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.

Wednesday, February 23, 2011

Diving into the Blue(s)

Depression.  The Black Dog.  The Emotional Flu.  The Blues.  
Along with anxiety, mood issues are a major source of discomfort for folks with the Troublesome Trifecta: Big Feelings, Big Radar and Big Processers. 
Depression is nothing new and, at least in its more common appearance, nothing rare.  Most people will go through periods of sadness in their lives when energy and concentration lags, thinking is cloudy, and the future looks dim.  It's normal following the loss of a loved one, illness, catastrophe or other sorts of regular life hardship. Time and emotional support will usually be enough to address these dips into dark places.  Jungians say aspects of depression can be a strange sort of gift:  the slowing down, withdrawing and going into one's thoughts can offer opportunity for rest and reflection.  Depression can be Psyche's way of expressing dissatisfaction with Ego's choices and a chance to think about what soul truly needs.

What's known in the biz as "clinical depression" is another matter.  This sort of emotional upheaval is so intrusive and persistent that the sufferer's life is affected in multiple ways. Work, relationships and physical health are disrupted.  Levels can vary from mildly incapacitating to life-threatening, and the sadness may be recurrent, with periods of remission and relapse. There appears to be a strong genetic component.  In families with histories of mood disorder there may be generations of substance abuse: perhaps markers of attempts at self-medication.

Symptoms of clinical depression as listed in the DSM-IV include sadness (you knew that one, right?), loss of interest in previously pleasurable activities, sleep disturbance (too much/little),  fatigue both physical and mental, clouded thinking and inability to make a decision, weight changes (loss of appetite is usually more significant than gain), thoughts about death and suicide, and the triple-threat-thoughts of helplessness, hopelessness and guilt.  Again, most everyone has some of these, some of the time, for a bit.  But for persons with clinical depression the symptoms persist, aren't necessarily related to anything happening in the outside world, and interrupt functioning on one or more levels.

The thinking can be the worst part.  Depressive thinking feels Very Big, Very True, and it's a liar.  It says:  You're worthless.  You've always felt this bad.  You'll always feel this bad.  You're a burden.  The worst outcome of the lies of depression is suicide.  Depression can be a fatal disease.

In Japan, the colloquialism for depression is "kokuro no kaze", which translates roughly to "when the soul has a cold."  Prior to a major marketing campaign by big pharma, depression wasn't much discussed in Japan, but the idea that one's soul could feel weak, leaky and lousy resonated with a lot of people.  Likening it to physical ailment rather than a character defect lessened the societal stigma, and inquiries to the medical profession about how one could address depressive symptoms immediately and dramatically increased, as did sales of antidepressant drugs.

In the US, antidepressants are at the top of the list for most prescribed drugs; some studies say nearly 10% of the US adult population currently take them.  Ads for antidepressant therapies are ubiquitious.  You can't flip through five pages of most pop magazines without seeing dramatic before and after pictures of hapless, then happy souls.  The symptoms described in some ads are general enough that most anyone could relate on a bad Monday.  Such campaigns have inspired numerous parodies.  Click here to see one from the satire newsmag The Onion. Reprinted as fact in a few web sources, it was apparently so close to actual ads that outraged readers couldn't tell it was in jest.   I want to be clear: antidepressants have made a significant and positive difference for many persons with depression.   There are also concerns about their overuse, effectiveness,side effects and limitations.   Medication is one approach to treatment of depression; we'll talk about that and other interventions in a future blog.

There are many authors who believe the high rate of medical intervention for depression is a result of overpathologizing these unavoidable life events.  I think it's a little more complicated than that.  Changes in American life, from technological and environmental to social, may all play a part in rising reports of depression.  Probable suspects are abundant.  Artificial light and poor wake/sleep cycles (not to mention environmental contaminants) mess with our hormonal systems.   As a nation, we eat a lot but are often poorly nourished.  We are too busy and we are much too stressed.  We don't sweat enough to work out all those fight-or-flight chemicals our brains pump out to deal with those stressors.  And we don't have nearly the social supports we had before we all moved so often, worked so much, and dropped out of networks (churches, clubs, coffee circles) where we could ask for and get support.

Psychiatrist Jim Phelps, a specialist in mood disorders, has been mentioned several times in my blog for good reason.  If you want a lot of great information on depression, its causes and treatments, check out his website or order his book Why Am I Still Depressed?.  He takes very complicated information on the genetics, neurology and treatment of mood disorders and makes it understandable and interesting.  You'll notice he talks a lot about Bipolar disorder.  Don't let that scare you.  Dr. Phelps makes a convincing argument (supported by leading researchers in the field) that most depressions are part of a spectrum of mood issues called "soft" Bipolar or Bipolar II, where periods of low mood are accompanied or interspersed with anxiety, irritability and other symptoms.  His site includes information on medical, therapy and lifestyle treatments with known positive benefits for addressing the symptoms and causes of depression. 

The most important thing to know:  depression is real.  It's a full-body illness, with physical, social, cognitive and emotional effects.  It is treatable and recovery happens.  Don't let it run you.  The WHO commissioned the video below.  Share it with others, and pass the word that the Black Dog doesn't have to have the last word.

Thursday, February 17, 2011

A Troublesome Trifecta

Being an oldtimer in the field, I've picked up patterns in clients over the years that are interesting and often predictive.  I noticed the kids I saw that struggled in English and more theoretical classes but were good at kinesthetic learning tended to have cross-dominance handedness as well as temper or opposition issues.  Anecdotal, but interesting, and there's probably a good neurological basis.

A very common feature I see in clients with anxiety and depression issues is what I call the troublesome trifecta.  These folks have a combination of traits:  Big Radar (they take in everything), Big Sensitivity (they feel it bigger) and Big Brains (they want to analyze everything).   As a result they have a high signal to noise ratio and spend lots of energy trying to figure out the data they are receiving.   Since much of it is noise, life can be pretty exhausting.

As stated in a recent blog, I'm a firm believer in the great benefits of the natural variation of human experience.  In other words, let's not pathologize everything.  But I can tell you, folks with the troublesome trifecta are both burdened and blessed.  Maybe they were bathed too long in the Oxytocin waters, and now that's what runs through their veins.  They see everything through the excruciating lens of Love's Potential.  They tend towards the ruminating spirit, as actor/director Jodie Foster called it in a recent interview with the National Alliance on Mental Illness.  The blessings come in the form of increased empathy and higher highs, creativity and a deep curiosity.  The burdens, unfortunately, come from the same place: the capacity for deep wounding, heaviness, and feelings of not being up for the Call.

Some people intentionally choose not to love and feel deeply.  Deep connection can result in deep loss when the connection closes, through choice or circumstance.  Highly empathic folk don't have a real choice about their capacity to experience life deeply.  But they may try to to run interference with the effects by dimming input with  drugs and other distractions. 

Half the battle is learning to know and love ourselves for who we are.  The other half is taking responsibility, even if we don't have the choice, for our limitations/strengths.  We can find ways to tone down the noise, to sort out the signal.  It requires attention and intention.  It is easier in the short run to be self-aversive or try and become comfortably numb.  That's back to losing the baby when we throw out the bathwater.  As Tom Waits sings, "If I exorcise my devils, my angels may flee too" (and he stole that line from Oscar Wilde, I think, though I can't find it now).  But it is our job--our calling-- to be aware of our impact with its gifts and limitations and take responsibility that it doesn't harm others.

Yes, I wrangle with the troublesome three-- well, at least the big radar/big sensitivity part.  I notice a lot and I don't naturally have a big filter.  This works well in my profession, especially if I apply the analysis to the data.   As always, I'm going for door number two in addressing the effects of this predisposition.  I want to wrestle with my demons and see what they have to teach, and trust my angels to keep me in line.  I want to keep enough shadow to know both light and dark when I see it and to pay attention to what I can learn there.  I don't want to trade knowledge with its discomfort and connection and wind up with blissful ignorance, at least over the long haul.

But I know there are tasks for me if I chose the less traveled road.  I need to practice mindfulness, gentle curiosity, and deep compassion as emotions and thoughts spontaneously arrive, sometimes unwelcome.  I can stay in wise mind of not-knowing the outcome.  I can decide when I've worried enough about some difficult matter and see that indulgence is of benefit to no one.  I can engage in acts of kindness and bravery despite lack of motivation or surpluses of fear.   I can practice self-soothing, not relying on others to have been hit in the same way I might be by a recent experience,  I know there is enough suffering in the daily that I won't look for entertainment in the nightly news or latest tearjearking Oscar winner.  I can sing not in spite of suffering but because there is suffering, and hope that like me, others may need my song more than my tears.  I can cry, too, when I need to, but not take residence in my tears.  I want to be available, and that means respecting my ability to deeply feel and connect, and knowing when to go quiet and replenish.

It may be that my childhood led to my family role as a caretaker.  It may be that some sensory integration deficits led to my enormous sponge for interloping sensory information,  It could be I became awash in excess oxtocyin in the womb and am forever reacting to its urgings or chasing its replacements.  For me , I am less interested in the why of how we end up who we are.  I want to learn how to best swim this ocean I am in, with respect for myself and the paths and people I cross and impact.

It ain't easy.  And it's important, beautiful, essential we don't give it up learning how to navigate these beautiful, dangerous waters.

How so?  Come back soon for tools I have gathered on the way.

Monday, February 14, 2011

Cheers from the Crowd

 Happy Valentine's Day.  Here's your own personal love-fest-valentine from Danielle Laporte, a women who blogs with the byline: "Because Self Realization Rocks".  Thanks to my sisters for the tip.

The Manifesto of Encouragement

Sunday, February 13, 2011

And now a brief pause in the Sturm und Drang for: LOVE!

 Happy almost valentine's day!
What the world needs is more love and less paperwork. --Pearl Bailey.
This is one of my favorite holidays-- a chance to love it up.  Don't be fooled by the commercials.  V day isn't just for lovers or to sell stuff.  It's a great excuse to think about love in all its wonderful variations, and to show it to those who engender it in you.
Most years I make valentines; this year's were made last night late and won't get mailed until tomorrow.   Or maybe next week.  I'm a lousy mailer.  But February is the longest shortest month there is, so I am happy to drag out the love-fest.  Mine are pretty simple: a quote and a picture glued to a piece of pretty paper. Sometimes I add some paint and glitter.  This year I am being a minimalist.

If you haven't made a valentine yet ,this year's quote batch is  below.   Go ahead, let someone know you love them.
xox, Jana

We are all a little weird and life's a little weird, and when we find someone whose weirdness is compatible with ours, we join up with them and fall in mutual weirdness and call it love. 
~Author Unknown

Must, bid the Morn awake!
Sad Winter now declines,
Each bird doth choose a mate;
This day's Saint Valentine's.
For that good bishop's sake
Get up and let us see
What beauty it shall be
That Fortune us assigns.
~Michael Drayton

Love is a smoke made with the fume of sighs. 
~William Shakespeare

Many are the starrs I see, but in my eye no starr like thee.
 Gravitation is not responsible for people falling in love. 
 ~Albert Einstein

kisses are a better fate
than wisdom.
~e.e. cummings

Who, being loved, is poor? 
Oscar Wilde

Without love, what are we worth?  Eighty-nine cents!  Eighty-nine cents worth of chemicals walking around lonely. 
 ~M*A*S*H, Hawkeye

Love is the magician that pulls man out of his own hat. 
 ~Ben Hecht

Time is too slow for those who wait, too swift for those who fear, too long for those who grieve, too short for those who rejoice, but for those who love, time is eternity. 
 ~Henry Van Dyke

Take away love and our earth is a tomb. 
 ~Robert Browning

Are we not like two volumes of one book? 
 ~Marceline Desbordes-Valmore

Love makes your soul crawl out from its hiding place. 
 Zora Neale Hurston

We don't believe in rheumatism and true love until after the first attack. 
Marie Ebner Von Eschenbach

I love thee - I love thee,
'Tis all that I can say
It is my vision in the night,
My dreaming in the day.
~Thomas Hood

Love, and a cough, cannot be hid. 
 ~George Herbert

Love unlocks doors and opens windows that weren't even there before. 
 ~Mignon McLaughlin

Poetry spills from the cracks of a broken heart, but flows from one which is loved.  ~Christopher Paul Rubero

Tell me how many beads there are
In a silver chain
Of evening rain,
Unravelled from the tumbling main,
And threading the eye of a yellow star: -
So many times do I love again.
~Thomas Lovell Beddoes

The heart has its reasons that reason knows nothing of. 
~Blaise Pascal

At the touch of love, everyone becomes a poet. 

Nobody has ever measured, even poets, how much a heart can hold. 
 ~Zelda Fitzgerald

Ah me! love can not be cured by herbs.  ~Ovid

Soul meets soul on lovers' lips. 
Percy Bysshe Shelley

Who would give a law to lovers?  Love is unto itself a higher law. 
Boethius, The Consolation of Philosophy

Candle light, moon light, star light,
The brightest glow is from love light.
Grey Livingston

A baby is born with a need to be loved - and never outgrows it. 
 Frank A. Clark

Anyone can be passionate, but it takes real lovers to be silly. 
Rose Franken

Love is like dew that falls on both nettles and lilies. 
Swedish Proverb

It is astonishing how little one feels alone when one loves. 
John Bulwer

Love is not singular except in syllable.  Marvin Taylor

Love is the poetry of the senses.  ~Honoré de Balzac

True love comes quietly, without banners or flashing lights.  If you hear bells, get your ears checked.  ~Erich Segal

Love is what you've been through with somebody.  ~James Thurber

As soon go kindle fire with snow, as seek to quench the fire of love with words. 
~William Shakespeare

My heart to you is given:
Oh, do give yours to me;
We'll lock them up together,
And throw away the key.
~Frederick Saunders

Love is the greatest refreshment in life.  ~Pablo Picasso

Give me a kisse, and to that kisse a score;
Then to that twenty, adde a hundred more;
A thousand to that hundred; so kisse on,
To make that thousand up a million;
Treble that million, and when that is done,
Let's kisse afresh, as when we first begun.
~Robert Herrick, "To Anthea (III)"

Love is a canvas furnished by Nature and embroidered by imagination. 

Love is metaphysical gravity.  ~R. Buckminster Fuller

If I had a single flower for every time I think about you, I could walk forever in my garden. 
Claudia Ghandi

"Each moment of a happy lover's hour is worth an age of dull and common life."
 Aphra Behn

"You know you're in love when you can't fall asleep because reality is finally better than your dreams."
Dr. Seuss

"Love is the condition in which the happiness of another person is essential to your own."
Robert Heinlein

"Love is something eternal; the aspect may change, but not the essence."
-Vincent van Gogh

"A life without love is like a year without summer." -Swedish Proverb

"Love is a symbol of eternity. It wipes out all sense of time, destroying all memory of a beginning and all fear of an end."
 -Author Unknown

"Anyone can catch your eye, but it takes someone special to catch your heart." -Author Unknown

"Love is a smoke made with the fume of sighs." -William Shakespeare

"Life's greatest happiness is to be convinced we are loved." -Victor Hugo

"Love is the only gold."
Lord Alfred Tennyson

"To love is to receive a glimpse of heaven." -Karen Sunde

"Oh, if it be to choose and call thee mine, love, thou art every day my Valentine!"
 Thomas Hood

"When love is not madness, it is not love."
Pedro Calderon de la Barca

"Gravitation is not responsible for people falling in love."
Albert Einstein

"Many are the starrs I +see, but in my eye no starr like thee."
“I never knew how to worship until I knew how to love."
Henry Ward Beecher

"To love another person is to see the face of God."
-Les Miserables

"Love is but the discovery of ourselves in others, and the delight in the recognition."
-Alexander Smith

"The richest love is that which submits to the arbitration of time."
-Lawrence Durrell

“Very small degree of hope is sufficient to cause the birth of love."

"There is no remedy for love but to love more."

"Love cures people - both the ones who give it and the ones who receive it."
Dr. Karl Menninger

"To love and win is the best thing. To love and lose, the next best."
William M. Thackeray

"Love is like playing the piano. First you must learn to play by the rules, then you must forget the rules and play from your heart."

"Within you, I lose myself. Without you, I find myself wanting to be lost again."

Attention is the most basic form of love, through it we bless and are blessed.
John Tarrant

Love is more than three words mumbled before bedtime. Love is sustained by action, a pattern of devotion in the things we do for each other every day.
Nicholas Sparks

Love doesn't make the world go round, love is what makes the ride worthwhile.
Elizabeth Browning

Love is a canvas furnished by Nature and embroidered by imagination.
Love is an act of endless forgiveness, a tender look which becomes a habit.
Peter Ustinov

Love is the greatest refreshment in life.

Love is the joy of the good, the wonder of the wise, the amazement of the gods.

When you love someone, all your saved-up wishes start coming out.
Elizabeth Bowen

One who wants to do good, knocks at the gate; one who loves, finds the door open.
Rabindranath Tagore

Wednesday, February 9, 2011

This is your brain on drugs...

 As always, for more information click the highlighted links.

First-- that's a misleading title.  I really want to talk about neurotransmitters, not drugs.  Let's call them NTs for short, because I am a lazy typist.

NTs are the little chemical stews that regulate much of our emotional life.  Too short or overstocked on some, and we fall on one end or another of the bell curve that folks call "normal".  In the next few posts I will be talking about the spectrum of difference we call mental disorders and how chemistry may be involved.  I will be doing some wild speculating, so take me with a grain-- or block-- of salt.  The theories spring from many years of work in the field and lots of reading, as well as my own particular biases.

Let's start with my biases.  I think that humans are profoundly affected by both nature and nurture.  By nature, I mean the machines of our particular genetics and the effect of environment on the same.  Familial nutrition (up to generations back), and current physical environment such as toxin exposure effect the nature part.  By nurture, I am referring not only to the emotional climate of our upbringing but exposure to information and experiences throughout life.  I firmly believe in the plasticity of every brain-- the ability to reroute, change and grow in spite of our genetics.  But I also believe those genetics set up the game.

Seems to me those pesky NTs and hormones play a pretty big role.  How much dopamine, oxytocin, testosterone, serotonin etc is flowing in the system-- either manufactured or being able to be received and used-- appears to have a lot to do with how we act and feel.  It may define our temperament and personality. 

I also believe that humans are naturally narcissistic.  As one author put it (and sorry, being a print surfer I can't remember where I read this), everything we know, feel, see comes through our filter and has happened to us. We are the lead actor in our lives, and the rest of the world our backdrop.   From birth on, we see our view as The View.  Luckily, we are usually naturally altruistic too.  But since our genes and those pesky NTs may decide in advance what we feel, we may have a lot harder time understanding how it is that someone else can feel or act a lot differently. What we cannot perceive, we cannot receive. In addition to what we learn, see and experience, NTs are involved in development of empathy.  Some of us have a lot of it, and others not so much.

More biases:  I think "normal" is overrated.  We benefit greatly from the variation of expression and thinking that results from the edges of that bell curve.  Folks with what I suspect is lots less dopamine than the average homo sapien tend to be perfectionistic, orderly, obsessively detailed and restricted in their emotional range and expression.  They don't get overly excited or reactive, and they are meticulous in thinking and performance.  That's just what I want in my accountant or surgeon.  I'm not saying that all in those field are like that, but that it is adaptive and helpful in certain professions or experiences.  On the other hand, people with bipolar disorder tend to have lots of energy, emotion and enthusiasm- at least some of the time--- as well as creativity, quick-wittedness, and quirkiness.  They make better artists than those dopamine-deprived folks.  Again, I am talking in generalities.

Last bias:  as hinted in the previous paragraph, I think nature is doing its deal by spreading out the variations to the gene pool.  Barbara Kingsolver talks about this in her book, Animal, Vegetable, Miracle.  In any given year, heirloom (read: not genetically modified) corn seed will produce a variable yield.  That's because some of the seed works well in wet years, some in dry; some with early warmth and some with later frosts.  This insures that any given year at least some of that corn will grow.  It's no different with us humans.  Some of our genetic tendencies will be either culturally or environmentally more desirable in a given era.  Luckily, it's not only those that get passed down, because times change.

Related post:  What's in A Name?  Diagnostic Dilemmas

That's it for tonight. See you soon,
Must be an Ani DiFranco sort of week...

Monday, February 7, 2011

Finding Your Perfect Look

A fly fisherman I once knew had the sweetest smile, with a little groove on his left front tooth.  It was the result of his biting off line, year after year.  I couldn't look at him without thinking of my sister saying "Never use your teeth as tools."  Apparently he'd not heard that, and as a result he wore his love of fishing in his smile.

We become what we do over the years.  Let it be a look you'll love.

Saturday, February 5, 2011

The Bravery of Relationship

People are messy.
When I'm asked about my theoretical foundation for therapy, that's my answer.  I'm not being trite.  People are messy, they do the best they can, and they show up with all their strengths and weaknesses if they do truly show up. And by them, I of course mean us.  All of us.

Psychologist David Snartch, an author of some really interesting books on relationship, talks about the tension between our desire for intimacy and our ability to tolerate it.  We want to be known, then flinch at the nakedness that involves.  It's hard to both preserve our tender egos and reveal our tender souls.  Thus relationship become the crucible where self becomes fully formed.  But crucibles are fiery and dangerous by nature, and in fear we withdraw to protect.

"A ship is safe in harbor, but that's not what ships are for", said William Shedd.   By taking the risk to stay present even when we fear our whole self will not be loved, we can reach depths in relationship that unavailable in solitude.  By taking the time to show our throats when we are scared and to deeply listen when we are tender, our hearts and souls can grow.

There is a reason for metaphors referring to the bonds of relationship.  Ties that bind us can provide safety even as they engender responsibility and discomfort.  We get connection, and it does come at the cost of staying seen and close.  Sometimes that can feel like too much.  But there is nothing like sharing a history with someone who has been there for you, warts and all; someone who has seen you at your worst and still remembers your best.  All of it is truly a difficult bargain.   We can try to be a rock, but we long for water, and relationship can slake our thirst.  Our job is to tolerate the discomfort of being whole with another.  I think the payoffs are worth it.