Center for Conscious Living
5/4/2020
The situation into which we have been thrust both by this new coronavirus AND the responses of our government and our fellow citizens is unique. 

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
2/28/2020
When I was first studying psychology, I read and pretty much had to memorize a tome called the "DSM IV". This stands for "Diagnostic and statistical manual". The title is important--it is NOT a compendium of measurable diseases and symptoms and treatments such as the _Merck Manual_ I grew up with. It is, indeed, a book of statistics and symptom clusters--by which we really mean sets of moods and behaviors. I recall feeling as if, at any given moment, I could qualify for any number of these diagnoses, absent only a phrase such as  "clinically significant stress or impairment." So these diagnoses require a determination of clinical significance prior to being diagnosed, unlike a cold, which is still a cold regardless of whether it keeps you in bed.   

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 (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.

https://www.madinamerica.com/2020/02/around-web-diagnosis-debate-old-story-important-news/?fbclid=IwAR37mFUJ16SZpGD9uxPHpBiD9nkOdwSkbQpj_F4yV7N389VYxTQw--jlydU 

https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013 

https://drhyman.com/blog/2010/05/19/why-cholesterol-may-not-be-the-cause-of-heart-disease/

https://www.psychologytoday.com/us/blog/charting-the-depths/201305/depression-over-diagnosed

https://www.diabetes.org/a1c/diagnosis
9/24/2019
Sooooooo, here I am, having just read _Wheat Belly_ by William Davis.  Now, for perspective, I eat a VERY low-grain diet. After years as a vegetarian, my health made it obvious that such a diet, full of vegetables, fruits, legumes, and whole grains was not for me.  So reading _Wheat Belly_ when it fell into my line of sight, seemed obvious, except that I have avoided it, because the author has that tendency to get overly enthused about his subject, and blame EVERYTHING on wheat, a premise I find questionable at best, even as a person who does not eat wheat.

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. 

 reference:
Davis, W., 2011 _Wheat Belly_. Rodale.  
7/3/2019
I have long agreed with Albert Ellis that his Rational Emotive Therapy (modernized to Rational Emotive Behavior Therapy), is a simple, elegant method for helping clients to learn how to improve their mood and live more comfortably. It is also a derivative of the ancient philosophy of Stoicism. I have worked with individuals and groups for many years, and most people to whom I have introduced REBT easily learn and use this technique for calming their unruly emotions and feeling better. It is not instant. It is not magic. But it really works. As with anything, using REBT well requires practice. 

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.
 
7/3/2019
The news media are difficult to avoid. I know; I tried for years. I had no TV, received no morning paper, but the news would find me--mostly on my car radio on my all-music-except-during-rush-hour station. Now I live with someone who fancies his morning news and, worse, likes to tell me what he has found out. Guess what? It is NEVER good news.

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.




1/16/2020
The concept of mental illness is at its core about control. When someone is labeled mentally ill, a system including physicians, social workers, and government authorities begins to gain access to her life. People have problems. People have mental or psychological problems. The practice of calling these problems by names reflecting illness and thus putting them into the purview of physicians has been doing harm for decades. It is also demeaning, taking ultimate control from the individual and placing it within their genes or their parents.

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.
   

https://www.madinamerica.com/2019/06/critique-diagnostic-terminology/?fbclid=IwAR3UusuWWcB_9tOTlscZd8fNvk8xTixGiJs0RZjm7VzJ5TvhKsS9abiwT0k

Szasz, T.E. (2011). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper Collins. 









4/6/2018
It's a new year, and we are always looking for resolutions to start our year; ways in which we can commit to self-improvement in the year to come. It has struck me through various interactions in this very early year, that the best thing to do in a new year is often to let go of stuff from the last one and the ones before.

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.

Spencer, R.L. (2005). The Craft of the Warrior. Frog Books.






5/3/2019
https://www.madinamerica.com/2017/07/new-study-examines-user-experience-discontinuing-psychiatric-medications/
6/19/2019
Goodbye to Bend and all the great people, clients, professionals, and friends and acquaintances, I met and helped or was helped by. It is time to move on, though. While we felt as if, after 3 growing seasons, we had finally mastered small greenhouse gardening in an  inhospitable climate with no soil,  what we really wanted was a place to grow food and watch nature thrive.

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.


7/20/2017


In the world of caring relationships, we are often told to sacrifice—to put the needs of others before our own. This is considered by many to be the highest form of caring, of service to others.  It contains a fatal flaw, however. It is one thing to “love they neighbor as thyself” and quite another to love him more. This is a valuable clue to many of the ills of humans in society. How can you take care of someone else when you are worn out yourself?

If you continually put others before yourself, whether these are loved ones or total strangers, eventually you will pay the price. As a parent, you often must put your child’s immediate needs first. A child needs help obtaining everything: food, clothing, a place to sleep. When your child is ill, his illness disrupts your sleep. When money is short, your child gets food first. At some point, however, if you wish to be healthy, you will need to catch up. If you continue to put your child’s needs first, you may just collapse one day and no longer be able to care as lovingly or even at all. Caretakers also require care. Even parents fall ill unexpectedly, and always inconveniently! Then, confined to bed, you are finally forced to catch up on self-care.  You realize that this is not the best plan.

It is vital to look inside and ensure that you, as a caretaker, are thriving. In this context, thriving does not mean, staying upright by a thread, thoroughly enjoying the health of your loved one. Rather, it means doing well as an individual—being happy and healthy in your own right. We provide the best care to others when we provide the best care to ourselves.

You say that you are tough, that you can take it, and that you love helping. All of this may be quite true, but no one is limitless; no one is without basic needs. And each of us is worthy of care. Even you.

Be very clear: this concept applies to all relationships. Whether we refer to a child, that dependent being who really does need your care even to survive, a loved one for whom you wish to care to express your devotion, or a stranger to whom you feel obligation because of the bond of humanity; if you do not take care of you, the caring other, then one day, those who depend upon you will no longer enjoy your care.

Caretaking is not some weird game of alternating who gets to be sick and needy; it is rather a social agreement whereby those we love and value share care with us, and we thrive as a group. Sometimes it is true that the caretaking goes one way, as with an elder or an infant, but in all cases, there is a mutual benefit. A parent helped us, and we later help them. A neighbor came to our aid, and one day we help someone else.Value is exchanged, whether in the form of love, trading favors, or simply the good feeling of contributing.

Recall that when you fly, you are cautioned to apply your oxygen mask first in case of emergency, because if you pass out from lack of oxygen, then who will help your child? Every human needs care, not just OTHER humans. The greatest gift we give to our children is the ability to survive independently. This includes being able to share in their own care as soon as they are able. It is not a chore for your child to tie her own shoes or make her own lunch; it is a success. Nor is it a chore for him to make you a PB&J along with his own; it is a chance to feel the joy of contributing.

It is okay to say no. Here is the magic, self-preserving, word that we teach children, but forget to apply to ourselves. When you are asked to put out more energy than you have, in the end, both of you will suffer. You can tell your child to make her own lunch or your partner to do the dishes or your elderly parent to wait until tomorrow for laundry. You can tell your neighbor that today is not a good day to take him to the store.  This does not make you a bad person; it makes you a person.

There is an old ethic that commands us to not be selfish, to not put ourselves first. The problem is that the math does not work. If everyone depends upon others who are not in turn cared for, who will be left standing?   
3/20/2017
I'll start by admitting something; medications scare me. Not all medications and not in all cases, but many. Perhaps this diminishes my credibility as a psychologist who fancies herself quite scientific, but there are reasons for my atypical stance. Allow me to state for the record that I am not a prescribing physician, and what follows is my opinion, which mostly consists of: "Buyer beware".

 In the years since I have been practicing psychology, I have seen a startling number of serious, damaging reactions to medications. In addition, I have also seen no small number of similarly bad reactions to street drugs. Years of observing and reading have thus led me to a very conservative stance regarding attempts to pharmaceutically solve health problems, both physical and psychological, as well as the ones sitting on the border thereof. Some examples follow, after which I'll provide some details about how I work with my clients in light of my observations.


A man called me for help with a serious problem--one that had nearly landed him in jail. He was a peeping tom. Suddenly. The long story was that he had Parkinson's disease and was being treated with L-dopa. In those days, it was not yet firmly established that, due to its effects on the dopaminergic pathways, L-dopa can cause obsessive-compulsive problems. Some time soon after this, the news began to surface--something that ought to have been pretty obvious, that when you alter a neurotransmitter system, since neurotransmitters serve more than one function in the body, you have to expect some serious changes beyond the hoped-for effect. As good a therapist as I fancy myself, nothing I did would completely break this man's obsessive preoccupations, until the drug was stopped. He made therapeutic progress and stopped violating people's rights, but that was not the same as overcoming his obsessive thoughts. So here we have an example of a drug prescribed for a medical condition causing a serious psychological symptom for many years before he came to me and we figured it out. Did that drug help his other problem? Indeed, but the solution caused a more serious issue.

A friend of mine complained of sudden pain and cramping in his muscles during his thrice-weekly jog. He had to stop exercising, which caused him great distress, not to mention weight gain, depression, and other problems. It did not take him much longer to stop his statin medication, change his diet to control his blood chemistry, and get back to normal. Not everyone is this lucky--for some, statins cause permanent alterations in muscle and nerve tissue. For others, lifestyle changes do not make the needed change in cholesterol. The caution here is to read those scary leaflets that come with every prescription and pay attention to your own responses. If you are the unlucky one to experience severe side effects, often there is an alternative to the medication that is causing harm. Talk to your physician.

For several years, my office saw quite a few clients with anxiety that had developed after a course of steroid treatment was ended. These anxiety problems turned out to be much tougher to treat than other forms of anxiety. Eventually steroid treatments began to be tapered carefully and used with more caution, and that problem decreased dramatically. Score one for pharmacology. But, again, proceed with caution when taking steroids. While they can be lifesavers, nothing comes without a cost.

The same caution applies as well to acne medications; while some sorts of acne can be severe and disfiguring, and I would not want a suffering individual to go untreated, the internal medications that have been developed to help sufferers are known to cause anxiety. This can be very hard on the target patient, who is a teenager struggling with a difficult issue. Parents--be willing to monitor your teen and seek psychological help when needed. This is no small matter.

Proceeding to the other end of the equation, we can peek at medications prescribed for psychological issues. And we can find both sorts of side effects; the physical and the psychological. Anti-psychotic medications can cause movement disorders and perceptual problems, not always reversible. Antidepressants have been know to cause anxiety, manic episodes, lethargy, and sleep issues, to name a few. And research shows very little demonstrable mood-enhancing effect. Stimulant medications for attention problems can cause depression, appetite suppression, and sleep problems. These medications are most often given to growing children, for whom such side effects are non-trivial. Again, the message here is to approach psychoactive medications with caution, particularly for children.

I have seen several young adults who either were or had been taking several psychotropic medications. In each case, the psychological symptom that had sent them to the doctor was easily treatable with psychotherapy. In each case, the youth in question suffered suicidal thoughts that struck them as out of the blue until their parents brought them to me. One young woman had taken herself off of all of her pills without medical supervision. Another was simply following doctor's prescriptions when she thought of self-harm. The scary thing for me and for them and their parents was that in each case, the young person had a mild depression, some life stress, or some other life problem that once we got to work at it, was readily treatable.

In another vein, a long, long time ago, a patient, my first actual client, in fact, appeared before me at a rehabilitation hospital. I nearly fainted, being a psychology trainee and not expecting massive quantities of blood. This incredible man was in fact, a high-functioning heroin addict, or had been. His last dose of his drug of choice had caused a massive event depriving his brainstem of oxygen and nearly killing him. He had, indeed, been comatose in a hospital for months, without the normal precautions having been taken to maintain skeletal function, as it was expected that he would not survive. Clearly, they were wrong. So, several surgeries later, finally able to walk a little, I met my patient in a hallway, covered in bloody bandages. My job was to learn about his cognitive functions and help him rehabilitate. He would never again rise to the top of his profession. In fact, he would never work again, but he could think, and he could understand that even an addict with perceived control over his use could have a devastating reaction to a non-prescription drug.

Two other clients, both college students, had bad responses to relatively small experiments with hallucinogens. One, salvia, not even illegal at the time, and the other, psilocybin. The first developed bipolar disorder and disorders of thought, which have not remitted 10 years later; the other developed depersonalization. I do not know his long-term outcome. Again, buyer beware--street drugs develop a mystique, and are often purported to be harmless--just a good time, but not everyone gets away with that. For some, putting such powerful, reality-changing chemicals into the brain makes frightening and sometimes permanent changes in perception and functioning. How do you know if you will be the unlucky one whose brain does not recover?

My reaction to the sum of these and other anecdotes, is to approach all chemicals that work on a neurotransmitter system or a hormone system with a great deal of caution. After all, even antibiotics can be misused and cause harm, and they work directly on the offending microbe. These drugs that affect our complex, multi-functional, interwoven system of chemical information can change us in many interconnected ways. They ought never to be taken lightly.

It worries me daily that so many people worldwide take such medications as if they are relatively harmless. I learned on my first day as a psychology student: First do no harm. Rarely is a medication completely harmless. Physicians, patients, and pharmacologists must always weigh benefits against risks. The problem is that when the problem seems dire, you, the patient, are afraid to risk not taking the medication and often therefore, blind yourself to the harm it is doing.

I run into this often with chronic pain. Many types of chronic pain do not respond to opioid medications, but patients in pain are terrified to stop taking a medication even when they cannot in truth tell me that their pain changes a jot when taking it. Pain is scary, and chronic, unceasing pain is really scary. But that is not a good reason to take a potentially dangerous drug that is not helping, nor the chorus line of subsequent medications to enhance mood, reduce the side effects from the first two, aid sleep, and then, of course, get the gut to work again after the effects of all of the nervous system suppressants.

Now let's look at how I approach clients who come to my office.  First, I make sure to get a complete health picture, as well as a decent lifestyle snapshot for each client. This way I can get an idea of their overall self-care, major health issues, and what other treatments they are receiving. Even though I am a psychologist, I often discover an important datum about my client from such information. Is my client eating? sleeping? attending to hygiene? able to work? People come to me for such problems as depression, anxiety, phobias, gut issues, chronic pain, headache, and trauma.

I do not differentiate the mind from the body except insofar as I need a medical review when there are physical symptoms to make sure nothing important has been overlooked, because, of course, I never treat a broken leg nor a brain tumor primarily with psychotherapy, though after medical treatment has been undertaken, I can safely offer pain reduction and immune enhancement via clinical hypnosis, which has been demonstrated to improve patient outcome. On the other hand, I will treat an irritable bowel or a migraine with psychological methodology, after that physical exam, because it is effective and can lead to a cure, which medications have not been shown to do.

What about drugs, then? In acute pain situations such as that broken leg, pain meds can be of great benefit. Hypnosis can be very useful with acute pain as well, but not everyone is in a situation to take advantage of hypnosis in the ER. On the other hand, in chronic pain, hypnosis surpasses medication on many occasions, especially when the pain persists despite many attempts to medicate, and the doses seem to be abnormally high with little effect. There is new evidence that chronic pain that lacks a current medical source or is in excess of what the medical issue accounts for, does not respond to medications, but it does respond to appropriate psychotherapy.

When we get to high cholesterol, diabetes, hypertension, and other clearly medical ailments, I ask my clients to have clear discussions with their physicians. All of the medications to treat these issues have side effects. For some, behavioral change and psychological counseling will rebalance the body's systems and restore health. For others, either the imbalance is too severe or the behavioral changes will not help enough, or you, the patient, really prefer the medication, which is your choice to make. But, again, it is always good to have a frank discussion with your prescriber as to potential for harm, alternative treatments, and what the drug research indicates a far as safety and effectiveness.

In the realm of depression, the modern tendency to immediately prescribe medications worries me. Research does not really support the use of medications with most depressions. Good (GOOD!) psychotherapy is more effective, and medications carry known side effects which are often worse than the offered symptom relief, and they are notoriously difficult to wean off.

As far as anxiety, we have a completely different issue. Anti-anxiety medications are less side-effect prone than antidepressants, but highly addictive, with the added issue that taking a pill rather than dealing with the cause of anxiety often leads to long-term psychological dependence as well as lifestyle restrictions to avoid feeling anxious. Anxiolytics are indeed effective, but not quite safe, as far as the dependence they can create. Psychotherapy is known to be effective for anxiety and phobias.

This issue of understanding psychiatric medications and other medications that are not serving a clear purpose is vital to how I practice psychology. I see many individuals with physical symptoms, taking several medications, and not able to identify any particular improvement from the drugs, yet afraid to stop or taper any of them. These same clients might also complain of poor sleep, lack of appetite, grogginess, or gut problems. The fact that this individual is in my office means that the medical approach is somehow not helping, or not helping enough, but because nothing better has been tried, the medications linger.

When a psychological approach is shown to be effective, working with my client's physician to taper medications is part of the process. We are able not only to work on the original problem, but also the new fear of stopping the medications.

When there is a psychological diagnosis such as anxiety, depression, phobia, or trauma, once again, if the client is sitting in my office, it is often because medications have not worked. In these cases, research bears out my own conclusion that psychotherapy is the approach most likely to help. Once again, when my client experiences an improvement in symptoms, he then needs to confer with the prescribing physician to assist in the tapering of any drugs that have not shown positive effects, but in this case, psychotherapy can proceed and the potential for cure rather than symptom reduction is real.

One of the problems here is that is can be very difficult to distinguish, as a consumer, good psychotherapy from just having a pleasant chat. Many supportive, empathic conversations help you to feel calmer and happier. Psychotherapy ought to be aimed higher than that. Not a short-term relief from psychological or physical pain, but a long-term learning process in which you acquire new knowledge and new behaviors that lead to a better mood and a calmer frame of mind. It is okay to hold your psychotherapist to a higher standard; you ought to see improvement. While this can be difficult to measure, it is less vague than some might think. Set goals with your therapist, and go over whether they are being met. Ask for assignments. The completion of assignments is a major predictor of therapeutic success; it means both you and the therapist are engaged in a learning process.

Psychotherapy has been shown to be effective in treating depression, anxiety, phobias, PTSD, and many other problems with life. Specialized psychological approaches have been shown to be helpful with chronic pain, migraines, functional gut issues, and problems with the immune system. Please discuss all medications with your physician at length, and if medication is not the answer, there are a variety of alternatives depending upon your issue, including, perhaps, a visit to a psychologist.

References:

Ananth, J: Pharmacotherapy of Obsessive-Compulsive Disorder, (1985) in ed: M. Mavissakalian, L, Michelson, S.M., Turner: Obsessive-Compulsive Disorder: Psychological and Pharmacological Treatment : Springer Science, NY. Chapter 5, p 177.

Antonuccio, D.O.; Danton, W.G. & DeNelsky, G.Y. Psychotherapy versus medication for depression: Challenging the conventional wisdom with data. Professional Psychology: Research and Practice, Vol 26(6), Dec 1995, 574-585.

Kirsch, I. (2010 ) The Emperor’s New Drugs: Exploding the Antidepressant Myth. Basic Books.

https://www.madinamerica.com/2017/02/integrative-mental-health-27-non-drug-options-that-work/

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013

Sarno, J. (1990) Healing Back Pain: The Mind-Body Connection Warner Books.

Whitaker, R. (2010)Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Random House.
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 The important thing is this: To be ready at any moment to sacrifice what you are for what you could become.  -Charles Duois