Category Archives: Mental Health

On Taking My Own Medicine

lexaproI resisted for six months or so despite having promised myself last time this happened (the year I changed jobs and our first daughter was born) that I would probably need the extra help whenever life changed in a major way. I told myself I could do it without the help, that lots of people struggle and who was I to complain or ask for extra help. I thought I could manage by trying harder: at self-care, willing away the worried thoughts, meditating more, praying more, exercising more, journalling more.

But the anxiety went with me on vacation. The second half of my family vacation to some of the most beautiful beaches in America (Malibu, Palos Verdes, Manhattan–all in the Los Angeles area) was punctuated with intrusive thoughts about stressors, fears of failing, money worries, and guilt about worrying while I should have been relaxing (ah, “should,” how much of our pain is caused by that word?) At home, my wonderful partner told me in a moment of honest confession she felt the worry had become a third member of our relationship. Ouch.

I reflected. I considered re-starting the antidepressant medication that had helped me with the anxiety in the past. After all, anxiety tends to run in my family–a sibling, a parent, at least one grandparent, and lots of cousins, aunts, and uncles all struggle with it. There is most likely some biological component of this. An inner thermostat set lower than average, when stress heats up, it kicks on the worry and forgets to switch it off. Plus, my own Holmes-Rahe Stressful Life Events score for 2013 was 248. Big changes in my life included a new house, new practice with all the major schedule changes it brought, moving a disabled parent to less than a mile from our home, a child starting pre-K, and the other normal life stuff that comes with working and having young children. And some of those big life stressors touched some of my personal worry buttons: the perfectionistic desire to be extra good at my job, the painful history with that parent I was now taking more care of. Some of them touched buttons that I’m convinced are pretty universal: income, bills, children, fear of failure in my career. So I was kind of due.

A month later, I’m managing much better with a little pharmaceutical support. I’m leaving the work worries at the office and enjoying the mental space it’s created for birthday parties, playing My Little Pony with the girls, walking to the park, talking with my spouse about what she wants to talk about, planning trips, and simply enjoying the way the earth is being reborn for another Spring.

I share all this for three reasons: First, to remind me and anyone who reads it that being a helping professional means not that I do not struggle with the very things my clients do, but that I do. Remembering that helps us all be fully present to the struggle together–and that’s what therapy at its best really is anyway. Second, I’ve come to appreciate (again) how hard it is for someone to admit it’s time to get help. I suspect we all wait too long as often as not. Third and most important for me personally: I believe that the most powerful antidote to perfectionism is honesty about my struggles and vulnerabilities.


Stress: Part 2B: Cultivating Self-Compassion

Giving yourself permission to be human

My mentor Alicia Gregory, and I share a sort of nerdy obsession with good research on what I’ve taken to calling “the good life.” Lately I’m really loving what I’m learning about Self-Compassion. I commend Christopher Germer’s website and free guided meditation downloads. Since I started this post, I’ve gotten halfway through Kristen Neff’s book Self Compassion, which I have enjoyed too. If you’re looking for a “self-help” kind of book that introduces the concept, some of the background, and the research, this is a good place to start. Self-Compassion can begin with a startling realization: most of us talk to ourselves in ways we would never talk to another human being (or even the dog).

“Suck it up!” “You are stupid to feel this way!” “Stop feeling sorry for yourself and just have another drink!” “Who do you think you are to think you deserve a break?” “If you don’t do better, they are all going to realize you are a fraud and leave you.”

There are three movements to cultivating something healthier: First, we must become aware of our distress, negative emotions, self-defeating habits, and automatic responses to pain. Without judgment: just aware. Simply learning to say to ourselves before we rush off into a reactive tailspin; “oh, I am feeling bad.” Or, as Sylvia Boorstein recommends: “Sweetheart, you are in pain. Relax. Breathe. Pay attention to what is happening. Then we will figure out what to do.” There is a mindful part of us that is aware of our experience without being caught up in it–an inner observer. It is out of this place that we notice, label, and sit with our difficult experience.

A separate paragraph to emphasize the hardest part of this practice. The attitude is kindness. It helps to imagine a beloved child, dear friend, or precious pet. Approach  yourself as you would a beloved other, with care, with compassion, with empathy. I’ve been teaching myself put my hand on my heart and say softly; “Wow, buddy, this really hurts, doesn’t it?” Because I can’t bring myself to call myself “sweetheart.”

The second movement is normalizing your experience. Everyone struggles. Failure is normal. Everyone knows discomfort. It can be a powerful teacher. Give yourself permission to be a fallible, normal human being.

Third, practice compassion toward yourself. Incorporate your own version of Boorstein’s wonderful “sweetheart” practice. Download Germer’s self-compassion meditations and put them on your phone and do one every day. It may be hard to sit quietly and wish yourself well. I recommend sticking with it. None of us will be fully compassionate with our weakness every time, but we get better with practice.

One further note: for those of us with a strong habit of perfectionism, shame, or feeling unworthy of love, it may be really difficult even to start with such a practice. We may fear that if we offer ourselves compassion for mistakes, pain, weakness, or hurt, we will be “lazy,” or slip off the deep end into failure. It can be hard to keep in mind that just as trees bear fruit in sunshine and good soil, humans grow with love, belonging, and security. I’m not merely being poetic here: the research is in. Secure, loving relationships (with self and others) are the basis for flourishing. If you want to work on self-compassion (or want to want to), but find the inner barriers too difficult to surmount, working with a therapist or spiritual director may help.

Stress: Part 2A: Filling up the Tank

The Better News

The last post sounds like bad news. There’s some good news, too. First, knowing that certain events are more stressful that others, we can cultivate some measure of intention about what we say “yes” to. If you’ve had some big stressors in life lately, it might not be the best time to sell your house (31 points on the Holmes Rahe Scale) and move (25). Second, knowing that stress is, in part, biological, we can cultivate rest, play, and exercise to replenish the reserves (stress reserves are another of Selye’s ideas).  Third, knowing that stress is unavoidable and that some years are full of unavoidable stressors, we can give ourselves permission to be less than our best selves (more on Self-Compassion in the next post). It’s just not realistic to expect that we’ll live through a series of major life changes and still do our best work, feel utterly calm, and never snap at the children when they’re chasing the cat around the house trying to give him a “haircut” (hypothetically speaking, of course, this has never happened at Team Kell Headquarters. ahem).

Saying “yes” and saying “no”

Most of chronically overestimate our ability to cope with new stressors. So we say yes too often. We do it for any number of imminently defensible reasons: we really want to, we are afraid of what will happen if we say no, we have an internal switch that defaults to “yes,” the opportunity really is too good to pass up. What’s important is to know why we say yes, and to cultivate the ability to say no when we really should. As my friend Steve Brown at Mercer University’s Career Services office once quipped to me, “you know counselors. We don’t care what you do as long as you know why you are doing it.” If you find yourself saying yes to everything and frequently wind up burned out, resentful, and overwhelmed, it might be wise to wonder what your internal script is around saying yes or no. I’m biased, but I think talk therapy helps here. And remember Brene’ Brown’s wonderful “boundary mantra:” “Choose discomfort over resentment!”

Doing Non-Doing

2007.03.09 063
2007.03.09 063 (Photo credit: sartzsche)

Adequate rest, fun, and down-time are essential ways to re-fill your stress resilience reserves. A story to illustrate: before I started a tough graduate program back in 2003, I was an avid rock climber. I went to the crag twice a month and to the climbing gym (fake plastic rocks) three times a week. Within a few weeks, I was going climbing only once every couple weeks. The wise manager of the gym mentioned that he’d been seeing less of me. I told him about the new stresses and busy-ness and how I felt I had too much to do to devote more time to climbing. “When you have too much to do, you have to give more time to non-doing,” he said. “Otherwise, you risk getting out of balance. And then you burn out and can’t do anything.”

Doing non-doing feels counter-productive, even scary, to those of us who derive some (or all) of our self-worth from being needed, being busy, being useful. But I’m increasingly convinced that to cultivate the ability to rest, to sit, to play, and to just be when we feel pressed to do more is one of the more important secrets to living a good life.

There are different kinds of non-doing. There are physically active pursuits like fun excercise (exercise is good for you even if it’s not fun, but why not do something you like instead of something you have to waste valuable willpower on by forcing yourself?), playing, gardening, building, yoga, walking the dog after dinner, and so on. There are the quiet ones, like making a craft or art, writing, reading for pleasure, meditating, or lingering over dinner with your loved ones and friends. It’s important to cultivate both kinds. When you are feeling panicky, that is no time to knit. Go for a jog.

Stress is Unavoidable and Cumulative

I think all therapists have a handful of themes they return to over and over. One of mine is “stress is cumulative.” Lots of people who seek help in offices like mine could list current stressors in their lives that would bring anyone to their knees. The other names people give to their problems–kids’ behavior, marital problems, depression, anxiety–are made worse by the pile-up of life events that have eroded the family’s ability to cope. In some ways, for nearly every problem, stress is part of the problem.

Some background:

English: Bust of Hans Selye Magyar: Komárom - ...
English: Bust of Hans Selye Magyar: Komárom – Selye János szobra a Tiszti pavilon udvarán Slovenčina: Komárno – socha Jánosa (Hansa) Selyeho vo dvore Dostojníckeho Pavilóna (Photo credit: Wikipedia)

Has Selye was an endocrinologist in the middle of the last century, a prolific researcher who coined the term “stress” in the way that most of us use it today. He noticed that organisms (people and mice!) who had many demands on them seemed to have more problems, emotional, medical, and social. To describe this phenomenon, he borrowed a term from metallurgy. “Stress” is what happens to an object when forces press against it repeatedly. With enough stress, the substance will bend or break. Same with people. When many forces are pressing, we may bend or break too. Selye defined stress as “a nonspecific demand for change.” Translated into everyday language, stress is any new or repeated demand on our time, energy, or attention. He also noted there are good stressors like promotions, new friendships, or marriage. And there are bad stressors like not having enough money or a hole in the roof. He also noticed there are three states in the biology of stress responses: alarm, resistance, and exhaustion. When we first experience a new stressor, our systems rev up to adapt, producing more physical and mental energy. After awhile, we settle down into the resistance stage, where we draw on our reserves to cope. When our reserves are depleted, we get burned out, or exhausted. This sounds dire, but the good life is about growth and change. So there is no getting out of new demands. Stress is unavoidable.

Not long after Seyle’s initial research, two physicians, Holmes and Rahe, noticed that patients were more likely to get sick after they had experienced stressful events in life. They came up with a list of stressful life events, weighted for how much impact they seemed to have on people: from “death of a spouse” (100) to “revision of personal habits” (24) to “Christmas” (11). They called the list the “Holmes-Rahe Stressful Life Events Scale” (of course). The more points you get in a year, the more likely you are to get sick. Stress is cumulative.

More to Come:

I started this post three weeks ago, but kept thinking of more I wanted to put in. Soon, it was way part internet-attention-span length. A web designer I knew from Mercer said, “Never put anything you want people to read below the fold.” I got way past the fold. Way. So, there are two posts to come: One on Saying “No” and Making Time for Rest and Play, and another on Cultivating Self Compassion

Resilient Kids Presentation

Resilient Kids Presentation.

For years psychology focused on helping suffering people to suffer less. And got pretty good at it. We can now cure or see significant improvement in many of the most common mental illnesses. What took longer for us to understand was how some people seem to be able to flourish in spite of terribly difficult circumstances. (for a really interesting perspective on this history, I recommend Martin Seligman’s TED talk) How is it that those people can go through experiences that would lay the rest of us low with equanimity? They feel sad, or afraid, or angry, or unsure, of course. But they go on. What is different about them?

“Resilience.” It turns out there are identifiable traits, habits, and relationship qualities that contribute to the ability to flourish in spite of difficulty or tragedy. Here’s a link to a presentation I gave with Tina Wootan at Stratford Academy to the Stratford Interested Parents meeting November 2012 about fostering resilience in your children.

(also: prezi=so cool)