Archive for November, 2013

not just feeling sorry for yourself

In mental health there is and has been a hot debate about the efficacy of medication to treat mental illness concerns.  Most research and evidence shows the quality of the relationship between therapist and client is the most robust factor predicting change and improvement (studies here).  Medication is rarely enough to cause real and positive change in someone struggling with mental illness; although a portion of the population, about 6% is diagnosed with severe and persistent mental illness (SPMI), the vast majority of those who are prescribed medication to treat mental illness are generally high functioning.  While one in four adults will suffer from mental illness in a given year (which is a huge number – 25%??  Whoa!), we still have an enormous complex about being open and honest in our quest for recovery.

Our cultural ideal is rugged independence – we score higher on that dimension than any other country on earth.  We look up to those who have made it on their own and pulled themselves up by their bootstraps.  This ideal doesn’t hold up well for most of us in the human race; we need social connections to survive , we benefit from collective action (unions, suffrage, state government road maintenance) and most of us need help learning what we do before we can support ourselves – even those who don’t do college were most likely apprentices, learning from someone who knew what they were doing.  Why wouldn’t mental health be the same?

Few mental illnesses require lifelong medication and maintenance; these are the SPMI, including Sczhizophrenia, Bipolar I Disorder and Major Depressive Disorder, recurrent.  These disorders disrupt normal functioning and cause significant distress for those suffering from these illnesses as well as those around them.  Major Depression isn’t just feeling sad and eating some ice cream after work; it’s not being able to move, not caring enough to shower, not having the energy to follow through on suicidal thoughts.

why do we make people ashamed for making an effort?

Beyond these, the most serious disorders, are significant mental illnesses of a potentially shorter duration.  One can be in a depressive episode (lasting about 2 weeks) and need medication to break out of that period, but may not require lifelong medication maintenance.  Obsessive disorders require extensive behavioral and cognitive therapy to replace harmful behavioral/thought patterns with more adaptive versions.  Certain medications can help with correcting these patterns and in rebuilding receptors to prevent a return to maladaptive behavior.

Mental illness is just that – an illness.  With the small exception of religious exemptions, we don’t chastise people for taking medication to cure their strep throat or to manage acid reflux.  It’s time to stop shaming ourselves and others for trying to recover.

So this morning I heard a song in my trampoline exercise class (which is fabulous, as you can imagine) with a chorus of “Only you can make me feel beautiful.”  Me being me, I started thinking about all the times that people tell others how beautiful they are.

imagine!

First and foremost, one of the hallmarks of individuation is being able to know who you are and what you think about yourself, not being moved from who you are by feedback from others.  Gestalt therapy notes one of the issues leading to neurosis is a lack of clear boundaries between “me” and “not me.”  In our internet articles, magazines, books, and movies, it is emphasized  how “sexy” confidence is and how we have to be our own people.  However, this overt message contrasts with the covert messages in the products of popular culture; in this case, music and movies are the most obvious examples.

A lot of responsibility is placed on our partners for our feelings.  We assure people that we can see beyond the outside and we like what we see.  We place our very survival on another person simply being aroundThe number of these messages is tremendous and transcends genres and generations.

oy vey.

Aside from the obvious neediness and lack of our own lives here, there are a few intersections with mental health theory which may not be so stark.  Firstly, women (and men, to a lesser extent) are stuck waiting for their perfect partner.  I can’t be beautiful unless someone’s telling me I am.  I can’t feel beautiful if my partner doesn’t constantly assure me I am.  I can’t feel beautiful and be single.  I can’t feel beautiful when my partner isn’t making me feel I am.

The other aspect has to do with a defensive reaction, something we’ve talked extensively about and that motivational interviewing therapy ‎ is built to reduce.  When we’re told something, that we should do something or we are a certain way, a lot of us have a knee jerk reaction, a defense, that NO WAY reaction.  Even when it’s a “good” thing or “good” behavior we’re being pushed into.  The problem is the push.

so if i do, it’s your fault!

Does telling someone they’re beautiful defeat the purpose?  I know when someone tells me they’re having a bad hair day, and I tell them it looks fine, most of the time they dig in their heels to convince me I’m wrong and they’re right.  In psychology circles, it’s known as the confirmation bias and surprisingly (or not), it confirms we’d rather be right than happy.  We’d rather confirm I’m right about being ugly than be wrong and be beautiful.

The point isn’t to stop telling our partners they are beautiful or to stop accepting complements, but that we first need to change our self-concept and correct the stories we tell ourselves.  Only when we see ourselves as beautiful can we hear and appreciate others telling us the same.

Recovery is a tricky thing.  Not just because there’s triggers everywhere you look, but because it’s a personal journey, and often a bit different for everyone.  How much should you say to a stranger?  How do you explain why you’re drinking club soda, or why you don’t keep candy in the house, or why you had to move out of your childhood neighborhood?

this is how we cut ourselves down so other women will feel comfortable around us.

This is a question I’ve been struggling with (so bear with me, this article may have fewer references than usual).  One of my big triggers is having people discuss weight loss efforts, so you can imagine my day to day life is triggers galore.  I read an article about body hatred as a bonding technique for women , but we can all testify to the truth of it without even reading the supporting literature. The literature that’s even in Glamour  – it’s so SHOCKING that women have poor body image, isn’t it?! It’s ubiquitous for women to share their hated body parts (“god, my ass is so big!”), weight gain (“I swear I gained 5 pounds just looking at that cake!”), weight loss efforts (“I shouldn’t eat that cookie”), sage family advice (“once on your lips, forever on your hips”) and so on.  This talk is everywhere in every kind of situation, and can serve as filler for silences or in new, uncomfortable situations.

While this discussion is old, my concern is where those in recovery should draw the line between speaking up and letting conversation pass.  I don’t suffer from anorexia, but I would assume listening to thin women (or women of any size) complain about their shape would be difficult to deal with.  It’s difficult for me to deal with!  The question is, do I ask other people not to talk about those things around me?  Or do I just refrain from engaging in that conversation?

It’s different with close friends, who, at least in my case, know that I’m dealing with food issues and for the most part respect my desire not to talk about weight loss.  It’s different with coworkers, or people in the gym, or clients.  With client’s its easier, because there it’s a clear distinction between therapist and consumer.  Do I tell my supervisor not to discuss her daily eating plan because it makes me want to binge?  Do I share with the woman who uses the locker next to mine that when she tries to get me to buy her diet products, it is uncomfortable because I’m aiming for recovery?

how much hate can you stand?

We tell alcoholics and addicts to avoid liquor stores and “wet places.”  To be assertive in their recovery.  At the end of the day, however, I believe most of recovery is dealing with your own stuff.  It’s not anyone’s responsibility not to talk about diets but mine; my responsibility is to increase awareness and manage my reaction to these triggers, because in no reality are triggers always avoidable.  Sometimes, though, that boundary is hard to maintain.

 

this article was too good not to share.

my favorite quote:

What if it were seen as not just unacceptable, but also emasculating and           pathetic, to take an incoherently drunk girl up to your room, or to have sex with someone who was not fully and enthusiastically into it? If the social norm were that sex is not about “getting some” from women, but rather about having a great time with a partner who clearly desires you, most of the ability for campus rapists to operate would evaporate.

via @Feministing

One of the mainstay concepts in any sort of treatment, but particularly in the treatment of sex offenders, is to assist clients in differentiating bad action from bad self.  It seems on the surface to be a distinction that is easily made – just because someone does a bad thing does not necessarily make them a bad person.  However, there are so many layers and perceptions imposed by our family of origin, society and culture, it ends up being one of the most labor intensive parts of treatment.

Understanding that good people can do “bad” things is often intuitive.  Psychologically we usually operate from what is called the “self-serving bias,”  the tendency to cut ourselves a break.  We are able to access our internal thoughts and motivations, so its easier to justify doing something ourselves versus someone else.  When we feel threatened (like, say, someone’s screaming at us that we’re a piece of shit that deserves to be killed) we are WAY more likely to engage in this behavior.

We’ve established before that when one is feeling shame, the natural reaction is defensive, because shame threatens our very sense of self-worth, of having the right to exist.  Separating our actions from who we are is essential to change, because you can change an action.  It’s not as easy to change who we are.

I was thinking about this a lot since yesterday, when it was explained to me why body hatred was so stupid.  Like, fundamentally stupid.  Leaving aside all the stuff about WE ARE WOMEN AND BEAUTIFUL, hating the container we’re in is…stupid.

When I was younger I’d make the argument against racism that it’s stupid to hate what’s on the outside, because it makes no rational sense.  And it came to me that hating our bodies is almost exactly the same.  Our bodies are results of behaviors and genetics and actions we take and food we put in and sun we get and clothes we wear and the climate we live in.  Too often, most obviously in weight loss settings, we are told to hate our bodies, that we are disgusting and weak and shameful.  Which leads to shame.  Which means NO ONE who is being told they are awful is in any place to start changing behavior.

The conversation around bodies and weight is about who people are, rather than the things they do.  Changing behaviors may not change body composition, and that’s okay.  Because we need to focus on the behavior, not the container.  We need to focus on the behavior, rather than the person inside.  Because the people who struggle with weight are people.  Bad actions do not equal bad self.