social anxiety

December 16, 2018

What are the Limits of Telling Your Patients Something Uncomfortable?

I wrote an October post offering suggestions to make oneself more interesting: Are You Boring? Words You Should and Shouldn’t Say.

Today I’ll take this another step: what should a counselor do if the patient complains of inexplicable, endless rejection and the healer believes the explanation is that the solitary creature is boring?

Not the kind of training we get in graduate school.

Most counselors first establish the therapeutic relationship, of course. They sidestep the dullness problem. But, when the uncomfortable complication remains untouched and the individual continues to experience exclusion, what then?

The “Are You Boring” article offers both dos and don’ts. Some of those remain unmentioned in the course of a routine psychological consultation.

A UK therapist, Emma Cameron, tweeted this in response to the notion of raising the issue:

But to me this seems like a recipe for increasing social anxiety, self-judgement and shame, which many therapy clients already struggle with…

I answered,

As noted within the essay, this is a risk. On the other hand, some might benefit from recognizing and improving their interpersonal skills, of which speech is a part.

Ms. Cameron is wise, but where do her point and my counterpoint leave us?

My approach in treatment was to engage in a Socratic dialogue: use questions to lead my fellow man into the light of self-knowledge. People skills, anxiety, depression, and self-image issues were addressed, as necessary. I’d evaluate whether my patient’s present relational distress caused him to offer only the safest conversation; as if he were “hiding his light under a bushel basket.”

Indirect suggestions of routes out of his tediousness might be offered. Something like, “Have you ever thought of reading this, or studying that; visiting museum X or watching movie Y? Perhaps you might enjoy trying something new.”

But what if the forlorn fellow doesn’t have much wit or wisdom worth sharing in a relationship, yet I believe him capable of striking sparks with some guidance?

Counselors and advisors ask themselves how much information is enough, how much too great? Whether the other is open to unsettling opinion and what will happen if the fraught communication is attempted? The cause of Ms. Cameron’s hesitation is to be found here.

No challenging tidings should be offered for the sake of the truth alone. Daily choices about what to say and how to say it are made by everyone.

We are now in the domain of the unmentioned and the unmentionable. Who will tell the other he has bad breath or a failed deodorant? Does your new female acquaintance mention your comb-over looks preposterous or you bore her to desperation? No, she just takes flight.

I’ve not met a single soul who needs to know everything about himself. One minute of complete self-awareness is a scorching, lazer-like invasion of insight. Inflicting pain in honesty’s name is cruelty disguised as moral superiority. The Hippocratic oath reminds us, “First do no harm.”

Let me put this another way. What does a psychologist give you and what does he take away? Therapy involves a transaction or exchange, as in all well-functioning relationships. What do you present or withhold and at what cost? How far do you go providing anyone painful knowledge?

One must not to take something useful away (including the foundation of self-esteem) without inserting a superior substitute. Mental and emotional defenses cannot be deconstructed without peril. They serve, perhaps imperfectly, but they do serve.

Some kind and decent people gain more by learning to deal with inevitable rejection than by heightened awareness of their lack of incandescence. Not a few profit from ways of enriching their lives without the degree of friendship or intimacy desired.

Do you see the problem with what I just said? The counselor who is swift to conclude his client unable to triumph over his limitations could sell him short.

Perhaps to protect the comforter from discomfort in delivering a harrowing message, he refrains from nudging the sufferer to exceed himself and improve his life.

A therapist is like a magical juggler. Before he walks off stage, he must do his best to provide as much or little of what the patient requires to stay aloft.

And understand how much weight the client’s reinforced wings can now bear.

—

Thanks to Emma Cameron for allowing me to quote her tweet.

The top photo is a Security Guard Sleeping on Duty, posted by Brad & Sabrina. The second image is Prince Florimund Finds Sleeping Beauty from Child’s Favorites and Fairy Stories. Both come from Wikimedia Commons.

May 21, 2017

Dying to be Seen, but Afraid to be Seen: Where Insecurity and Invisibility Meet

The quiet ones envy those who are sociable. Not always, but often. They wish for an ease of contact which is not theirs. Too many hunger for understanding, for a kind person to recognize them, accept them; even love them. They are dying to be seen, but afraid to be seen.

Anonymity is the preferred choice. Many escape to the shadows, at least if they can.

Don’t raise your hand, says Mr. Anxiety, even if you have the right answer. Too risky. Your voice might quiver, your hand might shake, and there could be a follow-up question which leaves you speechless.

The insecure ones make a trade. They take the apparent safety of invisibility at the price of being ignored, misunderstood, or quickly forgotten. They leave no mark on the world, hoping to avoid criticism and ostracism. Better to take yourself out of the competition for attention than be told to go away. Of course, you wind up alone, but you persuade yourself this is better than rejection.

Instead of belittlement you opt for the shrubbery, hiding behind the bushes. True, sometimes you get wet when the lawn sprinklers go on. Occasionally a kid throws a ball that hits you or a dog sprays you, but you get used to it.

Group conversations are the worst. When might I jump in? My face will flush. They’ll think I’m an idiot, too boring. I’ll just sit tight or stand and nurse my drink.

Who would have thought a man could dive into his glass, hide behind its opacity? Or imbibe enough to shed his disguise and turn into a more outgoing, confident version of himself?

Once you sober up, you will still be like a person with a fire inside who is afraid of venting a smoke signal. The result? You are consumed from within and your glorious flame is unnoticed.

Mark Twain said, “The man who does not read has no advantage over the man who cannot read.” Change two words and the sentence becomes: the man who does not speak has no advantage over the man who cannot speak. Will you be thought of as the latter? Are you already?

Or have you become someone who is told what he thinks, afraid of challenging a rude or wrong idea? You will be outdone by those with half your intellect. They, the half-brained, are kings and queens in the land of the mute.

You remain unknown, even if others think they’ve sized you up. Many believe you are stuck-up because you avoid them. Some say you are kind, several imagine you lack “personality,” others reckon you stupid, a few timid: an easy mark to be pushed around. Most strangers form no opinion. Not one of them will be completely right, know the whole package. You won’t even be seen in full by yourself.

Your attempt to vanish is exhausting. The task is like running a race, trying to escape the eyes of others, but distancing yourself from yourself. If all escape routes close you will grab your throat and squeeze, stifle your emotions and ideas so as not to offend anyone.

Do you wish asphyxiation by your own hands?

I hear you gagging.

Do I know you? Not completely. But I’ve seen you and I might have been you a long time ago.

It wasn’t fun.

It’s not as if everyone else is completely visible. No one is. One might display an eyebrow or an ankle, even a heart: that most precious portion of ourselves when offered as a present. Such a one is trying, practicing, gathering momentum.

A gradual path toward self revelation can grow on you.

In the end, however, if you are seen but unseen, dying to be seen but afraid to be seen, you should realize something: you cannot be both.

You must choose or remain in torment.

The therapist’s door is waiting, but even there you can try to be invisible.

A pity.

Counselors, you understand, don’t do their best work blindfolded.

—

The top image is a photo of the cover of The Invisible Man by H.G. Wells. The cover was illustrated by Ludvik Strimpl and the photo taken by Gallica/Sudoc. The image was sourced from Wikimedia Commons.

August 20, 2016

Treating Insecurity and Anxiety: Eight Roads to a Solution

512px-Anxiety_cloudImagine you are considering therapy for the first time. Or perhaps your treatment isn’t working. You stand at a crossroads, like the hub of a wheel where eight spokes beckon for attention. How should you choose among them?

Not all are good and you may even realize that as you decide. Here is a guide to thinking about what to do (and what not to do) with the weighty package of insecurities velcroed to your life. Click the link for a comprehensive list of the signs of insecurity.

ALCOHOL AND DRUGS. The issue of substance dependency should not be ignored. Recall the old Chinese proverb, “First the man takes the drink, then the drink takes the man.” Alcohol’s comforting relief and buoyancy is commonly replaced by longer term emotional darkness. Marijuana (cannabis) might mellow the smoker out but leaves underlying insecurity and anxiety untouched when sober. If you are attempting psychotherapy, best to tell the counselor the extent of your substance use straight away. The deepest wounds are slippery things. Grasping them is harder (if not impossible) when alcohol or drugs add to the excess lubrication.

WILLPOWER AND SELF-ANALYSIS. The old saying tells us, “When the going gets tough, the tough get going.” Yes, some few people manage their own psychotherapeutic project. Indeed, Freud analyzed himself. What is required? Although I know of no research on this, I suspect one needs a strong capacity for self-reflection, high intelligence, some degree of emotional openness, the courage to look in the mirror, tenacity, and knowledge gained through reading about treatment. Willpower is necessary because the self-analyst must inevitably get out of his head and leap the wall of fear to master behaviors blocked by insecurity: good eye contact, self-assertion, saying no, asking for things, making uncomfortable phone calls, inviting someone on a date, public speaking, etc.

THE SEARCH FOR A STRONGMAN. Some rely on a mate to perform avoided tasks. The significant other becomes a caretaker or body-guard, an individual who is sought to do the jobs the hesitant one believes he cannot: return a product to a store, accompany him to events otherwise avoided, and so forth. This is no solution to anxiety or insecurity, but a human crutch to sidestep the need to change. Another danger: too often the protector becomes an overlord, pushing you around or worse; the mister turned monster you hoped he would protect you against.

PSYCHOTROPIC MEDICATION. Medications, like other drugs, carry possible side-effects. Antidepressants can impair sexual performance, anti-anxiety tablets often have addictive properties. While a good psychiatrist will carefully watch for these, pharmaceuticals do not create a sense of security and confidence beyond the time you use them. Moreover, to the extent that the psychotropics help you feel better, your motivation to tackle underlying reasons for your symptoms may be reduced. That said, sometimes susceptibility to anxiety and depression is inherited and biologically-based, making the booster of drugs a necessary and permanent mode of treatment.

Girl_suffering_from_anxiety

AVOIDANCE AND THE INTERNET. Anticipation of discomfort, humiliation, or failure translates to turning down invitations — limiting chances for growth, accomplishment, and joy. The troubled soul is assaulted by hatchet-bearing ideas that have become permanent, non-rent-paying residents in the head. The data set of the insecure is based on an unfortunate history. The job of recovery translates to writing over your old history by gradually taking on social challenges and accumulating successes reinforcing your effort.

Beware the false god of the internet! The more time you worship at its alter and “let your fingers do the walking” on the keyboard, the less you have for direct human contact (involving actual walking out of the apartment). For all its marvels, this deux ex machina can become a screen behind which to hide the human face, trading yours for a virtual one. Yes, social media can be a stepping stone to a life beyond the keypad. For many, however, it’s another form of concealment and self-distraction. You can identify too fervent online social network disciples by the pain they will suffer for their god: a malady called text neck, the product of bending over their smartphone.

PSYCHODYNAMIC PSYCHOTHERAPY. Psychodynamic treatment, the traditional talking cure, can be a foundational part of counseling. It helps one clear the life-history undergrowth undermining a healthy self-image, planting  seeds of sturdiness to deflect the inevitable defeats we all encounter. Such counseling also lifts the weight of self-blame by recognizing the fingerprints of others on one’s problematic background story. It cannot stop there, of course. Grief and grieving demand attention.

Beyond relieving submerged pain, one must eventually take psychoanalytic insight for a test-drive: try new behaviors just as one would a new car before purchase. However much a “depth psychology” approach is needed, empirically based (research supported) interventions provide the practical impetus for emotional availability, symptom reduction, and behavioral change.

COGNITIVE-BEHAVIORAL THERAPY (CBT). Many of the well-researched and effective treatments just referred to fall into the category of CBT. Obsessive-Compulsive Disorder (OCD), for example, is among those problems amenable to this set of tools. Indeed, attempting a solution for OCD psychodynamically is, in contrast, a therapeutic cul-de-sac. CBT can often, however, be combined with more traditional talking therapy to join the best of both worlds.

ACT (ACCEPTANCE AND COMMITMENT THERAPY). ACT is described in the following way on its website: “Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.”

Plowing through this technical language, ACT deals with the losses most patients have sustained, traveling from a grieving process toward acceptance of those life circumstances that can’t be changed, reduced avoidance, learning to live in the moment via meditation, deciding what is most important to you, and choosing behavior consistent with your stated values.

WE ALL TAKE TURNS at life’s crossroads. Sometimes the best advice is to make no movement, patiently waiting for the traffic to clear. Do remember, however, not choosing is also a choice. The clock is always ticking, even if, in the digital age, we must strain to hear it.

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The top image by John Hain is called Anxiety Cloud sourced from Wikipedia Commons. The photo beneath it is Girl Suffering from Anxiety by Bablekahn at Kurdish Wikipedia.

August 21, 2014

Signs of Insecurity: Behavior That Reveals a Lack of Confidence

Here is a post many people have found useful. This version has been updated since its publication in 2010:

Dr. Gerald Stein

https://drgeraldstein.files.wordpress.com/2010/07/insecurity.jpg?w=225

Insecure people often reveal their self-doubt without being aware of it. Indeed, a wise observer can “read” another individual. For example, members of the Chicago Symphony Orchestra have told me they can tell whether a new conductor is competent and talented within 10 minutes of the beginning of their first rehearsal with him.

What follows is a short list of behaviors that suggest insecurity:

  • 1. Are you able to give a compliment? Even more important, can you graciously accept one? The latter behavior tends to be difficult for someone who is unsure of himself. He might blush or become flustered. Alternatively, he is prone to dismiss the validity of the praise, instead telling you why it isn’t true. What should one do if complimented? Smile and say “Thank you.” Nothing more.
  • 2. An inability to maintain eye contact is hard for many individuals who lack confidence. They will turn away…

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July 15, 2010

Signs of Insecurity: Behavior That Reveals a Lack of Confidence

https://drgeraldstein.files.wordpress.com/2010/07/insecurity.jpg?w=225

Insecure people often reveal their self-doubt without being aware of it. Indeed, a wise observer can “read” another individual. For example, members of the Chicago Symphony Orchestra have told me they can tell whether a new conductor is competent and talented within 10 minutes of the beginning of their first rehearsal with him. What follows is a short list of behaviors that suggest insecurity:

  • 1. Are you able to give a compliment? Even more important, can you graciously accept one? The latter behavior tends to be difficult for someone who is unsure of himself. He might blush or become flustered. Alternatively, he is prone to dismiss the validity of the praise, instead telling you why it isn’t true. What should one do if complimented? Smile and say “Thank you.” Nothing more.
  • 2. The ability to maintain eye contact is hard for many individuals who lack confidence. They will turn away or look down, but rarely hold the gaze of the other by looking into his or her eyes.
  • 3. The self-doubting person tends to apologize when no apology is necessary. It is as if she expects to be reproached or is afraid to give offense; so, she prophylactically tries to excuse any possible mistake to avoid such a response.
  • 4. Answering a question with an upward inflection of the voice has been done by everyone. The person being questioned doesn’t have certainty about his answer, so he replies with a tone betraying his insecurity. Since I originally wrote this piece, a name has been given to the practice: upspeak.
  • 5. Men and women who are uncomfortable with sharing personal information for fear of being judged will oft-times turn the conversation to a different topic, away from anything that might make them vulnerable or reveal too much. This is also called “changing the subject.”
  • 6. One way of inoculating yourself against criticism is to joke at your own expense. Do this often and others may conclude you believe you are flawed.
  • 7. Do you have trouble making a decision? The comedy team “Cheech and Chong” (I’m not sure which one) said: “Taking responsibility is a lot of responsibility.” If you automatically let others choose the restaurant, movie, and other activity, you are either easy-going and good-natured or don’t want to be held accountable for making the wrong choice.
  • 8. Do you state strong opinions? Those who avoid doing so might maintain the peace — often a good thing — but some fear drawing fire and unwanted attention.

Before I give you nine more signs of insecurity, I’ll say what might cause the condition. Many possibilities. Critical or neglectful parents, poor academic skills, frequent moves making you “the new kid” (especially if you are introverted by nature), learning disabilities and ADHD, being “different” in some fashion (size, shape, color, religion), thinking of yourself as the “poor” kid in a community of the affluent, sensing you are the average child in a school filled with bright youngsters, feeling ashamed of your parents or residence, frequent rejections, getting fired (whether deserved or not), clumsiness, a history of abuse or bullying; physical unattractiveness, deformity, or injury, etc. For a more thorough discussion of these causes, click here: The Causes of Insecurity. Now back to the list of signs of insecurity:

  • 9. Do you laugh nervously in social situations? It is another behavior betraying self-consciousness.
  • 10. People will appraise you harshly if they see you bite your nails or they appear bitten.
  • 11. Are you self-effacing, placing yourself at a disadvantage — letting others go first, speak first — reluctant to raise your hand? Do you hesitate to take your turn? Do you sacrifice your interests as a matter of course? Insecurity can make you wait until the opportunity before you is lost. Excessive deference displays little regard for yourself, even if some amount can be a sign of good breeding and consideration.
  • 12. Are you nervous eating in front of others? Do you fear dropping something, displaying poor table manners, or making a mess? You probably won’t, at least not more than the rest of us.
  • 13. Can you make phone calls without trepidation; especially those in which you need to introduce yourself, correct a problem, or speak to an authority? Too much discomfort in anticipation of these actions can reveal your sense of uncertainty.
  • 14. Might you make too many excuses? Those who are unsure give explanations where none are required. Imagine you order an entrée at an elegant restaurant and the waiter asks whether you want an appetizer to start. You explain why you don’t. Some folks offer multiple excuses for what they do, anticipating criticism. If you must give a reason, limit yourself to one. The more you give, the more uncertain (or dishonest) you sound. For  example, “I can’t come to the party because I have a stomach ache and my car broke and I need to study.” One reason will be more convincing. You needn’t explain yourself as often as you think.
  • 15. Insecurity can be suggested by hesitation to ask for a favor or an inability to say “no.” Anticipation of rejection or disapproval is the motivator for both of these problems with self-assertion. By contrast, a self-assured person will not believe the relationship (or his own value) is dependent upon going along with someone else’s wishes or fulfilling the desires of others as a matter of routine.
  • 16. Do you make frequent requests for reassurance? A few examples: “Does that make sense?” “What do you think?” “What would you do?” “Do you think that is a good idea?” “Do I look OK?” Must you have sex to prove your partner remains interested in you? If you are self-assured, you won’t implore your lover to calm your doubts and remind you, over and over, in words and deeds, of your desirability or intelligence.
  • 17. Last one. Here insecurity takes a different form. This person wants the spotlight at all times, the better to be told “You are the fairest of them all!” She or he pushes for recognition, strutting about the stage we call life; checking to see where he stands and what others think of him. Bragging and display become a full-time job. Perhaps he was the class clown in grade school, but now he drops names to prove his importance and get your attention. His inner emptiness must be filled and refilled, like a bucket with a hole in it. Such people are plagued by narcissism as well as insecurity, a troublesome combination. There is hell to pay for those who expose the pretender’s flaws: lacerating attacks against any critics. If you are this variety of insecure person, I doubt you will admit it even to yourself. If you meet such an individual, run!

I suspect you get the idea. Please add an item if you like. You can use the list in one of two ways: to consider whether you are insecure or evaluate the confidence of those around you. Of course, you are the only one whose self-confidence you can change.

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You may find the following related post of interest: Signs of Self Consciousness: When the Mirror Isn’t Your Friend. Also, you might want to read  The Upside of Insecurity or, this very recent post: Insecurity and Our Preoccupation with Appearances/

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The image above is Insecurity by Lacey Lewis: http://www.lacey-lewis.com/ With permission.

July 9, 2010

The African Dip: Thoughts on Passive-Aggressiveness, Powerlessness, and Acceptance

The Flying Turns

My dad occasionally took me to a legendary Chicago amusement park called Riverview when I was a little boy. I was dazzled by the roller coasters, the “Waterbug” ride, and something called the “Rotor.” The latter required you to enter a circular room which spun on a central axis until the velocity and centrifugal force were sufficient to pin you against the wall, just as the floor dropped away.

But, as small as I was, it is a sideshow called The Dip that I remember most vividly. Today I’d like to use this politically incorrect carnival attraction as a spring-board to a few thoughts on the expression of indirect anger that sometimes is called “passive-aggressive,” as well as a therapeutic approach to setting aside the temporary upsets that are a part of any life.

—

Black men in cages. That is what “The Dip” involved.

Unbelievable, perhaps, as we think about it in 2010. Each man sat on a stool inside the cage. In front of the cage, off to the side a bit,  stood a small circular metal target that was attached in some fashion to the stool, perhaps electronically, but more likely mechanically.

For less than a dollar, you could purchase three balls to throw at the target, one at a time. If you struck the target solidly, the stool on which the man sat collapsed, and he dropped into a pool of water underneath the cage. You might have seen similar “dunk tanks” at various fund-raising events, often giving students the chance to dunk their teachers.

Harmless fun? Not so in the case of a black man doing the sitting and a white man trying to knock him off his seat.

This sideshow was once reportedly called, “Dunk the N****r,” later “The African Dip,” and finally “The Dip.” It was eventually shut down by a combination of Negro outrage and the increasing disgust of white people to the offensiveness of its implicit racism.

The black men were in a relatively powerless situation — almost literally, “sitting ducks.” But, they did what the situation allowed them to do so as to unsettle, tease, and otherwise disrupt the white pitcher’s aim. The Negroes were careful not to say anything too frankly insulting, lest they stir up the racism (and potential for less veiled violence) that was at the heart of the event.

But they would and could get away with belittling their adversaries athletic skill or throwing ability in a way that was amusing. If their comments distracted the opposition at all — got them to laugh (or the crowd to laugh at them) — or caused a break in the hurler’s concentration, the chance of staying on the seat improved a bit.

According to Chuck Wlodarczyk in his book Riverview: Gone But Not Forgotten, the caged men’s banter could include comments about one’s appearance: “If you were heavy, they’d call you ‘meatball.’ If you were thin, they might have called you ‘toothpick.’ If you were with a girl, they might have said ‘Hey fella, that ain’t the same girl you were with yesterday!'”

You don’t have to be a black man in a cage to have some experience of expressing anger indirectly. We’ve all done it. It takes many forms: talking behind someone’s back and mocking that person, being sarcastic, complaining to a co-worker’s superior rather than to the offender’s face, neglecting tasks you have been assigned unfairly, and procrastinating. These passive-aggressive words or acts are rarely very satisfying. The anger doesn’t dissipate; the grudging discontent usually continues; nothing positive happens.

The sense of powerlessness and lack of control that the passive-aggressive individual experiences can come to dominate that person’s emotional life, rather than allowing him to put effort into changing the power dynamic or to remove himself from a position of weakness.

Unfortunately, for some of those who feel powerless and injured, even a passive-aggressive action seems impossible. Consequently, they take a more uniformly passive role. They defer to others, try to avoid giving offense, act meekly, and position themselves under the radar. All that does, however, is give them second class status, just as it informs bullies that they are easy targets.

Someone in this situation, who repeatedly feels mistreated but isn’t able to take on those who inflict the injuries directly, needs to ask himself a few questions. Why do I put up with it? What am I afraid of? Am I really as powerless as I feel? Am I perhaps overreacting? What would happen if I were more direct? Is there any way to get out of the situation I am in?

Cognitive Behavior Therapy (CBT), which aims to quell and counter irrational thoughts, is often helpful in dealing with a lack of self-assertion and the fear that is usually associated with it. Equally, it gives you practice (sometimes using role-playing within the therapy session) in a gradually ascending hierarchy of challenging situations that require an assertive response.

Some CBT therapists, much like ancient Stoic philosophers, employ an “acceptance-based” psychotherapy and integrate this Zen-like element into their treatment. Why, they might ask you, do you so value the minor indignities of daily life and of opinions and behavior of boorish persons? Is it really a good idea to spend the limited time of your life being upset over rudeness from a tardy repairman or a fender-bender accident you didn’t cause — things that will be of no significance in a week, a month, a year?

Put differently, there will always be injustice, and some of it must simply be accepted as the nature of life and of living. Not every fight is worth fighting about, not every slight is intended. If your skin is so thin that you are regularly being upset by people, perhaps you are valuing the approval and opinions of others too much.

For those who ask “Why me?” those same therapists might say, “Why not you — you are alive, aren’t you, so you are subject to all the same things that can affect any other person.” And, as the Stoic philosophers and Zen practitioners would tell us, if we can accept this vulnerability as part and parcel of living, thereby assigning it less meaning and taking it less personally, our lives will be more satisfying — less fraught with anguish, anger, and hurt.

This is not to say society should have tolerated the indignity and racism of “The Dip.” There are times when the indirect, but pointed wit of the caged men is the best course of action; and, many occasions when the force of your personality must be brought to bear by confronting injustice. But some combination of directness in taking on unfairness and forbearance in accepting things — in allowing oneself not to sweat the small stuff — tends to produce as good a result as life will allow.

Of course, you have to figure out what the small stuff is and what other things really do matter to you.

Meditation is usually a part of the treatment enabling you to stay in the moment, and let go of your attachment to passing feelings and thoughts, worries and regrets, and anticipations and fears. To be preoccupied with just such temporary upsets causes you not to be able to fully experience what is going on in the present and determine what is really of importance in your life.

By encouraging and training you in meditation, the counselor  is attempting to give you a method to achieve a state of psychological enlightenment that (without using words) helps you to distinguish the transitory aggravations, disappointments, worries and anxieties of life from whatever matters the most to you, so you can put your effort into the things of greatest value in your life.

Some final questions:

  1. Do you often find yourself fighting over things others consider to be small?
  2. Do you frequently feel put-upon but are capable only of a passive-aggressive response?
  3. Do you (too easily and too often) assume a fetal position with others (metaphorically speaking), who come to think of you as an easy target and treat you badly (in part) because they know you will not stand up for yourself?

If you have answered any of these questions in the affirmative, you might benefit from asking a couple of other questions:

  1. What does this mode of living cost me?
  2. Am I willing to do the work necessary to change?

If the cost is substantial and you are eager to change, then a therapist can be of assistance. Only then will you be ready to get out of the cage, real or not, in which you find yourself.

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The image above is the Flying Turns, a toboggan-style ride that was one of the many attractions that made Riverview Park famous.

March 4, 2010

The Upside of Depression and the Downside of Medication

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Are there advantages to being depressed? Something good about something we think of as so bad? A recent New York Times Magazine article by Jonah Lehrer makes just that case: Depression’s Upside.

The essence of the argument is that some episodes of depression allow for and encourage a kind of analytic rumination that is productive. Put another way, the tendency in depression to focus on a problem, mulling it over to the exclusion of other thoughts, permits the sad person to find a solution to his difficulty and change his life in a positive way.

The counter-argument, however, is that the ruminative process is both painful and unproductive — that it often creates a kind of self-flagellating preoccupation with one’s trouble rather than a process that leads to something good; that unhappiness and focusing on pain and its concomitants simply feed on themselves to no helpful end.

In my clinical experience, therapy with people who are depressed over loss or injury often breaks down into two phases. The first of these is a grieving process, where the person expresses and processes (or sometimes purges) the feelings of anger, sadness, emptiness, desolation, and hopelessness that come with the loss of something of value — a love, a job, high social status, a capability, a fortune, etc.

The second phase involves learning from one’s painful experience about how to live differently, make different decisions, associate with different people, become more assertive, overcome fear; value things differently in life such as money, material things, status, accomplishment, friendship, and love.

Naturally, neither of these two phases is absolutely discrete — they blend into each other and overlap each other. As a practical example, someone who has had a series of bad relationships will typically need to grieve the unhappy end of the most recent one and, in the process, learn how he happened to choose a person or persons who made him so miserable; then changing whatever needs to be changed internally and externally so that different and more satisfying choices occur in the future.

People who are like the hypothetical individual just cited usually come into therapy in emotional pain and seek relief of that pain as promptly as possible. This desire is entirely reasonable — who wouldn’t want this? Some of them request medication, which is often the fastest way to “feel better.”

But many are leery of psychotropic drugs and see them as artificial, hoping that therapy will produce a more lasting fix without dependency upon a foreign substance. Indeed, while a good therapist will strongly encourage the use of medication for someone who is seriously depressed, i.e. suicidal, unable to work, sleeping away the day away (or almost unable to sleep); that same therapist will also know that medication sometimes serves to “de-motivate” the patient, giving him or her a relatively quick solution that allows that person to tolerate an intolerable situation. In the New York Times Magazine article mentioned above, Dr. Andy Thomson describes this problem eloquently:

I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great. I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’

Clearly, this woman was aware that she needed to be in some amount of discomfort in her relationship with her husband in order to be motivated to get out of it. The drug made her feel better, but, it also reduced her incentive to change herself and her life. It was, in effect, a kind of band-aid, rather than a real cure. It anesthetized her and, in so doing, robbed her of something that was essential for new learning and behavior change to occur.

Unfortunately, most people who come to therapy are neither as courageous or insightful as the woman just described. Once they feel significantly better, whether due to therapy or medication, it is common for them to be less interested in continuing treatment. They have recovered from the event that precipitated their entry into therapy, but they might not yet have learned enough to avoid making the same mistakes that contributed to the problem in the first place.

Such a person can reason that the cost of therapy (both financially and in terms of time, effort, and the difficulty that comes with changing one self) is now greater than emotional pain from which they might still be suffering. Put another way, at this point, doing therapy “causes” more difficulty and pain than not doing therapy, just the reverse of what seemed true when they started the treatment process.

At this stage, those who continue in therapy have something that an old mentor of mine, Truman Esau, used to call “therapeutic integrity.” What he saw in some of his patients was an almost heroic desire to make themselves better regardless of how much the actual process of doing so was difficult, uncomfortable, or painful.

These patients didn’t shy away from problematic truths about themselves or others. They worked hard to stretch and challenge themselves, knowing that it was crucial to improve. They didn’t simply want a quick fix. Like the woman in Dr. Thomson’s example, they recognized that some pain was essential to being motivated. They knew that there was no such thing as “a free lunch,” and were willing to do whatever it took to repair and better their lives.

If you are in therapy now, it will be important for you to be sensitive to this shift from the often intense distress that brought you into therapy, to the point when the therapy itself might seem distressful. This can mean that the therapist is not skillful or that he is pushing you too much, but it just might also signal that some of the most difficult life changes you need to make are still ahead of you, even if the cost of making those changes seems greater than when you started treatment.

If you leave therapy because it is hard and unpleasant work, the problems you have won’t care. They will simply continue to reside in you, work on you, and trip you up. It is not enough to get over your last disappointment or unhappiness, but to change yourself enough to avoid future problems.

Few things that are worthwhile come to us for free.

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The above image titled Depression is the work of Hendrike, sourced from Wikimedia Commons.

January 30, 2010

High School Reunions

So you have a high school reunion coming up. And, perhaps you are a bit uncomfortable with the idea of attending. I’ve heard quite a few reasons that cause people to hesitate to go to just such events:

  1. No one will remember me.
  2. Everyone will remember me.
  3. I’ve gotten ________(fill in the blank here with such things as: fat, bald, wrinkled, or the physical defect of your choice).
  4. I haven’t accomplished anything or I haven’t accomplished enough.
  5. I’m divorced.
  6. I’m_________(another blank to fill with such things as: living with my parents, an ex-convict, dreadfully boring, etc).
  7. I never liked those people when I was 17, so why would I like them now?

I imagine there are other reasons, but you get the idea.

Let’s see if I can counter some of these excuses:

  1. Lots of people believe that they won’t be remembered. It is unlikely that no one will know your name. But even if you are recalled by few others, a reunion is actually an opportunity to get to know some of the people who you didn’t know well in high school.
  2. Apparently, you believe that you were well known as a social outcast or as an obnoxious teenager. But perhaps you will be surprised to discover that people are pretty forgiving after 10 or 20 years. If you are no longer on the outside looking in, you have nothing to worry about — people will take you as you now are. And, if you were a bad guy, maybe you need to apologize to a few people. They will almost certainly be gracious.
  3. Do you really think you are the only person who changed physically since your graduation? Unless your classmates live in a jar of formaldehyde, its likely that they haven’t escaped the aging process. It’s true that people age differently, and a lucky few are pretty well-preserved (or have been cosmetically altered to give that appearance), but only one or two have made pacts with the devil to remain ageless.
  4. In the midst of the “Great Recession” more than a few people are out of work or under-employed. You will hardly be alone in this either. Indeed, the reunion might be an opportunity to network.
  5. You are divorced? Look at the reunion as a chance to encounter a new love. Many of the divorced people in attendance are looking for just that opportunity. You might be the person they seek.
  6. OK, living with your parents is not something to brag about. Unless, of course, you are taking care of an aging parent, in which case it tells your old friends that you have a heart. And, if you have a criminal record and are reformed, good for you. Unless you made the front page of the Chicago Tribune, its unlikely that anyone will know this. As far as being boring, you have some time to think about what you might say to the people you meet at the reunion. Work on it. Think of some good questions to ask them. And remember what notable or amusing events you’ve lived through since the last time you saw your old friends.
  7. So you didn’t like your classmates. You didn’t get along with the snobs, the jocks, the brains, the preppies, the druggies, the burn-outs or all the above and more. The good news is that some of these people have changed and are now much more approachable. More good news: some of the people who seemed stuck-up were actually just as shy as you were, and you mistook their distancing for disdain.

A few more observations about high school reunions. The closer in time to your graduation, the more people will resemble their high school avatars. The first reunions, certainly including the 10th and 20th, do involve a certain amount of social comparison among people.

But, by the time you reach reunion 40, almost anyone who comes is just glad to see you and likely to be unconcerned with anything to do with your social status, bank account, or beauty. The feeling of good-will is pretty palpable by the time you are reunited in middle-age: you know that not everyone from your class is still alive, and you are likely to appreciate old friends more than ever.

There is something about being with people who lived in the same place as you did, had the same teachers, in the same moment in history, at precisely the same age as you were when you achieved many of the “firsts” of your life: first kiss, first love, learning to drive, taking your college board (SAT/ACT) exams, and so forth.

You (and your old classmates) had all the same anxieties, worries, hesitations, and learning experiences as you tried to figure out who you were and what was the best direction for your life. It’s likely that you’ve made good friends later in life, but these high school friends were the people you walked with in the formative moments of that life, the people who knew your still relatively young parents and your siblings, and the almost brand-new version of you. Nothing can replace that shared background and knowledge.

So, if your not certain about attending your reunion, I hope you will think about what I’ve written. You might be pleasantly surprised by the experience.

December 2, 2009

He Who Hesitates is (Sometimes) Lost

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Fear and hesitation go hand in hand. They hold you back, creating a slow motion to your progress (see above) and sometimes no progress at all. The trick is to separate the two, to recognize that you needn’t wait until you are free of fear in order to act. Indeed, if that were the case, most of the people whom we consider brave would still be waiting for the moment of bold action that earned them the appellation “hero.”

Years ago I heard a panel discussion on the subject of Wagner’s opera cycle The Ring of the Nibelung that actually touched on the issue of courage and decisive action. The experts focused on the character Siegfried, who is described as someone who has never known an instant of fear in his life. Should we therefore consider Siegfried’s fearless behavior to be indicative of heroism and bravery? The panel in question concluded it did not. After all, they reasoned, how can one be a hero without fear to overcome? Only a fool would rush to action without being aware of the attendant dangers. But a brave and courageous man would know the perils facing him and choose to act in any case.

Most of us won’t face dragons or fire, of course, but we still will all have numerous chances to act decisively or to hold back. Here is a trivial, but instructive example from my own life. In college, I was fulfilling a PE requirement by taking fencing. Now, I wasn’t a very good fencer, despite being a reasonably good athlete. And, my heavy academic course load didn’t permit me the luxury of spending time outside of class to practice fencing. Thus, in the first seven matches I had against my classmates, I won only three, a pretty mediocre showing.

Nonetheless, I was competitive enough to want to win more often, so I reasoned that there just might be a way that wouldn’t take time away from my other studies. I realized that I was a relatively tentative fencer, and so I decided to become more aggressive. I set myself the task of getting in the first “touch” as soon as each new match began. The strategy worked. Of the next 17 matches, I won 14. I was almost always able to get a 1 to 0 lead within a few seconds of the start of the competition by catching my adversaries off-guard. Yet, despite my new found success, I was really no better at fencing than I’d been when my record was three wins and four losses. I was simply less hesitant, more aggressive.

I once had a biology professor named Hudson who conducted the “Quiz” portion of his classes in a way to encourage behavior similar to my fencing experience. You were graded on the number of questions you answered correctly and lost points if you answered the interrogatories wrong. Hudson asked the questions aloud and it was a race to get your hand up first and have him call on you to answer. Naturally, you had to make a quick decision as to whether you had the right answer. Very fast indeed. Those who hesitated were, as the saying goes, “lost.”

But how does this all apply to daily life, the life outside of the university. You might say that “normal” life is less competitive than my examples suggest, but is it? To answer that question, ask yourself how often you hesitate to do things, take chances, give public voice to concerns that might engender disapproval, avoid tasks that are difficult or challenging? Do you ask out the beautiful woman, or do you wait until you feel “ready,” only to watch someone else beat your time in getting her attention? Do you, at least sometimes, see a crisis as an opportunity? Or do you hold back, put things off, wait and hope that another or better time for action will come? Sometimes it will, but sometimes it won’t.

If your “default” strategy, your habitual tendency, is to wait, you have a similar problem to those whose standard operating procedure is to act impulsively, without thinking. It may be the case that “fools rush in where angels fear to tread,” but it is also true that you are an equal fool if you forever hold back, hesitate, and watch the moment pass or see someone else “seize the day (carpe diem).”

What I am talking about is fear and the uncertainty that fuels it. When we are fearful and decide not to take action, most of us feel an immediate sense of relief. That relief reinforces our hesitation, while simultaneously depriving us of the opportunity to succeed in the endeavor. Soon enough the relief will pass, but not the self-doubt and lack of personal esteem and confidence that might have been won by an effective action.

The danger in allowing too many chances to pass by is a life of “quiet desperation,” a life on the sidelines, watching others play the game, but not playing it ourselves. And, at the end of life, regret for the opportunities passed and the chances not taken is more likely to be troubling than the failed efforts made. Beware the heartache of the words “what if?” True, acting boldly often fails; but, it also sometimes succeeds.

No wonder, then, that musicians spend relatively little time passively listening to music. They are too busy making it.

Make music of your life, then. Let the trumpet announce (or remind) the world of your presence. Sing your song. And if you cannot, find a therapist who will give you the tools to beat back your fear and help encourage you.

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The above image is an Animation of Newton’s Cradle created on August 8, 2006 by Demon Deluxe and sourced from Wikimedia Commons.