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Saturday, February 13, 2016

The Statute of Lmiitations

In the legal field there is such a thing as a statute of limitations.  I think this applies to just about everything except murder.  After a certain length of time, a person can no longer be legally prosecuted.

I was thinking it would be great if the same applied to people, that is, for people who are psychologically punishing themselves. Sometimes people do this not just for months, but for years and decades.

If the law eventually quits chasing a person, and they can no longer be prosecuted, why don't we give ourselves the same break?  This would be a psychological statute of limitations.  After a certain length of time, it would be healthy for people to quit punishing themselves and to let go.  If society does this for us, can't we do it for ourselves?

Friday, March 20, 2015

What Happens When We Avoid Life?

Much of what psychologists work on with patients is the way that they try to avoid aspects of their lives.

What do they avoid, or attempt to avoid?
  • Unpleasant thoughts or feelings.
  • What they consider to be unacceptable thoughts.
  • Situations and stimuli which make them feel uncomfortable.
  • New experiences which might cause some tension in them.
How do they attempt to avoid them?
  • drugs
  • alcohol
  • sex
  • overwork
  • very strict, straightjacketed ways of thinking
  • substituting one feeling for another
  • high stimulation activities
  • staying constantly busy

While not all of these are bad in themselves (high stimulation activities such as skydiving are sometimes positive in themselves), taken to an extreme they suggest that the person is trying to avoid something.

I work with my clients to truly encounter their lives.  However, recently, working with my jazz piano teacher, I realized that I was rushing through exercises.  And by rushing through them, I was not  getting the learning out of them which I could.

Some psychologists would go further, and would say that experiential avoidance is one of the root causes of human suffering.  (This was be true of therapists in the school called Acceptance and Commitment Therapy; however, it was also true of the older school called Getstalt Therapy.)

My clients might find this hard to believe.  They might point to the fact that they ARE experiencing depression, in fact too much of it.  Or they ARE experiencing too much anxiety.  They might say that they are not experiencing too little feeling but too much.

The paradox would be resolved by the idea that anxiety or depression may be the result of not really encountering or digesting the original feeling.  If something is digested, everything tends to work out alright.  However, if we are not digesting something, then bad things happen.  In the same way, if we encounter life's experiences one by one, and deal upfront with each one by one, then they tend to get digested, absorbed, and so on.  We learn from them.  We solve problems.  We can even desensitize to certain types of negative situations.  But when we avoid feelings and situations, we can't do any of these, and things just go from bad to worse.

Another way to think of this is that there are primary feelings and secondary feelings.  A primary feeling might be the hurt of someone breaking up with us.  We might feel sadness and anger.  If we allow ourselves to feel those feelings, then they have a good chance of getting digested, and we can go on.  If we do not deal with those primary feelings, then we may be left with a residue which is not directly attached to any particular situation, a residue of depression or anxiety which is more free floating, and which tends to linger and stay on.  It tends to linger because we are not fully aware of what is causing it or how to solve it.  It may be a free floating residue.

Or here is another way of thinking of it.  If we deal with situations and feelings up front, then our stress levels may decrease, and any underlying genetic biological tendency towards a mental disorder may not be triggered.

Now, I don't want to claim that it is always easy to face our situations and feelings.  Sometimes we may need professional help if situational stress is overwhelming to us.  BUT, I do believe that it always better (with help or without help) to face issues and try to solve them within a reasonable period of time.  Feelings can be faced but not exactly SOLVED.  We can't solve a feeling.  But by facing it, it will often go away.

That doesn't mean that it hurts anything to go home at night and have a glass of wine, saying to yourself that you will tackle the problem tomorrow (assuming you are not an alcoholic).  That is avoidance, yes,  but very temporary avoidance.  We do not have to tackle problems 24/7.  But if we put off dealing with problems day after day, then that is when the problem and feelings we face may transform themselves into something even worse.

Friday, March 06, 2015

Language as a Two Edged Sword

A news article came out the other day about research indicating that dogs are able to remember what happened the day before.  This made me reflect once again regarding the value of language and the problems that come with it.  I would guess that lack of language is one contributing factor to dogs not being able to remember recent events.  Words and phrases such as "family get together," "football," "Saturday," and so on, aid our memory.  Dogs don't have those words.  In addition to helping our memory, words make us more capable of conceptualizing problems and solving them.

It just may be that dogs may be a little happier than humans, or put another way, that they may be less miserable. If their basic needs are met, they probably are content. Human beings can worry about tomorrow, remember the past, and berate themselves interminably.  And much of those thoughts involve words.

Words are a two edged sword.  It would be much harder to be neurotic without words.  Many of the negative events and effects of childhood are stored in words.  Negative messages from our parents, e.g., "You can't sing,"  "You'll never amount to anything," and so on, take abuse to a whole new level.  Physical and sexual abuse certainly harm a lot of people, but words add an entirely new layer of negativity.  We can rehearse and remember those negative statements over and over, until our own demise.  Moreover, our own negative thoughts about our abuse, e.g, "I must have deserved it," "I caused it," and so on, make it even worse.

Much of the therapy I do with clients is aimed at helping them to rid themselves of irrational negative thoughts.  I have written about that many times in this blog and elsewhere.

Sometimes the negative thoughts come so fast and furious in therapy, that it is hard to keep up with them.  Consider the following dialog:

     Patient:  So I screwed up once again--just like my parents said.

     Therapist:  That would seem to be the same type of negative thought we discussed just a few minutes ago.

     Patient: Oh, you're right.  I'm so stupid.  I can't do anything right.

In this example, even before the therapist is able to assist the patient with dealing with one negative thought, two more have been added.

That is one reason why cognitive therapy for depression can take 10-20 sessions.  Eventually, however, most persons can get a handle on their negative thinking and make progress with their thoughts.

I could say a lot more about this, but I will make this short and leave you with the moral of this story:  Use language wisely.  Use it to describe thoughts, events, and behaviors accurately.  Use it to conceptualize problems and conceptualize solutions.  But remember that thoughts can sometimes be produced by the brain which are very unhelpful.  In that situation, they neither lead to better conceptualization of problems, nor better solutions.  Sometimes rampant, unbridled words and thoughts in our heads are the problem.

Saturday, March 29, 2014

Holistic Therapy--Yes But I Won't Be Using That Word

Well, I feel as if I have been drug kicking and screaming into the holistic revolution.

After years of resisting it, I just have to give in.

But outside of the title of this article, I still won't be using the word.  Why?  Because it is a buzzword.  It means so many different things that it means nothing.  It is a way of saying, "I'm with you; I'm with the modern IN crowd."  But the word means so many things it starts to mean nothing.

But what I do want to do is be comprehensive in the way I approach depression.  Cognitive therapy is not the only way.  Behavior therapy is not the only way.  Medication is not the only way.  Even electroconvulsive therapy may have its place.  Exercise is definitely a factor in recovery, and I believe that for some people nutrition may be important.

I did not reach this conclusion because of a desire to be part of a feel good movement.  I reached it out of pure practicality and what works.  Or what doesn't work would be a better description.  What doesn't work as well as we wished it worked.  And that would include pretty much every treatment that we know of now.

When I started learning cognitive therapy, in 1980, it was relatively new.  It was not inconceivable that cognitive therapy, or cognitive therapy combined with behavioral therapy, or cognitive therapy combined with medication, etc. just might cure most people.  Sadly, that has not been the case.  The ultimate solution to the riddle of depression lies a ways off--perhaps fifty years, perhaps a century.  Talking therapy has proved to be just as limited as medication.  Cognitive therapy has more research evidence behind it than psychoanalytic therapy.  But that doesn't mean it is much more effective.

However, there are a variety of interventions and coping techniques which can help depression:
spiritual techniques
mindfulness techniques, e.g. meditation
positive psychology techniques (such as altruism and volunteering)

These are just a few.

Why did I resist the idea of a comprehensive "holistic" approach?  It seemed just too much of a catchphrase, better at making authors money and being part of a feel good movement than really helping people.  The research for holistic approaches was often flimsy when one actually looked into it.  That is beginning to change.  Research into alternative techniques (alternative to medication and talking therapy) is growing in amount and in quality.

Also, I was simply overly focused on pure psychotherapy research and too much of a true believer.  Perhaps I can be forgiven for being a "true believer" in a technique which had really quality research showing that it worked.  What the research also showed, however, was that it worked only up to a point.  It worked for certain people and not others.  Or it worked partially for some people.  For awhile it seemed that there must be a moderator variable in there somewhere.  If we gave it for 40 sessions instead of 20, maybe that would make it much better  If we combined it with other treatments, or if we used it only for certain patients, or if patients would only do their homework, etc. then maybe it would work for almost everyone.  And each of these was a legitimate issue, but it never solved the whole puzzle. 

It's not that I have quit believing in cognitive psychotherapy.  It is still the main treatment I would recommend for someone who has mild to moderate depression.  If I had a family member with depression, I would want them to have cognitive behavioral therapy, and maybe medication.

It's just that it is now clear that no matter how you slice and dice psychotherapy, it will have limited results.  The same is true of antidepressants.

I have been reacquainting myself with the new biological research into the underlying brain issues associated with depression.  It is clear that for some types of depression, and maybe all severe depressions, there is a biological substratum.  We now believe that chronic stress releases so much cortisol over such a long period of time that it damages certain parts of the brain.  There is evidence for this as a possible cause of depression.

The brain can regenerate cells in some areas.  One of those areas is the critical hippocampus.  It is involved in memory and also in controlling our anxiety/fight or flight mechanism (HPA axis).  Regeneration of hippocampal cells is stimulated by brain derived neurotrophic hormone (BDNH), which in turn is released after exercise.  Outcome studies are pointing to excellent treatment effects for depression with exercise.

Thus, theoretical and basic science findings such as this are encouraging me to think more broadly.

Secondly, outcome studies of exercise and other techniques such as medication are showing good effects.  Cognitive therapy has a lot of good research behind it, but now we are starting to see some really good research outcomes for exercise and positive psychotherapy.

Thirdly, as I have improved my own healthy behaviors, I feel less hypocritical asking my patients to work on theirs.  I am more comfortable now advocating that other people do things which I used to avoid working on for myself.

Just how helpful are some of these alternative therapies?  Exercise has been shown to be quite helpful, perhaps yielding as large an antidepressant effect as current medications on the market.  Nutrition has not been as well studied as exercise.  However, one Australian study published in the prestigious journal Lancet, found that there was a correlation between fish consumption and a lowered risk of depression.  (Correlation studies such as this have to be followed by experimental studies to be fully interpretable, however).  Omega 3 fatty acids are thought to be very important in proper brain function.  Other foods, such as protein, are important because they provide a good supply of all the necessary amino acids.

Well, that's enough for now.  I hope to write more about this later.

Monday, March 10, 2014

Deilberate Mind

This state of mind is about living life in a consciously deliberate fashion. It may seem strange that this would have anything to do with mindfulness, since mindfulness generally incorporates a form of meditation which involves no thinking at all.  However, to meditate in this way is actually very deliberate and focused.

In a sense, deliberate mind takes away blame.  We oftentimes blame others because we see our lives as stimulus and response.  You do something, and I react.  Therefore, my reactions are your fault.  To live life with full consciousness on the other hand, or at least as full consciousness as possible, would involve living life so that less blame shunted onto other people for our negative feelings.

To live deliberately is to take responsibility for my actions and feelings.  And if, as sometimes happens, someone has harmed me and made life difficult for me, then deliberate mind is more focused on finding a solution than on my anger or blame at the other person.

To live life deliberately is also to live life consciously--conscious of what I am doing and why I am doing it.  To live unconsciously is to live without a knowledge of what is truly driving me.  We may never understand all of our feelings, but at least we can live in such a way that we can take considerable responsibility for what we think, do, and feel.

Thursday, February 06, 2014

Games, Belonging, and Avoiding Depression in Retirement

I am no expert in game theory, but there is something which is now so clear to me that I just need to write something about it on this blog.

Many people, when they retire, become depressed because they no longer play a role in society.  They are no longer part of the "big game."  (This is a phrase I picked up from a Harrison Ford movie.  I'll figure out which one later.)

For each of us, the "game" involves reaching a goal.  It often involves gaining something, which gives us some satisfaction.  What we gain could be a game of checkers, a smile from someone we like, or status within a group.  The kind of game I am talking about generally does not involve "winning" in any all or nothing fashion.  To win is simply to participate and to achieve some kind of goal.

In this kind of participation, we are "known" by others. They see us as part of their circle.  They expect something from us.  They may expect us to do our part and pull our weight.  We may be seen as doing something particularly well, such as playing checkers, scrapbooking, or giving political opinions.  If we are "in the game" others may seek to have us as an ally when there is conflict.  Or they may expect us to be an enemy, but either way we are known to them.  If we do not show up, our absence is noted.

In this way, we have "self objects" (see Heinz Kohut on self objects).  And we are a self object to them.

People retiring may look forward to having nothing that they have to do.  But they are no longer part of the "big game."  In a worst case scenario, they go into a state of deprivation for face to face contact, which can lead to depression.  Many persons who retire do not quickly go on to develop dementia.  Their minds are still capable of analysis and decision making, but they no longer have a role to play.  They are no longer a part of the "game."

In a best case scenario, people still have a role to play at church, at the VFW, or at the country club.  They can still run for an office.  It may not be earth shaking in importance, but it's just as good.  They are not irrelevant to the people around them.  There is a reason to make an effort, to strive, to think, and to progress.

Unfortunately, for some people no such "game" is available.  They are shut ins, or there are no available groups in which they can participate in any meaningful way.  If elderly people are not seen as desirable participants, then they are shut out of the "game."  One cannot easily barge into a system.

I believe that to some degree elderly participants can form their own groups.  But I also believe that it is even better when younger groups (people younger than retirement age) can find value and purpose in including older persons.

This issue is not limited only to retired persons, however.  It can also apply to disabled persons.  It can also apply to newly divorced persons.  It can apply to people who have been dislocated and/or have moved to a new geographic area.

Well, I've said my peace for now.  More on this later.

Monday, April 15, 2013

State of Mind: Observing Mind

The ability to observe ourselves is a distinctly human ability (as far as we know) and is associated with the frontal lobes of the brains.  It is one of the executive functions.

As far as we know, we are the only animal capable of observing ourselves and contemplating what is going on within us, and also about how we are affecting others by our actions.

This ability can keep us out of trouble by warning us about how we are coming across to others before we go too far and damage relationships. It therefore can help us to know what not to do.

The ability to observe outselves dispassionately gives us a means of coping.  It means that we don't always have to be fully immersed in our emotions.  We don't always have to participate in situations from a self-centered, me, me, me point of view.  We are not our emotions.  There is a person, an "I" or a soul, behind my emotions. 

We use observing mind in cognitive therapy.  There are two major steps in cognitive therapy: thought distancing and thought evaluation.  Observing mind is used in the thought distancing step.  We realize that we are having thoughts.  More than that, we can realize that these thoughts are not necessarily the same thing as reality.

I would also include here the concept of what I might refer to as "transcendent mind."  The transcendent, observing mind is capable of looking at ourselves and at our situation philosophically.  Philosophers call this "sub specie aeternitatis."  For a better understanding of this concept, see in Wikipedia.  We have the ability, as it were, not only to stand aside and look ourselves from the ceiling in the present moment, but we also have the capacity to imagine how out situation and behavior might look from a vantage point decades later or even centuries hence.  And the result is that we begin to see our problems, our needs, and our behavior in a different light.  In transcendent mind, our problems might seem quite small, just as looking through the wrong end of a telescope.  Instead of things looking exceptionally large, as when we look through the eyepiece of a telescope, they can look smaller when considered from the vantage point of eternity.  Emotional mind tends to make problems look larger than they might otherwise seem; transcendent mind tends to make them look smaller.