What is… Attachment theory

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Attachment theory

Attachment theory was developed by psychologists John Bowlby and Mary Ainsworth.  According to Wikipedia, it focuses on “how human beings respond within relationships when hurt, separated from loved ones, or perceiving a threat”.  Infants automatically seek attachment to familiar caregivers, and display attachment behaviours in order to maintain proximity of the caregiver.  Attachment to a primary caregiver is highly important for emotional development and emotion regulation.  Wikipedia says that infants will persist in seeking this attachment “even if this caregiver is not sensitive and responsive in social interactions with them.”  Based on early experiences, people will develop internal models of what interpersonal relationships should look like.

Wikipedia describes four attachment styles that are determined by examining an infant’s behaviour upon reunion with the primary caregiver following separation: secure, anxious-ambivalent, anxious-avoidant, and disorganized.  These attachment patterns are associated with certain patterns of behaviour, and can influence personality development.  With secure attachment, the primary caregiver is sensitive to the child’s needs.  Anxious-ambivalent results from unpredictably responsive caregiving, anxious-avoidant seems to stem from having attachment behaviours rebuffed, and disorganized type is related to flooding of the attachment system by things like fear.  Subsequent researchers have identified further subtypes.

Attachment in early life has a range of implication for the infant as they progress through life.  Early attachment styles tend to be consistently related to the development of interpersonal relationships later in life, as well as functioning across multiple domains.  Those who develop a strong internal working model for interpersonal relationships are able to form more stable attachments later on, while those youngsters who defensively exclude information from their awareness have problems with development of effective internal models.  This sort of repression can lead to dissociation and disconnection between emotional response and causative factor.  On a biological level, Wikipedia observes that “There is some evidence that the quality of caregiving shapes the development of the neurological systems which regulate stress”.

Attachment theory-oriented psychotherapy aims to reappraise ineffective working models for relationships between the self and others.  Psychoanalytic-oriented psychotherapy does this in part by delving into the transference the client imposes on interactions with the therapist.

Researchers Cindy Hazan and Phillip Hazer extended attachment theory to adult romantic relationships, identifying four styles: secure, anxious-preoccupied, dismissive-avoidant and fearful-avoidant.  Those who are more securely attached are better able to balance intimacy and independence.

I was lucky to have very secure attachment as an infant and throughout childhood, with a very attentive, consistent, and loving primary caregiver (my mother).  I realize, though, that far too often this is not the case.  I wonder what impact, if any, early attachment has had on the development of my illness and my current difficulties in feeling safe with other people.  On the other hand, I wonder how people who have had insecure attachment in their early years can best be helped to form more adaptive attachment schemas as adults.

Is attachment something that’s had a significant effect on your life?

 

Sources:

https://en.wikipedia.org/wiki/Attachment_theory

Inge Bretherton. (1992) The Origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology (1992), 28, 759-775.

 

Image credit: GDJ on Pixabay

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Let’s get suppressing

ACT for anxiety disorders book cover

I was browsing the web for interesting therapy materials, when I came across the worksheets for Acceptance & Commitment Therapy for Anxiety Disorders on the website of one of the authors, Dr. John Forsyth.  I’ve never done ACT, but I’ve done a lot of reading about it, and it makes a lot of sense to me.

One thing that I found particularly interesting is the White Bear Suppression Inventory, which I’ve copied verbatim from the linked site; the material is copyright (1994) by Blackwell Publishing Company.  All questions are rated from 1=strongly disagree to 5=strongly agree:

1) There are things I prefer not to think about.

2) Sometimes I wonder why I have the thoughts I do.

3) I have thoughts that I cannot stop.

4) There are images that come to mind that I cannot erase.

5) My thoughts frequently return to one idea.

6) I wish I could stop thinking of certain things.

7) Sometimes my mind races so fast I wish I could stop it.

8) I always try to put problems out of mind.

9) There are thoughts that keep jumping into my head.

10) Sometimes I stay busy just to keep thoughts from intruding on my mind.

11) There are things that I try not to think about.

12) Sometimes I really wish I could stop thinking.

13) I often do things to distract myself from my thoughts.

14)  I often have thoughts that I try to avoid.

15) There are many thoughts that I have that I don’t tell anyone.

 

I was already aware that I tend to use avoidance as a fall-back strategy, but this inventory reminded me just how much I end up doing this.  I would rate myself a 5 (strongly agree) for questions 1, 2, 3, 5, 6, 8, 10, 11, and 14.  Yikes.  Yet with the current state of my treatment-resistant depression, I wonder if this suppression is the only way that I can manage to keep it together most of the time.  That sounds avoidant in and of itself, but I think it’s a legitimate question; with an illness that’s only partially responsive to treatment, are there limits to how much my conscious mind can handle?  And from a mindfulness perspective, is it useful to think about things related to past and future that I have limited control over, or is it better to just keep on chugging in the present moment? I really don’t know, and to be honest, I don’t know that I’m prepared to trust anyone enough to dig into that further.

Did this suppression inventory tell you anything new about yourself, or did it confirm anything you already knew?

 

Image credit: https://www.drjohnforsyth.com/free-resources.html

Mental myths that get in our way

mythical dragon beast

We tend to create a lot of rules about how we should think, feel, and act.  We may believe that there is some sort of objective truth to these rules, but the reality is they’re really just myths.  These examples come from Dialectical Behavioural Therapy:

  • I don’t deserve to get the things that I want/need
  • Asking for help makes me a weak person
  • I should only ask for something if I know ahead of time that the person will say yes
  • Making requests of others is selfish
  • Saying no to others is selfish
  • Others’ needs are more important than my own
  • If I can’t fix this myself there must be something wrong with me
  • In a given situation there is a certain way I should feel
  • If I let others know I’m feeling badly then I am week
  • Negative feelings are harmful
  • Some emotions are wrong or stupid
  • If others don’t approve of my feelings, then there must be something wrong with them
  • Painful emotions should be ignored
  • My emotions define who I am
  • I can always trust my emotions

Do you have any thinking/feeling rules that you commonly get trapped in?

 

Source:  adapted from Marsha Linehan’s DBT Skills Training Handouts and Worksheets, 2nd ed.

Image credit: InspiredImages on Pixabay

Pet therapy

My guinea pigs are so important to my mental health.  Watching them play is an easy way to be mindful in the present moment.  They’re very interactive, so even though I live alone I never feel alone.  When my depression is so bad I can barely get out of bed, they’re a reason to force myself to get up.  And when things get so bad that I start to feel suicidal, my responsibility as their mom is a motivator to keep hanging on.

guinea pig sitting beside mom

This is Squeaky, my grumpy old man.  His buddy died a few months ago, but he’s a trooper and keeps on going.

 

guinea pig sitting on top of hidey-house

Casper is the baby of the bunch, and she likes to play.  Of all the guinea pigs I’ve ever had she’s the only one that likes to jump on top of the wooden hidey-house.

 

guinea pig eating grass while partly hidden under mom's skirt

Guinea pigs love to eat grass, but they’re not so into being exposed to the big bad world.  Oreo has found the perfect compromise being partly hidden under my skirt.

 

guinea pig curled up in a corner sleeping

They have a variety of cute sleeping positions,  Here’s Squeaky with his leg tucked up against the food bowl.

 

guinea pigs sticking their heads out the cage door begging for foodguinea pigs begging for food

The guinea pigs are very smart when it comes to knowing what sounds are associated with getting food, like the fridge door opening or the rustle of their food bag.  And sometimes they just want to let mama know that they think they’re entitled to a treat.  So they will put their front paws up on the cage door opening and stick their cute little faces out as far as they can, because they know they’ve got their mama wrapped around their little feet.  Cookie (the all black one) is the biggest of the bunch so she tends to muscle the other two out of the way.

So that’s my little family.  Do you have pets, and if so, how do they benefit your mental health?

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format, along with assorted other question tags and the like.  Feel free to join in the fun with your own answers to any or all of the questions 🙂

 

Questions from Fiona at Like As The Waves:

  • What is your favourite book?  Well, if we think of favourite as greatest number of times read, I’d say Anne of the Island by Lucy Maud Montgomery and These Happy Golden Years by Laura Ingalls Wilder.  I read them many times as a child, and continue to read them regularly as an adult.
  • Which of your blog posts are you most proud of?  I don’t have a particular favourite.  I’m probably the proudest of the posts in which I’ve been honest and open about difficult topics.
  • What quality do you value most in others?  It’s hard to pick just one, but I think kindness goes a very long way.
  • What is your best joke?  I don’t have one, to be honest.  But I think the tv show Seinfeld has the funniest jokes ever.
  • Who is someone who had a big impact on your life?  My Grandma.  She’s 101 years old, and she’s amazing.  We’ve always been close, and she’s a great example of someone who can stay positive through anything.
  • What’s one aspect of blogging that you dislike or find challenging?  The occasionally phases when I feel inadequate in terms of my numbers or what have you.  It seems to happen to most of us once in a while, and it sucks.
  • If you had to choose one meal to eat for the rest of your life, what would it be? My immediate inclination is to think cheeseburgers, but realistically the food I could eat over and over without ever getting sick of it is Cheerios.  Sometimes simple is best.
  • What is your least favourite movie?  I haven’t actually seen these, but probably movie versions of tv shows I find tremendously obnoxious, like Trailer Park Boys and Beavis & Butthead.
  • What is your favourite scent?  Guinea pig smell.  It’s kind of like baby smell, without the stinky poop.
  • What is one way that you cope with bad days?  Snuggles with my guinea pigs.
  • Where is your favourite place?  My bedroom – I’m such a homebody!

 

Questions from Anja at The Calculating Mind:

  1. Have you ever thought to make your blog anonymous, especially if it is on a ‘stigmatized’ topic such as your own mental illness? Why or why not…? If your blog is not on your own mental health, what do you think of others disclosing their conditions in such a public manner as a blog?  I’m pretty open in my “real life” about my mental illness.  But I keep my blog anonymous-ish because I have no interest in sharing my deepest thoughts and feelings with most people I know in “real life”.  It’s important to me to be able to be totally unfiltered, so my blog will remain anonymous-ish.
  2. How have you learned to deal with those who may [perhaps harshly] criticize your blog, post, article, vlog, or view?  Luckily I haven’t really had to deal with that, but my approach is not to engage.  I see other bloggers who have gotten quite bothered when they tried to defend themselves or stand up against blatant stigma, and I’ve come to the conclusion that people who choose to be rude or willfully ignorant are just not worth the mental energy.
  3. What do you love the most about the blogging community or blogging itself?  I love how supportive and engaging the blogging community is.
  4. What piece of advice would you give to those who are looking into starting their own blog?  Write for you, not for anyone else.
  5. If you could have coffee with any writer, blogger, or advocate, who would it be?  It would be a lot of fun to have coffee with Jenny Lawson, who wrote Furiously Happy.  We’d have a wild and crazy conversation with taxidermy playing a prominent role.
  6. What is currently your favorite song?  I’m liking One More Light by Linkin Park.
  7. What upcoming event or thing are you looking forward to the most?  I’m doing a trip to Italy in the fall.  It’ll be a cool mix of historic sites and fabulous food.
  8. Which movie, tv show, or documentary does an incredible job accurately portraying mental illness/symptoms, diagnosis, or treatment?  I really liked A Beautiful Mind.  It’s very rare to see schizophrenia portrayed in any sort of realistic way.
  9. In your opinion, what is the biggest issue regarding the impact of stigma?  On a personal scale it’s been negative impacts from stigma on the part of my employers.  On a broader scale, I would say stigma within the mental health care system, both on the part of people working in it and people funding it, has a major impact on people’s ability to get help.
  10. Dream vacation: where would it be?  I think it would be really cool to go to Lhasa in Tibet.  Even cooler would be if Tibet became independent and the Dalai Lama could return there.  Now that would be an amazing moment in time to witness.
  11. What [or who] makes you smile no matter how “down” you feel?  Watching Seinfeld, or Trevor Noah comedy specials on Netflix.  I always laugh no matter how many times I’ve re-watched.

 

Come on, you know you want to answer a few – that’s what the comments section is for!

 

Image credit: qimono on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • My sleep has been messed up, and I’ve felt really unfocused and vaguely physically unwell.  The heat has probably been messing with my lithium levels, and I don’t think it’s helped that there’s been horrendous air quality from forest fire smoke.
  • I went to yoga once, and also had a massage.  I’m still not thrilled with my new massage therapist, and I have a feeling things aren’t really going to improve much.  I feel kind of guilty thinking about bailing on her, but my vacation in October could be a good excuse to disappear a bit more subtly.
  • I had found out a few weeks ago that one of my jobs was going to be ceasing to exist in the fall, as the program was shutting down.  After an initial freak-out, I went into hardcore avoidance mode.  Anyway, this week I found out that I will be getting work with the company that’s pretty much taking over the work that my current employer has been doing.  It wasn’t a competitive application process; it seems like they’re taking any nurses that want to switch over.  Strangely enough, I don’t feel particularly happy or relieved, maybe because I’ve switching from not thinking about it due to avoidance, to now not having to think about it because it’s just not an issue any more.
  • I did a night shift Wednesday at my other job to cover for someone who’d called in sick.  I didn’t get called until around 7pm, and I was so tired already at that point that should have just said no, but I agreed to take the shift.  I can’t nap without meds, but 7pm was just too late to take any meds before an 11pm shift.  So I was a total mess.  I ended up sleeping almost all day and night Thursday.  I realized when I woke up still feeling gross on Friday morning that I had managed to miss 3 days in a row of morning meds, and I was probably going into venlafaxine withdrawal.
  • Near where I live there are some flowers that attract a ton of fat, fuzzy bumblebees.  It’s mesmerizing –  it makesthe perfect mindfulness moment.
  • My guinea pig boy has been hiding out in his house more lately.  He’s getting very old for a guinea pig, and I wonder if he’s not feeling very well.  My girls, on the other hand, have been extra adorable this week with their begging for food behaviour.  They’re not hungry by any stretch, they’re just sticking their furry little faces out the cage door hoping that by looking cute I’ll decide to give them extra treats.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… conversion therapy

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: conversion therapy

I’ve forgotten the details, but recently I heard/read something that mentioned conversion therapy, so I decided to look a little closer at this pseudo-therapy that aims to force people’s sexuality to fit with heteronormative expectations.  It is sometimes referred to as trying to “pray the gay away”.  I expected to be rather disgusted by what I would find, and I wasn’t disappointed.

Early strategies used in conversation therapy were outlandish and often cruel.  According to Wikipedia, one endocrinologist transplanted testicles from straight men into gay men.  Electric shocks were sometimes applied to people’s genitals, and other strategies included ice-pick lobotomies (by a neurologist with no surgical training), chemical castration, masturbatory reconditioning, and administering nausea-induced drugs at the same time as showing homosexual images.  From 1968 to 19977, researchers Masters and Johnson conducted trials of sex therapy, with subjects engaging in sex acts in a lab in order to basically fuck the gay away.

Wikipedia describes a more recent approach called “reparative therapy”, developed by in the 1990’s by psychologists Elizabeth Moberly and Joseph Nicolosi, which views homosexuality as “a person’s rational and unconscious attempt to ‘self-repair’ feelings of inferiority”.  So-called “ex-gay ministries” have also arisen promoting the effectiveness of conversion therapy.

Wikipedia states that between 1939 and 1969, “conversion therapy received approval from most of the psychiatric establishment in the United States”.  It became increasingly challenged after the Stonewall Bar riot to protest a police raid in 1969.  Homosexuality was removed in 1973 from the Diagnostic and Statistical Manual (DSM), where it had been classified as a mental disorder since 1952.

In 1992, the National Association for Research and Therapy of Homosexuality (NARTH) was formed, and began publishing material claiming that conversion therapy was effective.  One of the cofounders was Joseph Nicolosi, who developed reparative therapy.  This group was not supported by any mainstream mental health or medical organizations, but some fundamentalist Christian and other religious groups have partnered with them.  A group of Christian right organizations funded a $600,000 advertising campaign in 1998 promoting conversion therapy.

Wikipedia provides the legal status of conversation therapy in various nations.  I was surprised to learn that it’s only banned in one Australian state, two Canadian provinces, and 14 American States; the UK government announced just last month that it would begin putting together a bill to ban it; it is officially endorsed by the Malaysian government; and in 2016 and 2017 Israel voted down a proposed ban on conversion therapy for minors.

It disturbs me the outlandish practices that have been a part of mainstream treatment over the last century when it comes to the treatment of any group that is considered aberrant, whether that’s mentally ill, LGBTQ, racial minorities, etc.  As much as I might be inclined to shuffle something like conversion therapy into the same crazy bin as L. Ron Hubbard’s made up religion/psychotherapy Scientology, it’s something that was once accepted by major psychological and medical organizations.  There are countries that still allow it, or even, in the case of Malaysia, embrace it.

What is wrong with humanity that people are so blind, so willfully judgmental?

 

You can read more on this topic in an excellent article on the Be Ur Own Light blog: Gay Conversion Therapy in America and Its Toll on Mental Health.

 

Sources:

https://en.wikipedia.org/wiki/Conversion_therapy

https://en.wikipedia.org/wiki/Masters_and_Johnson

Image credit: GDJ on Pixabay

What we can learn from the ACEs study

adverse childhood experiences pyramid


The Adverse Childhood Experiences (ACEs) study was a landmark research trial conducted by Kaiser Permanente and the U.S. Center for Disease Control.  The study examined the correlation between adverse experiences in childhood and health outcomes in adult, and clearly showed just how profound that connection is.

The study participants were asked to report whether they had experienced physical/sexual/emotional abuse, physical/emotion neglect, exposure to domestic violence, household substance abuse, household mental illness, parental separation/divorce, and incarcerated household members.  Two-thirds of participants reported at least one ACE, and more than 1 in 5 reported ≥3 ACEs.

The results showed a dose-response curve between number of ACEs and risk of adult health problems (i.e. a higher number of ACEs was associated with a higher number of health complications).  ACEs were associated with the following negative outcomes and high-risk activities associated with negative health outcomes:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

child with hair over face and hands over ears

Not only are there a large number of negative effects, the size of these effects is extremely disturbing.  An ACEs score above six was associated with a 3000% increase in suicide and a life expectancy 20 years less than the population average.  I think that one of the particularly important findings of the study was that the negative outcomes were not a simple cause-and-effect relationship with high-risk behaviours.  The wide-ranging negative outcomes still occur with or without high-risk behaviours.

ACEs are thought to effect structural development of neural networks in the brain as well as biochemistry, including chemical messengers like cortisol and adrenaline.  The related stress can also cause epigenetic changes that alter how genes are expressed, and these changes can also be passed to fetuses.

I first heard about this study way back when I was in nursing school, and I remember wondering at the time why I hadn’t heard of something that important before then.  I still think it’s something that more people need to be aware of, because it sheds so much light on the experiences of those who have lived through childhood trauma.

You can find more details on the CDC’s Adverse Childhood Experiences study page.

 

Image credit:

Centers for Disease Control

counselling on Pixabay

Book review: Untangled

Untangled

In Untangled: A Story of Resilience, Courage, and Triumph, Alexis Rose offers raw, forthright descriptions of the repeated abuse she experienced in childhood and into adulthood.  I would caution anyone who has experienced abuse themselves to carefully evaluate whether they are far enough along in their own healing to feel safe while reading this kind of account; I would suggest a better place to start might be Alexis’s other book, If I Could Tell You How It Feels, which focuses more on the healing process.  Aside from this caveat, this is a powerful, eye-opening book.  It is truly remarkable that Alexis has been brave enough to share her story, and is able to tell it so clearly, in a manner that is calm yet still captures the emotional devastation at the time.  She very effectively describes the hell of not only living through traumatic events, but struggling with the lasting trauma reactions afterwards.  She also touches on many questions that those unfamiliar with trauma might wonder about, including trauma bonding with an abuser, continuing to follow instructions drilled in by the abusers, and maintaining silence.

The sexual, physical, psychological, and ritualistic abuse began at an early age at the hands of her parents and others.  As she was being abused, she would imagine seeing the house next door on fire through her window; she eloquently described how this helped her to find a “golden thread of survival.  That thread kept the pieces of my shattered soul together, and gave me the strength I needed to wake up and face another day.”  Messages to remain silent were frequently drilled into her, and as she grew older, various techniques were used to keep her under tight psychological control.

Alexis describes a horrific pair of trips to the Middle East, where her mother moved after her father died.  She explained the bizarre trauma bond she developed with a man she was forced to live with who exerted complete control over her and frequently spoke down to her as if she were garbage.  She was informed that she was to serve as “a killer and a whore,” or else she herself would be killed.  She observes that by that point, “any shred of my psychological health had been obliterated.”  She ended up being tortured and beaten, and she describes the ways in which she dissociated as her mind tried to protect itself.

When she was finally allowed to return home, she began the processing of repressing the memories of what had happened to her.  Without other skills available, she relied on this strategy of repression continued for as long as she could manage. Her abusers continued to make themselves known periodically, through phone calls, mail, and in person, and she was subjected to ongoing psychological abuse from her mother.

She began to have flashbacks, although she lacked the knowledge to understand that’s what they were.  She writes that she had “no idea that the level of abuse I survived as a child was worth talking about or bothering with.”  At one point she stopped therapy because she was unable to move past the brainwashed messages that she must remain silent.  She adopted a pattern of trying to “push feelings aside and keep moving”, as this was the only way she knew to keep going.  She made the interesting distinction that “it wasn’t that I was living in the moment; I was just continually on the move.”

Things came crashing down after her daughter was hit by a car while crossing the street. Alexis writes about the extremely intense flashback triggered by the call she received from the police, and finally realized that “my mental health was hanging by a  very thin thread that was about to break”.  At that point she started seeing the psychologist who became “my healer, my teacher, and the one I would call my Sherpa, who truly started me on my journey. Walking into his office that day I began six years of a difficult and treacherous trek up the highest of mountain peaks, but that was also the day I began to claim my life and start to live, not just survive.”  She finally got to a point where she could begin “forgetting how to forget”.

Despite the horrific things that have happened to her, she has been able to leave behind those who have abused her and move forward with healing.  She has been able to draw on resilience and an ability to thrive, and has reached a place where she can be optimistic and thrive.  Alexis writes: “I’ve untangled myself. My courage has set me free, and now nothing can keep me tied to the past. I can truly live today with blinders off and eyes wide open.”  This is a truly inspiring book that tells an amazing story of survival through adversity.

 

You can find Alexis on her blog Untangled, and in an interview on the Mental Health Book Club Podcast.

 

Image credit: Amazon

 

Psychotherapy alphabet soup

multicolored letters of the alphabet floating in a pool

Some studies have shown that the quality of the therapeutic relationship between client and therapist is a stronger predictor of therapeutic outcomes than the type of therapy used.  However, it seems logical that the type of therapy should at least to some extent match up with how you tend to conceptualize the problems you’re experiencing.  Here is a brief run-down of some different psychotherapy approaches.  This is by no means an exhaustive list, and it doesn’t include things like humanistic approaches  or those therapies that do a deep dive into past issues and attachment.  GoodTherapy.org has a much more extensive list.

ACT: Acceptance and Commitment Therapy

ACT takes the perspective that resistance to thoughts and feelings is the main cause of distress.  It addresses areas such as present moment awareness, acceptance, separating the self from thoughts, and taking committed action consistent with identified values.

CBT: Cognitive Behavioural Therapy

CBT is perhaps one of the best known counselling approaches.  It considers the relationships between thoughts, feelings, and behaviours, and how each of those elements can be changed.  Evidence for and against thoughts is examined with the goal of identifying cognitive distortions that cause distress and replacing them with more realistic thoughts.  As well, new behaviours are practiced to reduce distress and promote more realistic thinking.

CPT: Cognitive Processing Therapy: This is a form of CBT for PTSD, and aims to change cognitions about the trauma that are keeping the person stuck and preventing them from fully processing the trauma.

PE: Prolonged Exposure: This is a form of CBT that aims to decrease fear and trauma responses by exposing the person in a controlled way.  This can be either in vivo (in person) or imaginal (the client is asked to vividly imagine a particular situation), or a combination of both.  It progresses based on an identified hierarchy of feared stimuli.

TF-CBT: Trauma-Focused CBT: Like CPT, this is a form of CBT for trauma, but it is geared toward children and adolescents.

CFT: Compassion-Focused Therapy

CFT is influenced by CBT, and focuses on compassion towards both others and the self.  It can be useful for people struggling with emotions like shame and self-criticism.

DBT: Dialectical Behaviour Therapy

DBT was developed by Dr. Marsha Linehan to address some of the shortcomings of CBT for treating borderline personality disorder.  The dialectic refers to the idea that the way the individual is doing things now is valid and they are doing the best they can, but they would still benefit from change.  DBT is very skill-based, with modules covering areas of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

EFT: Emotionally Focused Therapy

This type of therapy consider emotions to be reflective of underlying needs, and classifies emotions as adaptive, maladaptive, reactive, and instrumental.  Therapeutic tasks are identified based on the client’s particular emotional experiences.

EFT: Emotional Freedom Technique

Not to be confused with the other EFT, this is an approach that utilizes tapping on meridian points while focusing on an issue and then an affirmation.  It draws on concepts from acupuncture and neurolinguistic programming (NLP).  There is not a robust research evidence base to support its effectiveness, although that doesn’t speak to how a particular individual might or might not respond.

EMDR: Eye Movement Desensitization and Reprocessing

EMDR is a type of trauma counselling.  The client uses horizontal eye movements to track the therapists’ fingers, and while this is being done the client focuses on an identified distressing image and the bodily sensations associated with that distress.  A Subjective Units of Distress (SUDS) scale is used to track progress, and as the SUDS score drops the therapist and client work on installing a new positive cognition.

IPT: InterPersonal Therapy

IPT is a short-term, structured approach that focuses on addressing interpersonal problems that contribute to problems with mental health, and building interpersonal communication skills.  Research has supported its effectiveness for the treatment of depression.

MBCT: Mindfulness-Based Cognitive Therapy

This type of therapy is focused on the use of mindfulness to address cognitive distress.  It covers things like acting on autopilot, being mindful of the breath, allowing and letting be, engaging in self-care, and recognizing that thoughts aren’t facts.

SFBT: Solution-Focused Brief Therapy

SFBT works on identifying and developing the skills to create changes and achieve goals.  The therapist asks particular types of questions to guide the client toward envisioning their future and identifying strengths and coping skills.

 

What types of therapy have you tried?  What was your experience like?

 

Image credit: Pexels on Pixabay

Quora: Dumb and dumber

Quora logo

I like to answer reasonable questions about mental health on the question-and-answer forum Quora, but often reasonable questions are hard to find.  Here are some of the dumb ones I’ve come across.

 

QuestionDo you think it’s cowardice to think that people with borderline personality disorders are all evil?

Answer (the most frightening one out of several): Do you understand that the Personality Disordered person is the coward? These people refuse to take responsibility for their own actions and constantly manipulate others to exploit them for their resources, precisely because they are COWARDS. The PD’ed person uses all sorts of tools, techniques to avoid the effort it takes to exhibit and exercise conscience towards others and themselves in the home and in society.


QuestionWould long term exposure to nature be a more effective treatment for depression compared to pharmaceutical medications?


Question: How is a bipolar manipulative behavior treated?


Question: Can meditation cause schizophrenia?


QuestionDepression, anxiety, “personality disorders”, etc. can be healed naturally, so why do we tolerate a mental health system that is drug-based, and is failing people?

My favourite answer: They can be healed naturally? You are out of touch with reality.


Question: Does depression lead to materialism?

Answer: Depression … n .. materialism … no way …. It is another disease callled bipolar .. where materialism comes .. go to google for details


Question: Is depression just sad narcissism?


Question: Do bipolar people have coexisting autistic and psychotic traits?


Question:  It seems like lot of untreated people with severe schizophrenia eat out of the garbage, are unclean, and lacking sleep, but do not get sick like well people probably would. Do people with schizophrenia have stronger immune systems than most people?


QuestionPeople with no real problems to tackle usually get depressed. Is depression a disease whose first symptom is laziness?

 

Are there any particularly stupid or bizarre questions you’ve seen/heard people ask about mental illness?

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format, along with assorted other question tags and the like.  Feel free to join in the fun with your own answers to any or all of the questions 🙂

 

Questions from Carol Anne at Therapy Bits:

  • who made you smile lately?  I regularly watch the Late Show with Stephen Colbert, and that’s always good for a laugh.  His jokes about the (alleged) Trump “pee-pee tape” always make me smile.
  • what types of videos do you like to watch on youtube?  I don’t watch a lot on Youtube – I get overwhelmed by the huge selection and lack of organization.  I like watching documentaries on Netflix and Amazon Prime Video.
  • Do you like quotes?  I love quotes!  There’s some great inspirational ones, but my real favourites are from Seinfeld.  These pretzels are making me thirsty!
  • Spring or summer and why?  It’s pretty rainy here in the early spring, so late spring/early summer is probably my favourite, as it’s sunny and not too hot.
  • What were you hoping for when you started your blog?  I thought writing would be therapeutic, but I had no idea how much of a community I would find.
  • Hot or cold drinks and why?  I like my hot tea in the morning, but otherwise mostly cold drinks because they’re more thirst-quenching.
  • Bath or shower and why?  Bath to relax, shower to get clean.
  • If you had a wish any wish what would it be?  To be a guinea pig.  There’s something very appealing of the simplicity of a life that revolves around sleeping, eating, and pooping.
  • Kids or animals? Who are your favourite?  My guinea pigs are my kids.
  • What are the qualities you like in a friend?  Understanding, non-judgmental
  • What is the worst thing about your depression?  Probably how much it has stolen away from me over the years.

 

Questions from 4M’s Bipolar Mom:

  1. What do you enjoy most about blogging?  Depression makes me isolate, but blogging makes me un-isolate.  Put those together and you have an almost-functional human being.
  2. What do you think about my blog – and how would you add to / change it?  I think it’s fabulous.  And I’m also a fan of the term “chicken” as a term of endearment, although I use it most often to refer to my patients.  I suppose my little crack-addicted sex trade worker chicken that I was so fond of at a previous job isn’t quite the same as a child, but everyone deserves a little love!
  3. What is your favourite chocolate?  (you can restrict this to five, I have a top ten that rotate depending on time of day and mood)  Such a deceptively simple question.  I’m a big fan of the peanut-butter chocolate combination, and I’ve recently discovered the fancy Reese’s Peanut Butter Cups with Reese’s Pieces chunks in them.  When it comes to fancy chocolates, there’s a Canadian company called Purdy’s that does amazing chocolates.  Chocolate in various other forms is good, like chocolate brownies (which absolutely must be under-baked so they’re ooey-gooey).
  4. What is your top tip for coping with anxiety?  I like to be snuggled in at home with tea, some aromatherapy, a cozy blanket either on or beside me, and a guinea pig sitting on my chest
  5. What makes life more bearable for you?  My guinea pig chickens.  They are cute as can be and it always makes me feel better to tell proud mama stories of their adorable behaviour (but I’ll spare you here).  Any time you get excited by talking about a little chicken’s poop you’ve got a good thing going on.

 

Come on, you know you want to answer a few – that’s what the comments section is for!

 

Image credit: qimono on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I spent the earlier part of the week visiting my Grandma.  It was a good visit, but quite tiring.  Especially hard was that she would have moments of confusion when she would get really irrational, like thinking my uncle was trying to steal her money.  Her short-term memory is really impaired, so I was having to try to explain the same things over and over, which got frustrating even though I knew it wasn’t her fault.  My parents, who live not far from Grandma, knew I was in town but I didn’t hear from them.  I’m not sure what that’s about, but it doesn’t feel very good.
  • I’ve been more irritable this week, although it’s hard to tell if that’s internal or just annoying stuff happening that pissed me off.  I full on spazzed at a guy in my building who was being a vehicular menace in the underground parking (e.g. he almost backed into me, I leaned on the horn, he paused for a second, then resumed trying to back into me).  I usually try to keep my irritability on the inside, but on this occasion I just let er rip.
  • I’d been waiting for my iPhone 5S to start giving me problems before getting a new phone, and this week that time had come.  I got a new iPhone 8 and switched to a different carrier that gave me a better plan for less money, so that’s a good thing.
  • I had some short periods of really negative thoughts.  Just when I start thinking that I’ve convinced myself I know these thoughts aren’t true, they pop up to say hello and remind me they’re still floating around in there, ready and waiting to do a little crazy dance.
  • I’ve been feeling a bit overwhelmed by things I want/need to do, even though there really isn’t much to be overwhelmed by, and I worked very little this week.  I guess it’s just taken a few days to get settled in and comfortable after being out of town at Grandma’s.
  • After an experience 6 months ago of crying and then getting up and walking out, I have concluded that dental appointments always need to be pre-treated with drugs.  With the assistance of Ativan and Seroquel, I made it through an appointment yesterday without a meltdown, although I still felt pretty panicky.  I think it’s partly the pain/discomfort, partly the feeling of having no control, partly that it’s intrusive, and partly I feel like I’m drowning when they use the ultrasonic water scaler thingamabob.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… type A personality

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Type A personality

The first question that popped into my mind when I thought of delving into this  topic was are there other letters?  Because you only ever seem to hear about type A.  So let’s get to it.

Type A and its opposite type B were first proposed by two cardiologists, Drs. Friedman and Rosenman, in the 1950’s to predict the risk of developing heart disease.  They determined that type A personalities had a higher risk for cardiovascular disease.  However, this finding was based on a sample of middle-aged men, and it was later learned that there was influence from the tobacco industry to support any findings that distracted from the clearly emerging effect of tobacco on health.  Damn they were slimy buggers.

According to Wikipedia, type A describes people who are competitive, highly organized, outgoing, impatient, anxious, and highly concerned with time management.  These people are often workaholics and experience high levels of work-related stress.  They tend to be impatient, impulsive, and quick to anger.

Type B personalities are defined less by what they are and more by what they aren’t; they’re the opposite of type A.  They tend to have lower stress level and are less competitive and more tolerant.  They enjoy exploring ideas and may be more likely to work in creative fields.

Another lettered personality type was later identified in the field of medical psychology, the type D (distressed).  According to Wikipedia, this includes a combination of negative affectivity (e.g. worry, irritability) and social inhibition.  Type D’s tend to keep their negative thoughts to themselves due to fear they may be rejected by others.  Some studies have found a correlation between type D and worse cardiac outcomes, although these findings have been inconsistent.

Type A/B personalities can be measured using the Jenkins Activity Survey.  A modified online version is available here.  Scores range from 35 (highly type A) to 380 (highly type B).  I scored a 204, with my tendency to be organized and always on time pushing me toward the type A side, even though I feel like overall I’m a very different person than the picture painted with the type A personality .

Type D personalities can be measured using the DS14 Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality.  I couldn’t find an easy online version that would spit a score out for you, but I did find a version here that involves doing some addition.  I scored sufficiently high on both negative affectivity and social inhibition to be considered a type D personality, but then again the answers to a lot of the questions would have been quite different if I was answering them while not under the influence of depression.

To me it seems a bit ridiculous to think that we can classify everyone into 2 (or perhaps 3) personality types.  And while type A may capture a certain type of individual reasonably well, it doesn’t seem nuanced enough to separate out those who exhibit only a few type A characteristics but exhibit them quite strongly.  This was the first time I’d ever really done any looking into type A personalities, and I had no idea that they were first proposed by cardiologists and that their development was promoted by the tobacco industry.  Given what I’ve learned, I’m not particularly inclined to buy into this typology.

Do you think you fall into one of these personality types?

 

Sources:

https://en.wikipedia.org/wiki/Type_A_and_Type_B_personality_theory

https://en.wikipedia.org/wiki/Type_D_personality

Image credit: GDJ on Pixabay

Book review: The Subtle Art of Not Giving a F*ck

book cover: The subtle art of not giving a f*ck

The Subtle Art of Not Giving A F*ck: A Counterintuitive Approach to Living a Good Life by Mark Manson.  Mark Manson is a blogger who wrote this book in reaction to the problems he saw in the self-help industry, but he doesn’t have a background in psychology or any sort of related field.  This book represents his opinion, and the ideas presented in the book aren’t based on any sort of research.  In broad terms I tend to take issue with books that present opinions as fact without being based in actual evidence.  There’s nothing wrong with an opinion, but I think it needs to be clearly delineated as such.

In some ways, some of the author’s philosophy is a rebrand of radical acceptance.  He discusses the importance of non-superficial values, and while his approach isn’t necessarily my favourite the content is reasonable.  He challenges modern society’s focus on materialism and more, more, more.  He also disagrees with the focus on the pursuit of positivity, to point of of avoiding the rest of what reality throws at us.  He repeatedly returns to the idea of entitlement as being a fundamental underlying problem, but there is a tinge of brattiness to his writing style that takes away from this message.

There were a number of ways in which this book fell short for me.  One of the places where he lost me was the idea of “don’t try”.  Trying for the sake of personal growth is very different from trying to keep up with the Joneses.  Manson argues that “everything worthwhile in life is won through surmounting the associated negative experience”, and while this may sometimes be the case, I doubt the veracity of this as a broad generalization.  There are some valid messages about things like values that get watered down by somewhat cavalier examples.

Manson criticizes the often-repeated “be happy” message, pointing out that “the desire for more positive experience is itself a negative experience.”  He adds that “accepting negative experience is a positive experience.”  He explains that focusing on positive expectations actually ends up showing people how they have failed.  Social media tends to trigger a “feedback loop from hell” that constantly reminds that others are doing better than we are, and we are inadequate.

Manson suggests that “to not give a fuck is to stare down life’s most terrifying and difficult challenges and still take action.”  He adds that we should choose what matters based on person values, which I would certainly agree with, and challenges the social media-fuelled idea that average represents failure.  The values-based metrics we choose determine what we perceive as success or failure.  He advocates for interpreting pain as a call to action, and recognizing pain as an action that one strives for rather than having it dropped in one’s lap.  He encourages acting even the absence of motivation, which is reminiscent of CBT concepts regarding behavioural activation.

Entitled people are presented as exuding a “delusional degree of self-confidence” and operating within a “narcissistic bubble”.  This made me wonder, though, isn’t this just an extreme example of not giving a fuck?  Manson explains that “The ticket to emotional health, like that to physical health, comes from eating your veggies – that is, accepting the bland and mundane truths of life….  This vegetable course will taste bad at first.  Very bad.  You will avoid accepting it…  [But then] the knowledge and acceptance of your own mundane existence will actually free you to accomplish what you truly wish to accomplish.”  I disagree with simple pleasures being presented as “bland and mundane” and something that is necessarily aversive at first.

The book touches on the idea of “victimhood chic”, with a lack of personal responsibility and the tendency to be easily offended and outraged by any perceived slight.  Whether or not this is true, I think it minimizes those that are victims of abuse.  I also disagreed with the author’s statement that “in the process of changing your values, you’ll feel like a failure and will experience rejection”, as I think there’s no reason why that should be true as a blanket statement.

Manson touches on what sounds like his own entitled, bratty past.  I get the sense, though, that in the present tense he’s not necessarily someone I would want to spend a lot of time with.  He explains that if his wife gets dolled up for a night out and he doesn’t like her fashion choices, he will come right out and tell her, “because honesty is more important to me than feeling good all the time”.  In my mind, there is honest, and then there’s asshole, and the difference lies in consideration of the other person’s feelings.  He states that “if two people are close are not able to hash out their differences openly and vocally, then the relationship is based on manipulation and misrepresentation, and it will slowly become toxic.”  I’m not certain why he presumes to dictate how couples should communicate within their relationships, but personally I don’t think it’s appropriate to project one’s own views onto others in that manner.

This was definitely an interesting book; sometimes interesting in a good way, but other times in a bad way.  I’d say it disappointed me compared to what my expectations were.

 

You can find my other book reviews on my blog index.

Image credit: Amazon.com

My relationship with alcohol

wine glass and wine bottle lying on its side

I was raised in a household where alcohol consumption consisted of one or two beer or glass of wine the occasional evening.  I was offered small sips of both, and didn’t like the taste of either.  In my early university days, I drank, often heavily, on or two nights a week.  It was part of a package of having fun with my friends.  It wasn’t something I used as a coping strategy, I never drank alone, and I never craved alcohol on nights  we weren’t going out.  I always planned ahead to make sure I’d be safe, so as far as binge drinking goes I’d say I was fairly responsible.

As I moved a little further into my 20’s, with the odd party night as an exception, I became a social drinker, having a drink or two when out with friends doing non-alcohol-focused things.  As I moved into my 30’s and became more asocial in general, I drank alone more of the time, but the general pattern of consumption stayed the same.

But then depression got in the way.  When depressed, alcohol became an escape tool.  It would allow me to forget some of what I was feeling and thinking about.  That worked (sort of) until it started making things worse.  Because the temporary escapes meant more and more pain was getting bottled up inside, ready to explode.  That’s where alcohol, instead of lifting me off the ground, dropped me hard on my ass.

The most spectacular alcohol-triggered meltdown happened when I was 33.  Unfortunately, it happened to be at a work team-building retreat.  The team I was working on at the time was pretty laid back, and some alcohol consumption was considered normal at the annual retreats.  I had brought a 4-pack of cider, and I figured that spaced out over the course of the day, accompanied by plenty of food, that would be manageable.  Except it wasn’t.  Somehow, by the end of the afternoon, that 4 cider had got me totally drunk.  I remember standing around with a group of people and I started crying.  I went to the washroom and had a huge sob-fest.  And then I, someone who has never driven drunk ever, started insisting that I was leaving and I was going to drive myself home.  Unsurprisingly, others intervened, but it got ugly.  I was yelling at people, and they had to physically wrestle me outside and into the passenger seat of my car.  Someone drove me home in my car, and I sobbed the whole way.  Things continued to get worse from there.  A couple of months later, I ended up in hospital, and then a couple of months after that I was back in hospital again after a suicide attempt.

You would think it would have been lesson learned.  Perhaps I have, in the sense that I recognize that depression-related escapist drinking is destructive.  I still do it, but manage to put the kibosh on it before it gets out of hand.  Yet when the depression is relatively manageable, alcohol and I have an easy non-problematic relationship.

Does mental illness interfere with your relationship with alcohol or other substances?

 

Image credit: Bru-nO on Pixabay

How to be supportive

hand statue supporting tree branch

Not too long ago I wrote a post on how not to be supportive of someone with depression, and had a comment from Meg that I should do a post on how to be supportive.  So here it is.  I freely admit that this is a post that’s been done many times before by many different people, so I doubt I’m coming up with anything particularly original, but here’s my two cents.

  • Validate: Validate, validate, and validate some more, and when you think you’ve validated enough, keep on validating until you’re blue in the face.  I need to hear that it’s okay to feel and experience what I’m feeling and experiencing.
  • “That really sucks“:  Don’t minimize, don’t sugarcoat.  Call a spade a spade.  Depression sucks ass.
  • “You don’t need to respond but I’ll keep messaging you unless you tell me to stop”: When I get depressed I isolate.  I hide from the world, and I think everyone most likely hates me as much as I hate myself.  If I’m feeling low, chances are I won’t respond to a message, but that doesn’t mean it’s not important for me to receive it.  If it feels like someone gets that, it means a lot.
  • Offer hugs: There is something soothing about physical contact, and it’s something I get very little of.
  • Recognize that 1:1 socializing is hard enough and anything more than that isn’t going to happen: I remember someone sprung a group lunch on me when I was prepared for just the two of us.  I was very, very unimpressed.
  • If you promise or suggest something, follow through: If you suggest we should get together next week, I don’t necessarily have any interest in doing that, but if I then don’t hear another word from you about it, I will think you hate me.  Ok maybe that’s a bit of an exaggeration, but not much.

 

What are some of the things you would like people to do when you’re not feeling well?

 

Photo by Neil Thomas on Unsplash

Another journalling update

journals

I recently had some additions to my journal family when I got my thank you goodies for judging Revenge of Eve’s P4J contest.  Rather than saving some journals for later, I decided to get all four going at once, each with a slightly different purpose.  As you can see below, I’m one of the most unartistic people in the world.  I can barely draw a straight line, for crying out loud.  I like to use stickers but I’m running very low on those and haven’t gotten around to getting some more.

Journal page with ACT models

This is the journal on the far left in the picture, with the pineapples on it.  It’s from Revenge of Eve.  This is my “therapy journal”, with my favourite bits and pieces from things like CBT, DBT, AND ACT.  It’s also where I’ll keep track of the skills I’m trying to work on and the distorted thoughts I’m able to identify.

 

gratitude log

This journal is the second from the left, and it’s the one I started with when I first got into bullet journalling earlier this year.  It’s pretty packed full, but I’m still using the daily gratitude log and monthly overview tracker in this journal rather than transferring them over to another journal.

journal page with affirmations

 

This journal is the third from the left, and it’s also from Revenge of Eve.  There are four different guided mindfulness-based page spreads.  It’s set up as a daily journal but I’m using the four spreads to cover a week instead.

 

 

journal entry: week plan with goals

 

This is the journal on the far right, and it’s sort of a carry-over bullet journal that I started when I was running out of space in the first one.  I have a weekly summary section, and this is what I use to write my weekend wrap-up blog entries.  I also started a mood tracker in this journal.  I had previously been using the Pacifica app, but as the year as progressed I’ve gone from doing all my tracking in apps to all of it in my journals.

 

 

So that’s my journal situation right now.  It’s slightly more artistic than these pages convey, but not much.  I love seeing pretty pictures on WordPress and Pinterest of people’s elaborate bullet journal pages, but unfortunately I’m just not that person.  I’m ok with that, though, because even if the insides aren’t necessarily pretty, the outsides are, and they function very well.

If you journal, has your approach evolved over time?

 

You can find my previous journalling posts here and here.

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format, along with assorted other question tags and the like.  Feel free to join in the fun with your own answers to any or all of the questions 🙂

 

Questions from Ida at Around the ward in 80 days:

  1. Has blogging been as you imagined it to be?  It has truly been all that and a bag of chips! (salt and vinegar, please)
  2. What’s your dream collaboration?  Ida mentioned a vibrator company, and I think I’ll have to second that idea
  3. Would you ever do other formats besides writing, such as youtube or podcasts?  I write much more intelligently and coherently than I speak.  When I’m being recorded I turn into a bumbling idiot, so I try to avoid that as much as possible.
  4. Talk us through your process of writing a post.  Sometimes it just flows and 5 minutes later I’m done, and sometimes I’ll work on something in dribs and drabs over the space of a few weeks.  First step in my process is the idea, second step is the title, third step is the image to go with the post, and then I bumble along from there.
  5. Do you get writer’s block?  Yes, although often it’s less of a specific writer’s block and more my brain deciding to take an extended road trip out to stupid-ville.  Sometimes it’s an overnight trip, and other times its a more extended say.
  6. What’s worse, a writer’s block or a cock block? (You can change this one into ‘what’s your favourite colour?’)  I myself seem to be a walking, talking, one-woman cock blocking machine, so I’m pretty used to that, and therefore I’d say writer’s block.
  7. Pitch your blog to me with one sentence.  Mental health, guinea pigs, yaks, and yurts – what more could one ask for?

 

Questions from A Guy Called Bloke and K9 Doodlepip‘s Friday Funday Challenge: Ok, so I’m not actually doing the challenge, but I did want to join in the fun and answer a few of the rather morbidly themed questions.

  • If you were facing the death penalty what would be your last meal choice??  A big ole bucket of chicken from KFC.
  • Have you ever had your tarot read?  By a friend who was quirky, to say it politely (although leaning more towards the nutty end of the spectrum). I would have more faith in a reading from my guinea pigs.
  • Would you sleep inside a coffin underground for a night?  No, no, a million times no.  The most claustrophobic space I’ve ever been in was the Cu Chi tunnels used by the Viet Cong in the Vietnam war.  The panic was not a pleasant experience, to say the least.
  • What is your best detective series?  Nancy Drew, hands down.
  • Are you afraid of clowns?  Only the clown from Stephen King’s It.  That thing scared the bejeezus out of me.
  • Of all the ways a person could commit murder which do you think is the worst? Why?  Well, they wouldn’t have called it murder, but the old British punishment of drawing and quartering gives me the heebie-jeebies.
  • If you were a detective investigating a murder what would your first steps be at the scene of a brutal death?  I’d call Starsky and Hutch, and when they came in to check out the scene I’d go out and “borrow” their car for a joyride.
  • Hanging, Injection, guilotine or firing squad what would you prefer?  Injection all the way.
  • What time of the day is the best time to commit a murder?  Between 3 and 4 am.  The night owls have gone to bed, and the early birds like me are sitting at home drinking tea.
  • Do you look guilty?  Not necessarily, but the guinea pigs do.
  • Uh oh, you have witnessed a murder, and you think the killer may have seen you but you are not sure, what would you do?  I would move to Kyrgyzstan and live in a yurt in the mountains, with a herd of yaks as a protection detail.
  • You are a suspect in a murder enquiry that you ‘know about’, what is your alibi to throw them off your scent?  I don’t operate well under pressure, so I’d probably totally lose it and give a false confession.
  • Whilst gardening the body of a neigbour is discovered in your back yard that everyone knows you had a feud with, what are you going to do to prove your innocence or?  Who says I’m innocent?

 

Come on, you know you want to answer a few – that’s what the comments section is for!

 

Image credit: qimono on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • Self-care included a massage and a yoga class.  Yoga class wasn’t as relaxing as it normally was because the teacher decided to do a lengthy guided meditation.  I was feeling strong urges to scream “shut up!” or just walk out, but I held it together and made it through the class.
  • I discovered a $450 charge on my credit card statement that wasn’t mine.  My bank reversed the charge and cancelled my card.  It sounds like they figure my info was obtained from a mass harvesting of credit card data like you hear about when retailers get hacked.  This was the first time anything like this had happened to me, and was a good reminder to look carefully at my statements.
  • I have had a strained relationship with my parents the last couple of years, and a few times lately I’ve gotten information from/about them via my brother.  This week I got an email from my brother passing on a request from our mom that I do something, and this kind of thing just makes me feel even shittier about the relationship.
  • I got very frustrated with a friend of mine who I’ve been helping with school.  His mindset towards it is very odd, and his grades have been crap as a result.  I have been trying for months to explain that if he just changed up his approach he’d be fine, but it just seems like he’s got blinders on.  I don’t deal well with frustration, and got kind of snappy with him earlier in the week.
  • I’m staying with my Grandma for the next few days.  I discovered her dumbass doctor had only ordered 2 weeks of a medication for gastroesophageal reflux (that she should have been put on a long time ago), so I called to make an appointment so I could take her in to get it reordered.  The receptionist gave me all kinds of attitude and was super reluctant to book an appointment.  If that’s how that clinic operates no wonder Grandma’s getting such shitty care.  I’m going to be on the fucking warpath when I take her in for her appointment in a few days.  And all the while my mother stands back and does sweet fuck all.  Ah, family dynamics.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… narcissism

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Narcissism

It seems like there’s talk about narcissism all over the internet these days, so I thought I would delve into it a little further.  The term derives from Greek mythology and the story of Narcissus, who fell in love with his own reflection in a pool of water and became so obsessed he did nothing but stare at it.  He eventually died out of grief that he was in love with someone who didn’t exist outside of himself.

Wikipedia explains that within the field of psychology there are two main ways of looking at narcissism: as a personality trait, and as a disorder.  One study reviewing literature on the topic identified six key elements of narcissism: a belief of being better than others, greatly exaggerated views of the self, an inflated belief in their ability to create change, a belief of being unique/special, and an orientation towards success.

painting of Narcissus staring at his reflection

Narcissistic personality disorder (NPD) is a diagnosis in the DSM (Diagnostic and Statistical Manual).  It is classified as being in cluster B, the dramatic/emotional erratic personality disorders, along with borderline PD, histrionic PD, and antisocial PD.  Lifetime prevalence rates in the general population are around 1%, with that number rising to 2-16% among people with other mental health conditions.  Wikipedia says that “people with narcissistic personality disorder (NPD) are characterized by their persistent grandiosity, excessive need for admiration, and a personal disdain and lack of empathy for other people”, and like any other disorder in the DSM they must meet a certain number of the diagnostic criteria to be given a diagnosis.  There is some evidence that NPD is heritable, but various environmental and cultural factors play a significant role.  The DSM-5 doesn’t break down NPD into subtypes, but various researchers have proposed different subtypes, including the often heard terms covert and overt.  Although people with NPD don’t typically seek out treatment specifically for NPD, the treatment of choice is psychotherapy, with a primary focus on improving empathy.

The Narcissistic Personality Inventory is one test to measure levels of narcissism as a personality trait, and there is a version available here.  This test is designed for use in the general population, so high scores don’t automatically indicate that someone would meet the criteria for a diagnosis of NPD.  My score on the test I’ve linked to was 5/40 (meaning low levels of narcissism), but what struck me about the test was the black-and-white nature of it.  Each question had two possible responses to choose from, with one response suggesting narcissism and the other response more suggestive of a lack of confidence.  There seemed to be little room for a person who is confident yet modest.

There are several terms related to narcissism that often turn up online.  Narcissistic supply is a psychoanalytic concept that refers to those individuals who are drawn upon to boost a narcissist’s self-esteem, and it tends to stem from a lack of such supply in childhood.  The narcissist may use techniques like flattery in order to maintain this supply.  The term narcissistic abuse was originally used to describe parent-child relationships, but came to be more broadly applied to relationships between adults as well.  This abuse may be used to gain/maintain narcissistic supply, and may result in trauma bonding.  Wikipedia states that “narcissistic injury occurs when a narcissist feels that their hidden, ‘true self’ has been revealed.”

I wonder sometimes about the appropriateness of ideas from the field of psychology gaining a life of their own on the internet.  A former friend of mine had a messy breakup and started spending a lot of time reading websites about relationships with narcissists, and she quickly identified with this.  Problem was, while buddy was a jerk, none of the behaviour she described was very consistent with narcissism, and she had brought her own considerable emotional baggage to the table that she seemed completely unaware of.  Latching onto this idea of narcissistic abuse wasn’t helpful to her, and if anything it made it harder for her to move on.  This isn’t at all meant to detract from the very real and very significant harm that narcissistic abusers may cause for their victims.  It’s just that once something gets popular on the internet, there’s a tendency for people to run with it, even if it means they’re running in the wrong direction.

Your thoughts?

 

Sources:

https://en.wikipedia.org/wiki/Narcissism

https://en.wikipedia.org/wiki/Narcissistic_personality_disorder

https://en.wikipedia.org/wiki/Cluster_B_personality_disorders

https://en.wikipedia.org/wiki/Narcissistic_abuse

https://en.wikipedia.org/wiki/Narcissistic_supply

https://en.wikipedia.org/wiki/Narcissistic_rage_and_narcissistic_injury

Image credits: GDJ on Pixabay and Wikipedia

Trapped

truck stuck in mud

I feel trapped in several areas of my life.  Trapped in a few different ways, and really not sure how to get myself out.

The most obvious is that I feel trapped in my depression.  I’m feeling at a loss as to what to do.  I’m managing ok for the most part, but I want to be able to do more than just managing.  Yet I have a reluctance to mess with the treatment regimen that’s keeping me reasonably contained a fair bit of the time, so I’m coasting along and getting knocked off the rails whenever anything mildly distressing comes up.

I feel trapped in my career.  I’ve kvetched about this before, but there are factors outside of my control that seriously limit my options (mostly related to a former bully‘s somewhat successful attempts to destroy my career).  Plus I worry that trying and failing to push back against those external factors could further destabilize my mental health.  So I look for the path of least resistance, which is typically to stay bogged down in the status quo.

Then there’s interpersonal relationships.  I shut people out of my life.  I’ve pushed my family away, yet at the same time the maintenance of this distant but still kind of there relationship doesn’t feel very good.  Yet I have no idea how to let myself open up and move in closer, because it just doesn’t feel safe.

In a sense I feel trapped in my city.  I like where I live, and I’m very comfortable in the condo where I’ve lived for the past 13 years.  But I’m so settled in that even if moving seemed like a good thing to do for my career or other purposes, the very idea is terrifying.  The thought of having to go through the process of selling my place and trying to find a new home is completely overwhelming, to the point that I don’t even think of it as a feasible option, at least for the time being.

While some of this trapped-ness is related to external factors, a large part of it is firmly rooted in my thinking.  Yet recognizing it doesn’t necessarily make it easier to move out of my rut.  When even my rut feels scary and unsafe a lot of the time, and when past experience has clearly shown that the world often in unsafe, it’s hard to contemplate what positive change could actually look like.

 

Are there areas of your life where you feel trapped?

 

Image credit: MikeMyCoach on Pixabay

Book review: Braving the Wilderness

book cover: Braving the Wilderness by Brene Brown

Braving the Wilderness is the second book I’ve read by Brené Brown (I recently reviewed Daring Greatly).  It’s a book about finding belonging within ourselves and using that to relate effectively to others.  She writes with very accessible language and a conversational tone that draws the reader in.  The book is relatively short, which makes it a fairly quick read.

The wilderness metaphor didn’t especially resonate with me, and so sometimes I found myself wondering what exactly she was talking about.  She writes: “Belonging so fully to yourself that you’re willing to stand alone is a wilderness—an untamed, unpredictable place of solitude and searching.”  She adds that “the special courage it takes to experience true belonging is not just about braving the wilderness, it’s about becoming the wilderness. It’s about breaking down the walls, abandoning our ideological bunkers, and living from our wild heart rather than our weary hurt.”  “Someone, somewhere, will say, ‘Don’t do it. You don’t have what it takes to survive the wilderness. This is when you reach deep into your wild heart and remind yourself, ‘I am the wilderness.'”  I think Brene Brown is wonderful, but I’m still reading those lines and thinking huh?!?  Maybe I’m just a bit too concrete.

That’s not to say that all of it was lost on me.  When she wrote “cynicism and distrust have a stranglehold on our hearts”, I felt like she could easily have been speaking about my own heart.  She tells us that in order to achieve true belonging, we must be vulnerable and have the courage to take on difficult things and be uncomfortable.  I liked her observation that when we’re bullshitting, “the truth  doesn’t matter, what I think matters.”

The book is focused around four key approaches to improve belonging:

  • People Are Hard to Hate Close Up. Move In.
  • Speak Truth to Bullshit. Be Civil.
  • Hold Hands. With Strangers.
  • Strong Back. Soft Front. Wild Heart.

The book contains many useful nuggets of advice, including practicing gratitude and breaking the habit of seeking confirmation that we’re not good enough.  There are also many common sense ideas that are perhaps not so common, such as approaching conflict with a genuine attempt to understand the other person’s perspective.  While boundaries may seem like a challenge sometimes, Brown takes the perspective that establishing and sticking to clear boundaries in conflict actually promotes compassion and belonging.  Boundaries are the first ingredient in her BRAVING acronym for facing the wilderness.

While there was definitely good stuff there, I have to say that for me this book was a bit of a disappointment.  I’m a big Brene Brown fan, and I like what she has to say, particularly about vulnerability, but the wilderness metaphor just didn’t do it for me.  I definitely want to read more of her work, though; anyone have any favourites they’d like to suggest?

 

You can find my other book reviews on my blog index.

Image credit: Amazon.com

 

Disclosing mental illness at work: The good, the bad, and the ugly

person walking on a tightrope

If you have a mental illness and have a paid job or volunteer gig, chances are that at some point you’ll be faced with the question of whether to disclose your mental illness, and if so, how much to disclose.  Yes, there may be laws in place to keep employers from discriminating against mentally ill employees, but that doesn’t necessarily mean disclosing is going to feel safe or be free from negative repercussions.  And working as a nurse in mental health care, it’s become clear to me that all too often the people who should “get it” really just don’t.

After my first psychiatric hospitalization, I had no choice about disclosing my illness. The provincial College of Registered Nurses put conditions on my professional license, and required that my employer be informed of these conditions. My manager used this as an excuse to treat me like I was incompetent and dangerous.  I had decided that I might as well be open with my colleagues, and luckily they were super supportive. Without that support I don’t know know how I would have  been able to handle my manager’s passive aggressive BS.

At my next job, they were initially supportive when I got sick.  But that changed when I didn’t make a neat and tidy recovery.  After my third hospitalization in the space of just over a year, my manager tried very hard to block me from returning to work.  I had no idea what was happening or why it was happening, and when I found out I felt completely betrayed.  I felt desperate to leave that job, but that was made harder by the fact that managers gossip, and the talk about things they have no right to gossip about.  Thankfully my coworkers were amazing, although I did find out later there was some slightly inaccurate information that got passed around as gossip.

One of my current employers seemed to use my illness as an excuse to step up the psychological assault.  I had disclosed my illness as a defensive tactic because I was experiencing severe psychomotor retardation and I figured they would be petty enough to assume I was abusing drugs or something like that.  They then seemed to turn it around and used it as a weapon against me.

Under Canadian law, employers have an obligation to accommodate employees with a disability unless it causes undue hardship (and from what I understand the bar is set pretty high for what counts as undue hardship).  A year ago I had requested an accommodation from one of my employers, as I was grasping desperately for any possible measure to prevent the psychological attacks they were launching at me.  My request was supposed to be passed to the 3rd party agency that provides disability management services in keeping with what was laid out in the nurses’ contract.  Did that happen?  Nope.  Management and HR wanted to deal with it themselves, and given that they were the source of the problem, it went nowhere.

I’ve chosen to be open about my mental illness, although some of that is a positive reframing of the times when I really didn’t have any other choice.  I can’t think of a single instance when a colleague has given me a hard time about my illness, but managers have been an entirely different story.  I really can’t say that I have any advice to give others on whether or not to disclose at work.  It’s hard to predict how people are going to react, so I think all you can do is go with what feels right in your gut.  And despite the crap that I’ve had to deal with, I still think I made the right decisions for me.

Have you disclosed your mental illness at work?  What has your experience been like?

 

Photo by Leio McLaren on Unsplash

There are no small acts of kindness

kindness word graphic around seated buddha with colored chakras

Beckie’s Mental Mess recently nominated me for a Random Acts of Kindness award, hence the topic of this post.

I have found so much kindness in the blogging community.  When I’m struggling, I can always count on getting words of support.  When I’m feeling discouraged about blogging or anything else, I always get lovely words of encouragement.  The kindness that we show each other is one of the things that makes the blogging community

As a nurse, my job is to be kind to my patients, but for me it’s so much for than just a job; it’s why I’m passionate about my chosen career.  And kindness is one of those things that when it’s given, it multiplies and tends to come back to you.  One of my former patients was very fearful about a particular procedure, but I was able to set his mind at ease and make it easy for him.  As a thank you he gave me an amazing wildlife photo he had taken, which now hangs on my bedroom wall.

Sometimes kindness turns up unexpectedly, whether that’s someone picking up something you’ve dropped, or complimenting you just when you most need to hear it.  Even though Western society is very individualistic, and mental illness is often so very isolating, kindness can help to break down some of those barriers.

Some of my favourite quotes on kindness:

“Kindness is the language which the deaf can see hear and the blind can see” – Mark Twain

“Be kind whenever possible.  It is always possible.” – The Dalai Lama

Kindness is loving people more than they deserve.” – Joseph Joubert

“The true greatness of a person, in my view, is evident in the way he or she treats those with whom courtesy and kindness are not required.” – Joseph B. Wirthlin

“Remember there’s no such thing as a small act of kindness.  Every act creates a ripple with no logical end.” – Scott Adams

“No act of kindness, no matter how small, is ever wasted” – Aesop

 

How is kindness important in your life?

 

Image credit: johnhain on Pixabay