Consolation and Hope in a Challenging Time

On most days, I wouldn’t be quoting President Abraham Lincoln. At a different time, this atheist might not be looking for solace in scripture, though I am often comforted when I do.

Today I’m doing both and offering their consolation to you.

Lincoln, this country’s Civil War President, authorized a day of “national prayer and humiliation” in the midst of that war. His proclamation reads, in part:

I do … designate and set apart Thursday, the 30th day of April, 1863, as a day of national humiliation, fasting and prayer. And I do hereby request all the People to abstain, on that day, from their ordinary secular pursuits, and to unite … in keeping the day holy to the Lord, and devoted to the humble discharge of the religious duties proper to that solemn occasion.

Humiliation fits for this time, too, just after the storming of the Capitol. Fasting fits, as is expected on the annual Jewish Day of Atonement, Yom Kippur. Self-reflection is necessary. Humility and prayer create the appropriate attitude and mood for the occasion.

People are dying. Loneliness overwhelms many, poverty and joblessness terrify, sadness covers the homes and the hearts. Then came the mob.

Humiliation, indeed.

Yet, there is hope.

Lincoln’s leadership continued under even more challenging circumstances.

As the Civil War neared its end, the President offered these lines in closing his Second Inaugural Address of March 4, 1865. His message was one of reconciliation between opposing sides:

With malice toward none with charity for all with firmness in the right as God gives us to see the right let us strive on to finish the work we are in to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow and his orphan ~ to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.

Abraham Lincoln knew our job is always to repair the world.

Reverend William Sloane Coffin, 100 years later, knew it, too. He offered this in prayer: 

Lord … Number us, we beseech Thee, in the ranks of those who went forth … longing only for those things for which Thee dost make us long, men for whom the complexity of issues only serves to renew their zeal to deal with them, men who allieviated pain by sharing it, and men who are always willing to risk something big for something good — so may we leave in the world a little more truth, a little more justice, and a little more beauty than would have been there had we not loved the world enough to quarrel with it for what it is not — but still could be. …

————

The top painting is called Woman at Prayer by Harry Wilson Watrous. Next comes The Morning Prayer by Ludwig Deutsch. The final image is the photo of a Nomad Prayer taken in an African desert, sometime between 1931 and 1936. The photographer was Kazimierz Nowak.

William Sloane Coffin’s prayer can be heard near the end of the award-winning radio collage/documentary created by Studs Terkel and Jim Unrath, Born to Live: https://beta.prx.org/stories/118275

Which Therapies Work? A Guide to Finding Them

Many people seeking psychotherapy are in crisis. The urgency of their need causes them to rely on recommendations.

They wonder who they should see. Under pressure, a deep dive into a complex field can be too much.

This essay intends to assist those in distress to match themselves with the best help.

The prospective patient may not know his condition’s precise name. Without this, the task of finding a practitioner who will fit his needs is harder. Generic descriptions like depression or anxiety offer a starting point only. Even if an individual consulted someone before, there is no guarantee he was correctly diagnosed.

No, I won’t give you a magic bullet or the name of someone to call.

This will be a different approach to the search for satisfactory psychotherapeutic care.

Allow me to establish a few premises:

  • No clinician, however gifted, is an expert in every form of therapy.
  • Not every remedy is appropriate for every ailment.
  • The most recent Diagnostic and Statistical Manual of Mental Disorders or DSM-5 is over 900 pages long. If you encounter anyone foolish enough to claim mastery of all the human problems within it, run.
  • Not every therapist is a talented diagnostician. Some are not well-trained in this area nor have an extensive range of experience with clients from the book’s numerous categories.

To the good, the number of empirically validated forms of counseling continues to grow.

How, then, do you find the kind of specialized intervention you need?

Division 12 of the American Psychological Association maintains a long list of treatments, including those “evaluated to determine the strength of their evidence base.”

The website links to the therapies, describes them, and indicates the degree to which research supports their use.

Each description also includes a link to enable you to find a therapist who practices the outlined remedy. Of course, there are many other ways to locate a practitioner: recommendations, professional organizations of those who allege expertise in delivering those services, and sites such as Psychology Today.

Your insurance company might propose a list of “preferred providers,” as well. The latter group agrees to accept their HMO or PPO’s fee limits.*

If you can identify your diagnosis, you can begin your investigation with its name. Division 12 also provides an inventory of these conditions, along with this disclaimer: “the absence of a treatment for a particular diagnosis or treatment target does not necessarily suggest the treatment does not have sufficient evidence. Rather, it may indicate the treatment has not been thoroughly evaluated by our team according to empirically-supported treatment criteria.”

I hope you will not be afraid of the diagnostic process or “classification” with a name for your suffering. Without a thorough understanding of your problem, no provider can address your condition in the way best for you.

Good luck!

————

*The acronym HMO refers to Health Maintenance Organization, a form of managed care. PPO refers to Preferred Provider Network.

The photo is described as Sunrise at North Point Park, Milwaukee, WI. It was taken on February 1, 2009 and is the work of Dori. The image was sourced from Wikimedia Commons.

Reaching for Happiness

Phil Brickman could be a funny guy, but he was not a happy one. Let’s start with the first words he said when I defended my Master’s thesis. Phil was one of the examiners, a member of the small panel passing judgment on whether I met the degree’s requirements.

All the committee members had signed off on my research proposal. Once finished and written up, they’d read the account I gave them of my efforts.

The group of three talked for a few minutes before asking me to enter the room. The 23-year-old version of GS inhabited a state of controlled anxiety typical of graduate students in such situations.

The questioning began. Phil spoke first:

There is a very serious problem with this thesis.

Those were not the words I’d wished for. Fortunately, I carried no sharp objects with me. I waited as my brain began to dissolve. While my imagined dead-end future passed before me, the same gentleman said more.

Philip is spelled with one (lower case) L.

Philip was calling attention to how his name appeared in the Acknowledgments section of my long paper.

It read, “Phillip.

Oops.

I don’t recall what happened next. My guess would be laughs, my apology, and relief. Or maybe my leaping across the desk (I can see it now) and throttling the man. No, I’ve never been one for rashness or battery.

Young Assistant Professor Phil wasn’t a popular guy, as you might have guessed. He didn’t fit well with people, including those of us who called him a teammate on our Northwestern Psychology Department softball team.

Everyone recognized Phil’s intellect, however. Indeed, Doctor B become famous in his field, and his research continues to be cited and discussed.

One of Brickman’s major contributions to our profession is an idea called “the hedonic treadmill.Simply put, the notion consists of this: we adapt to events in our lives, and our elation or dismay tends to fade. As time passes, we return to where we started in terms of mood.

Here is an example of the idea (co-created with Donald Campbell in 1971).

Imagine you get a happiness boost by achieving some goal you’ve long been shooting for. You feel great, but the pleasurable dose of enhancement diminishes with time. The set-point — your usual level of high spirits or unhappiness — returns.

Don’t despair; welcome news is coming. Your set-point doesn’t control everything about your emotional state. One can still reach a condition of well-being: a satisfying life with an often positive and seldom negative mood.

In 2005, long after Philip died, other social scientists took his idea further. A study involving over 2000 twins, Lyubomirsky, Sheldon, and Schkade estimated that 50% of your life satisfaction derives from inborn temperament — your genetic inheritance. Another 10% comes from life circumstances, with 40% determined by personal outlook and life-altering thoughts and actions.

The encouraging development is that various empirically validated forms of psychotherapy emerged since Phil’s work ended, concentrating on the 40% of our well-being we can enhance and the 10% of life conditions we can sometimes change. Although our genes can’t be altered, we can find ways to move through life at a higher altitude.

Therefore, the patient and therapist’s job aims to boost the things over which we possess some influence.

The irony of Phil Brickman’s life, one he took at age 38, was that his research led to improvements in many other lives, though he never achieved this for himself.

A story by Jennifer Senior from The New York Times (NYT) of November 24, 2020,  focuses on the tragedy, but I prefer to remember this man in a brighter light.

Think of someone who throws a stone into the ocean and then walks away. The ripples continue long after his departure. Many others, years after the missile touched the water, watch the surge catch the sunlight. The beauty of the reflection benefits all of them and those around them.

The cause of the tiny waves is a mystery to many whose lives thereby were enriched. Even you, dear reader, might be one who Dr. B’s distant hand helped to lift.

Now you’ll remember his name and the proper spelling of it, too:

Philip Brickman.

One L.

The top image is Pedra do Baú — Compos do Jordáo. The author is Izabel Tartari. The second photo shows Anna Stoehr, AUS, competing in the Boulder Worldcup 2012. It is the work of Henning Schlottmann. After the University of Michigan picture of Dr. Brickman, comes a 3D Graph That Shows a Rippling Pattern, the creation of Mr. Noble.xyz. All but the photo of Phil come from Wikimedia Commons.

Inside the Patient in Therapy: What’s Going On?

We think of therapy as a conversation between two people.

Dig a bit to find the unspoken thoughts and feelings stirring inside the client. What are they? In what order do they arrive? And why can’t some patients recall the discussion even a few minutes later?

Let’s imagine observing a middle point in a hypothetical session.

The client’s inner world, from a photographer’s perspective, might look this way:

Emotions are brewing. Think of beer or a broth. Visualize the internal concoction as a liquid of at least mild temperature and motion. Active ingredients could include anger, embarrassment, calm, feelings about the therapist, confusion, shame, and sexual arousal.

Don’t forget thoughts.

Where do the stew’s components originate?

  • the client’s life history and memories
  • sensitivity to pain or judgment
  • openness
  • the world in which he lives
  • his brain’s capacity to deal with and analyze complex material
  • the genetic makeup with which he was born

The therapist’s tone of voice, confidence, understanding, and guidance of the process play into the other person’s state. The security associated with the office shouldn’t be discounted as a factor, either.

The specialist’s next comment spins from his lips into the air. Perhaps it is a statement, a question, or an interpretation of what came before.

The client’s ears hear the voice, clearly or not, and understand the words as the counselor intended or not. The language now launched lands in the mixture already present.

The woman or man’s experience is a combination of what he perceives outside of himself and its meeting with what is inside.

More is possible. Patients, if they place a high value on the relationship, sometimes ponder how to respond. They wish to say the “right” thing — to be “good.” Self-consciousness in this setting isn’t unusual.

Consider the chance the listener is not listening and has lost focus. Maybe the language and inflection increase or calm any emotional turmoil.

The unconscious plays an undefined role too. Past events may be evoked.

The patient might not be as attentive and emotionally “present” as he was a few seconds before. Confusion sometimes scrambles his consciousness — bodily sensations, as well.

Therapists must be careful not to overwhelm this soul, amplifying his struggle to process the unstable encounter between external and internal events.

In some cases, the individual cannot “stay” with the flow of ideas, memories, visceral changes, and feelings. In this situation, the client often takes a kind of unseen flight from his fraught condition. His action is like putting a part of himself in another room, away from whatever is troublesome: dissociating portions of the momentary experience and “going away” from it.

He remains in the chair or on the couch, but a segment of his awareness, including access to his complete range of emotion and sensation, is elsewhere.

Treatment would fail if this were to occur in each session.

I’ve created an example of one kind of encounter, not typical of everyone’s experience. Many, if not most meetings, are calmer, less stirring, more laid back.

Assuming this did happen, however, the end of the visit might produce amnesia of some of the material discussed during it.

How do counselors prevent this?

  • They take in whatever is in front of them: tone of voice, postural alterations, physical evidence of anxiety. Eye movements, changes in the rate and intensity of speech, facial expressions, perspiration, and tears need to be noticed, as well. These and the patient’s comments concerning comfort or discomfort should enable the doctor to know whether to intervene: reduce the client’s tendency to become overwhelmed or dissociate.
  • Both parties need to converse about how much intense material can be tolerated and how to communicate distress as it occurs.
  • The health care professional can suggest the patient write a summary of the session’s end, perhaps when he returns to the waiting room. Like dreams, the experience or portions of it are not always recalled otherwise.
  • Zoom and comparable virtual treatment platforms include recording options. This permits the client to review a video of the session alone or with the counselor during the next appointment.

A sensitive and competent therapist will inquire about what the patient wishes to talk about and recognize what he might not recall from recent sessions.

His job is not to interrogate. Rather, he desires to be attuned to the person who has entrusted him with the responsibility of his care. He hopes the client will join him in a shared enterprise designed to achieve progress on the treatment path.

Obstacles like suppression or dissociation can prevent mastery over the life challenges that brought the individual to psychotherapy.

Psychotherapists aren’t magicians. We have only words, compassion, and understanding of what is required and when. Words in the right order spoken in the right way are often enough.

———

The first image is Picasso’s The Red Armchair, from 1931. Next comes Classical Head, a sculpture by Elie Nadelman, created in 1909/10. The third figure is featured in Stefan Kaegi’s Uncanny Valley. It is followed by the work of an unknown artist of the Fang culture, a Central African ethnic group. It is thought to date from the mid to late 19th century. Finally comes Sleep Muse, a 1910 sculpture by Brancusi. All but the Kaegi are sourced from the Art Institute of Chicago.

One Strategy to Reduce Your Unhappiness

Is it possible those who harm us might, after a passage of time, appear to be people who helped us learn something important?

Is it possible their very same cruel act enabled our growth and happiness?

I appreciate what I’m suggesting sounds odd, unusual, even crazy. Consider, however, a view based on a Buddhist text called The Vimalakirti Sutra. Its ancient wisdom offers those keen observations about the best way to live.

Imagine you are driving down a superhighway at high speed. Another driver cuts you off, raising your rage and your blood pressure. Not the first time.

Perhaps you swear and lean on the horn. Maybe you race to overtake the “evil” one, hoping to cut him off as well. Retaliation has taken hostage of all cooler thoughts.

Such animal vengeance is dangerous, both to you, the incident’s instigator, and other innocent drivers and their passengers. This time, however — this time — you tame your scorching animosity, internal disarray, and recklessness. This time you learn.

You recognize yourself in the other driver’s careless or mindless behavior: “I shall not become the thing I hate.” You no longer discount the possibility you — now — not the other man, inhabit the potential to create mayhem or death. You begin to transform the anger and impulsivity long a part of how you react to frustration.

The success in mending your problem contributes to an ironic insight: the man who almost maimed you did you a “favor.” Without him, your change may never have happened. It might also have occurred much later, after creating more sadness, fear, or hurt in others, as well as the suffering within.

Waiting in line offers a similar example of how we cause ourselves agony. The queue is long. You have other tasks to perform. Why is the clerk so chatty, so slow?

The blockhead is inefficient. Doesn’t the man realize time is slipping away? He ought to call someone to help with the flood of people!

Viewpoints like this grind the insides and ruin your day, but approaching them in a more Buddhist fashion achieves a better result. Ofttimes therapists counsel patients to “reframe” their distressing experiences — to envision them from an alternative perspective.

Tell yourself the unwanted wait is an opportunity to enhance patience. Consider the episode in a bigger picture. Will catastrophe occur if you spend more time than expected standing still? Use the moments to accomplish something else. Chat with the person in front of or behind you. Plan the week in your head.

Indeed, the unwitting agent behind the desk can be viewed as your benefactor: the one who helps you become more tolerant.

Happier, too.

If you are prone to holding grudges, changing your mindset reduces obsessive ideas about life’s unfairness. Perhaps, too, the world begins to appear more benign.

I’m not saying everything happens for a reason, but not all grievances lead without remedy to long-term misery. The “teachers” needn’t have intended kindness, but occasional gratitude toward them takes you a step nearer to a more fulfilling life.

Yes, some hurts are so grievous their perpetrators need to be brought to justice. Counselors are experts in aiding one’s mourning process when sizeable damage occurs.

A proverb often attributed to Buddhism tells us, “When the pupil is ready, the Master will appear.” Another formulation uses the word teacher for master, with the same meaning: someone who gives us wise guidance.

The one who harmed you might be the Master in disguise.

Either way, our job is to open ourselves to unexpected enlightenment. Overcoming the worst of the torments on life’s menu remains our responsibility, no matter the pain’s origin.

Unless we make something better of at least some of the misfortunes beyond our control, they will make us their plaything.

Hardship invites us to redefine it by the actions we take. When the dark invitation arrives, we do well to open it to find its hidden light.

—–

The top image is called Enlightenment by Peter Buirlakov. The sculpture photo is A Helping Hand by Forest Runner. Both were sourced from Wikimedia Commons.

Surviving in a Moment of Helplessness and Closed Doors

Before I present an unconventional way for you to think of your value, I must acknowledge your pain. I imagine your circumstances may be far worse than my own.

Those like myself are fortunate. My immediate loved ones don’t suffer coronavirus (fingers crossed), I am in no financial distress, and we enjoy continuing nearness to each other in our small bubble.

For every other pampered hostage to the pandemic/recession, however, heartbreak abounds. According to the CDC, over 40% of U.S. adults surveyed in late June “reported at least one adverse mental or behavioral health condition.” If all the world’s disquiet could be piled up in blocks of cement, it would reach higher than Mt. Everest.**

The world is overweight with pain.

We commonly define ourselves in terms of what we can “do.” Making a living often confers dignity. Status matters to those who make comparisons. Union with hands, cheeks, lips, and bodies have fueled desire for as long as man has been man.

How then does one hold oneself together when money is short, pride in social standing absent, health is imperiled, and touch means staying in touch rather than touching?

You are, in fact, already taking action of extraordinary worth.

First, you are surviving. For reasons you understand about yourself, you retain a portion of hope or a sense of responsibility for those closest.

Contrast your mortal state to that of a god for a moment. In the West, we think of any deity as an eternal being who is all-powerful and all-knowing.

This leaves humanity the possibility of displaying qualities absent in an invincible and omniscient entity who can’t die.

Think about danger. Bravery is possible because we are at risk of physical or emotional harm. The ever-present chance of adversity constructs the platform to display courage.

Man’s creaturely situation requires the choice to endure and persist. Misfortune happens, and its visit is not always brief. The Stoic philosophers believed this allowed each person to demonstrate “greatness of soul” by withstanding “the slings and arrows of outrageous fortune,” as Hamlet described his own tribulation.

To the extent hope is an idea, you have created it. Moreover, my guess is you are amid (or can recall) such woes as Shakespeare put into Hamlet’s life. You know the experience of bearing what appears unbearable, including depression. If you did not, you wouldn’t now be reading this.

Your survival at this moment is a tribute to your character and worthy of applause. I offer you mine. If, with time, you can do more, then do so. Enlarged strength is the residue of a series of small actions.

For now, remember the last eight words from the sightless John Milton’s poem, “On His Blindness:

They also serve who only stand and wait.

—–

The top image is Meeting on the Beach: Mermaid by Edvard Munch, sourced from the Munch Museum. The second is Hope II by Gustav Klimt, sourced from Wikiart.org/

**Perhaps the most distressing finding in the CDC bulletin is this: “The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18–24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid care-givers for adults§ (30.7%), and essential workers (21.7%).”

Signs of People-pleasing: When You’d Really Prefer to Say “No”

A question lingers like a floating bubble in the space between you and a friend.

He asked you to do something you don’t want to do. Maybe he urged you to attend a party or eat at a restaurant or help move furniture to his new apartment.

Part of you wants to reach out and swat the invitation away. Part of you fears what would happen if you did.

Yet saying “no” is one of the most liberating skills you can acquire.

Otherwise, your life and everything within it is reachable by the creature above, one you call a friend. What is yours — including your time, money, schedule, and personal choices — is his.

If the dilemma sounds familiar, you might be a person who extends himself for others — a lot. Indeed, the extent of your extension feels like your arm is made of rubber.

A recent New York Times article lists several signs of “people-pleasing:” It’s OK Not to Please Everyone.

Here are five of those pointers in paraphrased form:

  • A tendency to offer help even when you’re burned out.
  • Making immediate apologies for incidental problems you didn’t cause.
  • You believe you are responsible for the moods of those about whom you care.
  • You encounter guilt, worry, or anxiety when you don’t meet the expectations created for you.
  • Conflict avoidance: an attempt to side-step or give-in because of alarm over angering someone else.

The New York Times list is not exhaustive, so I’ve added a few:

  • A penchant for ignoring your discomfort: saying “yes” when “no” would be the authentic answer.
  • A movie of you would display excessive smiling as you attempt to create a pleasant persona, thus invalidating your actual state of body and mind.
  • You offer multiple excuses when trying to circumvent an invitation or request.
  • Unanswered prayers for permission to skate past the friend’s solicitation leave you helpless.
  • An inclination comes over you to enlist a companion, parent, or lover to say “no” for you.
  • Many days feature you enduring both the sensation of pressure to be what you are not and the inability to withstand the stress.

  • An impulse occurs to delay your answer to a counterpart’s entreaty in the hope the matter will be forgotten.
  • You cannot strike down the habit of kicking yourself after you agree to do a task you now wish to flee.
  • On the occasions you avoid the commitment, you pray for forgiveness from the buddy.
  • You believe “goodness” is never failing to “be there” for the other. The definition is both wrong and impossible to accomplish.
  • A sense of relief descends like a balm when an acquaintance cancels plans you agreed to.
  • You furnish unsolicited favors, in particular, if you believe you’ve been a disappointment to someone whose attention you covet.
  • You buy gifts to win the respect of the individual who matters to you.

What are we talking about? You inhabit the role of a “pleaser” who renders service as if employed as a servant.

Feelings of insecurity fuel your self-effacing behavior, undervaluing the talent and personality that makes you engaging and lovable.

You also display a misunderstanding of what you owe the rest of humanity and what is owed you. Your notion of obligation is inflated and determined by those who find you useful.

The problem, unless you change, gains you little, but rather:

  1. More, not fewer requests because your reliable responsiveness reinforces the petitioner.
  2. Endless reactiveness to the prods and pulls of your social circle leave you empty, unable to care for yourself. A chronic low mood and possible depression may follow.
  3. Your actions get you less than you hoped for from those to whom you are over-generous with your time. Rather than producing profuse praise, your exertions become entitlements. Moreover, any guarantee of reciprocation when you need help exists as a fantasy alone.
  4. Your repeated denial of desires meaningful to you creates a state in which you receive limited respect. The world views you as the rare self-effacing creature without any personal cravings or needs.
  5. Public statements asserting your joy in “helping” diminish the very acts you perform. The willingness to do what the other asks informs him he needn’t value those labors either.
  6. You hesitate to test whether this man will continue to keep you near if you quit the self-created job of gopher. Perhaps he would, but the risk of finding out terrifies you.

To the extent COVID-19 keeps you indoors, you might have a reprieve from the typical inundation of calls for favors. With the opening of society before conditions are safe, the pressure to perform your usual array of circus tricks may increase.

The stakes of going along with what friends want shall then include your health.

Should you recognize someone who looks like you in this people-pleasing portrait, professional assistance is available. While people-pleasing isn’t a formal diagnostic category, I’d encourage you to request a therapist who understands the concern.

A counselor who is skilled at delivering acceptance and mindfulness-based treatment, such as ACT (Acceptance and Commitment Therapy), deserves your consideration. Empirically validated interventions offer you increased assurance of benefit from a psychotherapeutic journey.

Living as a hostage to self-interested others is in your power to overcome. The choice to be useful is not the same as being used.

Fulfillment arrives when you experience the freedom not to.

In contrast, having to do what is distasteful because you fear rejection is a kind of ritual of sacrifice. Those who love you do not wish you such unhappiness.

Friends who tally your worth in the hours of uncompensated labor you supply may be lost as you change. Successful treatment, however, allows you a greater balance between give-and-take within your social connections.

The choice is yours.

—–

The first image is the Logo of the National Reconnaissance Office. The second object is an Ethiopian Stop Sign modified by Fry1989. Finally comes a Thumbs Down Sign, the work of KaiO.Ried. All three were sourced from Wikimedia Commons.

When Someone Says, “Others Have It Worse!”

People say you make more of your problem than you should. You know their names.

They use a variety of expressions:

  • Get over it!
  • Man up!
  • Don’t be a baby!
  • It’s not so bad!
  • Buck up!
  • Others have it worse!
  • Be a man!
  • You need to tap your will power!
  • I’ve gotten over worse myself!

Your critic implies pain is a competition. If you gain the gold or silver medal, your hurt is justifiable to them. The rest of humanity, you included, ought to recover. Soon.

There are always those who score higher on the calamity scale, but their misfortune is irrelevant to your condition.

You are not a rubber ball, ready for a quick rebound. Even spheroids deflate or lose elasticity.

Many of those who utter such phrases claim they mean to be encouraging. Maybe they also throw in the expression, “You are feeling sorry for yourself.”

Self-care requires self-soothing. Grant your afflicted soul sympathy, not censure.

The friends who judge can be impatient. They suggest you’ve been down too long. A stopwatch does not enable recovery. Slip-ups and relapses happen. A hostile world can grind away, predicaments pile up and add to one’s adversity.

As Hamlet’s Uncle said to his wife,

When sorrows come, they come not single spies, but in battalions.

It isn’t unusual for the other to offer examples of those who found a way to thrive after a catastrophe. All praise to such extraordinary people, I say. Yet comparisons like these are a bit like standing you next to Michael Jordan and demanding you play basketball on his level.

Oh yeah, sorry, I forget you are 5’2″ and 45 years old. My mistake.

Sometimes the man indicting you points to an incredible story of bravery or loss, someone who survived mass murder or genocide. In effect, he tells you, “If he cleared the hurdles, why can’t you?”

Such an acquaintance neglects to mention all those who didn’t survive or triumph, the ones whose stories we never read or hear, many of them dead.

The fellow’s implication is that you are unnecessarily weak when you should be tough and resilient. Perhaps he thinks you bear the stamp of moral failure, a lack of character. The bloke shadows you with shame.

Whatever his motive, he provides nothing of value with words like this and much for which he might deserve blame.

I’m assuming you are making an effort. I hope you recognize your shortcomings.

It is in your interest to make the changes you need. If you are 600 lbs. and you believe a diet of soft drinks and pizza are the royal road to weight loss, the other might be alert to an issue you would be wise to address.

Frustration comes with the job of observing somebody you care about fall short. The fellow pointing his finger may be well-intentioned and clumsy with language. Recall whatever kindnesses he offers you or contributed previously.

Your task awaits: heal. Time passes, challenges persist, try again. Give yourself patience and love. Find the proper remedy with professional help.

Ecclesiastes 9:11 of the Hebrew Bible recognizes not all hardship is deserved:

Yet another thing I observed under the sun is that races aren’t won by the swift or battles by the strong, and food doesn’t go to the wise or wealth to the intelligent or favor to the experts; rather, time and chance rule them all.

Uncontrollable events may befall you, but no law compels you to be still and wait for them. Our human race is capable of creation and accomplishment. Search for a fruitful path to your own agency.

The adventure of existence continues with or without your participation. The old baseball cliche reminds us: sometimes you win, sometimes you lose, and sometimes the games are rained out.

For quite a few people, just surviving in the period of a pandemic is a heroic achievement. Give yourself credit.

Dissent and criticism, judgment, and shame are everpresent. Listening to disapproval remains a choice.

Walk away if possible, dismiss accusers if conditions permit, assert your worth if this is in you. Not every accusation requires a rebuttal. Again, counseling can provide assistance.

Action awaits, even if you are not now ready. Prepare as you can. Please remember what Chicago’s legendary Studs Terkel used to say:

“Take it easy but take it.”

———————–

The first image is a Frown of Disapproval authored by Me. The second is the Frown photo of Rebecca Partington. Both are sourced from Wikimedia Commons.

Persistent Depressive Disorder: Not All Depressions are Alike

Some therapists don’t talk much about diagnosis, but it is essential they think about diagnosis. Proper treatment depends on the correct classification.

In the case of longstanding depression, here’s why:

  1. Effective therapy for Persistent Depressive Disorder (PDD) differs from approaches to other types.
  2. Persistent Depressive Disorder consists of a distinct set of symptoms not typical of the broad range of mood problems.

How is PDD different from other periods of unusual sorrow? Duration is emphasized.*

The syndrome lasts longer (at least two years) and often starts early. Symptom-free periods, if they happen, last no more than two months. More comorbidities are present: that is, other diagnosable conditions.

Among additional distinguishing characteristics, traumatic and abusive childhood experiences are frequently a part of the individual’s back story. In general, the younger the patient was at onset, the more limited his problem-solving skills are today.

Though the above list may be daunting, the evidence supporting the effectiveness of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is impressive. Indeed, an extensive review of the scientific literature endorsed by the European Psychiatric Association recommended it as a top-line psychotherapeutic procedure for people with PDD.**

Perhaps not surprisingly, significant improvement tends to demand an extended therapeutic regime. More than a year would not be uncommon, with an indefinite but lengthy course of less frequent follow-up sessions to maintain gains.

The prescription of psychotropic medication in combination with the “talking cure” is customary, as well.

One of the most notable features of CBASP is its focus on fragile self-esteem. The client views himself as unable to produce satisfying encounters with acquaintances, coworkers, and friends. Nor does he realize the degree to which his words and deeds (or their absence) cause some of his unhappiness.

While his pain is acknowledged as genuine, CBASP views the new client as someone with chronic and pessimistic expectations of the world: self-fulfilling prophecies.

History informs him of how his life has worked out and, he believes, will work out. The evaluation of the patient, therefore, seeks to uncover the ways he contributes (without intention) to the repetition of disappointments characteristic of his past.

Moreover, the practitioner expects such counterproductive social interactions not to be restricted to life outside the consulting room. Comparable events are predicted in-session. The provider of treatment discusses this prospect with the sufferer.

Together they analyze what the depressed individual forecasts will happen between them, along with the actual effects of his behavioral choices. The atmosphere of the conversation must ensure a feeling of safety, not judgement.

An enlargement of the patient’s self-awareness develops as his anticipation of the psychotherapist’s behavior is explored. The Socratic dialogue with the healer should lead him to conclusions he comes to on his own.

This enlightenment is also fostered when the therapist tells him of his own internal reactions to what the client is doing: the feelings or thoughts emerging inside himself (the analyst) in-the-moment. In this way, the patient begins to become aware of his impact on others.

When the process works as designed, the outpatient starts to try out what are novel efforts to accomplish the kind of responses he desires. This begins in the office and extends to people he encounters elsewhere.

Thus, the transference relationship with the counselor is key. The system builds toward recognition of the healer as somebody who responds differently from those in his pretreatment life who caused harm or neglect.

Just as he comes to grasp he was mistaken in many of his beliefs about the adviser, so he begins to recognize routine errors in expecting the worst from much of the rest of the human world.

Progress relies, in part, on the subject’s growing ability to sense his own power to affect how people react to him. Another marker of improvement is his expanding understanding of how failed actions and inactions have added to his fixed sense of helplessness and hopelessness. Increased flexibility in both cognitive and emotional domains is a goal.

The therapeutic conversation includes a step-wise analysis of how troublesome situations in the client’s life developed – what happened at the start, in the middle, and at the end of them. Questions include, for example, “How did you interpret what occurred?” “What did you do?” “What did you want” and “Did you get what you wanted?”

A successful course of CBASP empowers the patient to gain insight through the emotions and thoughts evoked by inquiries like this. The ease of performing similar analyses on his own expands. He reaches the point of engaging the interpersonal world with an enhanced belief in what is possible.

Hopefulness comes to occupy an enlarged place in the client’s vision of what lies ahead. As a result, he risks letting go of passive-aggressive, hostile, submissive, and avoidant strategies. Friendly and assertive advances toward society increase.

Put simply, while there are no guarantees, the news is encouraging for those long-depressed souls who have yet to find a satisfying route to the alleviation of their unhappiness.

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*The complete diagnostic criteria for Persistent Depressive Disorder can be found here: https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_PersistentDepressiveDisorder.pdf

**Jobst, A., Brakemeier, E. L.., Buchheim, A., Caspar, F., Cuijpers, P., Ebmeier, K. P., … Padberg, F. (2016). European Psychiatric Association guidance on psychotherapy in chronic depression across Europe. European Psychiatry, 33, 18-36. http://doi.org/10.1016/j.eurpsy.2015.12.003

The bottom photo is Central Utah in Late Summer at Sunset by Laura Hedien, with her kind permission: https://laura-hedien.pixels.com/

For the Curious and the Brave

Are you an optimist, a pessimist, or a realist? Are you curious? Are you brave?

Think of your life as a challenging but unique voyage. Just as we find ourselves in the churn of a pandemic, so others we call heroes endured and survived their own dangers.

Take the ever-resourceful Odysseus (Ulysses) in Homer’s Odyssey.

The 10-year Trojan War is over. Ulysses and the men of his isle-domain proceed home to Ithaca. The warrior soon angers the sea god Poseidon. The fleet is taken off course, all but his own ship destroyed.

The journey home will match the length of the siege of Troy.

Can our protagonist “bend history” as it is happening?

Observe his encounter with a set of lovely-voiced, lute-playing enchantresses. Odysseus has been warned of them by the sorceress Circe.

First you will raise the island of the Sirens; those creatures who spellbind any man alive, whoever comes their way. Whoever draws too close, off guard, and catches the Sirens‘ voices in the air – no sailing home for him, no happy children beaming up at their father’s face. The high, thrilling song of the Sirens will transfix him, lolling there in their meadow, round them heaps of corpses rotting away, rags of skin shriveling on their bones. ...

The greathearted leader discerned more than caution in Circe’s advice. He recognized a chance to listen to songs so lovely they would make him oblivious to the danger of mindless drowning.

In effect, he wondered whether he might find a way to have his cake and eat it!

Ulysses directed his crew to plug their ears with beeswax, as his advisor suggested. All but his own.

He ordered the men to lash him to the ship’s mast and ignore whatever ravings and directions he shouted until they were past the singers’ reach.

The crisis revealed an opportunity for Odysseus. Our own challenges are less fantastic, but perhaps not less mindless. The times require the best of ourselves for ourselves and the fraternity of our fellow humans.

We can weep the fate of flash-frozen, aborted plans. Many are deserving of tears. But, our wits have not been lost. If we can keep them, and benefit from luck, sound judgment, and those who take risks on our behalf, calmer waters may yet appear.

Ulysses had no guarantee of achieving his goal of reaching his loved ones, but a god bent on frustrating him. He survived to attain Ithaca, embrace his wife Penelope, reunite with his aged father, and clutch his grown son Telemachus for the first time. Moreover, he regained his kingdom.

Though the resourceful one was no longer a young man, Alfred Lord Tennyson imagined him speaking of leaving home once more with vessel and company of sailors:

Tho’ much is taken, much abides; and tho’
We are not now that strength which in old days
Moved earth and heaven, that which we are, we are;
One equal temper of heroic hearts,
Made weak by time and fate, but strong in will
To strive, to seek, to find, and not to yield.

Ulysses’s desire to leave home once again is the English poet’s invention. It is not present Homer’s original tale. Indeed, the Ithacan had wept for Penelope more than once during their separation.

Why might the poet’s version of Odysseus wish to depart for further adventures?

Did he regret giving up the offer of immortality, love, and comfort proposed by the beautiful Calypso? Might his nature simply have been restless? Did this “master of exploits” hunger for attaching more glory to his name and legend?

Perhaps the camaraderie of his Greek companions in wartime made him most alive. Or he felt empty except when the Sirens shared their melody.

Decide for yourself. But whatever you believe, your immediate task remains this:

Find the music in your confined life.

Even now.

The first image is Ulysses and the Sirens by Léon Belly. Next comes The Sirens (1872) by Gustave Moreau followed by Odysseus and the Sirens by Otto Greiner. The same title describes the Attic Red-figured Stamnos, ca. 480-470 BC (a type of Greek pottery used to store liquids). All were sourced from Wikiart.org/