Welcome to the middle path

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Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.

Friday, December 31, 2010

What a difference a day makes

 2010 is almost over, and as my sister said, "Don't let the door hit you in the butt on the way out." 

It's just another day-- but the changing of the calendar year encourages a chance to reflect, renew our choices, and if we wish, begin anew.

Last January I resolved to write a daily resolution. I didn't quite make it-- I think I got 27 out of the month-- so this year I'll give it another go.  And instead of 2010's big global action words, I'll write about specific actions we can take to improve health, happiness, community.  Think of it as daily therapy homework, but don't be limited to trying it the day I post it-- I sure don't expect to keep that busy. If you try some of these, I'd love to hear about your experience.

May 2011 bring you and yours the blessings of love and growth.
ps-- even though this is essentially a commercial-- it gave me joy.  Click the link to view.

The reality of suffering

"It is what it is", we hear. and even as we struggle to resist the inevitability of suffering, reality insists itself upon us.  A devil's bargain:   feel little, of either joy or sorrow; or  feel so unbearably much of both the best life can offer and more pain than we believe we can bear.  We die young, or we live long enough to see others leave us.

There is no fairness, no sensible story I can make of some of what happens in this world. In a critical care waiting room, strangers become intimate through the worst of life circumstances.  A young woman's family gathers praying for miracles after a skiing accident; a small town high school football star tries to live up to his tough image as his 48 year father recovers from emergency brain surgery.  A 19 year old boy dies from injuries sustained in a car accident despite the full house church members praying fervently he be spared.

Tragedy is not all life offers, but it is part and parcel.  We are called to be big containers.  We bear more than we believe we can, and sometimes all we can do is breathe in, breathe out, and love.  If nothing else, we can love-- scared, small as we feel.  We offer what we can-- our ear, our car, our dollars, our arms.  We can accept that we are part of this big family, do our best to be kind and stay conscious, and keep walking toward that place of love.

Saturday, December 18, 2010

Home for the Holidaze

 "Having a family is like having a bowling alley installed in your head"-- Martin  Mull

Christmas and Hanukkah are boom times for therapists.  What is it about holidays that cause so much trouble?  There's the  obvious:   the extra activities to cram in too already crazy busy lives, the financial strains, the booze and sugar hangovers.

And there's  the poignant and sometimes painful difference between the Hallmark commercials of ideal family communion and reality of messy humans coming together with their messy selves.

We spend the latter years of our family-of-origin time struggling to develop identities that resonate with our souls.  Part of that journey means turning away from the very sources of our safety and nurturing-- to be able to find enough differences between ourselves and our parents that we can leave them.

And then the holidays come.  And with it, questions unconscious or not.

Can I be different and still belong?  Can I be true to me and still be loved by you?

Visiting home, or reuniting with relatives, we bump into our younger selves.  Dependent, less competent, locked into family or community roles we may have long since left.   Oftentimes these self portraits aren't held so much by others as projected by us.  Boundaries shift, alliances conflict, and sometimes we fall apart.
We may also struggle to see others as they see themselves without us, and call them back into roles that no longer fit.

Reunions seem to work best when we notice our thoughts and judgments, and remind ourselves they are just that-- impressions and projections, not facts.  I read in a book on some subject seemingly unrelated to therapy-- I think it was economics-- that people are all looking through their own very narrow aluminum tubes, and thinking they are seeing the same thing that others see, looking at different points through their tubes.  When we can rise above ourselves take an eagle eye view, we gain understanding and compassion.  We get that in any given moment in time, we are acting with the limitations with us right then-- just like everyone else.  Sometimes we are being very limited.  We snap and complain, out of tiredness or just confusion from being out of our element or stretched past our resources.  We overfunction, out of hopes we will be shown the love we need.  We isolate, out of fear we don't belong.  And yet we still want acceptance, or at least recognition of our validity.  As do those we love, acting out of their own limitations of the moment.

If you find yourself with loved ones trying hard to conjure up some love, see if you can show them the same acceptance for who they are as you are hoping them to show you.  Even or especially if you disagree with their choices.  In between reminiscing in the sweetness or horror of how things used to be, remember to be curious about how things are now for them, and who they are becoming.  Relinquish your internalized limitations for them and maybe they can do the same for you.  If worse comes to worst, try the OLA strategy.

As hard as you try, no one can escape the horror of Christmas, so you may as well be with your own family."—Liz Lemon, 30 Rock

May the holidays and the new year find your heart ever expanding,

Sunday, December 5, 2010

600 hundreds kinds of love

Beautiful day here in the heart of the valley.  Hiked Bald Hill in what should be the afternoon; ended up walking down at dark-thirty, making lots of noise so as  not to be cougar bait.  Later, stopped at the local LDS church, where the Community Nativity Festival was in the last hours of its three day run.  In its 16th year, the free event hosts over 600 creches made of everything from rolled up recycled newspaper to fine porcelain and metals. There were interpretations of the birth of Jesus from every country, and in some, the characters wore the clothing or had the facial features of the region of the artist.  Some of the creches were mass produced series, some handmade originals; each was meaningful enough to someone that it was purchased or given.  There were "Precious Moments" nativities and at least 4 (!) manger scenes in which every character was a snowperson,  There were even all frog and all dog scenes.  But no matter how serious, whimsical, downright silly or highfalutin' the creation, each seemed a message of adoration and unconditional love.

Some people have some pretty specific ideas about religion, and I am fine to let them have them. We do the best we can understanding big pictures with our individual, fully human minds.   I do believe strongly in the law that informs all faiths-- the law of love.

This week, I saw our town come together in love to support a faith community that was targeted by an arsonist.  The day before, a youth who had occasionally attended there had allegedly plotted a terrorist attack in Portland.  The local mosque and others in the Islam community quickly condemned his actions, pointing out  it was not in keeping with tenets of the faith.  However, many commenting online about the incident seemed to confuse the actions of the individual with all people of Muslim identity or from Islamic nations. Some called for expulsion of all immigrants; others accused all Muslims of violent intent.

I was glad to see that here in our town, hundreds turned out on a very cold and rainy night to show support and love for the hate crime against one of our own.  Rabbi Barnett spoke of the need to bring light of hope against fear and hate.  Quakers and other Christians prayed for peace and understanding.  Mohammed Siala, an imam at the Salman Alfarisi Islamic Center, thanked the crowd for coming from the warmth of their home to show the warmth of their hearts.  He asked all to release anger and to embrace love and compassion that could be “stronger and more powerful than the might of evil."

Let the bigness of love be stronger this season than fear.

Monday, November 29, 2010

Fixing a Hole Where the Rain Comes In

It's been some week here in the heart of the valley.  When I first moved here, I would clip choice selections from the Crime Watch column of the newspaper and send them to my folks:  "Zucchini thrown through window of home.  Both zucchini and window complete loss."  "Caller reported an unwrapped birthday cake had been placed in her mailbox."  Things haven't changed too much over the years.   Here's one from this fall:  
THAT’LL CLEAR THE FLOOR: 3:11 a.m., Peacock, 125 S.W. Second St. The head of security reported that at about 2 a.m., someone set off a “stink bomb” on the upstairs dance floor, clearing the bar and alarming customers. The “bomb” was foul-smelling oil wrapped in foil, with “Fart Bag” written on the outside. 

But this week, our town received national attention when an Oregon State student was accused of plotting a bombing at a crowded Portland holiday gathering.  A 19 year old US citizen of Somalia birth,  Mohamed Osman Mohamud allegedly wanted anyone attending the popular event "to leave either dead or injured" and expressed no concern about innocent children and others being hurt.  He has been branded a terrorist; and if reports of his attempts to ignite the bomb he thought was in place are true, he truly tried to earn that title.

But nearly as troubling are the comments on news websites from viewers, quick to leap on Mohamud's Moslem identity (and his immigration status).  Many readers immediately blamed the religion, saying Islam supports and encourages such actions. Within a day of the news breaking, our local mosque was hit by an arsonist.  Some of those same readers applauded this hate crime.

To be sure, some individuals use their religion to support violence and oppression of others.  But this is a bastardization of religious intent.  Mohamud is no more representative of Islam than Fred Phelps is of Christianity-- or Hannibal Lector is of meat eaters.
Every major religion has a variation of the golden rule:  Do unto others as you would have them do unto you; and want not for another something you would not want for yourself. 

The Bible tells us: "There is no fear in love; but perfect love casts out fear, because fear involves punishment, and the one who fears is not perfected in love."  The Qu'ran specifically forbids any "compulsion toward religion" and invokes God as the perfection of Loving-Kindness.  Passages in either holy text can be cut and pasted to support individual perversions of the universal Law of Love and encourage violence of many kinds.
It's time we stand up for love, and each other.

If you are in or near Corvallis Tuesday, Nov. 30th, join our community in a vigil of love and against fear.  

 As Mahatma Ghandi said,  "An eye for an eye leaves everybody blind."

Wednesday, November 24, 2010

Happy Thanksgiving!

I am grateful for clementines and critical thinking, for lichens and literature.   For slow food, good friends, meteor showers, clean water, beautiful Oregon with its valleys, mountains, woods and ocean.    For time with those who passed on.  For my family, the best teacher I ever had.  For history and for the present moment.

For the small, the huge, the concrete and the abstract, I give thanks.

I am so very grateful for community.  Thanks for being part of it.
What are you grateful for?

Friday, November 19, 2010

OLA, baby!

Time to revisit the OLA philosophy:  let's all be the One Less @$$hole we want to see in the world.

It's been a hard week here in Lake SunBeGone.  Cooler temps and the retreat of daylight seems to have some people listless and some more pretty darn cranky.  I find my patience and my trust in the general goodness of others waning.   

But then tonight an old colleague posted the following quote on her Facebook status:
"Just don’t be mean. Being mean never works. Never. So that’s the only rule I can think of that’s worth following in life: don’t be mean." ~ Kate Bornstein

OK-- we get to be part of the problem, or part of the solution.  We can give in to the dreary, join the naysayers, roll up our tender little hearts and tuck them in our pockets, looking out only for Number One Is the Loneliest--

Or we can remember Plato:  "Be kind.  For everyone you meet is fighting a hard battle."

Love it up,

Song of the day:


Sunday, October 31, 2010

S.A.D.? Lighten Up!

Someone articulate said something about how we humans are caught in the crossfire of indolence and productivity.  I've crossed over to the dark side on that one, so here's an updated rerun on from two years ago, in tribute to the darkening nights and increase in phone calls we therapists get this time of year.  By the by, Costco has daylight simulators and light therapy boxes on sale this week.  Be sure to check  Dr. Jim Phelps' exceptional thorough discussion on research and information on light and depression.

 The days are darkening here in Corvallis, and it won't be long until what little slanty sun could shine will be thwarted by rain clouds. If you notice yourself getting sleepy, lethargic, or gloomy, you're in good company. Seasonal changes in light have a very real and physiologic effect on mood and energy. Our brains and bodies are set up by evolution to react to long light days with increased energy (work those fields! harvest!) and to cooler, dark days by slowing the system down (sleep! now sleep some more!). Our bodies would be perfectly happy going to bed not long after the sun sets. That probably worked well in days before widespread use of artificial light and 24/7 availability of food and things to do-- but it's unrealistic for most of us now. The result in the split between rapid societal evolution and much slower physiologic evolution can be sleep, energy and mood disorders, including the Oregon State Malady:  Seasonal Affective Disorder.

A light box can address both typical and more drastic results of the effects of waning light on the brain and body. Light boxes produce effects similar to sun exposure and can be used in the morning to assist in wakefulness and mood regulation and in the afternoon to increase energy. Exposure is typically between 15-30 minutes at a regular time each a.m. or early afternoon. To be effective, the light source should be at or above face level, with eyes open (although it is not necessary or recommended to look directly at the light)and within 15-30 inches of the light source. Specific instructions vary according to model. There is a great deal of evidence of effectiveness in the use of light boxes to treat seasonal affective disorder, a type of depression linked to low winter light.

Because they have a real--and sometimes profound-- effect, they are best used according to specific directives based on the particular mood or sleep issues one is experiencing. In some cases, use can increase hypomania (agitation, excess energy, and insomnia among other symptoms). Usually a reduction in the exposure time or moving exposure from am to afternoon  is enough to remedy that. However, I encourage persons considering light therapy to consult their physician or mental health practitioner and have some sort of system in place to track results. Because it isn't completely clear that such intense light exposure is safe over long periods for eyes, light therapy isn't for everyone and the risks as well as benefits should be explored.

I'm a chronically terrible sleeper, and an even worse waker. I noticed that the best sleep I have is when I am camping and rise and go to sleep with the summer sun. Since that time frame is typically also when I rise and wake in the winter, I have found great benefit in the use of a dusk/dawn simulator. The device I use attaches to my bedside lamp and is programmed to turn the (100 watt full spectrum) light down very gradually in the evening and then up again gradually in the morning. I use it from October to May and find I don't even need an alarm clock, as the dawning light creates a gentle alertness over time. I wake up refreshed instead of startled. Research suggests that gradual lightening stimulates a chemical cue to awakening, just as gradual darkness stimulates a chemical cue to drowsiness. I rarely use a light box since I've bought my dawn simulator. They aren't cheap-- mine was $150-- but I find it a bargain for the help it's provided me with sleep and waking.

Meanwhile, if it's a nice day, get out there!The average American is getting LESS than the 20 minutes of sun a day needed by the body to manufacture adequate vitamin D-- that's on a summer day.  In Corvallis, you'd need to be outside during 24 daylight hours to get that daily dose.  The USDA just doubled the RDA; if you are supplementing, they say go for D3 and 800 mg.  Harvard Health suggests 1000 and tells more about the importance of this vitamin, ways to get it, and effects for different populations in their newsletter here.


The Office of Dietary Supplements/National Institute of Health FACT SHEET on D.   There's a chart on getting vitamin D from diet.  Trust me, if you aren't taking cod liver oil or drinking a half-gallon of milk a day, you probably won't get it there.

Corvallis's own Linus Pauling Research Center is doing lots of research on D and are big proponents.  Find out what they are on about HERE.

Boston University reseacher and professor Dr. Michael Holick is considered one of the foremost researchers on D; he alerted a nation to links between D deficiency and increased autoimmune diseases and cancer.  He worries our obsession with sunlight protection in the form of sunblocks and clothing is causing a national deficiency.  Remember, no need to tan-- 20 minutes on hands and face in summer is plenty to produce all the D you need.

Quote of the day:  Albert Camus
To correct a natural indifference I was placed half-way between misery and the sun. Misery kept me from believing that all was well under the sun, and the sun taught me that history wasn't everything.

Song of the day (what else):  

Friday, October 1, 2010

Important Message; Please Pass it On

The following is cut and pasted from the good works of Trevor Project:

The Trevor Lifeline

Are you going through a difficult time?  Feeling confused, lonely or blue?  Call us!

Our trained counselors are ready 24/7 to talk to you.  If you’re a young person looking for someone to listen and understand without judgment or if you’re feeling suicidal, please call The Trevor Lifeline now at 866-488-7386. It’s free and confidential.  There is hope, there is help.   [U.S. CALLS ONLY]


Don't have access to a telephone?  Are you in a location where you are unable to talk?   Are you hearing impared?  Let's chat!

TrevorChat is a free, confidential, secure online messaging service that provides live help through this website.  TrevorChat is only intended to assist those who are not at risk for suicide.  It's available on Friday's between the hours of 1:00 PM Pacific (4 PM Eastern) and 9:00 PM Pacific (12:00 AM Eastern).  Connect with a volunteer who can support you with your concerns and questions.  [U.S. Residents only]  Click here on Friday's to see if an IM session is available.

Connect with others

There are plenty of ways for young people to get involved in spreading the word about The Trevor Project, whether you’re LGBTQ, a straight ally or anywhere in between! Youth are our most important advocates, and you can do a lot to be a “lifeguard” for your peers and create a safe, accepting environment for yourself and your friends.
Learn about the warning signs of suicide and what you can do to help a friend in crisis.
Visit and join TrevorSpace.org, TrevorSpace is a social networking site for lesbian, gay, bisexual, transgender and questioning youth ages 13 through 24 and their friends and allies. Join today!

Wednesday, September 29, 2010

finding mercy in the moment

This has been one of the hardest weeks in my circle I can remember.  Tragedies predictible and unimaginable have shaken those I love.  I have felt shattered and heartsick.

This morning I had an appointment to give blood.  I wanted to cancel it.  I felt literally tapped out.  I thought about Ansel, who needed so many transfusions and went through so much so that he could pack a life into 20 years.  I went.

I came home exhausted from a week of little sleep, with an evening full of things that needed done before bed.  Then I took one last walk to the grocery store.  I could have skipped it, but wanted the time with my friend and neighbor, also hit hard by the week's events.  We talked and planned and mourned together.

The night was beautiful.  The stars so bright, the sky so clear, the air smelling of pines.  The crickets sang in the brush.  And then, right in the middle of this small town, two owls called back and forth, back and forth.  The beauty of it lifted my heart, against my will.

It's not that things are ok.  It's that ok and not ok, beautiful and terrible, exist side by side.  That's life.  That's what makes life bearable.  That and a community of people, willing to listen and love each other even when-- especially when-- the terrible seems in charge.

"Christ, this life of mud and miracles-- it's the prettiest little burden, isn't it..."  --Richard Buckner

May we all sleep well tonight, and know we are loved.

Sunday, September 26, 2010

Grief 101: Guidelines for Witnesses

In memory of Mark, Sept 1965-Sept 2010,  Ansel, Sept 1985-March 2006, and Dave, Aug 1952- July 2002

Rule Number One:  There are no rules.
Everyone grieves differently.  It's an American desire to put a time-line or a formula on grief; to tie it up in a neat little package and put it to bed.  There are some relatively predictable phenomena, as Elizabeth Kubler Ross outlined in her stages of grief writings.  But even these are individualized-- people will bounce back and forth between stages, revisit them at different developmental stages, skip some completely.  Grief is as individual as we are.

That leaves us with guidelines, not rules.  Here are some:

How do you support the grieving? 
However they wish.
Some people need space.  Some need you there.  Sometimes they don't even know what they need.  Just show up, and follow their cues.  Best thing, when possible, is anticipate needs and take care of them, within reason.  Bring food, offer rides and rooms to visitors, leave lists of people family can call to take care of last minute necessities such as errand runs and chores.
Listen without judgment.
People react to the shock of grief in many ways, sometimes many ways within minutes-- laughing, being quiet, crying, reminiscing, being angry at being left. All are "appropriate" in the moment.  Don't push them to talk but don't be afraid of acknowledging what is happening and what they are feeling.  Don't push your agenda on what you think they should be feeling or talking about.
Remember that grief lasts a long time.  The grieving person is usually surrounded by others in the first few days.  It's later when they may really need your help. Acknowledge important events such as anniversaries.  Know that the first year is the first anniversary of everything since the loss-- the first particular season, the first holiday, the first birthday alone.  Let them know they are loved and their loved ones remembered.

A few don'ts:  Don't make them talk if they don't want, or try to force them to accept things they aren't yet ready to think about.  They will talk in their time.  Denial is nature's way of protecting our tender hearts while we are taking in realities that are very difficult.  Give denial room to work.
Don't tell them this is God's will or it was just this person's time unless they are already putting forth their belief in that.  If that comforts you, fine.  It may not be a comfort to them, and may feel like an invalidation of their own natural anger or right to sadness.
If you don't know what to say, just let them know you are there and you love them.
Don't berate yourself for being scared of doing it wrong, facing them in their grief, not knowing what to say.  All this is very common.
Similarly, be mindful that what you say to or do for them is for them, not for you.  What comforts you may not be what they need.
If possible, don't avoid them because it discomforts you.  That's your stuff, and this is a time to put it away to help others who really need you.

In short:  let them know you love them and are there.

Quotes of the day:
To live in hearts we leave behind 
Is not to die.
~Thomas Campbell, "Hallowed Ground"

Oh heart, if one should say to you that the soul perishes like the body, answer that the flower withers, but the seed remains.   --Kahlil Gibran

A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist.  --Stewart Alsop

I shall not die of a cold. I shall die of having lived. --Willa Cather

Poems of the day:
If Death is Kind 

Perhaps if death is kind, and there can be returning, 
We will come back to earth some fragrant night, 
And take these lanes to find the sea, and bending
Breathe the same honeysuckle, low and white.

We will come down at night to these resounding beaches
And the long gentle thunder of the sea, 
Here for a single hour in the wide starlight
We shall be happy, for the dead are free.

--Sara Teasdale 
Gone and Dust
When we have done our
and left
what will remain of us?
Certainly a statistic,
 and a number,
or maybe if you're lucky
a memory inside a head
or two.
He used a tool
and dug in deep
to leave a mark
that would last longer than
he would.
   --Anselin Reed

Video of the day:  Dave Carter and Tracy Grammer

Monday, September 20, 2010

How to Do Therapy Part Two: Bang for Your Buck

Therapy is expensive.  Insurance helps, if you have it, but the copays and deductibles can be significant.  I grew up frugal and I haven't changed. I want to get, and give, best value.    Psychotherapy is usually much less expensive than medical therapy (I think I paid $350 for 12 minutes with one doctor this year), but it can quickly add up with multiple visits.  Here's ways to make the most of the investment.

First, a disclaimer.  This is how I do therapy, and how I like to get it.   I use a very interactive solution-focused style.   Lots of therapists have different models and these won't apply to all of them, for example, to the practice of long term psychoanalysis.  This isn't meant to suggest those aren't useful modes of treatment; it's just not what I do.

Know what you want.  It helps a lot if you have some global goals and specific objectives for what you want to gain from your therapy work.  Your therapist should be able to help you articulate these, so don't worry about being confused at first or having vague ideas of "being better". You can work on these together.   An example of a goal:  Be happier.  An example of an objective:  increase social support network by spending quality time with two or more people this month.  Goal:  Improve my marriage.  Objective: learn and use two positive communication skills with spouse.  Goal:  Improve health and lose weight.  Objective: reduce emotional eating and decrease daily calorie count.  Goals usually remain constant for the course of the therapy while objectives change as you meet them and move on to new challenges.

Share what you know of yourself as early as you can to help your therapist know how best to work with you.  Some questions to ask yourself:  what's not working for me now?  What's been a historical pattern for me that hasn't served me?  What strengths do I bring to this work?  What learning style works best for me?

Tell the therapist what you don't want.  If you have dyslexia, for example, lots of reading assignments might prove overwhelming.  Maybe you've had a previous therapist and things didn't feel right.  Tell your therapist what you can about what doesn't work for you and why you think that is true.  Your therapist may ask you to trust them to try new things.  If you have real doubts, tell them. 

Do your homework.  Not every therapist gives it.  I do, for several reasons.  First, we get maybe 50-55 minutes together a week (and often I see people much less than weekly).  The main work really needs to happen outside of the session for you to see much change.  Secondly, I have a reason for assigning the homework.  Usually I want you to practice a new skill or gain some new information.  Even if you practice skills in session, that doesn't mean they translate in the rest of your life.  I want to know what works, what doesn't and this is how I find out.  Finally, insight without change is really not that worthwhile.  It doesn't help to label yourself and excuse behaviors that have never worked.  The idea is to find new ways of being in the world that serve you.  By the way, I don't fire clients for not doing homework, or yell at them.  Sometimes I get that you just got busy or distracted.  But if you consistently aren't doing any work outside of session, it's time to look at what that means.   Am I moving too fast?  Have we failed to appreciate the function of the symptom and find a healthier alternative to meet it?  Do we need to include significant others in your life to support the changes?  If you aren't doing the work, explore that with your therapist. 

Similarly, Prepare for your sessions.  Keep a notebook and jot down things that come up during the week you want to address, reactions to homework assignments, questions about the therapy process. Have your copay ready at the beginning of the session so time can be used for therapy, not paperwork. It really helps me if you come in having thought about your session and with some idea of what you want to get out of it.  Don't worry if you feel confused at times about this-- we're used to that.  But when you don't think about your process and therapy except when you are in the office, and wait for the therapist to do all the leading of the session, you just aren't going to get nearly as much out of it.

Ask questions.  This is a partnership in which both of you are working toward your best health.  You are relying on and paying for specialized expertise.  But if you don't understand what your therapist means by a certain comment, why they are suggesting a particular course of treatment, or their motive in asking to see you more/less often, etc.-- just ask.  Similarly:  make comments.  If something feels uncomfortable, if you don't know WHAT you are thinking or feeling-- it's fine to say so.  It's our job to help you figure it out when possible.

If it's not working, talk about it.  It may be a poor fit-- I know, for example, that I am not everybody's cup of tea.  I move and talk fast and some people need a much gentler, more reflective and less active style.  That's not a slam on them or me-- no one can be everyone's everything.  You can always vote with your feet, as psychiatrist Jim Phelps says-- just go to someone else.  But I prefer it, and it's usually helpful to both of us, if we talk about what doesn't seem to be working and either adjust treatment or talk about who might be a better fit.  Also I have found that sometimes just the conversation is enough to clear up misunderstandings about expectations and barriers to change.  

It's pretty common for people to come to a stuck point.  Sometimes it's simply fear about change, or discomfort (believe it or not) with being comfortable.  If you've been in crisis mode for a long time, you may not trust peace.  Sometimes it's time for a break to practice skills.  Sometimes you are just done-- you've done what you came to do, and it's time to stop.  Again, if things seem to be standing still-- talk about it. 

The gist of this is to encourage you to take agency in your therapy work.  You aren't meant to be a passive recipient in this process.  What you bring to the session makes a huge difference and saves you money, and will help you make the changes you are here to make.

If you have additional thoughts, comments are always appreciated.

Tuesday, September 14, 2010

How to do therapy part one: finding a therapist

Having been on both sides of the therapy couch, I know how anxiety provoking it can be to turn your inner life over to a near/complete stranger.  Here's some tips on finding a good fit.  None of these are guarentees, but it beats throwing a dart at the yellow pages.

1)  Talk to people who've seen them.   You can get some idea of their style-- formal, in-your-face, analytical, practical.  Some therapists are different with different people-- well, most are at least sometimes-- but it's a start. 

2)  Check out their website, if they have one.  It should give you an idea of their therapeutic orientation and demeanor.

3)  Google 'em.  Psychology Today has a "therapy finder" website that has bios and information about rates and insurances accepted.  It's a paid advertising service; not all therapists use it.  There are others as well.  

4)  Ask your MD or another therapist.  They aren't going to know everyone in town, but they aren't going to give you a name of someone they don't trust, either.  Don't be afraid to ask your OB/gyn, pediatrician, dentist-- they've all been asked before.

5)  Call,  or if they have a website/email contact, email. If you are comfortable, give a brief idea of what you're working on and looking for.  It can be discouraging, I know-- you will find most of us are full.  Some of us will still try to offer an idea of someone else you could try.  If we're not full, you'll get a better idea if you're a fit if you can have a brief conversation.  Ask if you can be on a wait list if it's someone you are really hoping to work with.

6)  Ask others who they've heard recommended and why.

7)  Call your insurance company or visit their website.  Some sites will have bios of providers and what they specialize in. They will also only refer you to people they are willing to cover (though copay amounts/limitations will usually apply).

Things to consider:  If you want to use insurance, make sure the therapist you choose accepts your particular plan, and get preauthorization if needed.  It often is. 

If you have limited availability, establish that up front-- most therapists operate like any other professional office, 9-5 M-F.  No sense opening up your entire life story if you can only come in on Saturdays and they can't see you then.

If you've got other tips, please add them in the comment section.

Tuesday, September 7, 2010

A Sermon on Uncertainty

Jana Svoboda/ Unitarian Universalist Fellowship of Corvallis/ Aug 21, 2005

Opening words: Poem
If There is the Seed of Something in You

if there is a seed of something in you, and
all you can think is house on a hill,
house on a hill; built by the river and
thank god for the hill-- maybe you
live too close to both safety and danger
to either enlarge or relax. if the
seed needs water, do you resent your choices,
the well you never bothered drilling,
the bucket you let rust? you
look down at the swollen river;
even the river's pregnant, you think,
bursting its confines-- and you, more
like the seed, dry and hard and contained,
but within you some untapped largesse,
something wanting to be wet, and to break open.
from the hill, the river looks dangerous.
you forget that water is just what you need.
                 JLS, May, 2005

In Plan B: Further Thoughts on Faith, spiritual writer and professional neurotic Anne Lamotte begins: “These are desert days… I feel we began witnessing the end of the world in super-slow-mo...and some days it takes everything I can muster not to lose my hope, my faith, and myself.” I relate closely to her fear, and the paralysis that wants to follow it. She takes her fear to a theologian friend and asks, what can I do? He tells her—“left foot, right foot, breathe”. Because sometimes that is all we can do—sit with our uncertainty, and connect—through our breath—with something deeper and more divine. In the desert, Anne writes, we “know” what we should do. Stay out of the sun. Seek shelter, and safety. The desire to go back, to retreat into nostalgia—the pain for home-- is a natural reaction to dangerous and uncertain times. But courage, as the saying goes, is not being without fear—it is doing what needs to be done despite the fear. 

At a workshop with Jungian psychoanalyst and writer James Hollis, he asked us to rank our values.  What did we see as the most important tasks of our lives? I've done this many times.  But then he asked something else: to estimate how much conscious intent we put towards the items at the top of our list. A middle-aged man remarked: “The top of my list is love and growth. But I realize I spend most of my days just trying to avoid discomfort.”

I believe this is true for many of us. And for some, religion becomes a way of doing that. A hope for easy answers, for formulas: if I do this, that will happen. It is both a hope for the illusion of control and predictability, and a retreat from facing in ourselves and the world that which we cannot know. Rabbi Kushner referred to it as “God as Santa Claus”—we follow the rules, we get the goodies. 

James Hollis talks about these competing agendas living with in us: the drive for growth and actualization, and that for regression-- the wish for “the confident hubris of youth”, and for the familiar and the comfortable. When the desire to go home, to go unconscious prevails, “we will choose not to choose, to rest easy in the saddle, remain amid the familiar and the comfortable, even when it is stultifying and soul-denying… Each morning the twin gremlins of fear and lethargy sit at the foot of our bed and smirk. Fear of the unknown, the challenge of largeness intimidates us back into our convenient rituals.” But he admonishes us: “To be recurrently intimidated by the task of life is a form of spiritual annihilation.”

Hollis continues: “The recovery of personal authority is a daily task imposed upon all of us by the soul. It means to find what is true for oneself and live it in the world. If it is not lived... we abide in what Sartre calls “bad faith, the theologian calls sin the therapist calls neurosis. Respectful of the rights and perspectives of others, personal authority is neither narcissistic nor imperialistic. It is a humble acknowledgment of what wishes to come through us.”  It is also the maturity of realizing we don’t have all the answers. We don’t even have all the questions. “...from this encounter with our limitations the wisdom of humility comes: to know that we do not even know what we do not know.”

And yes—dealing with this will make you anxious. Coming forward always does. Kierkegaard said: move away from what makes you depressed, and toward what makes you anxious. The former is to regress. The latter—scary as it is to leap into unfamiliar territory—is growth.

In Plan B, Lamotte says: “In my experience, there is a lot to be said for desperation. Not exactly a bright side, but something expressed in the word formed by one of the the acronyms for the names of God—gifts of desperation. The main gifts is give up the conviction that you are right, and that God thinks so too, and hates the people who are driving you crazy. And this forces you to listen deeper, with your heart.” This is where we come up with wisdom, instead of information. 

If we are students, and we really want to learn something, it’s best not to steal and memorize the answers-- BBACACC. That’s not knowledge. It’s certainty—but it’s not wisdom. Unitarians have accepted that task as a foundation of our principals: the individual search for truth and meaning. But it’s not unique to us.

Buddhists teach it:
“Do not believe in anything simply because you have heard it. Do not believe in anything simply because it is found in written in your religious books. Do not believe in anything merely on the authority of your teachers and elders. But when after observation and analysis, you find anything that agrees with reason, and is conducive to the good and benefit of one and all, then accept it and live up to it.” (from the Kalama Sutra)

And Daoists:
“A tree that is unbending is easily broken. The hard and strong will fall. The soft and yielding will overcome.” -- Tao te ching, 76.

And Confucians:
“To learn and never think—that’s delusion”. Analects 2.15 

The Koran states:
"Do not accept any information unless you verify it for yourself.  I have given you hearing, the eyesight, and the brain, and you are responsible for using them."  Koran 17.36.

Christians, at least in the early church, agreed:
"Test everything. Hold fast to what is good".  I Thessalonians 5.21

But when times get scary, we regress. Like children, we look for external authority. Benedictine Sister Joan Chissiter writes: “We suckle ourselves on clear or comfortable answers because we fear to ask the questions that make the real difference to the quality and content of our souls. The spiritual life begins when we discover that we can only become spiritual adults when we go beyond the answers, beyond the fear of uncertainty, to that great encompassing mystery of life that is God.” Uncertain times are nearly always accompanied by a rise in fundamentalism, and I see it happening now. We divide into us and them, good and bad. This tendency to split, present since birth, becomes urgent. 

Writer and Buddhist Nun Pema Chodrin quotes one of her spiritual teachers, who said, “"The essence of bravery is being without self-deception.” Pema’s favorite mantra is “"Om, grow up!" It takes great courage to meet life on life's terms and accept responsibility for our actions. "To stay with that shakiness -- to stay with a broken heart, with a rumbling stomach, with the feeling of hopelessness and wanting to get revenge-- that is the path of true awakening. Sticking with that uncertainty, getting the knack of relaxing in the midst of chaos, learning not to panic-- that is the spiritual path." It’s also about the very Adult goal of accepting reality and letting go of attempts to control it. Anne Lamotte puts that into her spiritual practice with her morning prayer of “Whatever”, and her evening prayer of “Oh Well.”

Thomas Moore said: “You cannot do good by thinking of yourself as good. You have to sink into the complexities and go down far enough into life that you realize that it is not even good to be good. To do what others may judge as bad may be the best you can do.” (Here I am thinking Rosa Parks). “Certainly you have to admit to your moral ignorance in many matters. Can any one be certain in every design they are doing the right thing?...
Religion often avoids the dark by hiding behind platitudes and false assurances. Avoidance and defense are not the true purpose of religion. It shouldn’t whisk you away from daily challenges but offer an intelligent way of dealing with all the complexity involved.” 

Another Jungian thinker uses the story Jekyll and Hyde to illustrate. Jack Sanford writes: “Striving for a pure goodness results in a pose or self-deception about goodness, a persona. Dr Jekyll had a very big persona and believed in it completely, but wasn’t really good and became compulsive about expressing Hyde. He went to religion, not to find God, but as protection against his own Hyde. Religion often attracts persons struggling to exorcise the shadow rather than understand and make peace with it but what we cannot see in ourselves, we cannot forgive in others.” When otherness takes over, evil takes root.

Jung said “I would rather be whole than good.” Before we ate the apple, we were a thoughtless people. We were a GOOD people, but not by choice. We were thoughtless.

Christianity has seen evil as something that destroys the soul-- but originally the tradition recognized we carried both, and the Bible said —“For the good that I would, I do not; but the evil which I would not do, that I do.” Knowing we are capable of evil and no different helps us to choose. It also helps us to understand that “Ain’t No Man Righteous”, as Bob Dylan says. And if that’s true, we are all in this together. Being without self-deception, and seeing our own capacity for evil, we then can responsibly manage it rather than act it our or project it into the world. When we don't accept our contradictions, we act them out. When we turn away from our true natures-- even those we are uncomfortable with-- we are asking others to act them out for us.

Part of the work is in learning to sit with our discomfort without reaction. To just be with it. if we are lonely, to be lonely. If we are angry, to see our anger. Not to feel we have to manage it, do something with it, or even change it. When we are sad and someone starts to tell us all we have to be happy about, we feel compelled to defend our sadness, and explain why they are wrong. The shadow must have that same instinct of self-preservation. Perhaps the battle is in befriending it. Not feeding it, but not turning away from it either. Just sitting with it. Like Jesus sitting with the sinners. 

Given the burden and gift of thinking and choice, we may want to regress to certainty. We are pattern-seekers. We want to know. But often knowing, or thinking we know, prevents us from seeing what is truly there. There is a Buddhist sutra that says: Protect me from the disaster of my own thinking. Realizing we don’t have all the answers may prevent us from uninformed decisions, or worse yet, stuckness in our thinking. We need to allow ourselves the bravery of loosening our grip on what we believe to be true to find even deeper questions. Maybe, in sitting with the mystery we’ll find what for us is true. 

Closing Words: Rilke, from letters to a young poet.
Have patience with everything that remains unsolved in your
heart. Try to love the questions themselves, like
locked rooms and like books written in a foreign language.
Do not now look for the answers. They cannot now be given
to you because you could not live them. It is a question
of experiencing everything. At present you need to live the question.
Perhaps you will gradually, without even noticing it,
find yourself experiencing the answer, some distant day.

Monday, August 9, 2010

The Pretty Much Very Bad Poet Basks in a Semblance of Glory

Part two of the Monkey-Minding Manual is in process. One of the tips is about engaging contrary emotion, being it's hard to stay anxious when you are laughing. In that vein, look what I got in my (virtual) mailbox today:

Your Very Bad Poem was just barely bad enough! From: Very Bad Poetry Staff
Good news! The poem you submitted to Very Bad Poetry was chosen to be on the front page in the near future. Tell your friends to expect that you'll be famous.

After their laughter drives you to the bottle, remember that Very Bad Poetry still loves you. By the way, you can see all of your poem by going to this link: verybadpoetry

Very Bad Poetry

Friday, August 6, 2010

Managing the Monkey Mind

Oh the nerves, the nerves; the mysteries of this machine called man! Oh the little that unhinges it, poor creatures that we are!
--Charles Dickens

As promised, though belated, a few tips for managing anxiety-- part one.

1) Don't suffer twice. When we worry about something in our future, (and there's nothing to be done about it) it's a lose-lose situation. If it happens, we get to suffer twice. If it doesn't, we worry for nothing.

2) Mind your stories. A Swedish proverb says: Worry often gives a small thing a big shadow. We can tell ourselves pretty alarming stories that have no real basis in probability. Check for facts. How many times have planes crashed at PDX today? This week? This year? Chances are that same pilot who's already landed the plane safely 8 times this week will also do fine today.

3) Take a breath. When we are fretting, we are often literally holding our breath. We don't breathe out all the used up air, and we end up in a bit of an oxygen deficit-- which does nothing to soothe our anxiety. Try "box breathing"-- take as much time to breath out as in, and make sure to pause for a reasonable time between inhalation and exhalations.

4) Get some distraction action. Since what you feed (your mind) grows, look for healthier places to invest. Listen to some music, taste a lemon, do some art.

5) Fire up a more logical part of your brain. Think of your brain like a power grid. If one part-- say that pesky amydala, which is all about emotion-- is all lit up, chances are the areas that access logic and reason are a bit dimmed down. Shift the resources by engaging in a few minutes of algebra, or even sudoku. Firing up those neurons will take a load off.

More to come.
Meanwhile, a song to soothe you.

Worry often gives a small thing a big shadow. ~Swedish Proverb

Friday, July 16, 2010

And now we pause to travel through space and time...

Blogging has slowed while summer is celebrated, with lots of family visiting and a time machine to build for Da Vinci days. If you're traveling through the Corvallis dimension, look for the TARDIS as it floats about the festival.

Thursday, July 1, 2010

Stuck in a (Bad) Story: PTSD

Been down this road so long...
Post Traumatic Stress Disorder
(PTSD) is a type of anxiety disorder (see last blog). Ten years ago the average Joe wouldn't know much about it, but it gets a lot more media now. Not that it's new: our brains have done a fab job of storing terror for millennium. It's a survival mechanism. If something life-threatening (or deemed to be-- the brain can't take the time to differentiate) happens, the brain will store away details to recognize the danger should aspects of it reoccur. When it perceives those details again, a quick chemical spill often occurs: adrenaline, cortisol, and a slew of other bio-goodies. Adrenaline helps you run faster, be stronger-- have any of you heard the tales of mothers lifting cars off trapped children? Cortisol (in the short run) releases glucose for energy, reduces pain perception, and increases memory. Both of these are good in a crisis. And ideally, these compounds will get used up in your flight or fight reaction. Should the situation never recur, and the brain "understand" the threat as a one-time deal, you're ok. But often the storage system isn't quite that selective. Here's an example:

Let's say you are walking downtown on a beautiful July morning when, just like in all those old Three Stooges movies, you look up to see a piano being lifted by rope to a third story apartment. Say you look up just in time to notice the piano and think "Gosh, hope I sure hope that rope's secure." And that in that split-second or two, you see the fraying of the rope, and the swaying of the piano, and the next thing you know you are lying on the sidewalk surrounded by ebony and ivories.

We're going to make this an easy one. It's your mostly-lucky day, and you walk off with a sprained pinky and a few scrapes. But Brain doesn't know that. It was way ahead of you. You could've been flattened! And it knows it. Logic knows something else: you're basically fine. You hardly ever use that pinky and it will heal pretty quick. With the exception of the loss of thirty minutes to recover over a latte', nothing in your life has changed.

Except good old Brain. Maybe now every time you see a piano your heart starts to race. Going downtown has the same effect. July makes you sweatier than it should in the Northwest. Or it could be, because Logic had such good intervention in your near-death experience, that those things don't get you-- but really discordant piano music puts you in an unexpected panic attack.

In the last blog, I talked about a Viet Nam vet who had a physical flashback after unexpected exposure to a popcorn popper that sounded exactly like rear machine gun fire. Most of the time Brain does a good job of knowing when it really needs to worry, so the one-time freak accident that results in no real physical harm pretty quickly loses its punch. But when the trauma is repeated, the peril real, or when other factors such as threat to one's children is involved, Brain solidifes the information and Logic can't budge it.

Because of the developmental differences of children, their brains are even more likely to store information in ways that prove troublesome when resources and circumstances change. Early exposure or experience of abuse can cause serious problems with hypervigilance (constant alert for danger even when none has been around for a long time) and chronic anxiety even as an adult. That's because the adult body is wired around the child's experience and capabilities-- at a time when the child had few resources to resolve the threat or escape.

Symptoms of PTSD include a hypersensitivity for stimuli related to the event (like the piano in the previous example), avoidance of such stimuli, and re-experiencing of the trauma when the stimuli is encountered, such as in flashbacks or panic attacks. Some folks have a paradoxical reaction of numbing out rather than "activating" when exposed to a traumatic reminder-- the freeze, rather than fight or flight response.

The main thing to remember, if you have symptoms of PTSD, is that you are not crazy. It's a predictable response to an unpredictable event. If the activacting stimuli themselves are not dangerous (like a piano), then repeated reexposure is the best bet for convincing Brain to settle down and quit seeing it as a threat. Several years ago my family had a traumatic event in which one factor was breaking glass. I had never had a panic attack in my life prior to that, though I'd treated people with them for years. I learned a lot about compassion for sufferers of same when for a while thereafter I had panic attacks whenever I heard breaking glass. Lucky (?) for me, I am far sighted in one eye and near sighted in the other, which means I have the depth perception of Mr. Magoo and am just as clumsy. I break things pretty routinely. Within a year or two my body/brain settled down and instead of thinking lives were in danger at the sound of breaking glass, I'd just curse my clumsiness again.

EDMR is another research based treatment for addressing PTSD. I'm not trained in it, but there are several folks in this small town, so likely some in yours too.

Cognitive Behavioral Therapy
has a good track record with PTSD and focuses mostly on re-exposure and correcting illogical thinking around the event.

Emotional Field Therapy
is a less researched but self-teachable method that employs many of the same ideas as EDMR. Many swear by it, and you can do it by yourself with probably little risk (some people might want/need support of another to confront scary material).

Recreation of the event through debriefing is a bit more controversial. For some, it's re-traumatizing. But many find it very helpful to process their experiences, especially if they are unique, with others who have been through the same. Groups for survivors of domestic violence, sexual abuse, or war are available in most towns-- check the web or ask me if you can't locate them.

Quote of the day: The wish for healing has always been half of health. --L.A. Seneca

Vid of the day: Willy Porter's BREATHE. A fan download,but if you can make out the words, it's worth it. Better yet, go buy the single (or the whole CD) at your local independent store or from his site.

As noted, next blog will talk about techniques for managing anxiety in general. The material will apply to those with PTSD as well.

Thursday, June 24, 2010

What Anxiety Wants is Predictibility

(Photo by Marla Dean Svoboda)
The spectrum of human experience known in the biz as ANXIETY DISORDERS account for much of my office traffic. As noted in previous blogs, there's reason to believe some of what makes a good chunk of our population more jumpy is genetic, and evolutionarily beneficial. People with more anxiety have Great Big Radar-- they are more tuned in to (and reactive to) changes in environment, internal and external.

Anxiety disorders in the DSM-IV, my professional's travel guide, include everything OCD to Post-Traumatic Stress. There's also categories for the generally jumpy (Generalized Anxiety Disorder) to the specifically frightened (phobias). Panic attacks are discrete periods of high anxiety that can be brought on something in particular, such as being in a crowded place or on a bridge, to nothing obvious at all-- worse, because that's a little harder to avoid.

The brain is great at learning what scares it. Danger memories can get hard-wired to provide a quick spill of chemicals that ideally would serve us well-- to get us the hell out of dodge, or help us fight off our attacker. Brain is not particularly selective in what gets filed, which can result in some strange associations we may not even know exist. For example, if you're in a car wreck, Brain may file away not only screeching tires and breaking glass. You might find yourself also getting panicky feelings (the emotional interpretation of all those chemicals coming to fore) when you pass white Hondas, or that particular intersection. That one's easy to connect, but while you might not have noticed what was on the radio, Brain could have, and you may not understand why your heart races every time that Lady Gaga song plays. I had a boss once who was a Viet Nam War Vet. Once during a staff meeting someone decided to make popcorn and started up the air-popper. Next thing we knew, our normally composed boss was under the conference table. Turns out the sounds the machine make are very close to what rear-machine gunfire sound like. Now obviously his logical thinking knew a popcorn machine was no physical threat. But body thought different, and it took a while for him to dial down the adrenaline.

Anxiety is the dizziness of freedom, said Kierkegaard. We are faced with an avalanche of choices, and each choice carries a responsibility and the opportunity to go wrong. Anxiety just wants to know and be able to plan for what's next. That's why a lot of people with the Anxious Gene can look like micro-managing control freaks (and why OCPD is probably just a coping response to an anxiety disorder). It's why we become much more anxious after an event that is not predictable, like the beautiful fall morning in NYC that later became known as 9/11. It's the seductive attraction of fundamentalism-- a simple recipe we can follow so that everything is guaranteed to turn out OK.

Our attempts to make an unpredictable world more comfortable often backfire. Addictions often start as ways to soothe, and we use many means to become comfortably numb, like TV watching. We substitute relationships that feel more manageable for ones that can provide greater intimacy with its resultant greater risk of loss and heartbreak. We practice avoidance through procrastination (consult me for tips-- I should be doing billing right now). We adhere to rules and ritual, sometimes crazy ones, to give an overlay of structure. All things in moderation -- some structure is a great thing, and too much or too little is a bad thing.

I'll talk more specifically about PTSD next blog, and follow that one with some tools for managing anxiety in the moment and overall. If you missed past blogs on fear and anxiety, click on the links below:
Obsessive Compulsive Disorder
She With Her Head in the Clouds
Tilting at Windmills
Be luminous! The day is over.

Song of the day:

Edu-Vid of the day:

Monday, June 7, 2010

Nourished by Community

Friday night I got my mojo refreshed at a celebration for a friend's graduating son. The party, held at her country home, was filled with music, dancing, and love. She'd prepared a traditional Indonesian feast-- a epicurean tableau of colors, smells, and flavors that drew many of us back for thirds. Ages of the festive ranged from 0-80 plus. Kids ran through the woods, sampled in the gardens and swung from the rafters and we all danced to a live band in a beautiful barn, playing original tunes with global flavors (with mama on keyboards!) . The night had all the ingredients of healthy living-- natural beauty, physical activity, creativity, wholesome AND interesting food, celebration of connection and life milestones, and involved, invested companions. I was rejuvenated by it.

We all need more of this in our lives. We get caught up in work, bills, disasters-- our created and life's unavoidable sufferings. Community makes it all more bearable, and reminds us of our generative potential.

Thanks, Evelyn and Mark, for reminding me what's important, and for throwing a heck of a party. And congratulations and best wishes for your future to Miro!

And if any of you need a band to play in your barn, email me for details---

150 ways to build community can be found at bettertogether.org

Today's quote: "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured." Author Kurt Vonnegut

Video of the day:

Thursday, May 27, 2010

Diagnosis of the day: Obsessive Compulsive Disorder

CHECK CHECK CHECK: Obsessive Compulsive Disorder is the label given to a anxiety disorders that have two chief characteristics: Obsessions (unwanted thoughts, images, beliefs) and/or compulsions (ritualized or repetitive behaviors). There are several subtypes. In contamination OCD, the sufferer worries about being affected by touching or being exposed to specific (although often many) people or objects, or being infected by germs. The fear is controlled where possible by avoidance (never touching doorknobs, refusing to shake hands, etc). When avoidance is impossible, the sufferer often develops rituals to "cancel out" the contamination. These may be logical though excessive, such as hand washing or use of antibacterial lotions. A person with contamination OCD may wash, scrub or apply chemicals to hands to the point of damaging the skin. Illogical rituals may also be used: retracing steps, saying a particular phrase, and so on. The rituals can be very time consuming and do NOT feel like a choice.

Rituals aren't limited to contamination OCD. Some OCD folks have intense fears something terrible will happen to them or someone they care about if rituals are not followed. Checking disorder, in which a person has intrusive concerns about not completing a protocol, may lead to checking and rechecking to make sure the lights are off, gas isn't leaking from the stove, or similar. Last year driving to the airport I saw a bumper sticker on a car that said "Are you SURE you unplugged the iron?" Like most people, I have a touch enough OCD  that it nagged me for a minute or two. For someone who really is affected by OCD, that might have led to a drive back home from over an hour away.

OCD can cause intrusive, usually illogical thoughts that cause distress. They are "ego-dystonic", a fancy way of saying the person doesn't want them. Those affected seek constant reassurance to refute them. In one case many years ago, I worked with a young man who worried he might be gay. He had never been sexually involved with a man, and never wanted to be. He had perfectly satisfying heterosexual relationships. Yet every week he would ask me "Are you SURE I'm not gay?" Reassuring someone with OCD is not effective, and in some ways contributes to the worry. The person with OCD knows their behavior or thinking is illogical. But it is not a choice to them.

"Pure O" OCD is the name given when the primary symptom is intrusive thoughts and/or images.  Disturbing sexual or violent pictures and thoughts are common in this type of OCD, but the name is misleading-- there are almost always some compulsions around being used to try to control the behavior.  For example, a person may avoid driving because of obsessive thoughts about running someone over.

I read once that the chief difference between the OCD and non-OCD person with egodystonic thoughts is the "stickiness" of their brain. We all think crazy thoughts. But if we don't have OCD, we dismiss them as random. The OCD brain worries them like the place where a lost tooth came out. They just can't leave them be.

The causes of OCD are unclear. There is an obvious genetic component that accounts for at least half of occurrences. While no one gene appears responsible, it's rare to treat someone with true OCD who didn't have one or more direct family members with some sort of significant anxiety disorder. But environment also plays a role. Life stresses, maternal pregnancy factors and even childhood strep infections can be factors. Hormones appear a factor at least in women-- it is common for new mothers (some say around 30%) to struggle with some intrusive thoughts and compulsive behaviors. Of course, stress and anxiety in such situations would be a clear contributing factor: is the baby breathing? Did I feed her enough? But the frequency leads researchers to conclude that hormones may exacerbate the situation. You can see in that case the evolutionary effectiveness of increased vigilance. Worried-over babies are more likely to survive than neglected or ignored babies.

OCD is different from Obsessive Compulsive Personality Disorder. People diagnosed with OCPD don't usually have rituals. Personality disorders are considered more personality types that cause trouble for people rather than isolated disorders. If you're old enough to remember "The Anal Retentive Chef" from Saturday Night Live, you've seen a classic OCPD type-- obsessed with rules and order, inflexible, fussy, perfectionistic. As I mentioned in my first blog about diagnosis, at their most basic most diagnoses describe a particular type of genetic predilection that have both strengths and weaknesses. You probably WANT your chef, your surgeon, the guy that lays your tile to be a bit on the obsessive-compulsive side. That means you will get a job done right. But when either of these slips into the really disordered arena, you get someone impacted so much by rigidity, anxiety, avoidance or time-eating practices they cannot function at all close to their potential. That's when it's time to do something.

Therapy for OCD
The most demonstrably effective treatment for OCD is not pleasant for those who have it. It involves systematic exposure to the triggering events so that the brain can rewire these to be perceived as non-threatening. OCD "boot camps" provide this quickly, though overwhelmingly. A person with contamination OCD might be forced to touch a toilet, for example, then eat something without washing. Generally, in outpatient treatment, exposure is done gradually to desensitize the person.

Medication can also be helpful. SSRIs (antidepressants such as fluxoetine, better known by its brand name of Prozac, or others) seem to help some people. There are risks and benefits to using medication and it appears that they work best when exposure therapy occurs concurrently. Medications of these sort should NEVER be stopped abruptly because serious withdrawal syndromes and rebound effects (worsening of symptoms) may occur.

New treatments using deep-brain stimulation (which involves surgery), transcranial magnetic stimulation (non-invasive) and even good old ECTs are also actively being explored to treat more severe and disabling forms of OCD.

If you're worried now that you have OCD, remember that most people have a little bit of every "disorder". The key factors for figuring out whether it's a problem is how disruptive it is to your life. Who's complaining? How much is it limiting you? If it's a problem for you, there are many options. Most cities (certainly Corvallis) have therapists and psychiatrists who specialize in treatment of OCD. Here are some other resources:

is an online source with chat groups and information by and for OCD sufferers.

The International OCD Foundation
, also run by persons with OCD, distributes information, research, and connects folks to treatment.

Dr. Stephen Phillipson has several good articles here at OCD Online.

Lots of successful, famous people have OCD. Click this post's title to see Howie Mandel talk to David Letterman about his.

We'll end on a lighter note: an OCD song.