Apparently Covid is not quite gone yet, so this month's blog will again discuss it from a psychological perspective.
Dr. Low, what do you mean, "not quite gone?" It's an epidemic. Well, about that. I follow several statistical websites whose authors are much better at analyzing data than I. I do NOT follow government proclamations, however. I stay as close as I can to the facts. And the facts say that this thing is a seasonal virus related to the common cold rather than the flu. It favors as its victims the elderly and the infirm and, unlike the flu, largely avoids children. The facts say that it is not spread casually, that it is rarely passed by children, unlike most viruses, and that it is not often spread by asymptomatic carriers. Contrary to the early scare stories, it is also not spread on fomites (inanimate objects like your groceries and shopping cart) or by flushing a toilet , it does not spread "exponentially," and masks do little if anything to stop it. The facts clearly show that, regardless of massive increases in positive tests documented everywhere PCR testing is done (PCR tests are not meant to be used in diagnosis; they are a screening tool which ought to be followed by a test more inclined to false negatives, and they have been being misused by running at a greater number of cycles than recommended (27-30 is normal--people are using up to 40 and each cycle doubles the chance of a scrap of NON-INFECTIOUS viral RNA to be found--AND the test is meant to be used on people who are feeling ill, not an entire populace)), the virus is killing a very small number of people, nearly all of whom are elderly and/or have pre-existing conditions. A "surge" of positive tests is not spike in illness nor in deaths. This virus is still doing what a seasonal virus does; it has passed through many of the weakest victims, killed an unfortunate number, and is resuming its course through the less vulnerable, killing very few, making most immune, and becoming "endemic" --part of the environment like the common cold. If it mutates, it mutates to be less deadly and more contagious so that it can spread more. So currently in the US and most of the northern hemisphere, there is no epidemic; there is a surge in positive tests as the less vulnerable gain immunity.
Citations for each of those statements can be found below.
I am not a conspiracy theorist, and I continue to prefer this blog to be apolitical. I will refrain from offering theories about what is going on worldwide with this virus and extreme government responses to it. Instead, let's focus on the psychological effects of all of that.
Remember when we were supposed to stay home to "flatten the curve" to prevent hospital overwhelm? Remember all the crises over ventilators and ICU beds? Well, it turned out that most patients ought not to be put on ventilators and most of those extra beds in hotels and naval vessels went unused. So we flattened the curve and flattened the health care business as well by forbidding "elective" medicine (which means, stuff you won't imminently die of, even if eventually you might). Do you also remember being told that the area UNDER the curve was pretty much a constant? Not many do. But that is the case, because, as stated above, a seasonal virus just works its way through, and if you hide from it, it gets you later.
So the curve got flattened, the ICU shortage emergency that never was went away, and we were all told to keep staying locked up and keep not working because we would kill granny if we went out. Some people complied while others tried to go back about their lives. Thus was born the mask mandate. If you won't stay home, we will make you wear a face cover. The stated reason was to prevent the spread of COVID, but as we know, it is a seasonal virus and it is going to move through the population of the planet. Also, much research shows that a mask does not stop a virus. Really. Surgical masks stop a bacterium and they stop globs of fluid. They do not stop the breath. But we wanted to get back outside and back to work and back to living, so masks were mandated, mostly as a feel-good measure in the name of "protecting others." (Which is insane on its face--cloth masks are not one-way.)
How does all of this affect YOU in your daily life? Are your activities limited? Is your financial situation constrained? How are your kids doing, if you have some? Are you positively or negatively affected by masks or lack of them? Are you experiencing shortages of needed goods?
All of these questions represent issues that people all over the world are facing. And these problems are mostly not due to the virus itself, but to government and public responses to the virus.
For some, having their kids at home is a blessing. For others, it means they cannot get back to work. For some professions, it is business as usual once again; for others, waiting continues while bankruptcy threatens. Some people appreciate masks as a way to protect society at large. Others, knowing that basic cloth and surgical masks are not meant to stop viral transmission, feel rather put out. Still others worry about the societal consequences of not seeing human smiles and of children missing the all-important facial expressions that help them navigate social reality. Some people feel phobic behind a mask, others cannot understand speech without visual cues, still others have trouble recognizing familiar faces when most of the cues are missing. For many, goods and services to which they are accustomed have become difficult or impossible to obtain, and prices have skyrocketed.
Then there is entertainment. What entertainment? you ask. And that is the point. Modern society is stressful and the variety of entertainment and relief from reality provided by sporting events, theater, film, amusement parks, beaches, bars and restaurants is necessary. We wonder why cities have become powder kegs of anger and resentment. Is it racism or is it confinement and deprivation of all the trappings of normal life?
Right now, all over the world, depression is up, unemployment is raging, and people are angry and afraid. Their lives are being controlled by authority figures whose plans change weekly with no evidence that the new plan is safer than the old one or even than no plan.
As an individual, how do you feel when you are told that a pandemic is threatening millions of lives and you need to use every precaution to avoid getting or sharing it? Do you feel better when you take precautions or angry that your life is being so disrupted? How can you know if what you are told is true? Or even, which part of what you are told?
And here comes the very rushed set of vaccines which we are told shall save the day. One wonders, however, how safe a vaccine is when the manufacturers have been freed from liability and testing has been rushed. One wonders how logical a vaccine is when the virus is said to mutate rapidly. One wonders if long-term side effects are being missed in the rush to production. One also wonders who is profiting from all of this!
Each of us has many decisions to make. How close to normal will we behave? Will we mask up or not? Will we shop in person or online? Will we comply with masking? Will we celebrate holidays with family or not? What do our older relatives need from us; sanitation or hugs? These are not simple choices--each has ramifications. So each of us must use our intellect as well as our emotions and our conscience to do the best we can. And no one is immune from the psychological strain of the constant state of fear the media and the politicos are pushing upon us.
Stress is bad for your health and mine. Is it worse to die of a virus or of stress? Is it worse to die alone, or of a virus but with loved ones? Can society recover from this year of forced isolation and deprivation? I know that we as a society will never be the same. I hope we learn valuable lessons for our future as a free people.
Each of us must choose whom to believe, how much to read, and how to respond. We must weigh logic and emotion, time and trust. Everything is in motion.
I saw a joke calling it "Schrodinger's virus"--you have to act both as if you have it (isolate and wear a mask) and as if you don't (go shopping for yourself and others, stay home because you are not immune) . If you might have it, you also might not be able to get treatment nor a test, but you are supposed to go home rather than to the doctor or emergency room. What's not to love? You can easily feel confused, anxious, and threatened.
It is also quite possible to both believe that the virus is as dangerous as some say and refuse to lock yourself at home to avoid it. It is possible to NOT believe that it is dangerous and still find yourself not traveling and using tons of hand sanitizer. Because we DO know that some people, usually older folks (that's me), but MOST usually really older folks (my mother), and almost always with another condition, will get really ill and die. And that is sad. It is also something we find incomprehensible. A new virus against which we have no defense. There is no vaccine for this yet, and we have little experience to go by as far as what it will do.
On the other hand, this is not the first coronavirus to mosey through the populace. There is no reason to believe that it is SO different that people fail to develop antibodies (yep, some have said this and there was a fake report out of Korea to this effect, see reference 1 below). But, if there can be a vaccine, there ARE antibodies---that's how you make a vaccine. The problem with this virus, as with other coronaviruses and flu viruses, is that they mutate. They ALL mutate. But we also know that viruses have a sort of prime directive, to spread. If they keep killing their hosts, they fail to spread; so, as they mutate, the tendency is for them to spread better but be less deadly to fulfill the prime directive.
There have been lots of reports that this virus is easily and casually spread--like in a park or on a beach or even in the grocery store. There have been more recent, more researched reports that it does not. Importantly, whichever set of statistics you choose to believe, it is a fact that more get it than show signs of illness and that not everyone, even on a crowded cruise ship or naval vessel, even show antibodies (2). It is not that easily spread and not everyone who is exposed gets it and not everyone who gets it gets sick and not everyone who gets sick dies.
Most people get exposed casually--this is how immunity begins to form--you are challenged with a small dose of virus, and your body begins to work on isolating it. In closer, more intimate situations, you get a higher dose of virus and you are more likely to get sick. But the viruses that travel home on your plastic lettuce shell are attentuated--they exist, but it has been shown that they are no longer capable of invading your cells. (3)
The casual contact between you and the grocery clerk or a fellow hiker/jogger is NOT how
virus spreads (4). Some people feel better wearing a mask. It might limit the expulsion of some virus IF you are ill, but a cloth mask is highly unlikely to limit the entry of live virus to your eyes and nose. AND many people fidget with a mask or hang it over the chin when they are not around people, thus breathing on it. Then they touch it to move it onto the face, transferring moisture to their hands. Net result, MORE passage of moisture that contains virus. If you choose to wear a mask, please DO NOT TOUCH, and wash between uses.
I hate politics, and do not wish this blog to be come political, but I feel it is part of my commitment to mental health to remind my readers that the original plan to shut some things down to "flatten the curve" to avoid running out of hospital beds, ventilators, and protective equipment, has been changed. Now many places are demanding no new cases and no new deaths before they allow us all to get back to work. The problem, in addition to the deceit, is that it scares people. This virus is little if any, more dangerous than a flu. The spread is NOT "exponential" as has been said (5). But, we all will get exposed and some people will continue to fall ill. Unfortunately that is the reality of human life. Thankfully, we never did run out of hospital beds, and even in badly hit areas, the extra beds that they scrambled to create went almost entirely unused. These are reasons for hope, not fear. And NOT reasons to keep the economy closed. (6)
I know, I know, that runs the risk of becoming political. But what it is, is compassionate. People need to work--for money to live and for a sense of purpose. If we were truly saving lives with all of this hiding, it still might be wrong because an economy is people, too. And every one of us needs to make a personal choice about whether we feel at risk and wish to stay in or feel a stronger need to work and interact within an economic reality. I'll not judge anyone either way, but I, for one, will keep working.
My point is that this thing is confusing. It is normal to feel confused and not be certain about what to do.Take care of yourself and anyone you know who is at particular risk. Eat well and exercise. Be informed and do what feels best for you in this weirdest of weird times.
1) Coronavirus: Discovery of antibody to stop human cell infection | Daily Mail Online
2) Diamond Princess Mysteries | Watts Up With That?
3) Jennifer L Kasten, MD, MSc, MSc - Posts
4) RTL Today - Leading German virologist: “So far, no transmission of the virus in supermarkets, restaurants or hairdressers has been proved.”
5) The Coronavirus Pandemic Is Not Exponential – AIER
6) The data are in — stop the panic and end the total isolation | TheHill
These days, we see more and more diagnoses, both of psychological ills and medical ones. Too many school children are taking one or more psychiatric drugs. Too many adults are, as well. But too many adults and children are also taking drugs for medical conditions. This would not be a such problem except for diagnosis creep. How many medical patients realize that what constitutes hypertension these days is not the same as what used to be hypertension? The criteria have gotten lower. The same goes for diabetes and high cholesterol. Results can also vary by doctor, as I discovered to my horror when a now-fired optometrist diagnosed me with macular degeneration and had me frantic that I was going blind. The specialist to whom I went running said I had no such, but a small particle of what my grandmother would have called "schmutz" on my retina, that was unlikely to affect my vision soon if ever. Diagnosis creep. Whether the reason is a surplus of caution on the part of a doc, a mistake, or a new set of rules from the AMA, more people have more diagnoses these days and it is NOT a good thing.
Perhaps you are thinking, "but if being diagnosed early makes you change your behavior, that is good." For some things you'd be right. It IS good for us to all wear sunglasses, and trust me, I have been scared into doing so. But did I need to endure half a year of sheer panic about my looming blindness to make such a change? Additionally, many such diagnoses come with prescriptions. Luckily the macular issue came with only a vitamin--expensive but harmless. But if it is diabetes or hypertension, you will be taking drugs for it. What's the harm of taking diabetes meds if you are showing some but not all the symptoms that used to be needed to make the diagnosis? One, you are less inclined to regulate your diet strictly (Ask anyone who keeps driving stats--people who wear seatbelts are a little less cautions than those without--the illusion of safety is dangerous.) And pre-diabetes can be stopped from leading to diabetes in many cases by diet and exercise. Cholesterol can be altered by--yep--diet and exercise. Same with low bone density and high blood pressure.
Clearly, many people prefer pills to making behavioral changes. I will not claim that it is foolish to prefer pills to diet and exercise. If it were that easy, why not? This preference, however, is not without consequences. First, when we take a pill for something, we tend to assume it is now under control and become less careful with our behavior., People diagnosed with diabetes still DO need to watch their sugar. People with low bone density still DO need exercise. Second, all medications have side effects,some of which can be quite dangerous. Statin drugs have been connected to neuropathies of the extremities. Is living with numb or painful feet and legs better than the slightly increased risk of heart disease (which, by the way, has NOT been unequivocally demonstrated--statins DO lower serum cholesterol, but a body of evidence shows that serum cholesterol is a symptom of arterial damage, not the cause.) Anticholinergic medications used to reduce bladder leakage (yes, there is an exercise for that) in older women carry a risk of decreased cognitive functioning!
SO diagnosis creep is serious in physical medicine. In psychiatry, it is the same. As more children are labeled depressed, oppositional-defiant, bipolar, they are put on medications that might improve their behavior, but surely provide a spate of side effects. I once treated a child for chronic pain who came to me on eleven (11) medications! The pain was a trauma-related pain, not a physically generated one, so the strong narcotic she had been on that caused severe constipation was no longer in her system (Pain meds are known not to work on this pain disorder known as CRPS), but various anti-constipation meds were. She also had a cocktail of psychiatric meds, each with its own set of effects, leading to other chemicals for THOSE side effects. Psychiatric meds are not known to help with CRPS, but MDs want to DO SOMETHING and desperate parents whose kid is in pain will agree to anything with a slim hope of helping the child. Similarly, children diagnosed with ADHD have trouble in school and may be difficult to handle at home as well. I won't deny the existence of this problem. In fact, my dissertation is on ADHD. What I do want to stress is that putting children on psycho-stimulant drugs is not without consequences for many. Some children fail to grow, some can't sleep, some get depressed, and some are fine. But, again, with diagnosis creep, how many more children are medicated than have a problem that "clinically affects functioning" versus an impatient teacher who demands more than the child can produce?
What about depression? Depression is a common symptom--we get depressed during the span of our lives for many reasons. The actual causes of depression are varied and inexact, but we know it when we see/feel it. For some, depressed moods are stable and debilitating, while for others, they are fleeting and situation-specific. It turns out that psychotherapy is pretty good at treating depression and that antidepressant medications are more placebo than cure and have serious side effects. Depression is being diagnosed in greater numbers than ever before and antidepressants are diagnosed for BOTH depressed mood and a variety of off-label uses, not to mention, being used widely in children, which, it turns out, is also off-label for the majority of such drugs. Some people swear by these drugs, but the people who find their ways to my office come because they are STILL depressed despite having tried a variety of meds in a variety of combinations.
Another cause of diagnosis creep, and therefore, treatment expansion, is testing. If we do enough tests on your body, something will look wrong and require more tests, and something will turn up that looks like it wants a treatment. And maybe it does, but maybe it just bears patient watching, as with the eye situation I described. Let's look at osteoporosis. The medications for it carry a serious list of weighty side-effects. But, despite belaboring the point, a diet rich in calcium plus weight-bearing exercise is preventative. AND, for a woman who might show low bone density despite adequate diet and exercise, is diagnosing the lower level of calcium in her bones as a disease going to improve her body's ability to hold calcium, and will the pretty serious medication actually improve her quality of life?
In conclusion, we must all remember that THERE. IS. NO. SUCH. THING. AS. A. FREE. LUNCH. There might be a pill for what ails you. But it is not free. You might have a diagnosable illness; you might simply have some symptoms or a pattern that approaches the pattern of the disease. Weigh your options carefully. Sometimes a medication really is the best and sometimes only, option. But many times, there are other, safer treatment options, and still other times, what you have is a pattern approaching a dangerous state, but not actually a disease, and a change in behavior would be the safer approach.
Remember that in medicine and psychiatry, YOU are the consumer and you are also the sole owner of the body being examined, diagnosed, and prescribed for. Shop wisely and do your homework. Your doctor does want what is best for you, but he or she also wants to do the most for you to avoid being sued. The first person in the medical treatment chain for your body needs to be YOU. Ask questions about both the diagnosis and the treatment. Seek other opinions. Take responsibility.
Now I have read it from cover to cover, and I am unconvinced, despite Davis's pages of citations. The extrapolations slipped between the lines were my cue to be suspicious, as were the occasional total falsehoods or misleading statements, not to mention the implication that EVERY patient coming to his office turns out to have a different ailment caused by wheat. This is not the first "theory of everything" I have come across, and it will not be the last, and it is no more credible than the others.
I almost did not make it past chapter 2, in which Davis ridicules modern wheat for being human-dependent, by saying: "Imagine...in the world of domesticated animals: an animal able to exist only with human assistance." (P. 22). Any farmer will tell you that modern chickens and turkeys and pigs and cattle are dependent upon humans for their existence--they are no longer adapted to living in the wild. Dogs, as they exist now, never were wild--wolves, from which they are derived, are wild. Dogs are domestic, and very few can survive in the wild. This, to put it mildly, created doubt--claims that are unsubstantiated and are supposed to support the author's premise.
Can wheat make you fat? Of course. Can other things? Of course. Can wheat increase your risk of heart disease? Of course. Can other things increase your risk of heart disease? Of course. Can wheat put you at higher risk for acquiring Type 2 diabetes? Of course. Can other things increase your risk as well? Of course. I do not remember where I first heard the answer to life, the universe, and everything (related to health), but here it is: "There is rarely only one cause for anything."
Given that I had already stopped eating wheat because it had noticeable effects on how I felt, I was the target audience for this book. Except that I am a critical reader, AND THERE IS RARELY ONLY ONE CAUSE FOR ANYTHING. I have heard such sweeping claims about Lyme disease, about acid rain, about eating meat. Can wheat be inflammatory? Yep. Can it cause leaky gut? Maybe (I do not pretend to medical expertise--just literacy and a critical mind). Does it cause psychological issues and skin disorders? maybe. I do know that a diet too high in carbs and too low in fats and protein CAN cause depression in some individuals, but that does not then lead to "wheat causes depression".
If I had infinite time, I would read all of the references, because one thing Davis did well was to provide many. The problem is, that then the references need to be reviewed for accuracy, for lying with statistics, for replicability. And all of that would take way more time than this book is worth to me. I read a book once that indicated that we should all basically live on spinach (really--the recommendation was for 2 pounds daily-- maybe I would live 10 years longer, but I'd have spent all of it chewing and running to the bathroom)--he also had lots of citations to support his theory, but in that case, I just did not care. In the case of _Wheat Belly_ , I do care because some of what Davis describes are things I have seen in myself, in friends, and in clients. BUT not all. And not in every case.
So here is my take-away: A high carb diet is probably bad for most humans. Now I know personally, a few people who thrive on such a diet, which keeps me from saying "all humans" even without doing tons of research. There is evidence on many fronts that lowering carb intake and raising fats, perhaps even more than proteins, is good for individuals with diabetes, unsafe amounts of body fat, and other insulin-related issues. But, given that when I search for "high-carb diet and depression," the hits I get DO NOT attribute depression to such a diet, while as a clinician, I know I have helped people to get beyond a depression with a higher fat diet, these things are NOT uni-dimensional. There is rarely only one cause for anything, and all humans are not created equal.
Thus, if you are having weird symptoms, and you eat a lot of grains, it may be worth consulting an MD who favors low-carb diets to see if this might be a factor. If you are in menopause, and you suddenly cannot sleep and feel tired all the time, it might be worth looking into a dietary change, as insulin resistance increases with age. It is clearly possible for SOME chronic tiredness and some depression and some diabetes and some arthritis, etc, to be impacted by wheat/grains/high carb diets.
Humans are complicated. Not only are we very adaptable omnivores, but we have very complicated lives, stretching us beyond what evolution has caught up to. Thus, THERE IS RARELY ONLY ONE CAUSE for anything. Can your diet affect your psychology? Absolutely:
This article (https://www.health.harvard.edu/blog/diet-and-depression-2018022213309) claims a high-carb diet is better for avoiding depression, but references this article (https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626) which mainly claims that unprocessed foods high in probiotics are best. This sort of thing can make your head explode. The latter article, however, states that when looking for a nutritional cause of a mental issue, it is most helpful to experiment for yourself--eliminate things that are suspect, and if you feel better, only replace them one at a time, slowly, to see what changes. Pay attention to when you feel better or worse and what you have eaten in the past 36 hours, seeking a pattern over a reasonable time period that spans weather changes, life changes, and other variables.
Here is a simple analogy--we all know that the common cold is caused by one of a variety of fast-mutating viruses. We also know that there are cold germs in our environment all of the time. One reason we do not ALL always show cold symptoms is that there are additional causes for our succumbing to that cold, including lack of sleep, poor diet, or excessive exposure such as when we are crowded into small spaces. There really is rarely only one simple cause for a given ailment. People can even both have the identical gene for diabetes, while one gets it and the other does not.
Thus, it is important to ask critically, is diet the only cause of depression and mental distress? Of course not. Can diet often help? Also yes, because, see rule 1, there is rarely only one cause for anything. The causes may be interconnected (you were feeling poorly in the gut, your MD told you to eat more fiber, which then increased your carb load, and you ended up with new symptoms such as weight gain or depression) , they may be sequential (you were somewhat depressed and started eating poorly), they may be totally separate (yes, something bad occurred and yes, you tend to live on junk food), but humans are not simple. Mostly, we are not as simple as modern medicine would prefer--because if we were, there would indeed be a pill or a surgery for every ill and there would indeed be a single cause for everything. Unfortunately, this reductionistic, if tempting view, is just plain false.
The bottom line is that there are many potential causes, often intertwined, for weight gain, gut issues, depressed moods, and other human ills. It is possible that carbs or wheat specifically, are having an effect on your particular symptom. It is also possible that they are not. A competent physician or psychologist (this latter after a specific, testable medial illness either been ruled out or diagnosed properly) will help you explore your particular symptoms and conduct experiments on what things help you to feel better or worse. Remember: there is rarely only one cause for anything, and thus, many things can potentially help you to feel better.
Davis, W., 2011 _Wheat Belly_. Rodale.
One of my long-standing puzzles as a therapist has been how CBT (Cognitive Behavioral Therapy) has gained more popularity than REBT as the go-to therapy. There are indeed many books by many authors on each technique. Does CBT work better? Does it have better press? Are there more practitioners? is it easier to teach to therapists in training? Is it easier to teach to clients?
My take on the above questions is quite the opposite. I find REBT to be easier to learn, easier to teach, and more effective than CBT. I am trained in both, and, while I learned CBT in school and learned it first, when I studied REBT (Albert Ellis was one of my instructors), I was immediately stuck by how easy it was to learn, to teach, and to put into effect in my own life not to mention those of my clients. So is it the press? Perhaps.
I was reading _Animals in Translation_ by Temple Grandin with Catherine Johnson, and an interesting point about how humans think and process versus how animals or autistic people think and process was made. Humans want a narrative. They prefer complexity and big picture thinking. They see the forest more than the trees. When Dr. Grandin was looking at the treatment of animals in slaughter facilities (regardless of your moral stance on this, she improved animal handling by light-years), she created SIMPLE, ELEGANT checklists for plants to use to determine if the animals were handled appropriately. Grandin notes that the more items on the old lists, the easier it was for a plant to pass if one critical item was missed. The more items on the list, the more difficult it was to get things right, but the easier it was to pass. The less clear and objective the criteria, the more questions arose and the less clear passing versus failing became, which caused less safety rather than more at the plants. "Most language-based thinkers find it difficult to believe that such a simple audit really works." (Grandin & Johnson, p 268). Substitute "form of therapy" for "audit" and there you have it! Sometimes simple is best.
Rational Emotive Therapy is so easy to learn that Michael Edelstein has an REBT-based website (and a book) called "Three-Minute Therapy". Now, he is not saying someone will be cured of his depression nor anxiety in three minutes, but rather, that there is a three-minute exercise you can learn that, with practice, CAN teach you to overcome your unpleasant and less-than-useful emotions. I love this. What CBT has done is to add complexity--to add more narrative, more layers, more paperwork, more words, to REBT. It works, but it has lost some of the elegant simplicity of REBT.
My clients know me as a very paperwork-adverse therapist. I keep my practice simple. I keep my intake forms simple. I love simplicity. If it is simple, I can keep track of it, and they can understand it. I learned to do CBT from many trainings and many books. It advises a lot of papers to be filled out and has a lot of diagrams for demonstration to clients. I copied all of them and prepared to use them according to my instructors. When I learned REBT, the lightbulb went off. THIS, said I to myself, is more for me. It is simple. It is elegant. It contains ONE simple homework sheet to be filled out. Clients can keep the responses as simple or complex as THEY desire. They can make REBT their own, and they can all learn it.
Maybe I lean a little in that direction of animal intelligence, where I like simplicity and clear statements and short, operationalizable lists, and I hate piles of paper. For me, REBT helps me to teach my clients what they come to learn, and this helps people to feel better faster, and be independent of therapy sooner.
Edelstein, M. & Steele, D.R. (1997) _Three Minute Therapy_. Glenbridge.
Ellis, A. (2016). _How to Stubbornly Refuse to Make Yourself Miserable About Anything
--Yes, Anything!_ Citadel.
Grandin, T. & Johnson, C. (2005). _Animals in Translation_ Scribner.
You already knew that, right? If you have been paying attention, you did. The various news media these days have more competition for your attention, and they have long known that to get your attention, they have to produce an emotion in you. They get more attention by producing a negative emotion. So the news is no longer JUST THE NEWS. It is a concoction of events developed into a story in language carefully crafted to get your attention. Even the weather is no longer just "here's what to expect." Today's weather reporters are also competing for your attention. So rather than, "We are expecting 5" of snow before 6PM ," now it is, "This is shaping up to the the worst snow in 52.5 years, so be very scared."
We know that most of what has changed is competition for your attention. But something more subtle has changed along with that. The news is no longer "just the facts, m'am." Today's reporters want to grab you with negative emotions: fear, anger, outrage. But we tend to assume that the news and weather types are still reporting facts, so we respond as they have guided us. This affects our lives in very real ways.
What is the difference between "Today the temperature will be -13" and "today there is a wind-chill advisory in effect and you are advised to dress warmly"? One aspect is the assumption that we are all too stupid to wear warm clothes; that we do not know what -13 means, that we need it to be painted in scarier terms so we pay attention. I don't know about you, but I am insulted by weather reporters on a daily basis. Yep, -13 is cold. Yep, I need a coat. Yep, I will cover my face and hands. This barrage of insults is bad enough for me to have stopped paying attention to them altogether. I want the facts, and I will decide how to behave, thanks.
But the more sinister aspect is that when people are continually subjected to such emergency tactics, they tend to feel fear. It comes on gradually as we are inundated daily with this and that emergency. From weather to climate to politics to foreign affairs, there is a reported emergency around every corner. Thus, my attempt to avoid all forms of media reporting.
As a society, however, trends become obvious. First is that more people demand to be kept totally safe from reality. We become more fearful of things that once were considered normal. This week, it is tornadoes. I have actually looked at the historical data on tornadoes. Every year, the midwest suffers A LOT of them. There is no evidence that they are worse than ever. In fact, my memory contains some crazy fragments of walking (admittedly, a little fear on the part of the school officials who sent us out the door would have been wise) home from school because of a tornado warning, watching a tornado out the window, another of walking to school the day after a tornado, surrounded by uprooted trees, broken back porches, and the school bleachers in the middle of the street! School closures? Nope, never. Well, once, in '67, after a blizzard totally shut down Chicago. We might have sometimes been stupid, but we did not live in fear of basic facts of reality. There is weather every day. Sometimes it is inclement. It is wise to plan accordingly rather than demanding better weather or blaming something for bad weather or refusing to plan for bad weather and getting into trouble.
The question is, are we better off now that we, as a society, are so much more cautious? Admittedly, there are times when this caution is well-placed. No, I ought not to have walked three miles to a movie in a short skirt in -15 weather when I was 13! But I did learn a lot about cold and frostbite and never did anything like that again. Are your kids better off if they do not have an after-school job, so they can focus more time on studying? If they get 12 vaccinations rather than the 3 we used to get or the 4 my kids got? If their playgrounds have short slides and soft landings? If they stay home from school when it snows more than an inch?
Alternatively, were we better off when we played outside all day and came home with bumps, bruises, and probably a cold? When we walked to school in every sort of weather? When a job was required if we wanted spending money? When we left the occasional kid in the car while we ran into the store? When, if our home lacked air conditioning, we found a way to stay cool that did not involve a public "cooling center" (yes, it did used to get over 100 degrees regularly in Chicago when I was growing up)?
Trust me, there has always been weather. There will always be germs. Bad people exist, and do harm, though not in the numbers the media would have you believe. Kids fall and need stitches. Life is not always safe.
So what am I getting at with all of this? Missing in many people today is resilience. Resilience is when a bad thing happens and you dust yourself off and try again. If we protect our kids from all forms of adversity, if we avoid adversity at all cost, if we deny adversity ought to exist, we do not develop the ability to deal with it. Adversities will occur. Often. There is more power in having the skill to deal with whatever happens than in demanding that it not happen or that it ought next time to be prevented by someone somehow.
Resilience is what kids demonstrate when they fall off the monkey bars, scrape a knee, and get right back on. Resilience is also what a kid demonstrates when he can fail a test or lose a ball game, feel sorry, recover, and work harder next time and do better. Resilience is what we show when we hear that it is going to rain all week where we are planning to go camping and either we still go and make the best of it or revamp our plans and have a great time even though we did not get to do exactly what we wanted.
Resilience does not develop when we protect kids from adversity. I see this time and again: A kid who is shocked when he is hospitalized and cannot cope with being away from home, and what's worse, feels betrayed by reality that he was injured at all, can indeed feel traumatized by normal life events! Another who receives a bad grade, goes home and complains, and a parent calls the school to complain (and I am a person who does not believe in traditional schooling nor traditional systems of grading--see other blog entries, but if you are part of that system, then you play by those rules). What did the child learn from that interaction? That he does not have to do the work to get the grade if he can get a parent to make enough noise. Is that going to work when he has a boss?
Lack of resilience has many consequences. Why do we see more anxiety and depression than we used to? Why are more kids struggling to adjust to college? Why are so many young people either on prescription medication or self-medicating with psychoactive (I am including nicotine, alcohol, cannabis, and all illegal drugs here) substances?
The answer to these societal ills is not more drugs. It is not getting society to change and remove all adversity from our lives. It is also not going back several decades to when life was more full of obstacles. It is good that humans can make life safer and easier. What is not good is when people then learn to demand even more degrees of safety and ease and lose the ability to cope with reality.
The answer here is learning when not to listen to scare stories from the media. It is learning that adversity is what helps us gain resilience. It is accepting that often life will be difficult, and we can learn to cope with these difficulties. It is also making sure the next generation, while gaining many advantages through technology that we do not yet have, and thus having an easier life, does not thus lose the ability to tolerate things that do not go as expected.
Challenges, or stressors, are what motivate us to act, to change, to improve. Without them, we become lifelong dependents upon others to save us from every twist of fate and every shift in our reality. This is not life; it is slavery.
I have said it many times and shall say it for as long as I can: there is not a pill for that. Make no mistake, your brain is a biological entity--YOU are a biological entity--thus distress of the mind and emotions are also biological entities, but this does not imply that the only or even the best or even a viable way to solve problems of the mind and emotions is with a pill. The overused "chemical imbalance" theory is dead. On the contrary, psychoactive pills cause chemical imbalances--they change your brain in ways science does not understand, sometimes they alleviate symptoms, but they do not CURE distress.
Thus one danger of calling mental distress a "disease" is that it is then treated as such--you become a patient and you look to a doctor to fix something. This works with appendicitis and broken legs and cancer. It is a fact, however, that not all things clearly within the realm of medical disorders are treatable by medical doctors. In general, there is no treatment for the flu or even the common cold, and physicians are stymied by irritable bowel and migraine. Medical science certainly does not work with depression, anxiety, phobia, PTSD, and the many variations of psychological distress delineated in the various manuals of disease such as the DSM and the ICD, because these are not diseases in the once-commonly understood meaning of the term. These problems do not show demonstrable tissue damage such as a cancer or a stroke, nor do they have symptoms that represent the body fighting a foreign invader, such as cough, fever, runny nose. Rather they have emotions and behaviors as their hallmarks.
How weird is it that one way of diagnosing ADHD is to try a pill and if that works, then the diagnosis fits? What this really means is that there is a behavior someone (not necessarily the individual in question) wants changed, and there is a pill to reduce that behavior, and someone thinks the reduction of that behavior will be beneficial to the individual. It is debatable whether there is always benefit in reducing the cluster of behaviors we have called ADHD. It also turns out that while it may be the case that for some individuals, reducing the behaviors we have come to label "ADHD" is indeed of benefit, this can be done via psychotherapy and biofeedback, both of which lack the potentially serious side-effects of commonly prescribed ADHD medication (lack of appetite, depressed mood, sleeplessness, loss of creativity, failure to maintain growth patterns compatible with age). By simply calling ADHD a disease in need of medication, we fail to account for individual differences, and potentially do harm to the individuals so labelled.
A similar paradigm applies to anxiety--anxiety is a signal that something is wrong. It is not the case that all anxiety must always be removed via medication. I submit that it is vitally important to understand the root of this anxiety and assist the individual in achieving a reduction in his discomfort via understanding and changing thoughts and behaviors in such as way as to feel calmer. Anxiety is basically a subset of fear. While in modern times we are rarely in actual fear for our lives, modern life has many stressors--job stress, school stress, health stress, financial stress, traumatic stress. Applying a pill to the results of these stressful situations is not a solution, and it is certainly not a cure. You are anxious for a reason, and you need to learn about this reason and either remove the distress or change yourself accordingly--which might mean anything from thinking differently to moving out of a dangerous environment. When we diagnose anxiety as if it is a disease, we neglect the vital information about the state of the individual struggling with the anxiety.
The answer thus to the title question is yes, these diagnostic labels speak to something very real. On the other hand, the use of such labels leads us down the wrong path to helping you, the client, feel better. So they are not "just" another label; rather any one of them is a misleading and potentially dangerous and stigmatizing label. It is all too easy to become trapped in the language of illness; "I have depression" or "I am depressed" rather than, "I feel depressed" or even "I have been feeling depressed for a long time".
Describing your distress as a temporary state rather than a fact of your existence can be very liberating and allows you to focus on the potential for change. Remember that stress is a motivator to change. It is hard to change when you are feeling anxious or depressed or in pain, but that is the time when even a small change in how you think or act can make a significant difference. Try something silly right now--pull your face into the biggest smile you can and observe what happens. Change your posture--sit up straighter if you are slouched--slouch if you were sitting straight--observe your inner state. Small changes can easily lead to bigger ones.
Taking mental distress out of the realm of illness and disease is not meant to belittle or disregard your very real pain. The point is to empower you to take control of your discomfort and regain control of your life, rather than submitting yourself as a patient to the experiment that is modern psychiatry.
Szasz, T.E. (2011). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper Collins.
As humans, we have long memories. Our memories vary in their accuracy, but to us, memory is a big part of who and what we are. Each of us is largely the product of the many experiences that we have had and the many people we have known.
The problem with being formed of memories is that it is easy to get stuck in regrets. What if I had not done this or that? What if he or she had not died, left, said that? What if........ And, of course, there is no answer.
When we have erred, hurt someone, suffered a loss, or missed an opportunity, there is an opportunity for growth and learning, but there is rarely a do-over.
It turns out that such difficulties are motivators to change, and are overall a good thing. If nothing ever goes wrong, we are never driven to grow.
Psychologists distinguish eustress from distress. Both are meant to stimulate action. Eustress like the birth of a baby certainly triggers many behavioral changes in new parents, but is nonetheless stressful! Distress also triggers activity, from eating when you are hungry to apologizing to a co-worker you have hurt. What we commonly call stress is really when we are overwhelmingly distressed; when life and work get out of balance, when too much goes wrong, or when something goes wrong that feels like more than you can cope with.
This is a good time to talk to someone, whether in your social network, or professionally, to gain some perspective on what you can do to reduce your perceived distress. When you remain overwhelmed, it can lead to depression, anxiety, or even physical illnesses caused by too many stress chemicals in the body, so it is important to keep your daily stress under control, but that is a topic for another day.
The problem we are focusing on here arises when you cannot fix an old wrong or get over an old hurt, and it reaches out from the past to haunt your thoughts. People whom you loved dearly have died, and you miss them. Friends have inadvertently been offended by something you said that you did not get a chance to right or vice versa, someone has done something to hurt you. Things from your past seem to creep into your attention and distract you from the present and upset you. It is difficult to ignore these persistent thoughts. They seem important. They seem to carry lessons. You have to fight to put them out of your mind and focus on work or get to sleep.
It turns out that trying to ignore persistent, bothersome thoughts from the past is not a good tactic, despite well-meaning people telling you it will get better with time. Often, that is true. But what do you do when it does not? Sometimes your thoughts seem to get bigger and harder to live with each time they resurface. A more successful approach is to confront these thoughts head on--to figure out the fallacy and deal with them when they surface.
If you miss a dead loved one, focus on positive remembrances. Death is, for better or worse, something inevitable in life. Some deaths seem more unfair and untimely than others, but healing is always possible. There are strategies that work to ease your pain. They are positive strategies--facing the thoughts that plague you, and dealing with their meanings. We all have regrets when a loved one dies, but regrets do not move us forward, and that particular issue cannot be repaired. It can, however, be reframed. Was that particular regret the focus of the relationship, or did it have good points? Death leaves us with sadness, but life is full of joy as well, and the time you shared with a loved one is irreplaceable--what does it take to focus on the positive thoughts about him or her? Is there a benefit to focusing on regret or loss? Which tactic has the best outcome? Perhaps even speculate as to which memories your friend or relation would prefer you to maintain.
Let's say you did something wrong--broke a friend's favorite vase; you apologized, but it is irreplaceable. The friend knows you did not break it deliberately. However, you find yourself agonizing day after day, night after night, about what a bad thing this was. Will this agony replace your friend's item? Will it prevent clumsiness in future? Will it make you a better person? The answer to each of these, is, of course, no. And the value in this is that if we are to learn from our mistakes, then it is important to know where the lesson lies. It does not lie in self-abuse and regret, but in self-improvement and constructive thinking. Obviously, the breaking of a piece of pottery is not a life and death mistake, but it is used here as a symbol for things that we might do in life that we feel are irreversibly harmful to someone. The important thing is remembering that nothing positive is achieved by tormenting yourself forever.
It is very human to get stuck in recurring unpleasant thoughts about past problems and losses. Our thoughts run our lives; they tell us what to do and how to do it. It turns out, however, that our thoughts are often repetitive and uninformative. By refusing to follow such destructive thoughts yet again to their inevitable, painful conclusions, you take control of your mind and of your feelings. It is weird to dismiss a thought in your own mind as harmful, but it is also liberating. What if the four-hundredth time you fret about that broken vase is still not going to restore it or make you a better person? Then it is high time you let yourself off the hook and move on.
You, I, and all of us, are fallible humans. We make mistakes. We suffer losses. We handle things poorly. Sometimes. But these issues do not define you. How you choose to deal with pain and regret is what defines you--what choice you make when you have a choice. It is not a deliberate choice to hurt a friend nor fall down a flight of stairs, but what happens next is. How you think about bad incidents and how you act on those thoughts affects your mood, your self-image, and thus your quality of life.
It often goes against your intuition to deliberately control your thoughts. It is natural to run with the thoughts as they pop into your head. But it can lead to rethinking the same destructive thoughts, getting stuck in unhappy thought patterns, and generally being less happy than if you take that odd-seeming step to say no to depressing, negative, self-effacing thoughts and choose to ponder uplifting and positive things instead. This does not mean go off into the distance in a fantasy where nothing ever goes wrong. To the contrary, what it means is avoiding being unrealistically negative in favor of being realistically positive.
Try it. You'll like it.
Ellis, A. & Doyle, K. (2016). How to Stubbornly Refuse to Make Yourself Miserable About Anything--Yes, Anything! Citadel.
Hello Ashland! Up here in the woods, amazingly only 15 minutes from town, clients will be invited to see me in a private space, with the sounds of nature to add to the ambiance. It was gratifying to see our garden immediately begin to thrive as it never had in Bend, and I know the beautiful environment will enhance the healing that occurs for my clients. In-person sessions will begin Sept. 1 in this new space.
I also welcome intensive clients starting Sept. 1: Medford is 30 minutes away and Ashland less than 15, and both have a variety of hotels, motels, B&Bs, and hostels, as well as a fine selection of eateries and groceries. We are 30 minutes from the Medford airport. While a therapy intensive is hardly a vacation, traveling to a beautiful spot far from your daily environment offers a unique opportunity to break old patterns and create new ones. Follow-up in person or via video-chat assists you in maintaining your new learnings in your home environment.
It has been stressful to move many miles for the second time in 2 years, and perhaps I have learned some new things about managing stress and the ways in which change affects me and others as well. Stress is always both good and bad: it forces new ways of seeing things and behaving, but it can cause strain on the system. Moving changes one's relationship to others, to resources, and to oneself. Out with the old, in with the new, to coin a phrase!
The new incarnation of the Center for Conscious Living will offer individual and family therapy, Rational Emotive Therapy, which is the elegant, effective precursor to CBT, Sensorimotor Trauma Therapy, and clinical hypnosis. I will continue to focus on physical symptoms that bridge the mind-body gap such as gut issues (irritable bowel, cyclic vomiting), headache (migraine, cluster headache), and chronic pain (RSD, CRPS 1, fibromyalgia); those difficult-to-treat issues that often defy medical treatment. Call for a free phone consultation.
Meanwhile, I shall be learning about my new environment and preparing a new space for seeing clients.