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9/11 and Recovery


I’ve been visiting my children and grandchildren on the west coast for the past two weeks, and with 9/11 upon us, it is a stark reminder that I need to get back to work. There are people out there who need to learn more and want to recover from trauma and tragedy. But, hey, isn’t that what 9/11 is all about?

OK. 9/11 is not only about recovery from trauma and tragedy, but recovery is a really important factor. One of the most important lessons from this terrible tragedy is not what most people focus on. It is about those people who seem less effected by the terrorist events. I am not referring to people who were not effected at all, but those who seem less effected because they quickly bounced back to normal. Most Americans were able to resume normal lives quite rapidly after that fateful September morning, even those who were terribly shaken by the attacks. What does that teach us about surviving and recovering from other trauma? How can we learn from their experience to improve the lives of others who have experienced other tragedies, trauma and abuse?

The technical term for the ability to bounce back from negative events is called “resiliency”. We know that some people are more resilient and others are less resilient. We also know that regardless of a person’s natural resiliency, it can be broken through multiple and consistent trauma. On the other hand, we know that, at least in regards to childhood trauma, resilience is bolstered when the child has at least one supportive relationship. One adult who believes and supports a maltreated child can often (but not always) save that child from the ravages of complex PTSD.

But people with high resilience are not often studied. They are the ones that have a good life (or reasonably goo life) despite the trauma they endured. They do not go for therapy, and they see no reason to dig into painful past memories. This is most unfortunate, because they certainly can shed light, or offer insights into the strengths needed to change a terrible life into a flourishing thriving life.

Fortunately there were some scientists who were thinking this way ten years ago. Most prominent among them was Barbara Fredrickson of the University of North Carolina. Looking at the whole population she found that people who bounced back had a greater amount of positivity in their lives. They recognized and felt the full impact of the tragedy, but also had the strength to reinstate hope and planning for the future.

If you suffer from PTSD you are probably saying to yourself, “Great. But what about me? They are the lucky ones. My life is overwhelmingly negative.” While that might be true, there are many techniques and exercises to build the ability to add positivity in your life. Some are simple and some are more work. But there is definitely some way of adding the positive in your life.

I am not talking about the Pollyanna, “look at the good side”, “just get over it” type of work. I am also not saying that the work of reducing troubling symptoms is not important. Not at all. One needs to address anxiety, flashbacks, anger triggers, etc. But it is not really enough. You need an additional focus on the things that make life worth living. Activities that engage you. Ideas that give meaning to your life. Relationships that that fill you with joy. Achieving goals that raise you up further and further.

In each one of us there are seeds, saplings or trees made of one (or more) of the following ten emotions: joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and/or love. Even if it is just a seed of one of them, you have the ability to grow, thrive, survive, and flourish.

Scientists learned that from 9/11. We can learn from them now. We can not only get rid of negativity but let’s work on the positive also!

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Beautiful and Deadly

Beautiful and Deadly by Ari Hahn
Beautiful and Deadly, a photo by Ari Hahn on Flickr.

Kaaterskill Falls is famous for its beauty. It was a favorite spot for the painters of the Hudson Valley School of Art. America’s first artist colony was in nearby Palenville, NY. While the whole Catskill area is beautiful, Kaaterskill Falls is especially captivating.

But it can also be deadly. Every year somebody gets too close to the raging water and meets real tragedy.

Beautiful and Deadly

Anybody who has experienced bi-polar disorder up close knows a special dimension of these words. Most of the time the metaphor used for bi-polar is a raging sea vs. the calm. Of course, that is a good metaphor. But the beautiful and dangerous waterfall is just as valid, but from a different perspective. The person who suffers from bi-polar disorder experiences the rush of a raging ocean vs. the dead calm of a stagnant pond. Often that is the experience of the caregivers also. But there is another category of loved ones that can see things differently. They can see the beauty in the dangerous side. They can love the person for the whole range of emotions and behaviors even while appreciating that it is dangerous and distance is often the prudent procedure.

I just read a book called “where are the cocoa puffs?” by Karen Winters Schwartz. It is a novel about an 18 year old girl who descends into the depths of bi-polar disorder. It is a wonderful and highly recommended book with many great qualities that I will not discuss right now because I want to focus on just one aspect. The protagonist, Mandy, picks up a boyfriend during one of her first manic stages. The boy, Ryan, falls madly in love with this hyperactive, hyper manic, hypersexual, beautiful girl. I suspect that part of the reason that he stays with her after some very extreme behavior is because he was accepted into her successful loving (but suffering and struggling) family. However, since he loves the whole person, he views her more like an extremely beautiful and powerfully dangerous waterfall. He just happens to be one that can also engage the waterfall.

Since the book is very realistic (although, by necessity cannot portray the true depth of emotions that family members actually experience) and since it is a novel, I plan to come back to this book often to illustrate things that I see in my clients.

The book is available at amazon. (I wish I knew how to put one of those “buy it at Amazon” links here.)

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Why Contradictions are Good.

Pondering the depths by Ari Hahn
Pondering the depths, a photo by Ari Hahn on Flickr.

Contradictions. We tend to think of them as negative, but in contradictions we can find the greatest truths. It is more than just a quirk of language that we can reach the greatest heights by plumbing the greatest depths. It is an actual fact of life that by accepting contradictions we can expand our minds and our understandings.

There are a few reasons for this phenomenon. First, since we have only a limited power of understanding, acknowledgment of our limits opens us up to understand things that at first do not make sense. Sometimes they make sense after we accept them. Second, there is often more details and depth in a reality that reveal secrets otherwise concealed. For example, in interpersonal communications we can gain only a certain amount of understanding through the words of a conversation. Once a certain limit is reached, we can attain a greater understanding by listening to the silence (and other non-verbal and non-visual) levels of communication. These can include sounds that are not normally audible and bodily reactions that we are non-consciously sending and receiving.

Of course, in art the act of savoring and becoming engaged in the art are supra-conscious acts. This is well known but not common enough. Especially in today’s over-saturated environment. In the modern Western world we are bombarded with sights, sounds, and mini-messages that attempt to keep us at a superficial level of understanding. How else can be be convinced to spend money on items and customs that are actually detrimental? (My favorite is the American belief that we need to shower every day (which I do.) By showering everyday we use more soap, deplete our natural skin oils, and need to buy more products to replace, at least minimally, those oils in order to retain healthy skin.) If we were to think deeply, and follow the dictates of our bodies we would slow down and need less.

This works also for intellectual pursuits. Learning quickly is only one aspect of intellectual success. True success requires slow thought. Contemplation. Greater understanding by pondering the depths. Ponder this (in darkness) and you will see the light.

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How to turn a child into an adult

I participated in a family support group this week that focused on “dependency” issues. The group consisted of parents of adults who suffer from various mental and emotional disorders. We discussed the difficulties of watching adult children engage in various self-distractive or self-sabotaging behaviors. Although the stories were much more extreme than one might hear from parents of healthy children, the attitude and perspective we need to take is really just the same regardless of the child.

One father talked about his son who is in a residential treatment facility. His son is in his late twenties. The facility is very good (and very expensive.) In order to begin to work on inappropriate behaviors that can be reenforced by the family, they have a 45 day no contact period at the beginning of treatment. Not surprisingly, many patients don’t like that. This man’s son decided to leave the facility and make it home but only made it half way. Penniless, tired and hungry, he called his father for help.

The father, with boundless love for his son, was heartbroken when he heard his son’s plight. “How could I let him sleep on the street without food?” he lamented.

How indeed? This man was spending approximately 10K a month for his son’s treatment and when his son needs $50 for a room and a bus ticket he can’t help?

But the perspective is wrong. While we all want the best for our children, we are not very good at getting them to make good choices. Many choose life styles that are not what we could imagine. Others make mistakes that if they would only listen to is they wouldn’t need to falter. Life would be so much easier if our children would learn from our mistakes. Alas….

We need to step back and get a long term perspective. Not a small step back, but a really big step. Remember how that child was when she came into this world. What the relationship like during his first weeks and months? At that age the human being is completely helpless and dependent. This actually defines the goal of parenting. We want out children to be independent adults. Even more important: this is the primary prerequisite for their happiness. Nobody can be a flourishing, thriving individual if they feel dependent on others for their well being.

How is this perspective translated into everyday behavior? How can this be understood in simple terms? How do we keep that goal of independence foremost in our minds and constantly in view?

Let us start with a simple example. Your kid is learning to ride a bicycle. You are there with her and holding on as she starts out. But eventually you will let go and she will ride without your help, independently. You know that she is likely to fall while learning and come crying about a hurt knee or elbow. That doesn’t stop you – or her. Independence is too important.

If a twenty something tries to start a business, you wish him best and give advise (if he’ll listen.) If he won’t listen then you keep your mouth shut and tell yourself that he is still young and he can learn from his failures. Hopefully he does and has a better round the next time. Why is that the best path to take? Because that is the road to greater independence.

That is the same message I shared with my group this week. Sure the child will fall and suffer. Since the behavior that triggered the problem was greater than learning to ride a bicycle the suffering will be greater, but it is the exact same process. In order to become independent the child (even if she is now a 35 year old child) needs to fall and get up and learn to do it on her own. Anything less than that is losing sight of the real goal of independence.

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Why Psychiatric Medication is Confusing

“Hey Doc, why are you using me as a guinea pig? I am not taking these meds!”

Anybody who has been around people who need psychotropic medications (drugs for mental illness) has heard this complaint. Psychiatrists can never be sure if the prescription they write will do the “magic” that is sought. It is normal practice for a physician to give a trail of one medicine for a few weeks (or months) and if it is not working, try something very different. Or even begin a “cocktail” of medicines that might just do the trick.

It seems unusually cruel that people who have issues trusting people are given medicine that is so unreliable.  In American culture physicians are the most trusted of people. But when some of us feel so bad that we can’t even think straight, and we can’t trust anybody, we often go to a doctor who will write something on that special pad that might help, but might even harm! Why is the system so cruel?

To understand this, we need to understand a little bit about psychiatric diagnosis, and then a little bit about the medicines themselves.

Psychiatric diagnoses or the types and categories of mental illness is defined in a book called DSM (Diagnostic and Statistical Manual) published by the American Psychiatric Association (APA). This book is periodically updated and is currently in the fourth edition. The APA is an association for physicians who specialize in psychiatry. So they are interested in having their particular specialty be as similar to other medical specialties as possible. But there is a major, essential difference. Mental illness is not like most other medical illnesses. Most illnesses are defined by what causes them. Mental illness is defined by symptoms.

In most fields of medicine a disease is defined by the pathogen (the “bug”- virus, bacteria, etc.) that causes it. You have a sore throat so you go to the doctor to find out what you have. She takes a culture and tells you that you have strep throat. And she writes out a prescription for a medicine that will kill the strep.

The sore throat is a symptom. Before you went to the doctor you knew you had a sore throat. You did not know if it was strep throat or post nasal drip. Any symptom can have multiple or various causes. It is the doctor’s job to figure out the cause in order to prescribe a cure. Otherwise, you could just go and but some Cepacol.

But the DSM does not define mental illness according to cause. That because we generally do not have much of a clue about the causes of mental illness. (Except for one case, I will mention later.) So all of the categories in the DSM are defined by symptoms. A person has bipolar disorder because he or she acts like a person with bipolar disorder. A person is labeled schizophrenic because he or she has two or more of one set of symptoms and a certain amount of other symptoms. But nowhere is there a diagnostic test that is similar to a blood test, MRI, or throat culture. (This is also why people with major mental disorders usually have multiple diagnoses or the diagnoses change over time.)

All of the symptoms are behavioral. That means, we can look at the way a person is acting and apply the label that fits best. Of a seven year old has six or more features of inattention for at least six months, then he has ADHD. But do we know (or care) if it is caused by a malfunction of the brain or because the home is so unorganized that the kid rarely gets enough sleep? (Try staying focused on 4 hours a night of sleep.) Or some other reason?

Since psychiatric illness is defined by symptoms and not causes, the medicines are also given to address the symptoms and not the causes. That can be very good. If you need to control the symptom of hallucinations, it is fine to give anything that will work. If you need some immediate relief for your sore throat there is nothing wrong with a Cepacol. But it might not work, if the cause remains and can overpower the symptom. So if it doesn’t work, we can’t be sure why not. So the next best thing is to try the next best thing. Try a different medicine that might attack the symptom a bit more efficiently.

There is one category of psychiatric illness where we do know the cause. That is Post Traumatic Stress Disorder, and the related diagnoses. We know that there is a clear environmental cause. But that just makes the problem of prescribing medication even more complex. You cannot prescribe a retroactive anti-trauma medicine. (It would be wonderful, wouldn’t it?) Which is why there is no medical intervention for ex-abused people or people who have survived trauma. And when medicine is helpful, it is very difficult to apply that helpful experience from one person to another.

So if symptom relief is the best we can get, go for it. It can be much better than being with the symptoms. Without a cure, I’ll go get a Cepacol.

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Should I send my bi-polar kid to camp?

“John wants to go to sleep away camp. With bi-polar disorder how can he go?” Joan, his mother, asked me one day after a few months of coaching.  She knew what was coming in the session, but we had to go through the whole process.

John has been suffering from bi-polar disorder from early childhood. It wasn’t too long ago that it was believed that such a malady could not effect children. Today we know that even children from stable families can suffer from extreme and violent mood swings. Many adults who have this diagnosis have mood swings for many other reasons and they are very difficult to live with. But somewhere along the line it was a choice if you live with an adult who suffers like this. But if it your child you have no choice.

If you are a parent of a bi-polar child you are constantly faced with heart breaking dilemmas. You cannot expect people to understand you or your child. You are always concerned about how they will treat you, your child and your family if you have to tell them about your child’s condition. You know that there is no right answer and no wrong answer, but that only makes the struggle worse. Your experience has shown that even intelligent, understanding people can suddenly view your entire family as “damaged” in some way because of this illness.

So do we send John to sleep away? I ask her, “What have you done to explore this?” She answers that she has talked to other people who have “been there, done that.” She is getting more scared about if something happens than the stigma problem. Joan’s friends, mostly on-line friends, have shared with her their experiences. One friend told her about when she sent her son on an overnight trip with his school and when all the boys went to sleep in the same room it was too much for her son. He “freaked out” and needed to be hospitalized. The mother said that it wasn’t even so bad, but the chaperone wasn’t taking any chances. “That was only an overnight. How can I send John away for a week?” Joan asked.

I explored with her why she wanted John to go away to sleep away. She wanted him to feel normal. She thought it was important for his social development. She needed a break herself.

She thought it might be time since John had been stable for over a year, and seemed to be accepting his illness. We celebrated how far they had come in the past two years. The whole family was doing a great job.

We then tried to look at it from John’s perspective. Did he really want to go? How would he deal with the medication issue and the possible stigma? How did that fit in with their educational goals? Was he mature enough to deal with these issues.

Joan did not have all the answers. Nobody ever does. But she was able to make a plan decide how to make a decision. She has few issues with the stigma question, which is unusual. She and her husband have been working on building an atmosphere of acceptance of the illness and that John will not see it as “who he is” but rather something he needs to deal with. She decided to clarify a few question with her husband and with John and get back to me in a few days.

They decided to send John after discussing it with the director of the camp and building a safety net that included the camp nurse and the head counselor. I am not sure that I would have made the same decision, but I am sure it was the best for them.

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Not Common Cold Depression

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Like all psychiatric diagnoses, depression is defined by its symptoms. Other illnesses are usually defined by the cause. A sore throat is a symptom while strep throat is a disease. Once we realize that depression is a symptom we notice that it is a symptom of numerous conditions.

Depression can be a symptom of thyroid disfunction. We know of SAD which is caused by lack of sunlight. There is post-partum depression. Also, since depressive symptoms are more common in women of childbearing years there seems to be something in thay population that preciptates those symptoms. The same is true for men with sexual dysfuntions.

In all of the above mentioned groups most people never have serious problems. They are resilient. The big question is how to increase resilence. Most psychologist can tell you how to combat depressive thoughts when they invade your mind but only recently have researchers and clinicians focused on prevention of depressive habits.

There are a number of useful habits. One well known exercise (mentioned by Martin Seligman in his new book, “Flourish”) is to write down your daily accomplishments. This type of journal has been shown to produce results in as little as four days. I have seen it work with true skeptics. It works because it forces us to think about what we have done well. And although many of us have been taught that complimenting ourselves is immodest and prideful, we all feel good with a job well done.

The resulting good feelings produce endorphins in the brain which ward off depressive symptoms. It allows you to rejuvenate your immune system and reduce actual stress. And it is more efficient than pleasuable distractions like watching a movie or having a good meal (which is also beneficial.)

This works for most people when they are overwhelmed but it is debatable that they are depressed. People who have too much stress. When responsibilies compete for your attention and you feel that if you do not give your all then things will fall apart.

Try it. You’ll like it.

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