Depression is one of the most prevalent mental health disorders in the country and it is on the rise as one of the most serious health concerns facing us. The irony is that it is also one of the most treatable disorders, through psychotherapy and/or medication. Yet barely a third of the people with depression seek help or are properly diagnosed.
It is estimated that about 10 to 15 percent of children and teens are depressed at any given time. Research indicates that one of every four adolescents will have an episode of major depression during high school with the average age of onset being 14 years!
These episodes typically last several months when untreated. While this indicates the main problem is likely to abate without treatment, these teens are at much higher risk for suicide which is a leading cause of death during adolescence. In addition, during an untreated episode of major depression, teens are more likely to get into serious substance abuse addictions or suffer significant rates of dropping out of their typical activities and social groups. Thus, even if the depressive episode wanes, significant problems may continue on.
The milder form of depression, called dysthymia, is more difficult to diagnose, especially in primary school children. Yet this form of depression actually lasts much longer. Typical episodes last seven years and often longer. Many depressed adults can trace their sad, discouraged, or self-dislike feelings back to childhood or adolescence.
With children, although typical adult features may be present, they are more likely to show symptoms of somatic complaints, withdrawal, antisocial behaviour, clinging behaviours, nightmares, and boredom. Yes, many of these are common for non-depressed children. But usually they are transient, lasting about four to six weeks. You should become concerned when the symptoms last for at least two months, don’t respond to reasonable parental interventions, and seem to pervade the child’s life rather than be confined to just one aspect.
I have referred to major depression and dysthymia as two primary forms of depression. Very briefly, there are a number of symptoms common to both but with a greater severity in the former. In adults, depressed mood, loss of interest or pleasure in activities, loss of appetite or overeating, sleeping a lot or not being able to sleep, loss of energy, loss of self-esteem, indecisiveness, hopelessness, problems with concentration, and suicidal thoughts or attempts are the signs of depression. People rarely have all of them.
We usually look for at least four or more and, again, severity and longevity are important determinants when making a diagnosis. Teens will exhibit more adult-like symptoms but severe withdrawal is especially significant.
In childhood, boys actually may have a higher rate of depression than girls but it is often missed because many of the depressed boys act out and the underlying depression is missed. In adolescence, girls begin the same predominance as women, about two to three times the rate of males. Contrary to popular belief, research rejects the notion that it is related to hormonal changes associated with adolescence. Instead, just as with adult women, sexual harassment and experiences of discrimination appear to be more significant causes.
Primary causes of depression in children are parental conflict (with or without divorce), maternal depression (mothers interact much more with their children), poor social skills, and pessimistic attitudes. Divorced parents who are still fighting have the highest rate of depressed children (about 18 percent).
Regarding depression in mothers, it is the symptoms of irritability, criticism, and expressed pessimism that are especially significant. Also, the environmental factors contributing to the mother’s depression (marital or financial problems) also may impact directly on the children. Depressed children are more likely to have poor social skills, fewer friends, and give up easily (which also contributes to poor school performance and lack of success in activities). You must differentiate, however, from the shy, loner child who is actually content to spend more time alone.
What to do? When concerned, talk with teachers and pediatricians. (However, both of these front-line professional groups need more training in diagnosing depression.) If there seems to be a valid concern, then seek help from mental health professionals who specialise in working with children. (Parents: above all, follow your instincts because there is a tendency to under diagnose problems in younger children.)
If marital conflict is present, then seek couples therapy (if divorced, seek help for cooperative parenting). If one or both parents are depressed, then individual therapy may be needed for each. Children’s therapy groups are particularly effective for those with social skills deficits. Family therapy is also very effective, particularly with older children or teens.
Depression does run in families and may have a biological basis. Antidepressants are especially important in these cases and may also be important even if the causes are primarily psychological because they help the child (or adult) attain the level of functioning needed to benefit from other interventions. Since children and teens are less certain to respond positively to medications for depression than adults, it is especially important to use child psychiatrists who specialise in psychopharmacology.
Just this week, I have seen three patients with depression requiring treatment. Treatment options include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy — sometimes more so.
In counseling my patients about self-care, I always feel like we don’t have enough time to get into diet. I am passionate about diet and lifestyle measures for good health, because there is overwhelming evidence supporting the benefits of a healthy diet and lifestyle for, oh, just about everything: preventing cardiovascular disease, cancer, dementia, and mental health disorders, including depression.
Diet and emotional well-being
Diet is such an important component of mental health that it has inspired an entire field of medicine called nutritional psychiatry. Mind-body medicine specialist Eva Selhub, MD has written a superb summary of what nutritional psychiatry is and what it means for you right here on this blog, and it’s worth reading.
What it boils down to is that what we eat matters for every aspect of our health, but especially our mental health. Several recent research analyses looking at multiple studies support that there is a link between what one eats and our risk of depression, specifically. One analysis concluded:
“A dietary pattern characterized by a high intake of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression.”
Which comes first? Poor diet or depression?
One could argue that, well, being depressed makes us more likely to eat unhealthy foods. This is true, so we should ask what came first, the diet or the depression? Researchers have addressed this question, thankfully. Another large analysis looked only at prospective studies, meaning, they looked at baseline diet and then calculated the risk of study volunteers going on to develop depression. Researchers found that a healthy diet (the Mediterranean diet as an example) was associated with a significantly lower risk of developing depressive symptoms.
So, how should I counsel my patients on diet? There are several healthy options that can be used as a guide. One that comes up again and again is the Mediterranean diet. Another wonderful resource for folks is the Harvard T.H. Chan School of Public Health website with an introductory guide to healthy diet.
The bottom line
The gist of it is, eat plants, and lots of them, including fruits and veggies, whole grains (in unprocessed form, ideally), seeds and nuts, with some lean proteins like fish and yogurt. Avoid things made with added sugars or flours (like breads, baked goods, cereals, and pastas), and minimize animal fats, processed meats (sorry, bacon), and butter. Occasional intake of these “bad” foods is probably fine; remember, everything in moderation. And, for those who are trying to lose weight, you can’t go wrong with colorful fruits and veggies. No one got fat eating berries or broccoli. Quality matters over quantity. And when it comes to what we eat, quality really, really matters.
Dietary patterns and depression risk: A meta-analysis. Psychiatry Research, July 2017.
Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. Journal of Affective Disorders, January 15, 2018.
Sandy’s mother, Lily, is beside herself. “I didn’t notice anything was wrong all winter,” she said. “Oh, she was quieter than usual and her grades weren’t the best. But we moved last fall and I figured she was just adjusting. Last week, though, spring really came on with 80-degree days and she insisted on wearing a wool sweater to school. Sandy got furious when I told her to go change. I’ve never seen her that upset! Three days of long sleeved shirts and I finally caught on. I’d heard about this, of course. But I never thought my daughter would be doing it. There are scars all up and down her arms!” Lily was doing her best to hold back tears. “Sandy wouldn’t come here with me. She won’t talk to me. What can I do?”
Lily is upset and bewildered. She can’t understand why her beautiful, accomplished 14-year-old would do something so self-destructive and painful. She feels terrible that her daughter is hurting herself. She feels terribly guilty that she didn’t notice something that has apparently been going on for months.
Sadly, Lily’s daughter is not alone. Self-harm has become far more common than most parents suspect. Some studies show that 2 to 3 million Americans engage in some form of self-injury (cutting, burning, or striking themselves to the point of soft tissue damage) each year. There are people who self-harm at every age, socio-economic, and ethnic group.
Why do kids do it? Often they learn from peers that it can be a way to actually feel better. They may then read about it on the Internet. Sometimes it starts as an experiment; sometimes as as a response to a dare. Sometimes a group of kids try it out as a way to be cool. Sometimes it really does begin with an accidental injury. And, rarely, it’s the result of a failed suicide attempt.
That last possibility especially terrifies parents. But kids who self-harm generally are not looking for a way to end life. They are actually looking for a way to end emotional pain, Some have found that hurting themselves brings their anxiety and stress down to a manageable level. Others, who have learned to dissociate (distance themselves from their bodies and minds) when under stress, find that the pain of inflicting injury brings them back in touch with themselves. Self-injury for these kids is a way to stay alive.
Contrary to what some adults believe, self-harming is rarely a bid for attention. Most of these kids are ashamed of what they do and do their best to hide it. Ironically, the energy needed to keep it a secret only adds another stress. Some are mentally ill and although some may suffer from depression, most do not. The most common mental health diagnosis for a teen who self-injures is borderline personality disorder. For kids who self-injure, hurting themselves has become a primary coping skill in the face of challenging feelings or situations. Often these kids have also learned that their feelings are wrong or bad. Often they never developed less drastic ways to deal with stress.
Self-harmers need to be understood, not scolded. They need to unlearn the idea that their feelings are “wrong” and learn that it’s okay to feel them. Most important, they need to learn new ways to manage stress and emotions that they find overwhelming.
When asked a few questions about Sandy’s history, Lily revealed that she left her husband last summer after years of verbal abuse. “From the time Sandy was little, he’d yell at her that she was too sensitive whenever she cried. He would threaten that he’d give her something to cry about if she didn’t stop. He never actually hit her but I never knew if maybe this time he would. It was hard enough for me to put up with his rages but after a while, I couldn’t stand watching what he was doing to our daughter. When a possibility for a transfer with a raise came about, I just packed us both up and left. Funny thing is, she misses her dad.”
Since Sandy won’t hear of coming to therapy, my job is to coach her mother. Lily needs to know that we can work as a team and that I don’t see her as a neglectful mom. Sandy has put a good face on the move and has even expressed how relieved she is to be out of all the family fighting. Meanwhile, Lily has been caught up with learning a new job and doing the thousand things that go with settling into a new town – from learning where to shop to finding a new doctor and dentist for them both. It’s no wonder to me that discovering that her daughter is cutting is a surprise and a shock. It often is.
Lily’s first step is simply to validate Sandy’s feelings. It’s a reasonable guess that she both misses her dad and is angry with him; that she is glad her mother got her out of the situation, but feels guilty that she is glad. She both loves her mother and is angry with her for not only taking her away from her father but for taking her away from her home, her school, and her friends. It probably makes no sense to her that she is feeling all those feelings at once. Complicating things further is that she was raised by her dad to think that her sensitivities are somehow wrong.
Lily needs to let her daughter know that she understands how overwhelming and confusing the move has probably been for her and that there are ways to handle her feelings that don’t put her at risk of giving herself a serious wound or leave her with permanent scars. Yes, Lily needs to be the mom. But she can also let Sandy know that the reason she can be understanding is that sometimes she also feels mad and glad and sad about the move and wishes there had been another way to make things better.
Once Sandy feels supported and heard by her mom, I’m hopeful that she will come to the next appointment. If not, Lily can still be coached to help her daughter learn new ways to discharge the emotional buildup that happens when she keeps suppressing her feelings. We can teach her that physical exercise (dancing, running, going to the gym) can release the same relieving endorphins into her system that cutting does. We can teach her other ways to relax like taking a warm bath, listening to music or making art. And we can give her some coping skills. Deep breathing or washing her hands or or getting a cold drink of water can calm her while she works to get the urge to hurt herself under control. Most important, we can help her learn to value her feelings by keeping a journal and talking to her mom or a friend or even to me.
While all this is going on, Sandy also may need a little help fitting in with her new school and making friends. Lily had lost sight of how hard it is for a kid to move in the eighth grade. She agreed that she could be more encouraging about having other kids hang out at her place and be a little less focused on grades for now.
I’m certain that before we’re finished, we’ll also need to at least attempt to involve Sandy’s dad. She doesn’t miss his rages but there is more to him than a walking ball of anger. There were good times too. She loves the dad who shot hoops with her in the backyard and who joked around with her when he was feeling good. My guess is that he’s a guy who can’t tolerate his own feelings and who hated feeling out of control when his daughter cried. Perhaps if he feels understood, he’ll be open to working on himself and his relationship with his daughter. Lily is okay with the idea as long as she has assurance that we’ll prepare Sandy to deal with disappointment if her dad doesn’t respond.
Coaching Sandy’s mom like this may work. Not all “therapy” happens in an office. A loving mother who can listen, stay calm, and offer some practical advice can also give a young person exactly what she needs. Learning some concrete ways to be helpful and having some support gives Lily hope and focus. She’s highly motivated to do the best she can for her daughter.
If this method doesn’t work – or doesn’t work enough – my hope is that Lily’s efforts will help Sandy eventually feel okay about getting some additional support. She might come to see me, alone or with her mom, or she might be more comfortable joining a support group with other teens who are struggling to learn how to manage strong and sometimes contradictory feelings. Whatever path therapy takes, she’ll know her mom is there to help.
Child Protection week runs from 27 May to 3 June under the theme:
“Let us protect all children to move South Africa forward.”
Social Development Minister Susan Shabangu kicked off Child Protection Week by putting the spotlight on issues facing young South Africans under the age of 18. She spoke of the effects of social media on children and combating sexual abuse.
National Child Protection Week is marked annually to raise awareness for the rights of children. It aims to mobilise all sectors of society to care for and protect children.
Children’s Rights and the Constitution
The Bill of Rights in the Constitution specifically states that every child has the right to be protected from maltreatment, neglect, abuse or degradation. South Africa has also drafted legislation to protect children based on the United Nations Convention of the Rights of the Child, and the African Charter on the Rights and Welfare of the Child.
Protections are further reinforced through the Children’s Act, which emphasises the State’s role in the provision of social services to strengthen the capacity of families and communities to care for and protect children.
The Child Justice Act (Act No. 75 of 2008) establishes a separate criminal justice system for children who have come in conflict with the law. The Sexual Offences and Related Matters Amendment Act (Act No. 32 of 2007) includes a wide range of crimes that commonly occur against children. The Prevention and Combating of Trafficking in Persons Act (Act 7 of 2013), deals with the global phenomena of child trafficking.
However, despite these and other protections, many children still remain vulnerable to abuse, neglect and exploitation. In a statement, the government called on all South Africans to protect children:
“As a society we have a duty to do more to ensure that the most vulnerable in our society do not suffer abuse. It is in our hands to stop the cycle of neglect, abuse, violence and exploitation of children. By working together we can create safer and healthier communities so that our children can thrive. Government calls on all South Africans to support Child Protection Week by wearing a green ribbon.”
What is abuse?
Abuse constitutes any behaviour that causes fear, bodily harm and forces a person to do things against their will. Forms of abuse include child abuse, rape, emotional abuse, physical abuse, sexual harassment and financial abuse.
Eating disorders are one of the unspoken secrets that affect many families. Millions of Americans are afflicted with this disorder every year, and most of them — up to 90 percent — are adolescent and young women. Rarely talked about, an eating disorder can affect up to 5 percent of the population of teenage girls.
Why are teenage and young adult women so susceptible to getting an eating disorder? According to the National Institute of Mental Health, it is because during this period of time, women are more likely to diet — or try extreme dieting — to try to stay thin. Certain sports (such as gymnastics) and careers (such as modeling) are especially prone to reinforcing the need to keep a fit figure, even if it means purging food or not eating at all.
There are three main types of eating disorders:
Binge Eating Disorder
Anorexia (also known as anorexia nervosa) is the name for simply starving yourself because you are convinced you are overweight. If you are at least 15 percent under your normal body weight and you are losing weight through not eating, you may be suffering from this disorder.
Bulimia (also known as bulimia nervosa) is characterized by excessive eating, and then ridding yourself of the food by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. This behavior of ridding yourself of the calories from consumed food is often called “purging.”
A person who suffers from this disorder can have it go undetected for years, because the person’s body weight will often remain normal. “Binging” and “purging” behavior is often done in secret and with a great deal of shame attached to the behavior. It is also the more common eating disorder.
Eating disorders are serious problems and need to be diagnosed and treated like any medical disease. If they continue to go untreated, these behaviors can result in future severe medical complications that can be life-threatening.
Treatment of eating disorders nearly always includes cognitive-behavioral or group psychotherapy. Medications may also be appropriate and have been found to be effective in the treatment of these disorders, when combined with psychotherapy.
If you believe you may be suffering from an eating disorder or know someone who is, please get help. Once properly diagnosed by a mental health professional, such disorders are readily treatable and often cured within a few months’ time.
A person with an eating disorder should not be blamed for having it! The disorders are caused by a complex interaction of social, biological, and psychological factors which bring about the harmful behaviors.
The important thing is to stop as soon as you recognize these behaviors in yourself, or to get help to begin the road to recovery.
What Does Depression Feel Like? By Gabe Howard
I’ve lived with depression my entire life. As far back as I can remember, I thought about suicide every day. On good days, I decided that I wouldn’t commit suicide and on bad days, I would think about how I would do it.
When I was younger, I didn’t realize this was abnormal. I assumed everyone thought about suicide daily. I just thought it was part of the human experience to weigh the pros and cons of living on an ongoing basis. I did recognize that I was sad — mostly because I recognized that others were happy.
I didn’t know I was depressed, however. I just thought I was bad at life. I believed that I just hadn’t found what I needed to be happy. I spent the first 25 years of my life feeling as if I was always one step away from happiness.
All of the accomplishments that I thought would make me happy didn’t. They would provide temporary happiness, of course, but a couple weeks of feeling like I was on top of the world would quickly decline into depression. When that would happen, I’d just choose a new something I needed in order to be happy.
Depression Is Like You’re Running on a Treadmill
In many ways, depression is like running on a treadmill. It takes a great deal of effort — along with a physical and mental toll — but you don’t get anywhere. But, unlike when on a treadmill, you don’t have any positive outcomes. No calories burned or smaller waistline. Just frustration.
It’s difficult to explain depression to someone because it feels like emptiness. Depression is best described as feeling completely numb, rather than feeling badly. And for people with chronic depression, it feels normal, because chronic depression has a way of wrapping itself around a person and taking control of all emotions.
It feels like swimming with someone who is trying to pull you under and not being sure you care whether they are successful. At first, you try to swim away, but after a while, you become comforted by the fact they are there.
You start to relate to the person trying to drown you and wonder if they are right to pull you under. Subconsciously, you start swimming in areas where it’s easier for them to grab your ankle. The fact that they are trying to harm you becomes irrelevant, because you’re so used to that feeling that you can’t function without it.
I don’t know that depression can every truly be understood by someone who hasn’t experienced it first-hand. When I’m depressed, I see no way forward. It’s an all-encompassing killer of emotions.
Depression is not darkness without hope for light. Depression is being pulled into darkness and forgetting that light ever existed.
Bipolar disorder (“manic depression”) is a mental disorder that is characterized by constantly changing moods between **depression(( and mania. The mood swings are significant, and the experiences of the highs of mania and the lows of depression are usually extreme. The new mood can last anywhere from a few days to a few weeks, or even months (see the bipolar cycling section below). The mood swings are usually experienced intensely by a person with this condition.
A manic episode is characterized by extreme happiness, hyperactivity, little need for sleep, and racing thoughts, which may lead to rapid speech. A depressive episode is characterized by extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities, and feelings of helplessness and hopelessness. On average, someone with bipolar disorder may have up to three years of normal mood between episodes of mania or depression.
Bipolar disorder is recurrent, meaning that more than 90 percent of the individuals who have a single manic episode will go on to experience future episodes. Roughly 70 percent of manic episodes in bipolar disorder occur immediately before or after a depressive episode. Treatment seeks to reduce the feelings of mania and depression associated with the disorder and restore balance to the person’s mood.
Types of Bipolar Disorder
Those with bipolar disorder often describe their experience as being on an emotional roller coaster. Cycling up and down between strong emotions can keep a person from having a “normal” life. The emotions, thoughts, and behaviors of a person with bipolar disorder are often experienced as beyond one’s control. Friends, co-workers, and family may sometimes intervene to try and help protect their interests and health. This makes the condition exhausting not only for the sufferer, but for those in contact with her or him as well.
Bipolar cycling can either be rapid or slow over time. Those who experience rapid cycling can go between depression and mania as often as a few times a week (some even cycle within the same day). Most people with bipolar disorder are of the slow cycling type — they experience long periods of being up (“high” or manic phase) and of being down (“low” or depressive phase). Researchers do not yet understand why some people cycle more quickly than others.
Living with bipolar disorder can be challenging in maintaining a regular lifestyle. Manic episodes can lead to family conflict or financial problems, especially when the person with bipolar disorder appears to behave erratically and irresponsibly without reason. During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behavior, such as repeated intoxication, extravagant spending, and risky sexual behavior.
During severe manic or depressed episodes, some people with bipolar disorder may have symptoms that overwhelm their ability to deal with everyday life, and even reality. This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations, and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a “natural high”) and/or rage that is not typical of the person during periods of wellness. These abrupt shifts of mood interfere with reason, logic, and perception to such a drastic degree that those affected may be unaware of the need for help. However, if left untreated, bipolar disorder can seriously affect nearly every aspect of a person’s life.
Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness or episodes is particularly important. People who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treating depressed bipolar patients with antidepressants can trigger a manic episode in some patients.
Many of you have probably seen friends post #metoo on Twitter, Facebook and social media. In the wake of recent allegations of multiple sexual harassment and sexual assault per Harvey Weinstein, actress Alyssa Milano suggested people utilize the #MeToo campaign (founded by Tarana Burke) for victims of sexual assault to break their silence and share their stories.
As a therapist who is passionate about the destigmatization of mental health issues, I love that the #metoocampaign is helping survivors of sexual trauma and abuse know that they are not alone. This type of campaign can bring about important awareness of real issues that are often buried in shame, fear and secrecy yet privately haunt all too many who have been impacted. Breaking the silence is an important part of stopping the cycle of abuse and a campaign like this bravely brings voice to the power of social media. The hope is that this will become an important social movement that will help people know they are not alone, seek the help that is available, and that we must work together to prevent the sexual abuse of women, men, boys and girls.
But how do we respond when we see a loved one post, “me too”?
What do we do if we have experienced sexual assault? Do we have to share that?
As a therapist who has practiced for over 20 years counseling women and men who have survived trauma and abuse, I recommend the following:
How to Respond to the Me Too Posts of Others:
-Do not ignore them. The tendency might to avoid “liking” a post that naturally brings up uncomfortable feelings. Remember that it took incredible courage to make these posts and ignoring them means being part of our culture that tolerates sexual abuse.
-Do not post on their wall, “Oh no! What happened?” Respect people’s privacy, boundaries and space. Understand that talking about the trauma can be re-traumatizing for the person. If you are close with them, you can call them and let them know that you care, you are there and you are willing to listen if they ever want to talk. Keep what they share with you confidential unless they express thoughts of hurting themselves. Never, ever play devil’s advocate or doubt what they are saying. This is their experience and you need to honor that.
-Respond with love and support. Depending on how close you are with the person, you can simply like the post, love it, send them love and/or offer support. Thank them for their bravery. Provide empathy and compassion.
-Don’t try and be their therapist. If you are close with the person, recommend therapy or counseling. Therapies such as EMDR can be extremely effective in helping people process and move through trauma response.
-Understand they are the same person they have always been. Knowing they have been through sexual assault may cause you to feel sympathetic, naturally. See their strength, courage and resiliency. Remember they are the same strong, amazing, vibrant person you have always known. Use this as an opportunity to open your mind and your understanding of what the face of a survivor looks like–it, unfortunately, looks like our best friends, family members, colleagues, etc.
-Recognize that this news may bring up a variety of feelings. You may feel deeply sad for your friends, angry, protective, or even guilty or hurt as to why they didn’t share this information with you previously. Breathe deeply and honor your feelings as normal responses. Get support from friends, family or a therapist or counselor.
How to Respond to Our Own Trauma:
-Know that news like the Harvey Weinstein controversy and even the #metoo campaign can be triggering. It can bring up old trauma symptoms from the past such as startle response, difficulty sleeping or eating, anxiety, depression, fear or sadness. This is normal. It will pass.
Appreciate the power of our defense mechanisms. We may try and deny, rationalize and intellectualize away our experiences of sexual harassment or abuse. This is a normal response. Recognize if you are rationalizing that something you went through might not have been as bad as others. This type of thinking is what allows abuse to persevere.
-Know you have the choice to share or not. Choosing not to share, if you do not feel comfortable, is self-care, it is not selfish. As somebody whose boundaries have been violated, you have the right to set the boundaries that help you feel safe and comfortable. Period.
-Recognize that sharing “#metoo” is brave, amazing, socially important but also may be re-traumatizing. Be sure you are prepared to deal with people’s responses. If you are, wonderful. –And thank you for being part of the change.
-Access support. Talk to your inner circle about how you are feeling. Reach out to a therapist or counselor. Attend a support group. Call a hotline. Take excellent care of yourself.
How to Be Part of the Needed Cultural Change:
-Report abuse. Don’t be part of the silence. Don’t turn a blind eye. Press charges as needed.
Have anti-harrassment trainings and policies at your workplaces. This can be provided by your Employee Assistance Program or a local therapist or corporate trainer.
-Volunteer at programs that help survivors of abuse, such as the YWCA and RAINN.
I believe in the resiliency of the human spirit. I believe in recovery and healing. I believe that our challenges and traumas carve deep wisdom into our lives. I believe this #metoo campaign is coming out to increase the consciousness of our world. May all who have been impacted have access to love, support and whatever resources they need—and may we all be part of the positive change that is needed.
“Sexual, racial, gender violence and other forms of discrimination and violence in a culture cannot be eliminated without changing culture.”~ Charlotte Bunch
October is Bullying Prevention Month, so let’s break the silence surrounding all types of physical abuse. Let’s speak about the negative ramifications of childhood abuse, and talk openly about the repercussions.
Specifically, today we’ll clarify the powerful connection between physical abuse and trauma and addiction. We’ll talk about what physical abuse is, how it is linked to addiction, and what people can do in order to heal fully.
What Is Physical Abuse?
Physical abuse is defined on Wikipedia as “any intentional act causing injury or trauma to another person or animal by way of bodily contact.”
According to The Child Welfare Information Gateway at ChildWelfare.gov, child abuse is defined as “any nonaccidental physical injury to the child”, including striking, kicking, burning, or biting the child.
In most states, the definition of physical abuse also encompasses “acts or circumstances that threaten the child with harm or create a substantial risk of harm.” Neglect – the failure of a responsible adult to provide for the child’s needs – is also a type of abuse categorized by the absence of action.
Statistics on Physical Abuse and Addiction
Research has established a strong connection between physical abuse — particularly childhood abuse — and addiction.
Childhood trauma and addiction are definitively linked.
According to a study by Kaiser Permanente and the CDC (Centers for Disease Control), individuals who score high on the Adverse Childhood Experiences Questionnaire are five times more likely to become alcoholics, and up to 46 times more likely to inject drugs.
Five out of the 10 total questions in the ACE survey center on bodily harm, so people with high scores are extremely likely to have a history of physical abuse.
As Neil Swan writes in Exploring the Role of Child Abuse in Later Drug Abuse:
“As many as two-thirds of all people in treatment for drug abuse report that they were physically, sexually, or emotionally abused during childhood, research shows.”
How Childhood Physical Abuse Can Lead to Addiction
While enduring physical abuse at any age can be devastating, childhood physical abuse tends to be particularly harmful because children’s brains aren’t fully formed.
As such, children must create stories to make sense of the deeply painful abuse experiences. Too often, those stories boil down to, “It’s all my fault.”
Why? Because the idea of true helplessness – total dependence on an unreliable, hurtful parent or authority figure – is too hard to bear. Being the one at fault allows children to cling to a small semblance of control.
However, the hurtfulness of the painful story — “It’s all my fault” — only increases over time. As people repeat this subconscious story day in and day out, the mental and emotional pain builds, prompting them to use drugs and numb out.
When people don’t know how to work with that original trauma, they’re much more likely to abuse substances. Addictions begin when people try to manage their mental and emotional pain with drugs rather than with self-compassion. We call this an underlying core issue.
To fully address this trauma, it’s important to locate the original hurt and work with it in a safe setting.
It’s Not Your Fault
A classic scene in the movie Good Will Hunting demonstrates the power of connecting with a safe person and rewriting a painful belief related to childhood physical abuse. (The scene is Hollywood-style dramatic, but it’s still illustrative.)
When Robin Williams’ character Sean (the therapist) tells Matt Damon’s character Will (the troubled math genius) that Will’s brutal history of childhood physical abuse wasn’t his fault, Will mutters, quickly, “Yeah, I know that.”
That knee-jerk “I know” is Will’s conscious mind speaking. Intellectually, he understands that of course the abuse he endured wasn’t his fault. Emotionally, however, he’s trapped by the pain of his past. He’s defensive, walled-off, unwilling to feel. On a subconscious level, he believes, “It was all my fault.”
But Sean – himself a survivor of childhood physical abuse – doesn’t let it go. Instead, he keeps repeating, “It’s not your fault. It’s not your fault.”
Will gets angry, but then his anger quickly dissolves into tears. His control breaks, and – after many weeks of building trust with Sean – Will allows himself to feel the pain of his past. This is a turning point in his life.
Will’s story is not uncommon.
If you’ve been struggling with substance abuse and the pain of past bullying or physical abuse, it’s time for your turning point.
It’s time to know what you know and feel what you feel.
It’s time to work with your past, and thereby free up your future.
There are many things in life we try to control on our own. We try to control what other people do, say and feel about us. Sometimes, we internalize these things. There are also times where we don’t control the things we can. Some days, we just don’t feel like it because it appears as though everything is falling apart in the middle of a life-storm creating a flight or flee response. But even in difficult times, we can get through life-changing events.
As life happens, try to be honest for what’s true for you. Remind yourself, you have power no matter the circumstances that comes your way and with the help of a therapist; you can cultivate a meaningful, fulfilling and compassionate life for yourself. It is empowering to keep in mind that you are not alone.
Here are 12 ways **therapy can be helpful in navigating life.**
1.How you talk to yourself – therapy can provide tools on how to use positive self-talk.
2.How you react to others – therapy can help you align your emotions so they do not negatively impact your behaviors.
3.How you structure your time – therapy can help you identify ways you may be spending useless energy and time on things that do not add to your overall, daily productivity and well-being.
4.How to create your space – healthy boundaries in every area of your life are important to avoid emotional, spiritual, physical and mental fatigue.
5.How to ask for help – this can be a struggle for everyone, yet therapy starts the process of learning how to ask for help and from others in your life.
6.How to say yes and no – therapy can help with not feeling guilty for saying “no” or “yes” when you absolutely need and have to.
7.How to take care of you – therapy can provide tools on how to practice meaningful self-care with a lasting impact that can be used time and time again.
8.How to be honest with yourself and others – it can be hard to face yourself and admit certain truths, but therapy provides a safe space for being honest and self-exploration that can be freeing for you and others in your life.
9.How to channel your grief – a therapist can help guide you through the stages of grief in a healthy way.
10.How to manage racing thoughts – therapy can provide a safe space to release those racing thoughts and process in a healing way.
11.How to deal with regrets – therapy can show you how to be mindful, thankful and live in the present while accepting the past as it is – the past.
12.How to have a healthy relationship with your body and food – therapy can help you identify loving ways to treat your body not based on food.
I encourage you to think of ways therapy can be helpful for you.
I’m proud of being an occupational therapist, but I don’t always like explaining it.
Occupational therapy is a profession that a lot of people don’t understand, some people think it is all about work and others confuse it with occupational health.
In June 2016 an occupational therapist sent a confession into the Simon Mayo BBC radio 2 show, she stated that she was not going to give her job title or explain her role as it was too confusing. It soon became clear to myself and all occupational therapists across the land that were listening that she was an occupational therapist.
It was a shame that she didn’t want to explain our profession, what a great opportunity to fly the flag for occupational therapy on national radio at prime time. But also completely understandable that she would not want to take this task on, and endeavour to succinctly explain on national radio. Occupational therapists were listening and an occupational therapist from the OT Practice was on the programme the following day explaining very well what occupational therapy is. The profession sighed a huge sigh of relief.
You may have heard that we are called OTs too, that’s right, but I’m not using the phrase here as I think it confuses matters more, and that as a profession we need to use our full title to promote occupational therapy.
Some people say that the physiotherapist will support you to walk again, but the occupational therapist will support you to put your dancing shoes on and get back on the dance floor. An explanation I heard when I was studying was that the doctor will help you live longer and the occupational therapist will help you live better.
The trouble is with explaining occupational therapy is that the profession is so broad and occupational therapists work in so many settings. We are dual trained in physical health and mental health, we work in paediatrics, orthopaedics, social care, learning disabilities, hospice, hospitals, community, the list is endless, but we could pop up anywhere. All of these roles will be different, so there is not a set answer for what is occupational therapy?
But let me have a stab at explaining it for you here.
Occupational therapy is a profession that promotes health and well being through occupation. Occupational therapy focuses on enabling people to take part in their hobbies and activities despite illness, disability, mental health or emotional difficulties. We are motivated and inspired by the things that we want to do, this is what gets us out of bed in the morning!
We view occupation as being anything that we do, so this includes having a shower and brushing your teeth, paid or voluntary work, leisure and sports activities, even sleeping. While we can take these things for granted, if we have an accident, illness or disability it can become much more difficult and exhausting to do any of our activities or our occupations. If you are fortunate enough to be fit, well and able bodied how would you cope if you broke an arm or a leg?
After illness or injury it can be difficult to participate in your every day roles, and maintain structure and routine, especially if your mind and body are affected. When you have barriers to achieving your goals an occupational therapist can support you as an individual to accomplish what is important to you, by building on your skills and adapting your activities and environment.
After my breast cancer surgery I was unable to run, so I had to adapt and substitute running with walking. I could not reach or lift things so again I had to adapt by placing things in reach, and getting help with the heavy stuff. I was fatigued so I had to learn to pace myself throughout the day and I had trouble sleeping so I developed a good sleep hygiene routine.
I was being my own occupational therapist, making adaptations to the way I do things and to my environment to enable me to live life my way, and continue doing my occupations.
This is what occupational therapists do, we treat the person, not the diagnosis, we find out what is important to you, what you’re having difficulty with and support you to live life to the full. We are problem solvers, and love to be creative in our approach, we treat you holistically and will work on small goals with you to reach the big ones.
If you or somebody you know are living with or beyond cancer and you think you or they could benefit from occupational therapy please get in touch.
If there’s anything I have learned from more than 20 years of being a therapist, it’s that we all can benefit from therapy at different points in our lives.
As part of the human condition, we each may experience issues such as stress, anxiety, depression, grief, or relationship problems. Therapy can help us resolve these issues and move forward in our lives, both personally and professionally.
Many of us have somebody in our lives who we believe might benefit from therapy. This may be a sensitive issue to broach because we don’t want them to feel criticized by the suggestion that they might benefit from counseling. The following are seven tips for effectively recommending therapy to somebody:
1) Act swiftly, don’t delay
Resist the temptation to minimize issues or just hope the problem will magically disappear
Don’t wait until there is a full-blown crisis to recommend therapy
Remember that saying something sooner may prevent a larger issue from arising (i.e. relationship break-up, job loss, etc)
2) Normalize, don’t shame
Express empathy for their feelings; recognizing that their feelings are a normal response to their nature and nurture
Consider saying something along the lines of,“It’s completely understandable that you are overwhelmed with everything you have going on right now. You deserve real support.”
Share your perspective that therapy is something healthy and proactive—a routine aspect of healthcare, like going to a dentist or physician. Encourage them to consider a therapist as a personal trainer or coach for the mind, or for relationship success.
Disclose if you yourself or others you know (without violating any confidentiality, of course) have benefited from therapy. If you haven’t, express that you yourself would be open to the seeking counseling as needed.
3) Express care, not judgement
Provide love and support, not criticism
Don’t diagnose–leave that up to the experts
Do say, “I love you” or “I care about you” or similar expressions of support. “You just don’t seem like yourself and I want you to feel good.”
4) Address concerns and provide reassurance
Explain that therapy can shift your thinking so it’s more positive, help you process feelings, know yourself on a deeper level, increase coping skills, improve self-esteem, stop self-sabotaging behaviors, end relational patterns that no longer serve you, facilitate healthy communication at home/work, and help you create healthy work/life balance.
Let them know that therapy doesn’t have to be long-term. Solution-focused, short-term therapy can be very effective in resolving many issues.
Understand that some people have a fear of being analyzed or judged but that a good therapist is one who is compassionate, supportive, and objective. Therapists are professionals who can provide insight and tools to help you move forward in your life, both personally and professionally.
5) Provide resources to find a therapist
Some people aren’t sure which type of provider to select.
Psychiatrists:: provide medication and sometimes therapy
Psychologists:: provide therapy and sometimes testing
Therapists (Licensed Clinical Social Workers, Licensed Clinical Professional Counsellors and Licensed Marriage & Family Therapists) provide therapy
When in doubt, start with a therapist because they are generally less expensive and they can asses and refer out if medication or testing is needed
www.findHelp.co.za can help you find a therapist who meets your needs in terms of area of expertise, cost, and location.
Community Mental Health Centers (CMHCs) are available in most urban areas and provide quality and affordable outpatient counseling services, often on a sliding fee based on income. Check your community directory for a CMHC near you.
Many local hospitals offer counseling services in outpatient mental health centers.
Many schools and universities offer free or low-cost services.
6) Provide information about the cost
Recognize that expense is often a concern and provide the following information:
Many therapists offer a free consultation to determine fit. They might also help you determine if individual, couples, or family therapy would be most effective.
They may have benefits through their employer which may include 1-5 free sessions for assessment, brief treatment, and referral.
Sliding fee services are available at CMHCs or in practices that have clinical interns or therapists-in-training.
Due to the Mental Health Parity Law, insurance coverage for outpatient mental health coverage is the same as it is for major medical services.
You may be able to save money by seeing an in-network therapist but out-of-network coverage may also be pretty good. Many practices will check your benefits for you and explain your out-of-pocket costs ahead of time.
Flex spending or Health Savings Accounts are a great way to use pre-tax money to pay for your health expenses. This may be especially helpful if you have a high deductible.
7) Provide support and access support
Offer to go with them to the first session. If you have significant concerns about the person you are trying to refer and they are resistant, consider enlisting the help of other friends or family.
For serious concerns, consider facilitating an intervention or hiring an interventionist.
In cases of emergency, dial 911 or bring the person of concern to the local emergency room for an evaluation.
Assure them you will continue to be a source of support–therapy is not a replacement for your friendship.
Let go of outcome. If the person does not follow through with therapy, know you have done your part. If their behaviours are harmful to you or your relationship with them, you may also need to reevaluate your boundaries with them or even if the relationship is one you wish to continue. You might consider seeking support through 12-step programs such as CODA or Al-Anon.
“If you light a path for someone else, it will also brighten your path.” ~Buddha
When life becomes too burdensome, when home and work responsibilities become too much, and when you feel as though you have the weight of the world on your shoulders; what do you do? Maybe you ask your spouse or family members to help you with the laundry or the cooking, or you ask your boss or coworkers for a hand when the pile in your inbox begins to overflow and spill over the sides. You ask for help because you realize that no one can do everything on their own. You ask for help because you accept that you need it and you are willing to take it.
I wish it were as easy as that for me.
Asking someone for help when I need it is one of the hardest things I have to deal with in my adult life. I can think of a thousand other things I would rather endure than to pick up the phone and ask someone I know for a helping hand. In my head, no problem is too big or too small for me to handle on my own and if I’ve made it this far in my life without anyone to lean on, then why start asking people for help with any problem I have now?
The easy explanation for why I have such a difficult time asking for help is that I let my pride get in the way of my common sense. If I’m having a financial, parenting, or relationship problem, the last thing that I want is for other people to know about it. I don’t want an outsider knowing anything about my household or any of the problems I may be having in it. If there is a problem in my house, then I will fix the problem and no one else needs to be involved in any way.
Pride is the easy explanation. The more difficult, harder to face explanation is that I can’t ask people for help because I don’t feel like I can count on anyone in my life to help me when I truly need it. I expect people to abandon me or ignore me when things get hard and the last thing I expect out of anyone is to step up and be there for me in my time of need. I spent most of my adult life deathly afraid to ask anyone for anything because I was afraid that they would walk out on me and I was afraid to lose someone I cared about because I needed their help.
How can I expect people to help me in my adult life when I spent my childhood experiencing one person after another letting me down and leaving me in my abusive situation? How can I expect anyone to lend me a helping hand as an adult when I begged for help as a child and was ignored time and time again? I spent my childhood watching adults ignore my situation and refuse to step in, which made me learn quickly that if I needed help, I would have to figure it out myself.
If adults wouldn’t help me back then, how in the world can I expect them to help me now?
It’s physically and mentally exhausting trying to do everything by yourself and trying to be everything to everyone without any help whatsoever. It’s heartbreaking to go through life believing that no one cares about you enough to lend you a helping hand if you need it. And it’s silly to actually believe that you can go through your entire life without ever getting help from anyone.
There have been a few times in my adult life where I truly needed someone’s help. A few times where a problem has arisen that was just too big for me to handle on my own and it was absolutely necessary to have someone else step in and lend me a helping hand. Asking for help was one of the hardest things I had to do, but at the end of the day, I couldn’t have made it without it. I had to take that risk, learn to trust, and hope for the best when I asked for help when I needed it. I had to realize that once in a while, it’s OK to appear vulnerable and show people that you are as human as they are. No one is perfect and everyone needs help once in a while.
It’s one thing to be prideful and not want to involve people in your problems; it’s another to go through life scared to trust anyone to help you. It’s a fear in your head that you are carrying over from a past experience or a past relationship; a fear that is crippling you in forming meaningful relationships as an adult. Everyone has problems that they need help with and everyone needs a helping hand once in a while. Just because you ask for help doesn’t mean you are weak and helpless, it means that you are human.
And trust me; there are more people out there willing to help you than you think. Don’t be afraid to ask for help if you need it and don’t be afraid to show people your human side. Life and people aren’t as cruel as we were made to believe from our past.
New research has found that a major factor predicting how much an alcoholic will drink is immediate mood.
The new study also found that suffering from long-term mental health problems did not affect alcohol consumption, with one important exception: Men with a history of depression had a different drinking pattern than men without a history of depression. Surprisingly, the researchers found that those men were drinking less often than men who were not depressed.
“This work once again shows that alcoholism is not a one-size-fits-all condition,” said lead researcher Victor Karpyak of the Mayo Clinic. “So the answer to the question of why alcoholics drink is probably that there is no single answer. This will probably have implications for how we diagnose and treat alcoholism.”
The study, presented at the 2017 European College of Neuropsychopharmacology (ECNP) Congress, determined the alcohol consumption of 287 males and 156 females with alcohol dependence over the previous 90 days, using the accepted Time Line Follow Back method and standardized diagnostic assessment for life time presence of psychiatric disorders (PRISM).
The researchers were then able to associate this with whether the drinking coincided with a positive or negative emotional state (feeling “up” or “down”), and whether the individual had a history of anxiety, depression, or substance abuse.
The results showed that alcohol dependent men tended to drink more alcohol per day than alcohol dependent women.
As expected, alcohol consumption in both men and women was associated with feeling either up or down on a particular day, with no significant association with anxiety or substance use disorders.
However, men with a history of major depressive disorder had fewer drinking days and fewer heavy drinking days than men who never a major depressive disorder, according to the study’s findings.
“Research indicates that many people drink to enhance pleasant feelings, while other people drink to suppress negative moods, such as depression or anxiety,” Karpyak said.
“However, previous studies did not differentiate between state-dependent mood changes and the presence of clinically diagnosed anxiety or depressive disorders. The lack of such differentiation was likely among the reasons for controversial findings about the usefulness of antidepressants in treatment of alcoholics with comorbid depression.”
While the study will need to be replicated and confirmed, Karpyak said the reasons alcoholics drink depend on their background, as well as the immediate circumstances.
“There is no single reason,” he said. “And this means that there is probably no single treatment, so we will have to refine our diagnostic methods and tailor treatment to the individual.”
It also means that treatment approaches may differ depending on targeting different aspects of alcoholism, such as craving or consumption. Treatment also needs to take into account whether the alcoholic patient is a man or a woman and whether the patient has a history of depression or anxiety, he noted.
Source: The European College of Neuropsychopharmacology (ECNP)
Have you ever stopped to think about how profound music has been for you in your life? Just the beginning of a song can change someone’s mood, drop us into a state of reflection on life, reduce stress or even prepare us for a better athletic performance.
For many people there may be a calming effect to Billy Joel’s “Piano Man.” Or Rachel Platten’s “Fight Song” can create a surge of energy bringing up a feeling of courage and confidence. Or Harry Chapin’s “Cat’s in the Cradle” can drop you into a reflective mood on the impermanence of life and the longing for connection. Apparently, science shows that Beethoven’s 9th symphony can have positive impacts on our health and well-being.
In this study, Oxford University scientists took 24 healthy volunteers and had them listen to a variety of different forms of music. They found that listening to music with a 10-second repetitive cycle like Beethoven’s third movement No. 9 can lower blood pressure and prevent heart disease.
There’s no question about it that music has dramatic effects on our thoughts, emotions and sensations. Matisyahu’s “One Day” can inspire a sense of global hope and instantly bring a smile to your face.
Does this resonate with you?
When it comes to your brain’s ability to believe what I’m saying, talk only goes so far, but experience takes it to the next level. If you’d like to investigate this for yourself, Beethoven’s 9th Symphony is over an hour and you can find it here. But I believe you’d have to listen to the entire hour to replicate the study.
In the six month online mentorship program A Course in Mindful Living, a element we use to better understand ourselves is music. We post music and watch how it impacts our thoughts, emotions and sensations from moment to moment. Take some time to consider what relaxing tunes are to you, create some space, put them on and notice what comes up for you. If you need any help, here’s a Relax and Retune Playlist that was compiled by the last group that went through the course.
After listening, tell us how music impacts you! Share with us other music that inspires any of these feelings for you – calm, wakefulness, self-acceptance, self-compassion, joy, happiness, energy, compassion, generosity, and balance.
Let’s learn from one another, allowing for the creation of a Playlist for life.
Betty sits alone in the kitchen late at night, tearfully reviewing the current state of her life and marriage. Things looked so promising when she married Arthur after meeting at school! A modest home in the suburbs, two beautiful children, a small circle of friends, meaningful work as a school administrator, church picnics and potlucks—what more could she want?
And yet, unbeknownst to even her closest friends, Betty has suffered for nine years as a result of Arthur’s longstanding depression. At first, she attempted to utilize her naturally cheery disposition to “jolly” Arthur out of his dark moods, but came to realize that Arthur’s gloom could not be so easily dismissed. With the help of their family physician, she was able to persuade Arthur to seek treatment. After a number of false starts, he is now taking his medication “fairly” regularly and seeing a therapist “almost” every other week in a nearby town.
Over the years, Betty has had to make excuses for Arthur’s absence from community functions. Often, she herself has been reluctant to leave him at home alone with the children, since he seemed incapable of providing the kind of supervision she believed was necessary given his low energy level and seeming preoccupation with matters that might have best been put behind him.
As she dries her eyes and begins to prepare tomorrow’s school lunches for her children, she has difficulty recalling the last time she and Arthur shared the kind of “quiet exhilaration” she knew with him when they first met.
As this example illustrates, the harmful effects of depression are not limited to the person diagnosed with that disorder. Clearly, depression in one marital partner can affect that person’s spouse. In fact, depression in a marriage often disrupts communication and social patterns and can even contribute to depressed mood in the “non-depressed” spouse.
WHAT CAN I DO?
The first and most important thing you can do is to find ways to remind yourself that your spouse or partner is ill—not hostile, not stupid, not out to get you, not stubborn, not any of a dozen unfriendly things you might feel like calling him or her when you are at your wit’s end. Diagnosed depression is much like diabetes or heart disease from the perspective that it is a chronic illness that requires special attention and considerable patience.
Patience of this magnitude is a tall order. It will help if you have a good friend, a supportive family member, a pastor, a therapist, or some other caring person in your life to listen to you and help to shore you up during the hard times. Recovery from depression often takes longer than the ill person or the people surrounding him or her think they can stand. You need someone to be in your corner!
TAKING CARE OF YOUR PARTNER
Perhaps the single most important action you can take is to assist your spouse in getting proper diagnosis and treatment for his or her depression from a health care professional.
This is not the time to try to make him or her take responsibility. Not going for treatment is generally not a reflection of irresponsibility. It’s part of the illness. A sense of hopelessness is common to all depressive illnesses and may be the very thing that keeps your spouse from getting needed help! You can gradually turn responsibility back over to him or her when he or she has accepted the diagnosis and is actively working on getting better. In the meantime,
If you have to be the one to schedule the appointment with your spouse’s doctor or therapist, do it!
If you want to ensure that your spouse gets to the appointment, arrange the necessary transportation or provide it yourself.
If medication is prescribed, remind your spouse that it will take several weeks for the effects of medication to be experienced. Remain patient, supportive, and reassuring about the eventual success of treatment.
Offer to assist in monitoring the pill-taking and refill process to ensure that the medication schedule is followed closely to ensure the maximum benefit.
Once the depressed person is under a professional’s care, you can add other kinds of supports:
Encourage, but do not “push,” activities, hobbies, sports, and games that gave your spouse pleasure in the past. Inactivity is common during depressive episodes and can prolong the depressive cycle.
Encourage him or her to be physically active. You can start with something as simple as taking walks together. As your spouse feels a bit better, you can encourage him or her to get to a gym, to get on a bike, to exercise to a video—anything that gets him or her moving.
Make an effort to find things that will make him or her laugh. Rent a comedy video, share a joke, do some gentle teasing, draw on your own sense of the absurd. Laughter is the enemy of depression.
Don’t ignore or make light of suicidal talk. There is a risk for suicide at all phases of depressive illness. Be sure to alert your spouse’s doctor or therapist to suicidal talk— it is likely to be a request for help!
TAKING CARE OF YOURSELF
If your spouse is unwilling or unable to follow through on social engagements, remember that it is not your job to make excuses for your spouse to family or friends. Letting those you are closest to know that your spouse has been seriously depressed will not only put the issue squarely on the table, but will open up the potential for you to receive the support anyone in your circumstances would need.
Whatever you do, try not to take the depression on as something you can personally “fix.” Although your support, encouragement, and caring are clearly needed, you can’t “love” this particular problem away. Treatment is the answer and the services of a professional are required.
Take care of yourself. You won’t be of much help to yourself or others if you allow your spouse’s depression to envelop you as well. Eat well. Get enough sleep. Stay in contact with your friends. Continue your work and social commitments to the greatest extent possible.
As stated above, don’t hesitate to get some professional help for yourself if you need it. It’s okay to need a private place to deal with your feelings of anger, disappointment, and upset.
Spouses of depressed people often benefit from couples’ work or family therapy involving the depressed partner. A mental health professional can assist the couple or family to recognize and change destructive patterns of relating that often accompany depression in the family. For example, a couple might renegotiate their approach to shared activities and agree to the benefit of time apart. This may remedy disruptions to the social life of the non-depressed spouse and ease marital discord.
Marriage and commitment are for better or worse. Depression is definitely one of the “worse.” It can be trying to maintain one’s own optimism and joy in life when someone you love is under a constant cloud. But with good treatment, encouragement, and caring, most depressed people do recover. With good support, most spouses break through the silence and make it as well.
Have you ever stopped to think about how the mental health stigma doesn’t make sense? So many of us walk around feeling ashamed of our struggles, trying to hide them from the rest of the world.
Yet functioning with these immense internal difficulties actually evinces our strength!
As actress Carrie Fisher wrote in Wishful Drinking:
“Being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of.”
Plus, try this statistic on for size: according to the CDC, nearly 50% of U.S. adults will struggle with at least one mental illness in their lifetime. In this post, we’ll focus on the dual diagnosis of addiction and bipolar disorder.
What Is Bipolar Disorder?
Bipolar is a mood disorder characterized by emotional swings from high to low. People with bipolar deal with depressive “down” phases and manic “up” phases, and they struggle to find a healthy middle ground.
In a depressive state, a person might be immobilized, unable to take care of their usual responsibilities. But in a manic state, that same person might work around the clock.
One quick definition for bipolar is “experiencing extremes”.
This disorder does have a genetic component, but an individual’s environment matters a great deal as well. Growing up in a physically, mentally, or emotionally traumatic environment is a strong risk factor.
Why an Accurate Diagnosis Can Be Difficult
Here are a few key reasons why bipolar disorder can be difficult to diagnose accurately:
First, if a person is under the influence, it’s extremely challenging to provide an accurate diagnosis. Having people detox prior to diagnosis is ideal.
Next, the bipolar label has increased in popularity in recent years. This is great for awareness, but it can also lead to misdiagnosis. For example, sometimes people who are dealing with clinical depression are misdiagnosed with bipolar because of the dramatic difference between their low-functioning depressive state and their usual functioning state. Similarly, rigid, black-and-white thinking can be confused with bipolar symptoms, and so can the aftereffects of trauma.
Finally, when people have a great deal of conflict in their lives, they may be labeled as bipolar. But when they gain the tools they need to resolve those conflicts, often the level of internal tension changes significantly.
In short, understanding bipolar disorder and addiction is critical for accurate diagnosis and treatment.
True bipolar disorder involves an imbalance in brain chemistry, and it’s certainly a serious condition.
Yet in our experience in running a residential addiction treatment center, we see people misdiagnosed as bipolar when in reality they have mental and emotional issues causing a lot of upset in their lives.
That’s not brain chemistry; that’s just upset. We find that when such people heal those issues, the upset in their lives decreases dramatically.
The Connection Between Addiction and Bipolar Disorder
Bipolar disorder is part of a family of mood disorders, including depression, anxiety, and seasonal affective disorder (SAD).
While mood disorders can be caused or exacerbated by drug use, more often people with mood disorders use addictive substances to self-medicate. Many people with bipolar turn to substances during their depressive states.
There is a particularly strong connection between bipolar and addiction. Statistics from DualDiagnosis.org suggest that 56% of people with bipolar disorder have experienced drug addiction.
Healing from Bipolar and Addiction
September is National Recovery Month, and it’s also Self Awareness Month. This is fitting, as you can’t really have one without the other.
Self awareness is an essential component of recovery, especially when you’re dealing with a dual diagnosis.
That said, medication certainly has its place as well. If you find that you continue to struggle with emotional extremes after you’ve detoxed from substances, then medication may give you the support you need to maintain emotional stability.
However, don’t shortchange yourself by skipping over the mental and emotional issues that contribute to mood disorders. Finding and addressing the root causes of physical disorders can minimize (or eliminate!) the need for medications to treat symptoms, and the same is true for emotional disorders.
What Counseling Strategies Work Well with Bipolar?
Specific strategies that work well with bipolar include:
On the mental level, Rational Emotive Therapy (RET) allows people to work with the judgments, the limiting beliefs and the projections in a person’s life.
On the emotional level, Gestalt and Developmental Psychology are particularly helpful for people that went through a trauma and are reliving that trauma over and over.
On the spiritual level, learning about compassionate self-forgiveness empowers people to reconnect with their Authentic Selves.
A trained therapist can help you to work with these counseling strategies, but no one else can force you to do the kind of mental and emotional work necessary to recover.
You yourself must be motivated to question your limiting beliefs and feel the feelings of anger, sadness, and fear that you’ve held at bay for years.
It sounds daunting, and in some ways it is. But we’re willing to bet that you’ll be surprised by your own strength.
Four practitioners open up about why they seek professional help: to maintain boundaries with clients, process their own life events and decide when to retire
Britain’s Prince Harry has earned praise in recent days for speaking up about his personal issues with mental health, the need to not stay silent about emotions, and the benefits of seeking therapy.
Describing how he arrived at a breaking point in an interview with the Telegraph, he explained it was listening to other people’s problems and realizing he was unable to be as helpful as he wanted to be that pushed him to seek help.
“You park your own issues because of what you’re confronted with, and all you want to do is help and listen, but then you walk away and go, hang on a second, how the hell am I supposed to process this?”
He then added that for every three hours of listening to people, psychologists take half an hour to process it themselves with someone else. He’s right: it is one of the most important traditions within the mental health world. Therapists also need therapy.
We asked four psychotherapists with extensive experience in the field to open up about how they, too, use therapists.
David Lopez, practitioner for 15 years, Connecticut
David Lopez, a former president of the American Academy of Psychoanalysis and Dynamic Psychiatry, says there are a few different reasons why therapists will seek therapy.
The first is during the training process, when therapists in training will have a supervisor and often a therapist of their own.
“Typically, people who want to become therapists have an interest in connecting with people. When they are doing therapy that need needs to be redirected, to be tamed so that it does not get in the way of not being objective,” Lopez elucidates.
What needs to be addressed in training is something called “countertransference”, Lopez explains. While a client transferring emotions they would have for someone in their outside lives on to their therapist (called “transference”) is generally considered a good thing, a therapist transferring emotions on to their client is to be avoided.
If a therapist in training was orphaned young, they may emotionally react to stories their clients bring into sessions about parents and loss, for instance. The challenge for the therapist is then not necessarily to get rid of the feelings related to loss and parenting, but to become aware of them and become intimately acquainted with these “blind spots”.
A common blind spot might simply be witnessing a patient struggle with some kind of grief and watch them cry: a therapist may want to go and hug them, and be their friend.
“You may wish to connect with a patient for your own need, instead of applying the tools that you have been taught. But they’re not paying you to be their friends, even if a hug in that moment may feel good to give.”
Elena Lister, private practitioner for 30 years, New York
“Shockingly enough, therapists are also people,” Elena Lister says, not without a considerable amount of irony.
Lister, a psychiatrist, analyst and professor who teaches at Cornell and Columbia universities, says that there is nothing particularly mysterious leading therapists to seek treatment of their own, beyond the initial training requirements during the early years. The answer is it’s life, and life’s trying and often painful events.
Lister herself sought therapy when she lost her six-year-old child to leukemia. At the time, the help she found did not adequately meet her needs, she says. Identifying this lacuna in her own field convinced her to specialize in grief and loss, meaning she could seek to be there for others in a way she had not been able to professionally find herself.
Treating patients (including patients who are therapists) who are undergoing such extreme pain means developing an ability to leave what has happened during a therapy session in the room once it is over.
“You have to be able to keep it in boundaries. Some people have gone through such tremendous suffering. You have to be fully present in the room. But if I am going to do this, it’s my mandate to not carry it to the next room. I have a duty not to.”
To keep herself upbeat and in the right mental space for all her patients, as well as of for herself, Lister says she has to do “all sorts of things. I talk to friends, to myself, to my husband. I exercise, I meditate.”
Leslie Prusnofsky, private practitioner for 35 years, New York
Leslie Prusnofsky, a psychiatrist, psychoanalyst and faculty member at Columbia University, says that in some ways treating therapists is no different than treating non-therapists.
“You’re dealing with a lot of people’s pain. Whether it is therapists or lay patients, pain is human, and human suffering is not unique to one group.”
But Prusnofsky says that treating therapists does sometimes come with its own particular obstacles.
“It can result in more walls that have to be pulled down,” he explains. This will be the case even if the therapist-patients are very willing to engage in treatment.
Part of the therapy process is trying to break through to things that are naturally being protected, he explains. There is “an unconscious resistance” that can be found in everyone, Prusnofsky says, but therapists who know the jargon may be even better than others at hiding the real root of their problems.
“Using the jargon is one of the cover-ups to stay away from the depths of what they [the therapist-patient] actually need to explore.
“If someone comes in saying they have a lot of ‘repressed anger’, you may find with time, the deeper you go, that the anger turns into sadness. What is revealed is a sense of loss or of deprivation that is harder for the person to deal with.”
David Forrest, practitioner for 50 years, New York
For David Forrest, a clinical professor of psychiatry at Columbia University, and a trained psychotherapist and psychoanalyst who also holds a private practice in Midtown Manhattan, one of the most interesting – and tough – questions that therapists go to therapy for is when it’s time to call it quits.
Forrest, whose work includes research and teaching in the field of neurology, says that asking the question of when a psychotherapist should retire is a particularly fascinating one.
“To ask how does a psychotherapist know when it it time to hang up their spurs, asks us to define the mental capacities necessary to be a psychotherapist in the first place,” Forrest poses.
A surgeon may no longer physically be able to withstand the arduous hours, or may suffer from an injury that prevents them from operating, but so long as a psychotherapist’s brain is going, when do they know to stop? Doesn’t an older therapist mean a more experienced therapist, an attribute one would seek?
Memory loss or small mental failings can affect the mind as one gets older and negatively affect remembering a patient’s complex history.
But other things may start to go with age, too, Forrest says, elements that might be just as crucial to quality therapy-giving.
Deciphering what is funny and not, for example, sometimes morphs with age.
If someone contracts frontotemporal dementia, their sense of humor tends to degrade from the more elaborate sensitivities, Forrest says. A therapist with this kind of affliction may develop a new kind of sense of humor – that is less suitable in a therapy room.
“It [the sense of humor] would no longer be deadpan and dry. It would sink to slapstick and sadistic, and the brain would enjoy low-quality humor.”
“The pun is a low sense of humor,” the psychiatrist explains, helpfully.
As for Forrest himself, a veteran of the profession: have decades and decades of practice and inquiry into the human brain started to wear him out? Such a question is one more adapted to younger professionals, he responds.
“For someone like me, there is no question of burnout.”
Cognitive-behavioral therapy (CBT) has been shown to strengthen specific brain connections in people with psychosis. Now, researchers at King’s College London have found that these stronger connections are associated with a long-term reduction in symptoms and recovery even eight years later.
CBT involves helping people change how they think about and respond to their thoughts and experiences. For those with psychotic symptoms — common in schizophrenia and a number of other psychiatric disorders — the therapy involves learning to think differently about unusual thought patterns, such as distressing beliefs that others are out to get them. CBT also helps the patient develop new strategies to reduce internal distress and improve well-being.
The new study follows on the heels of the team’s previous work showing how, after receiving CBT, people with psychosis displayed strengthened connections between key regions of the brain involved in processing social threat accurately. The new results show for the first time that these changes continue to have an impact years later on people’s long-term recovery.
In the original study, participants underwent fMRI imaging both before and after six months of CBT in order to observe the brain’s response to images of faces showing different expressions.
Since the participants were already taking medication when they joined the study, the researchers compared their images to those of a medication-only group. The group receiving medication only did not show any increases in connectivity, suggesting that the effects on brain connections were a result of the CBT.
For the new study, the researchers tracked the medical records of 15 of the 22 CBT participants for eight years. The participants were also sent a questionnaire at the end of this period to assess their level of recovery and wellbeing.
The findings show that increases in connectivity between several brain regions — most importantly the amygdala (the brain’s threat center) and the frontal lobes (involved in thinking and reasoning) — are associated with long-term recovery from psychosis. This is the first time that CBT-related changes in the brain have been shown to be associated with long-term recovery in people with psychosis.
“This research challenges the notion that the existence of physical brain differences in mental health disorders somehow makes psychological factors or treatments less important,” said lead author Dr. Liam Mason, a clinical psychologist at the Maudsley Hospital where the research took place.
“Unfortunately, previous research has shown that this ‘brain bias’ can make clinicians more likely to recommend medication but not psychological therapies. This is especially important in psychosis, where only one in ten people who could benefit from psychological therapies are offered them.”
The research team hopes to confirm the results in a larger sample and to identify the changes in the brain that differentiate people who experience improvements with CBT from those who do not. Ultimately, the new findings could lead to more effective and personalized treatments for psychosis by allowing researchers to determine which psychological therapies are effective.
The findings are published in the journal Translational Psychiatry.
Source: King’s College London
Woman in therapy session photo by shutterstock.
You might wonder, at some point today, what’s going on in another person’s mind. You may compliment someone’s great mind, or say they are out of their mind. You may even try to expand or free your own mind.
But what is a mind? Defining the concept is a surprisingly slippery task. The mind is the seat of consciousness, the essence of your being. Without a mind, you cannot be considered meaningfully alive. So what exactly, and where precisely, is it?
Traditionally, scientists have tried to define the mind as the product of brain activity: The brain is the physical substance, and the mind is the conscious product of those firing neurons, according to the classic argument. But growing evidence shows that the mind goes far beyond the physical workings of your brain.
No doubt, the brain plays an incredibly important role. But our mind cannot be confined to what’s inside our skull, or even our body, according to a definition first put forward by Dan Siegel, a professor of psychiatry at UCLA School of Medicine and the author of a recently published book, Mind: A Journey to the Heart of Being Human.
He first came up with the definition more than two decades ago, at a meeting of 40 scientists across disciplines, including neuroscientists, physicists, sociologists, and anthropologists. The aim was to come to an understanding of the mind that would appeal to common ground and satisfy those wrestling with the question across these fields.
After much discussion, they decided that a key component of the mind is: “the emergent self-organizing process, both embodied and relational, that regulates energy and information flow within and among us.” It’s not catchy. But it is interesting, and with meaningful implications.
The most immediately shocking element of this definition is that our mind extends beyond our physical selves. In other words, our mind is not simply our perception of experiences, but those experiences themselves. Siegel argues that it’s impossible to completely disentangle our subjective view of the world from our interactions.
“I realized if someone asked me to define the shoreline but insisted, is it the water or the sand, I would have to say the shore is both sand and sea,” says Siegel. “You can’t limit our understanding of the coastline to insist it’s one or the other. I started thinking, maybe the mind is like the coastline—some inner and inter process. Mental life for an anthropologist or sociologist is profoundly social. Your thoughts, feelings, memories, attention, what you experience in this subjective world is part of mind.”
The definition has since been supported by research across the sciences, but much of the original idea came from mathematics. Siegel realized the mind meets the mathematical definition of a complex system in that it’s open (can influence things outside itself), chaos capable (which simply means it’s roughly randomly distributed), and non-linear (which means a small input leads to large and difficult to predict result).
In math, complex systems are self-organizing, and Siegel believes this idea is the foundation to mental health. Again borrowing from the mathematics, optimal self-organization is: flexible, adaptive, coherent, energized, and stable. This means that without optimal self-organization, you arrive at either chaos or rigidity—a notion that, Siegel says, fits the range of symptoms of mental health disorders.
Finally, self-organization demands linking together differentiated ideas or, essentially, integration. And Siegel says integration—whether that’s within the brain or within society—is the foundation of a healthy mind.
Siegel says he wrote his book now because he sees so much misery in society, and he believes this is partly shaped by how we perceive our own minds. He talks of doing research in Namibia, where people he spoke to attributed their happiness to a sense of belonging.
When Siegel was asked in return whether he belonged in America, his answer was less upbeat: “I thought how isolated we all are and how disconnected we feel,” he says. “In our modern society we have this belief that mind is brain activity and this means the self, which comes from the mind, is separate and we don’t really belong. But we’re all part of each others’ lives. The mind is not just brain activity. When we realize it’s this relational process, there’s this huge shift in this sense of belonging.”
In other words, even perceiving our mind as simply a product of our brain, rather than relations, can make us feel more isolated. And to appreciate the benefits of interrelations, you simply have to open your mind.
Visually creative people tend to have poorer quality of sleep overall, while verbally creative people tend to sleep longer and later, according to new research at the University of Haifa in Israel.
The study, which compared the sleeping patterns of social science and art students, strengthens the hypothesis that visual creativity and verbal creativity involve different psychobiological mechanisms.
“Visually creative people reported disturbed sleep leading to difficulties in daytime functioning,” said study co-author Neta Ram-Vlasov, a doctoral student at the Graduate School of Creative Art Therapies at the University of Haifa.
“In the case of verbally creative people, we found that they sleep more hours and go to sleep and get up later. In other words, the two types of creativity were associated with different sleep patterns.”
The researchers sought to understand how the two types of creativity influence objective aspects of sleep such as duration and timing (measures such as the time of falling asleep and waking up), and subjective aspects like sleep quality.
Creativity is often characterised by four traits: fluency — the ability to produce a wide range of ideas; flexibility — the ability to switch easily between different thought patterns in order to produce this wide range of ideas; originality — the unique quality of the idea relative to the ideas in the environment; and elaboration — the ability to develop each idea separately.
The study was conducted by Professor Tamar Shochat of the Department of Nursing and doctoral student Ram-Vlasov, together with Amit Green from the Sleep Institute at Assuta Medical Center and Professor Orna Tzischinsky from the Department of Psychology at Yezreel Valley College.
The study involved 30 undergraduate students from seven academic institutions, half of whom were majoring only in art and half of whom were majoring only in social sciences. The participants took visual and verbal creativity tests. They also underwent overnight electrophysiological sleep recordings, wore a wrist activity monitor (a device that measures sleep objectively), and completed a sleep monitoring diary and a questionnaire on sleep habits in order to measure the pattern and quality of sleep.
The researchers found that among all the participants, the higher the level of visual creativity, the lower the quality of their sleep. This was manifested in such aspects as sleep disturbances and daytime dysfunction. The researchers also found that the higher the participants’ level of verbal creativity, the more hours they slept and the later they went to sleep and woke up.
A comparison between the sleep patterns of art students and non-art students found that art students tend to sleep more, but this in no way guarantees quality sleep. For example, art students evaluated their sleep as of lower quality and reported more sleep disturbances and daytime dysfunction than the non-art students.
Further studies may help determine whether creativity influences sleep or vice versa (or perhaps neither is the case).
“It is possible that a ‘surplus’ of visual creativity makes the individual more alert, and this could lead to sleep disturbances,” the researchers suggested. “On the other hand, it is possible that it is protracted sleep among verbally creativity individuals that facilitates processes that support the creative process while they are awake.
“In any case, these findings are further evidence of the fact that creativity is not a uniform concept. Visual creativity is activated by — and activates — different cerebral mechanisms than verbal creativity.”
Source: University of Haifa
Moving from the culture of addiction to the culture of recovery is a challenging journey that requires physical, mental, emotional, social and spiritual recovery capital to ensure that we have the resources to support us in our recovery.
In order to fill the void that is left by abstaining from harmful substances and behaviour, it is important that we start to develop tools and techniques that aid our recovery.
By giving us the objectivity of “mindsight” to be able to observe our feelings, thoughts and behaviour in a potentially harmful situation, we are better equipped to develop new thought patterns, so that we are able to overcome early-stage cravings and urges.
By understanding the importance of spiritual principles and determining what our personal values are, we can start to feed our souls. Instead of pursuing destructive behaviour patterns that are prevalent in substance abuse, we should try and develop healthy pursuits, explore new interests and identify which elements of our lives need to cultivated. People in early recovery often experience difficulties because they are not prepared for the feelings of loneliness and emptiness they experience because of they have lost their “best friend”. According to psychiatrist, Elizabeth Kübler-Ross, people in recovery go through the stages of grief, like those experienced when losing a close friend or family member. People will most likely experience denial, anger, bargaining, depression and acceptance during the process and may be unaware that we are actually grieving. Again, by understanding and acknowledging our situation, we are able to more effectively deal with obstacles we may confront in the early stages of our recovery journey.
Personal learning and self-development will ensure that we are more empowered, moving towards a life of purpose and fulfilment in the later stages of recovery. Goal setting and action planning are skills that can be consciously developed to aid forward movement in recovery.
By joining a Recovery Wellness Program clients are encouraged to design their own recovery plan and identify and capitalise on their personal strengths, while be aware of areas of weakness and possible obstacles that might jeopardise their early recovery. By engaging in adult education in an environment of positive psychology, solutions-driven coaching and peer support, one is given a safe to explore recovery in an honest, empowering program.
It is a widely accepted statistic that only 1 in 10 addiction patients who receive treatment, will achieve long-term recovery of 5 years or more. Without looking at how statistics are formulated we know that whatever the actual rate is, it is incredibly low.
The question to be asked is how do we increase the chances of a successful recovery?
The answer to that is quite simply after-care (or extended care). We wouldn’t release a patient from Intensive Care without follow-up rehabilitation, support and medical assistance and addicts need and deserve the same kind of post-treatment care.
The phases of recovery, as laid out below, demand that in order for patients to have a reasonable chance at a successful recovery, continued treatment needs to be applied that deals specifically with these phases. The Extended Care Model differs in approach and content from Inpatient Treatment.
The extended care model also and most importantly proposes that the most difficult period of recovery is going to occur when most patients have left Primary Care treatment and the patient needs to be managed during this time. Much of what happens during the first six weeks of treatment / recovery is about containment and dealing with denial. Learning the coping skills required to achieve long-term recovery only become possible after about 3 – 5 months of sobriety, as by this time the brain has only begun to heal sufficiently enough for the patient to be able to process and learn anything new.
The addict is also faced with life away from the secure and structured environment of a treatment centre, which brings its own challenges. Facing these challenges with the assistance of an Extended Care model, will greatly assist in not only achieving long-term recovery but true happiness in the years to follow.
PHASES OF RECOVERY
1. Withdrawal Stage (First 7 – 14 days)
Difficult withdrawal symptoms are related to the amount, frequency and type of substance use.
Early Abstinence (First 14 – 45 days) – “Pink Cloud”
Most people feel quite good during this period and often feel “cured.” As a result, they may want to end treatment or stop attending a support groups. The energy, enthusiasm and optimism felt during this period must be directed towards building a strong recovery foundation.
Protracted Abstinence (First 45 days – 5 months) – “The Wall”
“The Wall” is a period characterised by difficulties with thoughts and feelings caused by the continuing healing process in the brain. The most common symptoms are depression, irritability, difficulty concentrating, low energy and a general lack of enthusiasm. Relapse risk goes up during this period due to strong craving cycles. Focus must remain on remaining abstinent one day at a time.
Readjustment (First 5 – 7 months)
The substantial brain recovery after 5 months allows for developing a life with fulfilling activities that support continued recovery. Although a difficult part of recovery is over, hard work is needed to improve the quality of life. Because cravings occur less often and feel less intense, relapse risk can increase if high-risk situations are not avoided.
Finally, the recovering addict has no concept of a life without alcohol or drugs and this thought is truly terrifying, with the support, care, knowledge and understanding that after-care teaches, the addict is nurtured until they can experience for themselves the true joy and serenity that recovery has to offer.
Imagine you were in a raft on a lake headed for an enormous waterfall. While many of us would panic and immediately start praying to G-d to help us, (suddenly making promises to give more charity or vowing to start becoming more observant should He intervene to save us!) not many people I know, would rely on prayer alone. Most, would also be frantically using their ores to try and steer away from the fall.
Change requires action! It is no use to complain about things in our lives without putting in the work to try and shift them. Addiction is a black hole of helplessness. It is dark, scary and lonely. It renders you powerless and broken spirited. It is so hard to imagine that it is possible to change your life. Perhaps the intention to stop is strong but where to even begin is an enigma. The point is, to stop using drugs, you have to stop using drugs. Things will only begin to change when you decide to do something different: consider attending your first NA meeting, reaching out for help, calling that counselor whose number you have had for months. You don’t have to change everything at once, but you cannot do what you have always done and expect different results.
The great news is that help is available for anyone who wants it, and recovery from addiction is absolutely possible! It is uncomfortable to ask for help if you are the kind of person who isn’t used to relying on others. But you cannot arrest an addiction on your own – and you don’t have to. There are so many people ready to support and help you through the process – so let them!
Sound inviting? Didn’t think so. So why is it that thousands and thousands of people voluntarily put poisonous chemicals into their bodies, up their noses, down their gullets and into their veins, knowing that there is risk of addiction?
Think back to when you were in grade 1 (for some this may require digging deep into your grey matter) and your teacher was asking the class “What do you want to be when you grow up?”. I hardly imagine any one of you put up your hand and said: “Well Miss, I really hope I land up in the gutters of Hillbrow, not a cent to my name, not a friend in the world, with a dirty needle sticking out my arm, nursing one chronic heroin addiction”.
No one chooses to be an addict. No one takes their first drink, first puff or first snort thinking they will loose a battle for control because in the beginning stages of using drugs and alcohol, there is a degree of control. But as the usage becomes more and more frequent, the less and less control there is, until the using becomes compulsive in nature.
A major reason this happens is because drugs alter the chemistry and structure of the brain! Let’s look at an analogy that’s useful when talking about structural brain change and chemicals.
Imagine walking the same line on a carpet, every day, all day for a year. At first the carpet – all brand new – doesn’t have any indication of a path. But the more you walk on the same line, the more and more the carpet will begin to wear until eventually it is completely worn in, with a clear pathway of where you have been treading. After a year the pathway you have walked, is clearly visible and the carpet is certainly worse for wear. It cannot ever go back to way it was when you bought it. It cannot be repaired. If you want a carpet with no path, you have to buy a new one.
Chemicals do the same thing in the brain as they activate the pleasure pathway (i.e. it feels good, that’s why people say you feel high). At first, your brain – prior to the ingestion of substances – it a beautiful mass of mess. Consisting of billions and billions of neurons. But the more and more you use, the more and more the pleasure pathway becomes activated until it is completely worn in – more like a trench than a pathway. And as was the case with the carpet, so is the case with the brain. It cannot ever go back to the way it was before. It cannot be repaired. And that ladies and gentlemen is why no addict can ever return to a state of controlled use. Unlike the carpet, you cannot buy a new brain! What’s done is done and cannot be undone (I doubt Shakespeare had this in mind when writing Macbeth).
How do I know if my loved one has an addiction?
For some friends and families the addiction is “out in the open” and everyone is aware that it is happening, but for others of you there may be the start of a suspicion and an inkling that something is not right with the person you love. For these of you, this is never an easy straightforward question to answer.
It may start with thinking Something’s up! I’m not sure what’s happening but something in my gut tells me my loved one is not telling me the truth.
It may start with stories that seem too far fetched to be true or it may become too unlikely that bad things keep happening to them and everyone else is to blame.
Its likely that the person you know and love has changed so much that they are not the person you know and care for. While there may be a number of reasons that could account for a change in someone’s behaviour, it could be reason enough to think IS IT AN ADDICTION?
What can be an addiction? What should I look out for?
Remember: whilst drugs and alcohol may be the most common things that come to mind when speaking of addiction, addiction is like an octopus, it is able to change forms and take on many different manners.
While the signs and symptoms for specific addictions may vary, here are some of the more common ones across the board.
Living with addiction is like being on a rollercoaster
It can be very frightening and frustrating living with addiction. We understand that you are probably filled with anxiety and fear and have many questions to ask. It may confuse you, and at times it may feel like you are on an emotional rollercoaster. One day you may feel completely drained and empty and the next hopeful that you can live with, and recover from your loved one’s addiction. We welcome you here and hope you find something that can help you, wherever you are today, in this moment!
We know that you may have hoped and prayed that your loved one would wake up one day and decide that enough is enough and willingly ask for help. You may even have had your loved one in treatment only to face the reality of relapse once they leave and it seems like you are back to square one. You may have hoped that they would hit their “rock bottom” and have reached a point where they couldn’t continue for one more day. We know that you may have believed that if you could love them more, be harsher, shown them more compassion, set more rules, shown more empathy and acted with unconditional kindness that they would stop. And we also know that you may have learned and lived through enough to know that this so often simply doesn’t happen.
Me? My recovery? I don’t understand it’s not about me!
As addiction is a lengthy process, so too is recovery. We hope you have found this site for YOU, for YOUR recovery sometimes irrespective of whether your loved one is in recovery or not . Living with addiction is consuming. It takes over your life, your thoughts, and your behaviour and somewhere in all the chaos and confusion YOU get lost. You may have discovered that despite all your efforts to help your loved one they still haven’t changed. What we hope you grasp now is that while you may not be able to change your loved one, you can discover that YOU CAN DO SOMETHING FOR YOUR OWN HEALING. And when you start to do things differently, you being to heal and your loved ones slowly begin to change.
We truly understand what you are going through, we are so glad you found this site but sad that you had to. We hope you find what you are looking for.
Please check out the halfway houses, support groups and treatment centers on: www.findHelp.co.za
The phenomenon of relapse proves that addicts and alcoholics can be clean and sober with no physical craving and still choose to pick up a drug or a drink despite knowledge of the consequences.
How can seemingly rational and often intelligent people lose sight of how dangerous drugs and alcohol are to them? The Big Book of Alcoholics Anonymous refers to a “peculiar mental twist”, a thinking error, which tells us that addiction affects the mind of the sufferer as well as his body.
12 Step programs go further than this though – the founding concept is that addiction is a three-fold illness that affects the mind, body and spirit. As soon as the word ‘spirit’ is mentioned, one begins to understand the limits of medicine and psychology in the treatment of addiction.
Once the drugs and alcohol are gone, most of us are left with the ongoing problem of the way we think and react to life on life’s terms. These coping mechanisms are the exact character traits that gave addiction so much power in our lives.
12 Step treatment centres like The Cedars recognize the value of introducing a spiritual program as early as possible to our patients, knowing that to treat only the physical addiction is treat a symptom and not the underlying cause of the illness.
Spiritual matters are often intimidating and misunderstood. 12 Step fellowships are not religious in nature though members are obviously free to adhere to or explore individual religious beliefs.
Spirituality in terms of the 12 steps though, is practical: our understanding of a spiritual experience is that it rearranges us internally and changes our outlook. On a daily basis, we recommit to a way of life which is an active attempt to grow as people, take responsibility and strive towards ethical ideals. Not because we want to be saints, but because we want to feel connected, purposeful and good about ourselves.
Membership of 12 Step fellowships worldwide is in the millions, with 23 million confirmed members in the United States alone. The reason for this would be that it is one of the only proven methods not only for achieving recovery, but maintaining it. It outlines an approach to life that dramatically alters the way we respond to reality and gives us possibly best chance available of becoming happy, free, productive members of the human race.
Rather drink nothing if you have to drive, is the advice for responsible drinking this festive season.
Mrs Sorika de Swardt, Elim Clinic Addiction Consultant said that having a good time and enjoying a few drinks has become synonymous in our society.
Alcohol is supposed to be enjoyable and relax you, but don’t try and quench a thirst with Alcohol because this will lead to gulping way more drinks much faster than what the body can deal with.
Some ways to limit your alcohol intake during long hours of socialization are as follows:
· Drink a glass of water in between alcoholic drinks.
· To avoid the constant pressure for a full glass, dilute alcohol with water or ice.
· Don’t mix or top up your drinks as you cannot keep track of quantities.
· Stick to familiar drinks of which you know what the effect on you will be.
· De Swardt said the best way to keep track of what you are drinking is to pour your own drinks and to finish a drink before having another one.
· Ensure that you know the recommended safe limits for your gender, age and weight.
Contrary to popular belief, a proper meal does not sober you up. This meal would only protect your stomach lining but does not dilute the alcohol. De Swardt said each body reacts differently to alcohol and drugs, as it depends on you gender, age, period of time you have been drinking and the use of medication with alcohol. The legal drinking limit in South Africa allows 0.05 grams of alcohol per 100ml in your blood. People reach this sooner than they realise. For an average male this would be after one and a half drinks and after one drink for an average woman if a drink equals 340ml beer, 125ml wine or one metric tot of spirits.
The average body of 68kg or more breaks down alcohol at a rate of one drink per 75 minutes. Not even black coffee or a cold shower would speed up the process.
Because people don’t necessarily feel intoxicated they are not aware of the effects the substance has on the functioning of the brain and central nervous system, as well as co-ordination reaction time, balance and vision. They also have problems with depth perception and the ability to judge distance.
”Imagine someone in this state behind the wheel of a car” e Swardt says. You definitely don’t have to be drunk to exceed the legal limit for your functioning to be impaired,” De Swardt said. Drink responsibly tis Festive season, or your last drink for the night, might really be the last drink ever.