plenty to think about. I found myself returning to different sections for guidance and to apply some of Schoen’s suggestions to my own experiences with discomfort. That said, the first half of the book was more useful and engaging, whereas the tools and techniques that make up the second half seemed difficult to truly master without some professional guidance.

Another issue: Schoen seems to rely mostly on his own experiences with patients to validate his claims. And those patients, perhaps, are not average. I had trouble accepting that his techniques would work for patients who aren’t into hypnosis.

Still, the book provides many useful ideas, one of which is the concept of discomfort as a tool to strengthen our mental hardiness. Successful people, after all, frequently experience episodes of discomfort, but they thrive on such episodes because they have learned to master their reactions. To try to get there, it helps to acknowledge that we are all still at the mercy of our ancient biological systems. And it is empowering to realize that things like anxiety and addiction may be our body’s way of avoiding discomfort.

Since reading Schoen, I’ve found myself questioning some of my own behavior patterns, and looking for ways to be more tolerant of my own discomfort in particular situations. The book, despite its flaws, has been a great way to start thinking about everyday situations — waiting in long lines, completing tasks that I’d rather not do — and how to master, rather than succumb to, the ill-at-ease feelings that arise.

Your Survival Instinct is Killing You: Retrain Your Brain to Conquer Fear and Build Resilience
Plume, March 2014
Paperback, 272 pages

Stan Rockwell, PsyD <![CDATA[The Feeling Brain: The Biology & Psychology of Emotions]]> 2015-09-17T16:22:30Z 2015-09-21T18:18:41Z The dichotomy between mind and body is a false one — and so, it turns out, is the separation between emotion and cognition. In The Feeling Brain: The Biology and Psychology […]]]>

The dichotomy between mind and body is a false one — and so, it turns out, is the separation between emotion and cognition. In The Feeling Brain: The Biology and Psychology of Emotions, Elizabeth Johnston, a professor of psychology at Sarah Lawrence, and Leah Olson, a professor of biology at the same college, provide a marvelous and fascinating review of our feeling brain in a clear and understandable way.

The book grew out of a course the two authors co-taught and makes for a good resource for anyone interested in the neuroscience of emotions. And with its nuanced research, history, and case studies, it drew me in. As both a therapist and a taijiquan teacher, I found much in the book useful for my work, particularly when it comes to mindfulness and on the impact of stress on the brain.

But first: What is emotion, and do we really exist without it?

In popular science fiction, the separation between emotions and cognition is a common theme, presented in one of a few ways. When we become robotic and lose our emotions, some stories tell us, we lose our humanity. Think of the Borg from Star Trek: Individuals are assimilated and become part of a cold and calculating collective that seeks to further assimilate more individuals. Or, also from Star Trek, there is Spock, the logical Vulcan whose civilization gave up hot emotions for cold logic so that it would not destroy itself.

As for a real-life version of getting cut off from emotions, Johnston and Olson offer the story of Elliott, via neuroscientist Antonio Damasio. Elliott had a nonmalignant tumor in the ventromedial prefrontal cortex, the region that is essential for learning that a previously fear-conditioned stimulus is now safe. After the tumor was removed, Elliotts prognosis was good. Yet after his successful surgery, his life took a different turn: divorce, a second divorce, the loss of his job, and bankruptcy. Why?

Elliott performed well on tests of cognitive ability as well as reasoning, moral judgment, and problem solving, Johnston and Olson write. What he had lost was the ability to feel, whether that feeling was stress, impatience, frustration, sadness, or anything else. He was unflappable. He no longer had emotional input into his decision-making, and so his decisions post-surgery caused him great loss.

Case studies like this help illustrate the research in the book, but I also liked the historical perspective that Johnston and Olson take as they review the evolution of our ideas about emotions, from the dualism of mind/body and thinking/feeling of Plato and Descarte to the union of mind/body in Eastern philosophy (with neuroscience supporting the latter). The authors reach back to William James and Charles Darwin, too. I think James would be pleased at the turns this field has taken.

And it was reassuring that Johnston and Olson acknowledge how difficult interpreting studies can be, in part because researchers don’t always map the brain identically — not to mention that just trying to define an emotion can be hard. What is the difference between a feeling and an emotion? Can you even experience an emotion without some kind of bodily feeling?

The authors discuss this, as well as many more subtopics: Emotions can solidify a memory, they explain, and content without an emotion attached may not even be internalized. Another big issue: At times it is difficult for us to know what it is we feel. And: Are there universal emotions that cut across culture?

Weather can affect our mood, the authors write. Our mood affects what we pay attention to, how we interpret what we perceive, and how we make decisions. Hot emotions and cold cognition are tied together in our brains from the bottom up and from the top down. And the list goes on. I took so many notes as I read and found so much valuable information in the book that I can hardly narrow it down.

The book also includes the work of Berridge and colleagues and the ways dopamine affects lab rats’ self-administration of cocaine: The rats kept giving themselves cocaine rather than eating, and eventually starved to death. Last year, Baarendse and colleagues looked at another aspect of addiction, and reported that isolation and a lack of social experience in early developmental stages increased the self-administration of cocaine in rats. Meaning, socialized rats, unlike more isolated ones, did not starve themselves to death. Our bodies and minds are one, our feelings and cognition are integrated, and we do not exist in isolation.

I have worked in the addiction field for a very long time, and I suggest that everyone who works in the field read this chapter, at least, if not the rest of Johnston and Olson’s fascinating book. The authors write that their book is not comprehensive, that it is a “tasting menu that introduces a variety of delicacies available in the vibrant and growing field of emotion research.” What a well-written and well-researched tasting menu it is. 

There is one other false dichotomy in the West that I hope researchers will address more in the future — that of the supposed separation between the individual and the greater society. For now, as Johnston and Olson deftly show, neuroscience is putting one more myth of dichotomy behind us.

The Feeling Brain: The Biology and Psychology of Emotions
W. W. Norton & Company, May 2015
Hardcover, 416 pages

Sandra C. Fykes <![CDATA[Book Review: Paths to Healthy Aging]]> 2015-09-17T16:18:30Z 2015-09-20T18:16:39Z On most days, as a baby boomer, I proudly embrace my age. On those other days, depending on the situation, I deny it, fight it, or pray to make peace with […]]]>

On most days, as a baby boomer, I proudly embrace my age. On those other days, depending on the situation, I deny it, fight it, or pray to make peace with it. Yes, Virginia, getting older is real, and I have started to experience the inevitable tell-tale signs of it.

So at this stage in my life, and because I also have aging family members, I felt compelled to read Paths to Healthy Aging, a workbook by Mehrdad Ayati, a physician, and Arezou Azarani. After all, I want to adapt a healthier lifestyle as the aging process sets in: a process that will continue to unfold regardless of my feelings about it.

The book is very senior-friendly. It is written in clear, straight-forward language and has large font and pictures, which my aging eyes much appreciated. I take great pleasure in not having to squint.

While reading, I felt like I was having a nice, informal conversation with the authors in my living room. Their warmth and compassion clearly comes across. And Ayati, a geriatrician, writes that he spends a significant amount of time with his patients during their appointments, which we all know is a rarity these days.

And honest conversations are key at my age. Now that most of my friends and I are “mature” women, our conversations intentionally or unintentionally include discussions about our health issues: our current symptoms, treatment plans, prescriptions, side effects, diet, weight-loss struggles, vitamin intake. We have our doctors’ appointments and diagnostic tests, and then we get together to debrief.

As for vitamins, Ayati’s take on vitamins and minerals is the same as all of my doctors’. But we live in a world that constantly and convincingly markets quick fixes for our ailments and our sluggishness. I take doctor-prescribed vitamins, but every now and then, I admit, I am lured in to try additional non-prescribed vitamins and minerals that guarantee results. When I write those on my medication list, my doctors firmly insist that I do not need to take them, regardless of countless testimonies and recommendations. Ayati agrees. If you “are not deficient in vitamins and minerals,” he writes, “it is not beneficial to take dietary supplements. The bottom line: Get your vitamins from food rather than supplements.”

Similarly, when it comes to diet and weight loss, Ayati believes in a slow and steady approach for successful, long-term results. So as tempting as a smoothie diet is for quickly losing a few pounds, Ayati recommends that his patients lose one pound a month and eat in moderation. “If they lose the weight slowly their bodies don’t go into shock and there is a much stronger chance that they will lose the weight and keep it off for years to come,” he writes. “Consequently, the stress will be minimal on their body and mind.”

This approach seems almost too easy for me, and definitely takes the stress and frustration out of losing weight.

The authors also highlight the importance of routinely exercising, having an active social life, and having a strong support system. All of these can prevent or lessen feelings of isolation and depression.

In a friendly tone, Ayati shares inspirational and teachable moments from his own family. Overall, I enjoyed reading this book and will frequently refer to it in the future. It provides a solid base of knowledge about healthy aging that will help me care for myself and my family members in our golden years — even if sometimes I feel less than sparkling.

Paths to Healthy Aging
CreateSpace Independent Publishing Platform, September 2014
Paperback, 176 pages

Dave Schultz <![CDATA[Book Review: When Kids Call the Shots]]> 2015-09-17T16:15:26Z 2015-09-19T18:24:48Z How did it happen? Your child went from occasionally talking back to you to bullying you. When did you become terrified of interacting with your own child, and what can […]]]>

How did it happen? Your child went from occasionally talking back to you to bullying you. When did you become terrified of interacting with your own child, and what can you do now?

In When Kids Call the Shots, Sean Grover doesn’t try to solve all of the ways that bullying crops up in our culture. But he does a fine job of addressing an important dynamic in today’s families — that of children bullying their own parents. Grover provides some good ideas to help readers change the dynamic, and challenges parents to look at themselves to see how they might be contributing to the problem.

Grover is a psychotherapist who works closely with children and adults in New York, especially those in the parent-child relationship. His detailed examples of past cases are useful, as is his own experience as a father. But rather than encourage troubled parents to run straight to therapy, Grover suggests that there are things a parent can do now that might help. Though counseling is an option, working on the issue at home can save both time and money — something most parents can heartily appreciate.

As children develop maturity, self-reliance, and confidence, Grover explains, they test the limits of their boundaries. Naturally, this creates conflict with parents, teachers, and other authority figures. If this boundary-testing is at what parents consider reasonable levels, problems are minimal. But when a child pushes in ways that parents find unacceptable, that’s when the real issues begin. And though it is sometimes both parents who feel the child’s wrath, Grover writes, often it is just one.

The reasons for a parent to push back may vary. There are healthy reasons, such as safety, financial cost, and discomfort or unfairness for siblings. Then, there are other factors: Parents who have issues lurking from their own upbringing may create unhealthy reasons for stifling their child’s development.

And so, Grover writes, we as parents may find many helpful clues to behavioral issues if we examine our own history as children and how our parents treated us. He tells us that the three types of parents most likely to be bullied by their own kids are those who were bullied by their parents, those who had absent or neglectful parents, and those who had narcissistic parents.

If you ever think, “It was good enough for me; it should be good enough for him,” or, “My parents would have never let me get away with that,” those are thoughts to look at more closely. They may be a sign that your own childhood is manifesting itself in your parenting style and how you react.

Grover offers tools to regain a balance of power so that the parent takes back the upper hand needed for effective parenting while still giving their child appropriate autonomy and status in the family. He also suggests having an “anti-bullying support team” comprised of one’s spouse, friends, relatives, teachers, and others. It may be hard to admit to your peers that you’re having trouble with your own kid, but isolating yourself only makes fighting bullying more difficult, Grover writes. Having support can help.

It also helps that Grover readily admits mistakes he made in his own parenting, which lets us relate to his teachings — and makes him more believable, too.

Plus, he writes, children often know when they’re being bullies, and may even want their parents to take away their ability to get away with it. In the end, we must keep in mind, kids want a happy family life, just as their parents do.

When Kids Call the Shots: How to Seize Control from Your Darling Bully — and Enjoy Being a Parent Again
AMACOM, June 2015
Paperback, 224 pages