Q8 Counseling

Imaginary Tinfoil Hats

Fri, 18 May 2012 11:40:00 +0000

[Please note: Any case studies/people which may be mentioned in this blog are composites (unless otherwise indicated) of personal and professional experience over 25 years of people-helping in a number of different capacities and circumstances. Resemblance to any specific individual, living or dead, is purely coincidental and totally unintentional.]

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'Schizophrenia' is a big word but there aren't many people who haven't heard it. Thanks to such movies as A Beautiful Mind, Benny and Joon, Donny Darko, and K-Pax, the general public has been exposed to the Hollywood interpretation of this form of mental illness. Robin Williams in several of his stand-up comedy routines has focused on such issues as Bipolar Disorder, Major Depressive Disorder, and Schizophrenia. Robin Williams uses the tools and the opportunities he has to raise awareness about mental illness (he himself having been diagnosed with Bipolar Disorder), and this is definitely a good thing. But on the whole, while people laugh at the comedic exaggerations Mr. Williams offers, there is nothing funny about living with chronic mental illness.

The worst part is the bias, prejudice, and outright ignorance of people. Schizophrenia can be successfully managed in today's world with medication, therapy, and social support. In fact, statistically, there are likely to be people in your sphere of acquaintance who have been diagnosed with some form of schizophrenia, but you don't know it because the treatment and ongoing support they've received allow them to function just like a real person. Like you. The other reason you don't know who they are is because quite possibly if your colleague from the accounting department told you that he has been diagnosed with schizophrenia, it would change the way you think of him. And he knows it. He's experienced this before and so he's learned not to share this information.

Think about it. If your friend or colleague told you s/he had been diagnosed with Major Depressive Disorder, and was finally getting some help through medication and therapy, what would your reaction be? Essentially positive, it's safe to assume. But if that same friend or colleague told you s/he had been diagnosed with schizophrenia, what would your reaction be then? If you're like most people (and maybe you aren't), there's a slight mental recoil - schizophrenics can be dangerous and unpredictable. They do weird things and might be violent. You might even surreptitiously look to see if your friend is hiding a tinfoil hat.

The truth is, a very small percentage of people diagnosed with schizophrenia become violent, and almost always in response to the delusions and paranoia from which they suffer. Once that aspect of the illness is controlled, usually through medication, the danger of violence is gone. More likely, someone with Paranoid Schizophrenia is likely to act terrified; afraid that others are dangerous to his/her safety. The other possibility is that the person with schizophrenia is trapped in the delusion of his/her mind and loses touch with reality completely (think Russell Crowe in A Beautiful Mind, or Kevin Spacey in K-Pax).

The reality is that this condition is almost as varied as the people who suffer with it. Schizophrenia is a mental illness which causes disorder of the mind, separation from reality, and disintegration of personality. It generally starts slowly, in later adolescence or early adulthood, and is often mistaken in the beginning for something else. Canadian statistics reveal that 3% of the population will experience some form of psychosis or a psychotic break, and of that 3%, 1 in 100 will be diagnosed with some form of schizophrenia. There are no published statistics on mental illness available in Kuwait.

A study conducted in the UK found that, "...one in 5 respondents thought they would be unable to maintain a friendship with, one-half would be unable to room with, and three-quarters would be unable to marry, someone with schizophrenia. Those over 60 were least knowledgeable or enlightened and the most socially distancing. Greater knowledge was associated with less-distancing attitudes. When other factors were controlled, exposure to the mentally ill was not correlated with knowledge or attitudes, even among those who had worked in agencies providing services to the mentally ill." (This study exposes bias amongst professionals working with people diagnosed with schizophrenia) Essentially, these studies show that people distance themselves socially from, and avoid intimacy with, anyone identified as schizophrenic.

It is knowledge - not exposure - that changes peoples' perception of the mentally ill, and of schizophrenia in particular. If all of your information about schizophrenia comes from the movies, you're probably about half right. There are movies with schizophrenic characters which have provided a compassionate and compelling portrayal of this chronic mental illness; but there are also movies which exploit and sensationalize the paranoid aspect of schizophrenia, playing on theme, "The voices told me to kill her," or some such variation.

Accurate knowledge is essential for positive, life affirming choices in any circumstance, and this one is no different. A diagnosis of schizophrenia no longer means a life spent in a mental institute, drugged up and drooling. This condition responds to treatment. What people who struggle with schizophrenia can't manage is the attitudes and prejudice of others. Don't be one of those who stigmatizes and further isolates a fellow human being who may be struggling with mental illness. Take the time to learn something about schizophrenia. Don't imagine a tinfoil hat where none exists.

Share the whole cost of being a part of a common humanity and embrace the opportunity to interact with others from a place of understanding, knowledge, and compassion. It makes us all al little more human.

Some resources -

Surviving Schizophrenia, E. Fuller Torrey

The Complete Family Guide to Schizophrenia - The Guildford Press

General Information

Boiling Frogs

Sun, 06 May 2012 10:20:00 +0000

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Just how stressed are you? Do you know? Think about it... on a scale of 1 - 100, 1 being so laid back people think you're dead, and 100 being so stressed out you wish you were dead, where do you fall? Is your current stress level "normal" for you? Is it unusually high for some reason? (If you've got a 'mellow' groove going on right now, don't read any further.)

We're generally pretty bad at gauging our own stress level. Apparentlly, it's like the frog-in-hot-water thing. By the time we actually comprehend that we're suffering stress-related health issues, it's too late. We're waaaaaaay passed the point at which we should have turned off the heat and gotten out of the water. We all know that some stress is necessary or we'd all be at home, lounging in our pajamas or at the beach, surfing. Stress gets us up and moving. Too much stress, however, and we're demotivated, and inclined to implode, collapsing in on ourselves, becoming less and less efficient.

Really. Too much stress is nasty. Stress related issues include high blood pressure, heart disease, chronic pain disorders (i.e., Fibromyalgia, Chronic Fatigue Syndrome), anxiety, depression, and now, there appears to be a link between chronic stress and infertility.

Ouch.

DeLongis, Folkman, and Lazarus [1988] did a study on stress because they theorized that stress is blamed for a lot of ills, but there didn't seem to be any longitudinal studies on stress which might actually establish a causal link between the evils of stress and ill health. Following the same 75 couples for six months, these researchers had each couple complete 20 assessments in total. To sum up ten pages of dry numbers (means, medians, and methods) they found a "...significant relationship between daily stress and the occurrence of both concurrent and subsequent health problems such as flu, sore throat, headaches, and backaches." This study is from 1988! Twenty-four years later, we're still not very good at recognizing the impact of chronic stress on our daily functioning.

“I was a little excited but mostly blorft. "Blorft" is an adjective I just made up that means 'Completely overwhelmed but proceeding as if everything is fine and reacting to the stress with the torpor of a possum.' I have been blorft every day for the past seven years.” ~ Tina Fey, Bossypants

Some interesting facts - North Americans have fewer vacation days per year than their European counterparts (approximately 14 days per year in America to 20 in Europe), however, the average American closes out his/her work year with 3 - 5 days of vacation unused. Canadians are the same. We don't use all the vacation time allotted to us, but we use every single sick day we're entitled to, and more. How weird is that? Both forms of time off are paid, and yet we apparently can't manage to give ourselves permission to take a vacation day when we need it! Stress-related absenteeism costs employers and the economy almost a billion dollars a year in lost productivity. High stress jobs have a much higher turnover rate leading to loss of expertise and increased costs for recruitment. At home, chronic stress can be a factor in mood disorders, anger issues, relationship conflict, and suicide.

What's wrong with this picture?

What makes it so difficult for us to take care of ourselves? Self-care is really not that hard, but the simple truth is, we just don't do it. In a fast paced, high stress world, often the only "wiggle" room we have is the time we spend on ourselves. So, like the frog in the water, we give away our "me" time here and there, and then a little every day Suddenly, the water's boiling, we no longer have the energy to jump, and so we croak.

Don't get boiled alive. Take this stress test, and pay attention to the results. If you don't like the results of that particular test, you can seek a second opinion - here, here, or here.

If your stress level is higher than it should be, turn down the heat. Find some time for yourself. Make a date with a friend. Go for a massage. Don't go in to the office this weekend. Hug your spouse, play with your chldren. Read a book. Take a digital holiday and put your phones, iPad, Android - all those gadgets - in the sock drawer. Go to the movies or try that new yoga class. Choose to take care of yourself. More stress relieving ideas here, here, & here.

“Stress is the trash of modern life; we all generate it but if you don't dispose of it properly, it will pile up and overtake your life.” ~ Danzae Pace

It's All About the Ritual

Fri, 04 May 2012 15:15:00 +0000

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"Addiction: When you can give up something any time... as long as it's next Tuesday." ~Lemmy

We human beings tend to get addicted to things rather easily, it seems. Whether we're talking about cocaine or gambling, there seems to be a space in most people that can be filled with the ritual of addiction. That is not to say the space is not legitimate, it most likely is, but our problem is that we don't want to do the internal work required to a) determine what the need actually is (see Maslow's Hierachy of Needs) or b) fill the need in a positive, no-bite-back manner.

Nope.

We blithely and blindly sail through life throwing all sorts of things at the hollow space inside us, and rather unfortunately, one or several of those things tends to become an acceptable if temporary substitute for what we really need. The basic needs we have truly are legitimate - let's not forget that. And let's not forget that not everyone has the same opportunities to experience those needs being met in positive, nurturing ways. These early experiences tend to form our perspectives on asking for what we need, how we see ourselves in relation to others, and what we think of the needs we do recognize. When these early experiences are consistently negative, the common response is to find ways to meet those needs without regard to others, by manipulating others to fulfill those needs without having to ask, or even, sadly, by refusing to acknowledge that we even have needs. Sometimes. we meet our own needs by sacrificing for others, hoping to get what we need in return - a subtle variation on the manipulation thing.

Addiction manages to temporarily meet the need in a way that the addict can handle. The thing that ties process addictions and substance addictions together, is ritual. There are very few things in life that we can count on to be totally reliable, 100% of the time. Our jobs change, our performance is up and down, even longtime and much-love partners can let us down. But the ritual and the outcome of addiction is the same, every single time. Whether to a process, or a substance. it is the ritual that draws in the addict, that fulfills the need, that is the lover of the addict. ('Lover' or 'mistress' is the most commonly used description by an addict of the place the addiction holds in his/her life)

This ritual follows a well-worn and predictable path. From the triggering event (easily identifiable in the beginning, not so much latterly) to the thoughts, to the actions taken to fulfill the need, it is the ritual which brings a (false) sense of comfort to an addict. Each ritual is unique to its adherent, but the foundational basics are the same. A triggering event produces internal feelings of discomfort or emotional pain, and the person initiates a ritual intended to assuage, or mask, or remove the discomfort. This ritual begins with a thought pattern that eventually becomes so ingrained, that the person no longer feels as if there is an actual decision to engage in the addiction. The person engaging in this ritual takes comfort in the predictability and reliability of the process. For short period of time, "Everything will be right in me and with the world."

The aftermath, however, is more shame, more self-loathing, and the cycle begins again. This is the nature of addiction. Substances also cause physiological dependence which adds to the destructive nature of the addiction. Both types of addiction cause personal anguish. family distress, economic consequences, and eventually, most people's lives implode under the weight of the addiction.

If you think about your life in terms of rituals, you're likely to find things that you do in times of emotional stress that help relieve the internal pressure, and allow you to carry on with your life. For a person with a genetic pre-disposition to addiction, and a chronically stressful life, those ordinary routines can become more than just a temporary 'fix' to an unpleasant situation. Addiction is both a disease and a habit. For anyone caught in that trap, the only way out is the opposite of what got you there in the first place.

Admit you no longer control your own life.

Let others support your process of becoming whole and healthy again.

Ask for help.

Kuwait has a thriving 12 step program, and there are several private psychological practices with professionals well-versed in working with people in recovery. The Soor Center also has information for good residential treatment programs outside of Kuwait. All you have to do is ask.

Anger is a Short Madness ~ Horace

Fri, 27 Apr 2012 14:05:00 +0000

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"Anger is a wind which blows out the lamp of the mind." ~Robert Green Ingersoll

Anger is a funny thing. Not as in 'ha ha' funny, but rather as in 'strange.' People find it difficult to tell friends or loved ones about things which cause feelings of anger, but will explode with towering rage at the barrista at Starbucks because the coffee isn't hot enough. Or vice versa. The executive who was just given the "Boss of the Year" award, takes out his anger on his wife and children who cower when they hear him coming. Or what about the adolescent who is popular with her peer group and socially in demand, but at home, her parents and siblings are afraid to provoke her in case she gets angry.

As human beings, our emotions are a package deal. All sorts of research has demonstrated that emotional intelligence (EI) is essentially the capacity to accept the emotion one is feeling in the moment without losing the ability to stay present and think rationally. Daniel Goleman is recognized as the frontrunner in the field of EI and he's got some great information here, and an Emotional Intelligence test here.

This is what makes anger so strange. People excuse or rationalize a loss of temper in one situation as justifiable under the circumstances, but control or manage their anger in another circumstance. It seems that when we believe the "bite back" of the situation is minimal, we will allow ourselves free rein to express our anger. So it's not that the executive above never gets angry at work, it's that he responds to that emotion in ways which are proactive and effective, because the consequence of doing anything else is too high.

After three years of marriage, Melli sought help to understand what was happening in her marriage. Her husband had exploded the evening before over what she thought was a straightforward question, "When is your vacation this year?" In response, he had suddenly thrown his dinner plate against the wall, swept everything on the sideboard onto the floor, called her several foul names and stomped out the door. Melli cleaned up the mess, and sadly threw away several figurines which had been her grandmother's, broken beyond repair. Later, after returning to their home, Loretto tried to explain to Melli that he did not like her questions. He was sorry, but when he had information she needed, he would tell her. With that, he kissed her and went to bed.

Melli relayed a part of the event to a co-worker who immediately suggested that she talk to a psychologist because "Loretto isn't normal." Melli made an appointment and asked the psychologist why Loretto was behaving like this.

As children, we learn how to manage our anger through the modeling we see in our families, and the responses to our own expressions of anger. In some families, anger is seen as a legitimate emotion, and the WAY the anger is expressed is shaped and molded in order to be non-destructive and productive. In other families, anger is forbidden. It is simply not acceptable to be seen to be angry, and so the expression of a very real emotion morphs into something else. It does not go away, it becomes something 'acceptable' in the family. This is likely how behaviours such as 'The Silent Treatment,' passive-aggressiveness, and the 'Jekyll & Hyde Syndrome' are learned.

The psychologist explored the 'pattern' of Loretto's anger with Melli, who came to realize that the painful explosions she experienced with her husband were actually quite predictable. Furthermore, with some additional discussion, Melli came to understand that she had been excusing his behaviour, rationalizing and justifying his outbursts in ways that she herself could accept in order to avoid having to confront Loretto about the behaviour. Melli completed an 'anger map' for herself, and also completed an experiential map for Loretto. One of the most painful things Melli had to accept was that her husband's anger was calculated. In all of his explosions, he had never once broken anything but her belongings - never anything of his own. He seemed out-of-control to Melli, and she had excused him on this basis, but his actions demonstrated otherwise.

Melli completed six sessions of anger management therapy - not because she had angry outbursts, but because Melli swallowed her anger, and rather reluctantly admitted that her outlet was passive-aggressive behaviour. Anger management techniques helped her to learn how to express her anger appropriately, and to speak up proactively for a better outcome. After completing her sessions, Melli decided that she would speak with Loretto about anger managment. He was very angry that Melli had spoken to "someone outside" about their problems, but when Melli persisted, Loretto agreed to see the psychologist.

Anger managment therapy is short-term, solution focused help intended to provide the understanding and the tools necessary to handle any strong emotion appropriately. People who have angry outbursts often have difficulty handling any strong emotion, and the strategies for anger management work well for emotional self-regulation, not just for anger.

Loretto completed six sessions with the psychologist, at first reluctantly attending, but after several incidents with a successful outcome from using the new strategies, he became a more enthusiastic participant in the process. Not surprisingly, Melli and Loretto then felt it would be helpful to attend several sessions together as the changes each had made personally were impacting their marriage and they wanted the changes to be positive.

Under the age of three, children have an uncontrollable whole body reaction to strong emotion - this is observable. When they are excited, they wiggle, they can't sit still, and everything about their behaviour says "EXCITED!" It's the same for anger. The temper tantrums, inarticulate screaming, and physical expression of their anger is normal. We as parents begin to shape that expression by teaching our children how to regulate themselves. Not by forcing them to supress the emotions, but rather, to teach them how to accept and deal with that inside feeling in a way that doesn't injure self or others. (Children who are really excited can also hurt themselves or others) Emotional dysregulation in school age children is a sign they need help. The techniques for adult emotional management are a little different than for children, and care should be exercised when asking for help for your children.

So no general recommendation today - help is available if you struggle with anger, or you love someone who has trouble with anger. The Soor Center has several professionals who specialize in anger management, conflict mediation, and relationship therapy, the most common components of help for an individual with anger issues. Additionally, the Center has professionals whose particular expertise is working with children. If your child struggles with emotions in general, get help before their coping strategies become the dysfunctional behaviour of adulthood.

www.soorcenter.com

Waiting to Exhale

Thu, 19 Apr 2012 06:10:00 +0000

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In the movie, Waiting to Exhale, Savannah Jackson (Whitney Houston) is trying to get to the point in her life when it's okay to stop holding her breath. That point when it's okay to relax. In true movie fashion, that point arrives, hearts and flowers abound, and the credits roll.

For children and adults struggling with Attention-Deficit Hyperactivity Disorder (ADHD), exhaling isn't an option. They mostly live their lives defensively, expecting at any moment to be at the center of some dust-up, like a deer in the headlights. Blamed, rightly or wrongly, for whatever bit of chaos is currently happening. This in turn tends to create a siege mentality, which is then manifested most often as aggressive, over-the-top responses to minor irritations, or the development of a victim mentality complete with practiced whining.

To complicate matters, ADHD has often been dismissed as "spoiled child syndrome" or "the last refuge of incompetent parenting," or "an excuse for not performing." While looking for resources for this post, I came across an article on the neuroscience of ADHD, in which the scientist doing the research using fMRI likened the search for the cause of ADHD to the search for the cause of Epilepsy. The parallels are striking. Epilepsy has observable behaviour (ditto for ADHD); epilepsy is visible in the brain as altered patterns of electrical charges (ditto for ADHD); there is no blood test which definitively detects epilepsy (ditto for ADHD); and lastly, epilepsy was dismissed for hundreds of years as demon possession, fits, vapors, hysteria, head sickness, and a whole host of other explanations (ditto for ADHD... though I haven't heard anyone attribute ADHD to demon possession). The neuroscience of ADHD is becoming more clear as fMRI research data becomes longitudinal, and the sheer number of people competently assessed and properly diagnosed rises, adding to the data pool. For a good, understandable explanation of the neuroscience, NYU has a great write-up.

Some facts about ADHD - girls and boys are impacted by ADHD in different ways, therefore the observable behaviours are different. The differences are significant, and girls are currently thought to be under-diagnosed. The difference between potential as measured by IQ and achievement is often wide. An ADHD child or adult may be very articulate and verbally proficient, but produce almost nothing tangible to support that 'head' knowledge. ADHD has symptom overlap with other disorders, and careful, criterion-referenced assessment is vital to ensure diagnosis is accurate. Co-morbid disorders are common with a diagnosis of ADHD, and both disorders must be addressed concurrently. And probably most importantly, ADHD is not a "death sentence" to potential, achievement, or success. Many famous and successful people live with ADHD. Check out here, and here, and here.

Abdullah is 34 years old. He has completed a graduate degree in business, started his own company in the environmental sector, and completed several endurance running events, but he's sought help because in his words, "My social life is awful and my wife is constantly angry with me. Something's just not working and I don't know why."

He was a 'collection of fidgets and twitches' sitting in the chair opposite the psychologist. A brief clinical interview regarding Abdullah's history revealed that school had been a "nightmare," and he had taken almost 8 years to complete his MBA because he continually flunked out of classes. The US university he attended was accommodating, and Abdullah was referred for assessment in the student services center, however he didn't go as his family was 'suspicious' of the whole process. During this interview, Abdullah waved around a 16oz cup of coffee, which he informed the psychologist was his third of the morning. He also admitted he drank only Turkish coffee, the stronger the better.

Abdullah agreed to a complete assessment with the psychologist, and completed a Structured Developmental History, the Test of Variables of Attention - Visual (TOVA), the Conners Behavior Rating Scales for Adults, and Personality Assessment Inventory Screen. He also quickly did the Beck Depression Index, and the Beck Anxiety Index. The psychologist correlated the results and reported back to Abdullah that his profile closely matched that of Attention-Deficit Hyperactivity Disorder, Combined Type. His TOVA score was -12.85. The TOVA threshold for a diagnosis of ADHD is -1.00, so Abdullah's score definitely indicated the likelihood of an attention/focus problem. The collected corollary information supported this conclusion - he was consistently disordered in two or more domains, the problems had been present since before he started school, and had persisted into adult life.

Abdullah brought his wife with him to the report session, and her input greatly helped in understanding how Abdullah had coped on his own without help. However, in their relationship, she struggled to understand and deal with his mood swings, his forgetfulness, and his inability to sit still long enough to connect emotionally in any significant way. These difficulties had all come to a head as they considered starting a family. Abdullah's wife was very much afraid she would become responsible for two 'children' - "Abdullah and a baby."

The psychologist explained that in many ways, Abdullah had learned to compensate for the deficits of his disorder by trial and error, but that some of those issues were not completely overcome, and several had never been addressed. Abdullah and his wife were provided with educational material on ADHD, and referred to a couple therapist whose area of expertise included ADHD in relationships. Additionally, the psychologist pointed out that Abdullah was self-medicating - caffeine has the same stimulant effect as some of the medications prescribed for ADHD (though caffeine has several unpleasant side-effects when consumed in such quantities), and that he might want to consider a trial period of Ritalin or Concerta to see if/how the remaining issues might be impacted.

Abdullah was referred to a psychiatrist who prescribed Ritalin XR (10mgs) plus 40mgs of caffeine in tablet form, and had Abdullah cut back on his coffee consumption to no more than four cups per day of regular coffee. Over the next six months Abdullah and his wife worked with the therapist, and Abdullah saw the psychiatrist once a month. The medication proved to be "a miracle" as Abdullah put it. His performance in his work became much more efficient, and his social relationships, including his relationship with his wife, improved in ways he couldn't have imagined.

Now, three years later, Abdullah is a new father, his environmental company has won a grant for developing a cutting edge technology, and he's completed another five or six endurance events. He still takes RitalinXR, and believes medication was the best choice for him. He told the psychologist during their final session that he felt he was relaxing. He had realized he was no longer holding his breath, waiting for the next explosion of anger or disappointment from his wife or his friends, and he felt like a "new person."

Abdullah was no longer 'waiting to exhale.'

Attention-Deficit Hyperactivity Disorder is a real condition, and just like any other disorder, the quality of the information you receive, the calibre of the professionals involved, and the treatment choices you're offered can make the difference between whether the ADHD controls your life, or you control the ADHD and live life on your own terms. Do your research so you know what questions to ask. Don't be afraid to challenge the psychologist and the method of diagnosis. Look at all the treatment options and expect to try several different ones before the perfect combination is achieved. And most of all, remember that ADHD is a neurologically-based disorder. It is not, and does not define the person. If you suspect that you, or a child you love may have ADHD, find help.

Accurate info and great resources...

Additude Magazine

CHADD

ADHD and More

NYU Child Study Center

Living on the Edge of Darkness

Tue, 10 Apr 2012 06:20:00 +0000

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"Rory," failed a high school math class in the first semester. Though he professed himself to be unhappy about it, neither his parents nor his teachers could see any significant effort to change things. At the parent-teacher conference, Rory's teacher asked his parents if anything had changed at home. She went on to point out that Rory's behaviour had changed over the past few months, and she was concerned. He now chose to sit at the back of the class, he rarely participated in class discussions anymore, and he seemed isolated from his usual peer group, and was no longer seen regularly hanging out with his friends.

Both of Rory's parents indicated that the only real change they felt they could "put their finger on," was that their son seemed exceptionally irritable and had begin to show signs of anger in situations where previously, he would have laughed or been more agreeable. Neither, however, could say that they knew of, or could identify any specific incident or point at which his behaviour had changed. It seemed more gradual to them.

The teacher suggested that Rory might benefit from talking to the School Counselor and his parents agreed. Rory, however, was angry that his parents had had such a discussion without him and angrily refused when the teacher suggested he speak with the Counselor. He denied that anything was wrong, and said he would improve his grades on his own.

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Depression sometimes seems like a spectre that stalks the edges of our society like a hungry hyena, looking for the weak, the old, or the wounded individual. Easily separated from the herd by a shroud of darkness, the individual then drifts off into isolation, as if a huge chasm has gradually opened between where s/he exists and the rest of the world lives. Depression is publicly acknowledged, talked about, even joked about, and sometimes dismissed as unreal. 'Depression doesn't exist. The pharmaceutical companies would have us all convinced we need Prozac or Xanax if we let them. People just need to get out of their heads and into real life.' To someone struggling with the isolating spectre of darkness, feeling delicately balanced on the edge of a black void, such pronouncements are painful.

In fact, depression does exist... and in many different forms.

Depression is also trans-cultural - this mood disorder appears to be a human universal. [Interesting fact: Robert Schrauf, associate professor of Applied LInguistics and an anthropologist at Penn State University, found that we humans think negatively. Irrespective of culture, race, socio-economic status, & age, 50% of the emotional language we ALL use everyday is clearly negative. 30% is clearly positive, and 20% is ambiguous or neutral.] Depression statistically affects more women than men, but ongoing research seems to support the theory that depression presents differently in men and is often unrecognized, therefore is unreported and untreated. Adolescents and children can suffer from depression as well, and in both groups symptoms don't necessarily look like they do in adults.

The individual consequence of depression is well documented, and anyone who struggles with depression is likely to experience some, if not all of the following symptoms: insomnia, sense of sadness, chronic body pain, brain fog, fatique, emotional numbness, irritability, short-term memory loss, weight gain/weight loss, feelings of hopelessness, and in severe cases, suicidal ideation. People struggling with depression may lose their social support network, all but their closest friends, and some may lose their jobs or be reduced to disability benefits as a result of being unable to function effectively. Adolescents and children also stop functioning effectively in their primary environments, often leading to social, emotional, and academic problems. The corporate cost of depression is staggering - lost man hours, poor productivity, absenteeism, and health care claims make depression the third most prevalent short-term disability claim - after family problems, and stress.

Thankfully, depression responds to treatment.

Research has demonstrated over many years, and in many different countries that depression does respond effectively to treatment. Whether primary, secondary, severe, mild, or chronic, proper intervention and support can help an individual regain their emotional equilibrium and begin investing in life again. Essentially, research has shown in many clinical trials over many years that a combination of psychotherapy and medication is the most effective way of treating depression. For secondary and less severe forms of depression, psychotherapy may be effective on its own, but for long term treatment of depressive disorders, medication is a necessity to allow the individual to actively participate in the therapeutic process. (Medications for depression are myriad, and beyond the scope of this post, but you can read an excellent and informative article here.) Psychotherapy - talk therapy - for depression is a vital part of treating this condition, but not all therapies are equal. Evidence-based treatment for depression is Cognitive-Behavioral Therapy, or one of its close cousins such as Interpersonal Therapy, Dialect Behavior Therapy, or Mindfulness Based Cognitive Therapy. The University of Denver has an informative page on their website and it's worth reading.

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When the Academic Officer eventually informed Rory that he was in danger of failing his grade eleven year, he reluctantly made an appointment with the School Counselor.

The Counselor talked with Rory and soon learned that he had, unbeknownst to his parents, broken up with his longtime girlfriend in August, just before school started. She also learned that the girlfriend had then begun revealing private information regarding their relationship through social media. After several weeks, she had apologized to Rory, and the harassment had stopped, however Rory had been unable to recover his equilibrium. He admitted to the Counselor that he was having trouble sleeping, he could not concentrate, and he felt his memory had "just evaporated."

The Counselor suggested Rory complete the Beck Youth Index, which he did. This suite of normed assessments is quick to do, and measure an adolescent's level of self-concept, anxiety, depression, anger, and disruptive behaviours. The results of Rory's assessment indicated his Self-Concept was much lower would be expected of his same age peers, and his level of Depression bordered on clinical. Anxiety was slightly elevated above the norm, as was Disruptive Behaviors. Anger registered as only slightly less than Depression.

In discussing the results with Rory, the Counselor was able to help him understand and normalize his current emotional and psychological distress, and suggested to Rory that he would benefit from several sessions of psychotherapy. Rory agreed, but asked for a referral to an outside agency as he was uncomfortable with the idea of seeking counseling at school. She provided the referral, and Rory choose to see a community psychologist for Cognitive-Behavioral Therapy (CBT).

Rory attended the first session in the mental health clinic with his mother, and after completing the inital intake and information session with her present, began confidential sessions with the psychologist. When the psychologist suggested that Rory would benefit from actively seek academic support in order to get back on track with his schooling, even while therapy was ongoing, Rory agreed. After completing nine sessions of CBT, Rory felt he had, "...control of my life again," and with the psychologist's approval, terminated therapy. He finished the year with a slightly lower GPA, but not enough to impact his academic choices or future college applications.

If you think you might be depressed, or you think you know someone who is, take this quick online assessment. If the score indicates depression is a possiblity, don't suffer needlessly. Get help. It's readily available, even in Kuwait.

Autism Awareness Week

Fri, 30 Mar 2012 06:45:00 +0000

Map of the particular gene (SLC25A12) implicated in the development of Autism.

This week has been dedicated to raising awareness about Autism. This is a good thing - we need more awareness about this disorder and how it impacts individuals, families, and communities. Autism is a puzzling disorder, almost as diverse as the individuals who struggle with its grip on their lives.

I've been thinking about Autism from a different perspective this week as the Soor Center looks at using social media to connect with others in this cause, and to raise awareness of the services available in Kuwait. I was doing some research on this subject (Google is my friend) and was surprised at the number of websites and blogs dedicated to Autism which are run by "Aspies" as they call themselves. There are also a number of famous people diagnosed with Autism in early childhood. The most obvious person who comes to mind is Dr. Temple Grandin.

Her website is fascinating, and as busy as she is, apparently she takes the time to answer all the questions posted to her site. She's written several books, is actively involved in animal rights activism and Autism awareness. She says of herself that she feels "...like an anthropologist on Mars," and speaks frankly of her memories of growing up, struggling to find a way to connect her inner world and the external reality of being human. Dr. Grandin characterizes her middle school and high school years as "...the worst parts of my life." It is the mostly ignorant but often deliberately cruel comments, jests, and taunts from both her peers and teachers during those years that form the backbone of Temple Grandin's passionate advocacy of others. When in the 1980s she began to speak out about her experience of Autism, people were fascinated. Here was someone who could describe what it felt like to be hypersensitve to sound ("like being tied to the rail and the train's coming")...; who could talk about how she is a primarily visual thinker and who says that words are her second language. "Based on personal experience, Grandin advocates early intervention to address autism, and supportive teachers who can direct fixations of the child with autism in fruitful directions. As a partial proponent of neurodiversity, Grandin has expressed that she would not support a cure of the entirety of the autistic spectrum." Her most famous book is "Emergence: Labeled Autistic," and it, along with her other books, are worth reading. Check out her webpage: Temple Grandin, and listen to her TED talk.

Daniel Tammet was finally diagnosed with Asperger's Syndrome at the age of 25. His prodigious memory (he holds the record for reciting 22, 514 digits of Pi in 2004. In addition to Asperger's, Daniel is an "autistic savant." "Tammet's memory, mathematical and linguistic abilities have been studied by some of the world's leading neuroscientists at California's Center for Brain Studies and the UK's Cambridge Autism Research Centre [12] and have been the subject of several peer-reviewed scientific papers." What makes Daniel so interesting in the world of Autism, is that he has synthaesesia. This is a sensory-perception anomaly than manifests in different ways and to differing degrees. For Daniel, numbers and letters each have their own distinct "personality" or manifestation. He says that "289 is particularly ugly, and 333 is particularly attractive." The number 6 to Daniel is almost a "nothingness" but 9 is a towering giant. Letters are the same, and he sees words as people speak them. As a consequence of his memory and his visual capacity, Daniel speaks ten languages, and learned Icelandic in one week, and demonstrated his command of the language by participating in a live TV interview in Iceland, 8 days after arriving.

Although he has said that he did not think he would be here if it were not for the love and support of [his partner], more recently he noted that he used to live a rigid existence aimed at calming his many anxieties — "I was very happy, but it was a small happiness" — whereas now, as the subtitle of Embracing the Wide Sky: A tour across the horizons of the mind asserts, he believes that we ought to seek to liberate our brains — a belief reflected in his new life. "Born on a Blue Day" is Daniel's book about what it's like to be in his skin. It catapulted Daniel to the attention of the world. Eventually, he wrote a sequel, "Embracing the Wide Sky," and gave people an unexpected and very articulate peek into the world of someone whose brain is wired to see almost completely visually. Daniel's website is worth visiting. Daniel Tammet and his TED talk is fascinating.

Not every child diagnosed with Autism, Autism Spectrum Disorder, or Asperger's Syndrome is going to go on a write a book. But every child has potential and it is in early identification, diagnosis and intervention that potential is maximized. In Kuwait, there are limited resources, but those that do exist are growing and expanding in an effort to meet the demand. If you are worried, or suspect that your child is not meeting normal developmental milestones, have a professional assess your child's progress. It only takes a short time, and if the result is a diagnosis of Autism, Autism Spectrum Disorder, or Asperger's Syndrome, the earlier it's caught, the better.

The Soor Center offers assessment, diagnostic, and referral services for families who suspect they may have a child on the Spectrum and we can help you find the services your child needs.

The Edge of the Psyche

Sun, 25 Mar 2012 07:30:00 +0000

"I LOVE A CHALLENGE, AND TRYING TO BECOME THE FIRST PERSON TO BREAK THE SPEED OF SOUND IN FREEFALL IS A CHALLENGE LIKE NO OTHER." ~FELIX BAUMGARTNER

Felix Baumgartner is planning to do something no man has done before. He's going to ride a radio-sonde balloon 38,000 feet into the Stratosphere and then freefall back to earth in the most extreme parachute jump ever attempted. In the process, with the support of Red Bull Stratos, he'll set a few new records. Highest ever ascent by balloon, highest ever parachute jump, longest freefall ever, first ever human body to break the sound barrier... I'm sure there's more, but I don't have the magazine article in front of me, so I don't remember all the firsts that will be happening.

I think he's crazy.

But the most interesting part of the article is that for about eight months, it appeared that the jump might never happen. After a particularly high test drop, Felix Baumgartner had his first ever panic attack. And they kept coming. In the interview, Baumgartner talks about the emotions he experienced as he struggled to control the seemingly random bouts of extreme anxiety that plagued him. Given the level of support required for an enterprise such as this, it was not surprising that someone eventually steered Felix in the direction of a psychologist who specialized in Panic Disorder.

The thing that caught my attention in this extreme athlete's experience was his statement (I'm paraphrasing) that his mind had exceeded the capacity of his psyche. He felt he had reached "...the edge of my psyche..." and he needed help to "...broaden his psychological horizons." That idea really stuck with me.

Panic attacks are a common reason for people to seek professional help, and it's sometimes difficult to explain to clients how/why these seemingly random flashes of panic and distress take over their lives. Many of them don't believe they're that stressed out or that anything in their lives would trigger something so debilitating. Always, a part of my role is psycho-education, and I've developed some word pictures to help the client understand what's happening physiologically, and they get that. What they mostly have trouble with is the idea that they have exceeded the capacity of their psyche. As Bill says, "Their minds are writing cheques their psyche can't cash."

This concept seems incomprehensible to a lot of people. We're certainly told, "If you can think it, you can do it." "Just visualize it, and it will happen." "If you see yourself doing it, you can." While there is some truth in these rather trite maxims, the reality is that we utilize our emotional and psychological equilibrium and resources just in living. If we experience trauma, have a childhood with an adverse event (or events), or carry within our psyches an entrenched negative self-image, we simply don't have the same pool of resources to draw on, and may reach the "edges of the psyche" a lot sooner than we wish.

In this world of globalization, where communication is instant, images often have no backstory or context, and the whole world has become our neighbour, the self-supervision required to maintain our inner world becomes exhausting. And when we reach the limits of our resources, something breaks. In Felix Baumgartner's case, he's doing something extreme. It's absolutely understandable that he might experience an internal rebellion over the things his mind is planning. For the average human just being, the cause/effect scenario might not be so clear cut. But the answer is the same - a willingness to ask for help, and a good, experienced therapist.

The article in Red Bull Magazine is fascinating - and Felix Baumgartner is a man mentally committed to doing something incredible. And he's doing it because he took the time to repair, explore, and broaden his psyche. We can all do that.

Social Media

Fri, 09 Mar 2012 05:30:00 +0000

[Please note: Any case studies/people which may be mentioned in this blog are composites (unless otherwise indicated) of personal and professional experience over 25 years of people-helping in a number of different capacities and circumstances. Any resemblance to real people, living or dead, is purely coincidental and totally unintentional.]

For an earlier post, I had written about the experience of social media and the whole concept has kind of rattled around in my brain, surfacing occasionally for another bit of thinking. (if you haven't read the post, you can find it HERE, and if you have read it, read it again. It's been modified:)) Yesterday when I was at the P2BK (Proud to be Kuwaiti) Exhibition where the Soor Center shares a booth with The99 of Teshkeel Media (we have a common boss), I had occasion to need the restroom- Iikely because of all the water the organizers handed out with blessed regularity. Anyway, I took my bag ('purse' to we Canadians) with me, and at the time of maximum possible inconvenience, my phone rang.

I normally switch my phone to silent for these interludes, but this time I forgot. So I'm busy, and my bag is on the back of the door, blaring out "Twelve Bars Blues" loud enough to be heard in the concourse. Ugh. The normal hubbub of woman washing their hands and gossiping stopped. Silence reigned except for my stupid phone. As soon as I could, I sidled out of the bathroom trying not to catch anyone's eye. I didn't answer my phone.

The ringing phone demands a response. This used to be confined to our homes, and as a child, I remember my parents refusing to answer the phone during dinner. But if it rang, we all sat there frozen until it stopped. I know even as a child I felt somehow bad about not answering, and we certainly didn't carry on as if nothing was happening. Today, many of us don't even have a 'home' phone anymore - we carry it around in our pockets or handbags. And consequently, we get to experience the "To-answer-or-not-to-answer" dilemma everyday. Sometimes a lot. And our global citizenry has become accustomed to being connected.

"I tried to call you today. You didn't answer."

"Really?"

"Yes. I know you carry your phone everywhere." (Here in Kuwait, what generally follows is an examination of the various phones by the offended party in order to establish the truth of this incident.)

"See? You have a missed call from me at 4:10! Where were you that you couldn't answer?"

Fights or arguments are no longer resolved by walking out and cooling off - you were never in the same room in the first place. What started on the phone ends with hang ups, and then migrates to angry texting. Some clients have talked about arguments with friends or loved ones going on by text for days, but not in person. Everybody "acts normal" in person. This seems almost to me to be schizophrenic in the sense of the word's meaning, not the mental illness.

How often are you talking to someone and as they relate a conversation to you they are fluttering their hands at waist height, wiggling their thumbs? Either the conversation they're relating took place by text or the phrase "talking with the hands" has a very literal meaning these days. Or you're having a conversation with someone and their phone rings. Almost inevitably my friend/colleague takes the call. It is rare these days to have a decent conversation that isn't interrupted by the phone. I think the outcome is STRESS. We are never unconnected, alone, or private. Or at least it can feel like that. Digital connectedness is not without cost.

I'm not against social media, mobile phones, or the global village. In fact, whenever I write about this issue, it's usually because I've been brought face-to-face with the impact of the digital age in my own life, positive or negative. There is so much that's good about being instantly connected to my daughters, or being able to provide eTherapy to a former client experiencing a current crisis in another country, or having Google at my fingertips. But this connectedness costs me something.

I'm never "off." Just about anyone, from anywhere in the world can find me, no matter what I'm doing. This is not always a good thing - even when I really enjoy talking with the caller. We all need moments to be inside our own skins, separate from others, and self-contained. The constant, random, and unconnected disruption of those moments is fracturing. At least it is for me.

Self care has always been an absolute necessity for anyone in the people-helping professions. Unfortunately, we tend to be very bad at it. Adding technology to the mix has just made it more complicated. But I'm determined to do two things - to take advantage of all the positives of our globally connected world, and to protect the integrity of my sense of self. Because more than ever before keeping the 'I/Thou" boundary between 'Self' and 'Other' firm and sharp is vital to my mental health. And I suspect yours, too.

I'm contemplating instituting a technology free day each week. But first, I'll have to get over feeling the need to lie down every time I think about actually doing it.

Long overdue

Mon, 05 Mar 2012 10:05:00 +0000

Note: All "clients" or case studies mentioned are composites created for illustrative/educational purposes and are based on 20+ years in professional practice. No individual person is represented.

Being in the helping profession is not for the faint-of-heart. Even if you've got your groove on and all your clients love you and every session is filled with insight and paradigm shifts (wouldn't that be nice?) there's always the administrative side of being in private practice. And the reality is, if it's not one thing, it's another. It doesn't really matter how passionate, how committed, or how fulfilled I feel, the very process of hearing other peoples' pain, combined with needing to manage my practice, my life, my existence (and Bill would say his, too:D) is draining. We need time away, time to be off, time to just be.

Having recently returned from a holiday in France, I was contemplating what it takes now for me to feel rejuvenated, recharged, and ready to listen again. I'm finding as I get older that this process is different than it was in my earlier life. It helped tremendously that being in the Alps meant I didn't have good Internet access so I couldn't work. (I unknowingly left my iPhone on "data roaming" and didn't learn until I returned home that this may cost me hundreds of dollars... *sigh*) If I am prevented from working, I can let it all go and just be present. Funny how our minds work. Well, at least my mind anyway.

All of that to say, I wonder how good we are at actually assessing our own level of burnout/compassion fatigue? If you're like me, you tend to dismiss the physical signs of mental and psychological exhaustion such as aches and pains, not sleeping well, or general fatigue. Or you may, like me, assign some other random reason (i.e., My hair was wet when I went outside yesterday. That's why my head is paining.) I know I don't readily consider that my "aches and pains" (which I have done nothing physical to deserve) may actually be my body 'voice' because I won't acknowledge my mental/emotional state.

Signs of burnout and compassion fatigue are insidious - it's a lot like the frog in the pot. At first, everything is wonderful, then the water begins to heat up, and by the time the frog is alarmed, the heat from the water has sapped his energy and he cooks to death. Ugh. If you're like me (and others I know) it's a sudden revelation that the water is too hot. Our clients deserve better. We deserve better - and what do we model if we ourselves are not cognizant of, and caring for, our own state? The downside to our profession (if you are able to pretend that the clerical/legal demands are not a downside) is the very real danger of vicarious trauma. Just how much heartache, dysfunction, and pain can we hear without being wounded ourselves? I know this is different for each individual, but I would challenge any professional who claims not to be impacted by the damage inflicted on human beings by life. I'm not sure I'd be particularly effective as a therapist if I were not in some way touched through contact with my clients. "Every time we [interact with another], we are confronted with unpredictability, with non-linearity, with ambiguity and uncertainty..." (The Proteus Initiative) and in the context of interactions with traumatized, dysfunctional, hopeless, or chaotic clients this is doubly true.

I was reminded of this as soon as I returned from France. I've been working with a client who has been making progress but it wasn't until I came back rested, with all my mental faculties functioning that I, as a therapist, connected two really significant issues from previous sessions. The result was a huge insight for this client. The session ended with a totally new perspective, and a sense of hope in overcoming the mental chaos my client has lived with for years. I was pleased with the session outcome, but wondered if this breakthrough might have happened sooner if my own mental fog had been less? I've been reminded (again) that as a therapist, my presence, my state of being, and my ability to engage in the process of therapy with my clients is directly impacted by how I care for myself.

Do you know the signs of burnout/compassion fatigue? How often do you take stock of your internal resources and equilibrium? And when you do take stock, what do you do about it? Why not take a moment today and do a little self-check? There are some great resources out there for identifying and addressing the personal cost of being a people-helper.

http://www.compassionfatigue.org

http/compassionfatigue.ca/ (This Canadian website also offers a great ebook on recovering from CF)

Don't be like the frog and wait until it's too late.