“My Own Strength and I”

Happy Holidays everyone! Thank you for staying with me through the year. Thank you for your support and generous comments. I hope you will find the next story inspiring, comforting and uplifting.

Happy Holidays and a very happy New Year!

Alice came in as a new patient a few months ago. From the start, she told me she suffers from “schizoaffective” disorder, or so she was told by the psychiatrists she had seen to no avail so far. She came from out of town to participate in an outpatient program at a reputable mental health research clinic in Los Angeles. She put her college education on hold to do this, but the waiting list even to get an initial evaluation interview was a few months long. She was desperate and did not know what more to do to get help. She was taking two mood stabilizers, two antidepressants, one powerful sedative and an antipsychotic --a lot of medication. Still, she was not feeling any better. She was still hearing “voices” telling her to do “terrible things” to herself and could not sleep more than two hours a night. She was feeling “heavy,” depressed, hopeless and constantly exhausted from lack of sleep. She found me through a referral, and she wanted to have a psychiatrist in town to manage her medications until she got into the clinic.

At the first glance, she seemed a pretty straight forward case. The first thing we did was to go over her medication, addressing the reason for her coming to see me. At a closer look though, her medication regimen was a pharmacologic mess. It seems that the few psychiatrists she has consulted were at a complete loss of how to help her, and all they could think of was to pile up more and more medications on her. The two mood stabilizers were redundant so I recommended stopping one of them--the one added most recently and from which she felt no improvement. I recommended replacing the two antidepressants with one that was more effective and had a broader spectrum than either of the two combined. I suggested replacing the antipsychotic with a different one, which I hoped to be more effective and more sedating to help her get more than two hours of sleep at night.

These were a lot of changes for the first session. But Alice was brave and desperate to feel better and decided to go for it. One week later, she felt somewhat better. She reported her mind being more “clear” and she was getting three to four hours of sleep at night. But she still felt depressed and very tired through the day. The “voices” were still there.

I referred her to another outpatient clinic for evaluation so that she would have a backup if she did not make it for some reason into the first.

Sooner than she expected, she had both initial evaluation interviews. She came to see me after the interviews; she was more desperate than ever. On one of the interviews the psychiatrist took issue with her sleeping pills and recommended she go into a dual diagnosis program, one that addresses addiction and mental illness at the same time. Alice felt, for a good reason, that the psychiatrist completely missed the point, as she was not taking sleeping pills because she was addicted to them but because she was unable to get restful sleep without them.

On the other interview, at the prestigious research clinic, she was told, after half-a-day evaluation, that she did not fit the selection criteria for any of the research studies that were soon to be initiated at the clinic, and they suggested to continue treatment with her private psychiatrist. That was me. Suddenly, I became her only hope, disappointed as she was by her experiences at the two clinics.

Fully aware of my increased role in her treatment, I sat down with her and started discussing in greater depth her symptoms, trying to get a more comprehensive view of what was going on with her. As I became her only hope, she allowed herself to be more open with me. Her previously monosyllabic answers became now more elaborate. She did not know me all that well, but she decided to trust me by default as the other treatment options had not worked out.
We spent a lot of time talking. I asked her all sorts of questions about herself. She answered patiently to the best of her knowledge. She was not hearing “voices” but only one “voice,” that of her brother who abused her sexually when she was very young, and who repeatedly told her to harm herself by jumping in front of traffic or putting her hand into the garbage disposal.
Her brother left home years ago, and she and her family are not in touch with him. But her parents never knew about the abuse. She was in psychotherapy for years trying to address this trauma.

Previous psychiatrists automatically thought she was psychotic because she was hearing “voices.” They did not consider the possibility in her case of the “voices” as a symptom of posttraumatic stress disorder (PTSD). That was likely the explanation of her diagnosis as schizoaffective disorder, which missed entirely her PTSD. That was also likely the reason for the heavy antipsychotic medications she was given, which made her mind cloudy and undermined her ability to work through the trauma. Talking about the abuse was a great vote of confidence in me as she was extremely embarrassed and fearful of my reactions. But her courage and determination to get well held, and we did talk about the past in detail.

“When you hear this voice in your head,” I asked, trying to get as much information as possible, “is it in the morning or at night, or is it related to something you do through the day?”
“I always hear it when I am alone, especially at night, when no one else is in my room.”
“This voice has been telling you to harm yourself for years yet you have never done it, right?”
“I was very close a few times.”
“What did you do then?”
“I called 911. They came and took me to the hospital.”
“So you have never actually attempted to harm yourself. You asked for help every time you got close to do what this voice in your head was telling you to do, right?”
“Right,” she answered, unsure of where I was going with these questions.
“Why?” I asked.
“Why what?” she asked.
“For people who have been abused and traumatized it is not unusual to hear the voice of their aggressor ringing in their head years after it happened. If this voice has been telling you to harm yourself, why do you think you have never actually done it?”
“I don’t know,” she answered, trying to make sense in her own mind about it. “I know, with some part of my mind, that this voice is not to be trusted. He was harming me for years. How could I give in to what he told me to do? I don’t want to obey this voice. I often fight with it. I tell it to go away. Sometimes it does. But it always comes back when I am tired or alone. I try to keep busy, be around other people and try not to go to sleep because that is when I hear it the loudest in my head. Both times when I was very close to taking a knife and chopping my hand off, I was all alone in the house.”
“And instead of picking up a knife, you went to the phone and asked for help, right?” I asked to make sure I understood clearly.
“Yes,” she said a little irritated at my over emphasizing a point that, to her, seemed irrelevant.
“I think the healthy part of your mind is what has always protected you from harming yourself. No matter how loud and obsessive your former aggressor’s voice got, the healthier part of your mind has been stronger and prevailed in protecting you from harm. It seems to me that it is your own strength that is fighting, even now, years after the trauma, to keep you safe. It’s just that, busy as you are dealing with this “voice” inside your head, you have ignored your own strength. You have not paid enough attention to the healthy part of your mind that was working all this time to keep you safe.”
“What are you saying?” she asked in dismay.
“This “voice” becomes stronger when you think you are alone, unprotected and vulnerable. But you see, if your own strength has protected you all these years, you are, in fact, never alone. You are never without your own protection. The voice of your perpetrator still rings in your mind. But also in your mind there is this powerful thought that you should not give in, that you should deny your abuser full access to your mind and your actions, that you should keep yourself unharmed and safe. You have always carried this strength within you. Which means that you are, in fact, never alone and unprotected. That is why you never actually harmed yourself physically.”
“You mean that my own strength and I are always together and that is why I am not alone?” repeated Alice with increasing amazement.
“Exactly. Your own mind is much stronger than you thought. You have just been unaware of it all this time. You had hoped that others, even through their mere presence, would protect you from this toxic voice, remnant of the old abuse, when, in fact, the true strength and defense you need is built into your own mind.”
“What should I do then? How can I use this strength?”
“Practice staying in touch with your own strength. Practice silencing the harmful voice by strengthening the healthy aspects of who you are. It doesn’t matter that you did not get in any of the programs you were hoping to get into. You can create your own program, based on your own strengths and qualities. You mentioned that you like writing. Join a writing group, for example. Stop idling. Be as productive as you can be. Cultivate your own strength and talent. And, when you are ready, make sure you go back and finish college. Do that sooner, rather than later. You came to Los Angeles to start on outpatient program—why not set up your own outpatient program?! You can pick and choose activities that are best suited for your needs rather than trying to adjust to a group treatment program that is not right for you.”

“And I can do all this with the help of my own strength?” she wondered, thinking hard. “But I still can’t sleep,” she said as an afterthought.
“Yes, I can help you. Let’s go over your medications again. Maybe we can find some alternatives to the current sleeping pills. And after that, let’s look at some of the things you would really like to do. We’ll start from there.”

During the next few weeks we made a few more fine tuning adjustments to her medications until she was able to sleep closer to six hours almost every night, which gave her a lot more energy through the day. I suggested to her a writing group I came across at a writers’ conference I attended not long ago, and she took the initiative to research it. She liked it and signed up. She now finds journal writing helpful to manage her storm of emotions. A few weeks after that she interviewed for a part time job as an assistant librarian, an ideal job for her as she loves books. She started planning to go back to college a few months after that.

As she was getting better, we were able to reduce her medication regimen to only two standing medications and one to use just as needed for anxiety. She did not have any difficulties stopping the potentially addictive medications she used to take because she was not an addict. She never was. There are clinical reasons to believe that she will even be able to stop all the medications.

“What happened to the “voice” in your head, Alice?” I asked after a few weeks of her not mentioning it.
“Oh, I am way too busy now to pay any attention to it. It comes back sometimes, but I am able to push it away,” she answered, without any trace of fear or pain.
The day she came to tell me she was returning, in a few weeks to her home town to finish her last semester of college, she was almost unrecognizable. She had a new, chic, hairstyle; she had new, fashionable clothes; but more importantly, she had a radiant face. She was feeling hopeful and strong. She was well. More than well. She told me she was happy.
Each and every one of us has the strength Alice discovered in herself. We need to know how to discover it within ourselves, pay attention to it, recognize and follow it. That is how we make our happiness come true.

Happy Holidays!

Antidote for Information Overload

My patient, we will call him Leo to respect his confidentiality, is a high paid salesman. When he has a job. The problem is, having attention deficit disorder and anxiety, he has a great deal of difficulty keeping his jobs. In fact, he is one of 3.5% of people in the workforce with this problem. Like them, his annual income is 10-15% less that his peers with the same educational level. Like the 3.5%, he has changed jobs, on average, every 12-18 months all his life. Either at his own request, getting easily bored with doing one thing over and over again, or being fired because of poor performance, he can’t keep a job for long. He has had “12 jobs in 14 years,” as he often reminds me when he feels particularly upset with himself. This spotty work history has inevitably made him insecure and anxious, also typical for adults with ADD.

But unlike the vast majority of the 3.5% who do not or cannot ask for help, Leo found his way to my office, determined to “finally nip this problem in the bud,” as he put it at our first meeting. His own motivation to overcome this deficit is a very good indication that he will succeed, now that he has asked for help and will have my professional experience and knowledge on his side. Talking to him about his job, it took me very little time to understand that he is a talented salesman, which, along with his motivation to get well, will be the foundation of our intervention strategy to improve his overall prognosis.

We started our intervention by teaching him a great deal about ADD: how it manifests in adults; why he accumulated over time so much hatred of himself; how anxiety is very often a consequence of the frustrations created by the ADD symptoms and not the other way around. With this information, he was able to see the areas in his job and in his life that have been greatly affected by ADD: from strenuous relationships with frustrated friends because of his being “distracted” all the time and forgetting to show up or being very late to social functions…to constantly falling behind at work because of being unable to manage his time and meet deadlines, ADD had a clear negative impact on his life.
During our sessions he began, for the first time, to have an explanation for why he was finding himself in these predicaments, when he had no intention of being irresponsible, lazy or rude. He just appeared that way, but everybody ended up treating him as such.

Then we started Adderall, a type of medication often used for the treatment of ADD. This was another learning experience. As the medication works only for either four or seven hours at a time, he had to figure out how best to use it to take advantage of it during key hours of his daily schedule.

Then we started troubleshooting his problems at work. I taught him how to keep a tight schedule, how to work with the planner and how to manage deadlines. A big problem for him has always been sorting out information so he can use it promptly at work whenever needed.

Recently, a few weeks ago, Leo got a new job. This was his first job since we started our work together. He has made a lot of progress in dealing with ADD so far, but getting and keeping this new job is the ultimate test of his new and improved abilities.

Two days ago, Leo marches into my office with his laptop in hand and an upset but resolute expression on his face. “Doc, you’ve got to help me with this or I’ll lose my job again like the idiot that I am,” he said as soon as he sat down. He then opened his laptop and turned it on, which is unusual for our sessions. “Please,” he said, “come over here so both of us can look at this screen at the same time.”

I turned my armchair so I could see his screen. His new job involves working with a few different groups of complex products. He needs to know them well so that he can present and sell them to buyers in his industry. When on the phone with a client, he needs to rapidly access these information and the technical specifications for each. But when I looked at his work screen, I was horrified. I could not see how in the world he would be able to accomplish that. All the categories and subcategories, along with different files referring to different products, were all chaotically mixed up.

His screen looked like this:

“Is this the screen you need to work with when you talk to a client?” I asked in disbelief.
“Yes,” he answered.
“I’m sorry,” I said, “there is no way I could work with this screen either.”
“Thank you!” he said, relieved that he was not the only one struggling to understand it or use it.
“Are you allowed to move things around on this screen?” I asked, reaching out for a piece of paper and pen.
“Yes, they told me I can organize the material in any way it works for me,” he said, frustrated again. “I did this mess myself, not my manager. I put all the information in, trying to sort it all out. But when I try to find a particular piece, it’s impossible to remember where I put it, under what heading. Or if I sort of know, it still takes me forever to find it and retrieve it. Look, these are all the main categories and subcategories, and all of these, here, are the files that have to go with each category.”

I asked him more questions to better understand what each category and its elements were. We reorganized the whole screen together. We created new files, separated the old ones and put them into the folders to which they belonged. We even designed files for his follow-up discussions with clients without having to use pieces of paper that he would certainly loose or mix up later. We also did a task manager to remember to call back his contacts, for each category of product, at a certain interval of time. I had him practice with some of these files and folders. He took an imaginary buyer and walked him through all the stages from introducing the product to completing the sale. He soon figured out the new structure. He still needed to do some additional work but he had the basics. I knew he could manage from this point on.

A simplified version of the new structure of his work screen looked like this.

He took a long look at it. After a pause he said: “I think I got it! I’ve got to go, Doc, I have work to do!” He obviously wanted to finish sorting out all the categories and polish them a little more at home. On his way to the exit door, he stopped and said as an afterthought, “I think I will actually be able to keep my job this time!” He walked out into the world, more confident and more resolute than I have ever seen him before.

Two weeks later he called to tell me he had just closed a complex sale with many zeros in the price tag. He received recognition in front of the entire department. He was very happy. And he will keep this job.

What was actually Leo’s problem?

He knew his material very well, he was smart and he was very motivated to do the necessary work to succeed on his new job. What was the key ingredient that was missing and undermining all his effort? He got himself into a state of information overload. Being unable to sort out the different categories and subcategories of information he had to work with, his thinking became paralyzed. This happens very often to people with ADD but can happen to anyone who does not take the time to think about organizing the data in a simple, logical and accessible way.

This ability does not automatically come with practice; but once you get it, it becomes like a game, a puzzle waiting to be solved. Once you begin thinking about how to sort your information before you start working with it, you will see how much easier it is for you to access it and use it effectively. This goes for personal life as well. How many times have you faced complex decisions about something and got a headache just trying to sort out randomly all the facts in your head?
If we cultivate the ability to sort out facts, ideas or information, in a clear, logical way, it is easier for us to see the pros and cons of each possible decision. It becomes much more obvious what is a good choice. Sorting out the information strategically gives us a much better chance to achieve a desired result with a great deal more confidence.

Try this out: take a recent example when you had to make a decision, even a simple one like whether or not to buy a new sweater or a new pair of shoes. Remember what your thinking was at that time. Remember how you felt after making that decision. Were you making the purchase impulsively? Were you debated endlessly with yourself, unable to reach a satisfying conclusion? Were you happy with your decision in the end? Or did you think about it so much that you got a headache and were unable to make any decision, exactly what I call information overload block?
Now think about the same event and try to sort out logically the pros and cons of buying and not buying that article of clothing. Look at the two categories, and if it isn’t obvious already, you can attach numbers to emphasize the facts with the highest importance to you. The more important the fact, the higher the number on a scale of one to five. You can tally the scores if you wish. Or feel free to come up with any priority system that works for you and helps you see clearly which decision will make you happier. Then follow that course. How do you feel about your decision now?
Once you have found a structure that works for you, you can apply it in a similar way to more complex decisions. You will have more factors in play, but essentially, sort out the information available in your own mind and possibly on paper. Follow your own priority ranking and then make your decision. It will likely lead you to better results. To avoid getting bogged down in an information overload mental block, take pen to paper and draw your strategic diagram. If you do it right, you will see clearly your decision steps in their best sequence.

Taking the time to construct a plan or a strategy before you act will give you a logical edge and a confidence that will help you make decisions. You will have fewer regrets and less guilt. Making strategic thinking a common practice in your everyday life will help you become happier with your decisions and, ultimately, with your life.

Who says it isn’t in our power to construct strategically our own happiness?

Please let me know how these ideas work for you.

How Mindfulness Training Can Make Your Life Better

Over the weekend I attended a workshop on mindfulness taught by Dr. Ronald Siegel. Mindfulness psychotherapy derives from Buddhist psychology. Dr. Siegel has been practicing and teaching mindfulness to patients for many years, even before it was considered okay to mention Buddhism in medical circles. He is part of a small group of pioneers, including Dr. Jon Kabat Zinn, who have advocated including mindfulness practice in medicine since the 1980s. Now, backed up by an increasing body of well documented research, the medical world is better prepared to accept the notion that our minds are an even more powerful health component than believed, and that learning how to access and use that power facilitates physical and emotional healing, and increases our overall capacity for happiness.

The first part of the workshop was about how we, as mental health workers, learn and apply mindfulness to our own lives. The second part, was how to teach it to our patients.

Here are two of my take-home points:

The more you try to run away from a nagging thought or fear, the harder it is to escape it.

The more effort we put into forcing out of mind an uncomfortable thought or fear, the more we focus on it. The more we focus on it, the more we reinforce it and lodge it deeper in our mind. It’s the old “try not to think of a pink elephant right now” and the whole class suddenly imagines a variety of pink elephants promptly inhabiting the room.

But if we stay with an uncomfortable thought without an excessive effort to subdue it gradually our mind begins to get accustomed to it, bored with it; and gradually our mind will start looking for new thoughts or feelings to focus on.

We did this exercise in class and you can do it at home too: Go to a quiet place where you will not be disturbed for ten minutes. Set your alarm for ten minutes. Now sit comfortably and breathe freely. While breathing, think of something that usually annoys you. Stay with that thought. Try to keep it in mind as long as you can, maybe even for the whole ten minutes before the alarm sounds. Were you able to do it, or did you have difficulty holding that unpleasant thought in mind?

Pleasant and unpleasant thoughts travel in and out our minds in waves. They reach a peak and then, if we do not hold on to them, they decrease in intensity and go away. They become more controllable, less obsessive or disturbing or painful. If we do not hold on to these troublesome thoughts, the wave passes. If we try to fight them, the wave lingers until we do let go. It is a counterintuitive way to manage frustrations, but it works better than trying to oppose them and fight them head on.

Meditation is an attainable “feel good” practice.

This came as a surprise to me. I was under the impression that meditation is hard and complicated and takes a lot of time to do. I could not have been further from the truth.
We did a few meditation exercises in the class. Meditation for our purposes means sitting comfortably in a chair, or standing, or even slowly walking, while breathing normally and focusing on the breath. Stay calm and focus on how the chest and abdomen distend to receive the nourishing air that brings oxygen to the heart, brain…to the whole body. Breathing in and out, stay with it. Because our minds are used to being busy, the tendency will be to jump from thought to thought. But no matter where your mind goes by itself, like an unruly puppy, you bring it back to focus on the breath—a single, simple focus point. As with a beloved puppy, be gentle and kind (nonjudgmental) in bringing the focus back to the breath. Thoughts will occur; they do in everyone.

If you can do that for at least ten minutes a day, you will increase your ability to stay calm when facing frustrations, you will feel more rested and more peaceful; additionally, you will increase your immune system’s strength and your tolerance of pain--among many other benefits.

It does take practice to focus the busy mind on something as basic as the breath. But you may feel so peaceful when you do that, that you will want to extend the time you spend meditating. That would be a good sign.

This is a simple step, a humble beginning. If this works for you, you will likely take further steps in this practice.



Using my IPad, I drew a few diagrams on this subject.


The first one represents an unruly, untrained mind, one that is very busy worrying about everything, can't focus on anything in particular and is completely overwhelmed by the chaos it creates for itself.



The second diagram represents a trained mind, used to sort out worries, prioritize them and deal with worrisome thoughts without panic. It holds many different thoughts, many more than an unruly mind, because it has a clear, uncluttered focus. It is a much calmer mind, too. Much more balanced and much less overwhelmed. Formal meditation is one way to achieve this clarity. But not the only one.



The third image is a picture I found on fotolia.com. It is a good visual metaphor for an enlightened mind, able to go beyond the obvious, so powerful that it can hold the entire world in it. Some say that through years of diligent practice of meditation, one's mind could get to this level.




Here are some helpful references if you would like to explore this subject:

Happiness: Essential Mindfulness Practices by Thich Nhat Hanh

The Mindfulness Solution Everyday Practices for Everyday Problems: book and website by Ronald Siegel

Explore the work of Jon Kabat Zinn

Finding the Right Words to Rule and Control Your Anger

Let's say something bad happens. It could be your boss being unfair to you, or your partner feeling hurt for no apparent (to you) reason. Or your teacher, or your colleague, or your son or daughter do something stupid. Or you do something stupid and get caught. In other words, an upsetting event.

Speaking our mind, having a voice—letting people know what we really think—is often suppressed by the fear that we will come across angry and out of control. Sometimes worse is the fear that no one will listen or that everyone will get even more upset. Is it worth saying anything, or is it better to swallow our frustrations?

Emotional conflict can be so very frustrating. If we do not know how to manage it, we will most likely not feel satisfied with the outcome. There can be many unwanted and often unforeseen negative consequences of acting on the first impulse when upset. This will likely include the angry reaction of the person at the receiving end of our verbalized frustrations, which may lead to a never ending string of complications and worries. We have all faced such situations.


How can one find the right words to rule and control anger? Is there a recipe we can use when we are upset about something to express that feeling eloquently and successfully change the course of the negative events? Should we act instinctively and lash out our anger at the person in front of us, making everybody angry and digging a deeper hole for ourselves? Or should we withdraw within ourselves and slowly brew in our own self-destructive anger, saying nothing, resolving nothing, only perpetuating a bad situation and making it a hundred times worse?
Are there better options than to say nothing and implode or to say the first thing that comes to mind and explode outwardly? Continue reading and you will consider a third option.

Option 1: Lash out/Turn the anger outward

What happens if you say the first thing that comes to mind?

If you listen to the first impulse to immediately and loudly lash out your frustrations, the likely result will be that you will make everybody angry and escalate the conflict. This leads to no resolution of the initial problem.

Option 2: Keep quiet/Turn the anger inward

When a negative event happens, you may instinctively sulk and withdraw within yourself, nursing your emotional wound while becoming increasingly angry and resentful inside.


Eventually, under the pressure of this growing resentment, you will be pushed into some kind of self-destructive behavior. That may mean exploding in front of your boss or quitting your job in defiance, or breaking up a relationship on an impulse, or picking yourself up and leaving without having any clear plan of what you might do subsequently.

One of the most common feelings people have when faced with a negative event is feeling hopeless. Saying nothing and turning the anger inward will increase the feeling of hopelessness even more.
The reality is that you always have a voice and you always have a recourse, but only if you know how to manage your emotions and chose your words carefully.

Option 3: Speak your mind/Manage your emotions

If a negative event happens, instead of opening your mouth in anger and saying anything and everything that comes to mind, hold your thought for a moment. Take that angry monologue and consider that your "first draft." Spoken aloud, the "first draft" will likely get you in trouble. Not saying anything, will likely make you withdraw in anger. But when you control your emotions, you start thinking of a better, more civil version of the "first draft," and will arrive at a "second draft."

Even the "second draft" of your angry thoughts is usually only roughly worded and lacks tact and polish. If you speak it aloud, you may not trigger an explosive conflict, but you will likely fail to resolve the negative event satisfactorily. Probably the effects will be only moderately satisfying.

But if you really want to appear cool and in control and want to prompt a better resolution regarding the negative event, take a few more seconds and think of a "third-draft" version of what you want to say.

You can only get at this level by mastering your emotions. In your mind practice going quickly over the first instinctive draft and the second slightly more polished draft of what you have to say. Then come up with the last draft--the most carefully chosen words and the most diplomatic way to voice them. Arriving at and speaking aloud the third and final draft will help you appear thoughtful and will more likely resolve the negative event favorably.

With practice, you will see that your mind will efficiently go through the different revisions and will provide you with a surprisingly fast and good final draft almost automatically.

Of course, there are never guaranteed outcomes. Life is not that simple. But we can greatly increase the chances of a favorable resolution and greatly reduce the probability of serious collateral damage if we have a logical framework in mind. I hope this discussion and the diagrams provided will give you that framework and reference point. The rest is up to you.

Good luck in trying it out! And don’t forget to leave a comment or send an e-mail to let me know how it worked.

BACK ON THE BLOGOSPHERE

Sorry for the long absence. I am, finally, back. Thank you for not giving up on me.



Many things have happened during my unplanned "blogging break."

1. I have been to a Writers Conference in Long Beach, California, where I submitted a writing sample from my book project, Better Than Cured. I was happy to meet a respected editor and a prestigious literary agent. They gave me very helpful notes to better structure the content of the future book and said they are interested. The Better Than Cured book project follows this blog more or less, so you are familiar with the general idea. The book project, however, has more developed concepts and points of view, includes more research and scientific data and many more practical tips and exercises for readers. It will be a great pleasure to let you all know when and where you can get the book, but it is still in the difficult phase of being created and developed to publishable form.

2. I have worried about and nursed back to health my mixed Siamese cat, Karma, who developed a severe allergy episode. We took him to the regular vet and then to a dermatologist vet. When the Western medicine brought about bad side effects from the medications, we took him to a naturalpathic vet .
This whole process took a few weeks, which proved very traumatizing for my husband and me and very painful for Karma. We learned much about how similar cats and people are. For example, in the Western medicine, allergies are treated with steroids or with antihistamines, in both species.

Cats and people can have the same side effects from these medications. Karma developed urinary retention because his dose of antihistamine was too high. We spent a night in an veterinary emergency room with him because of that and stopped all the medication.

The naturalpathic vet offered much more helpful suggestions. He recommended a special cat food, Innova, with more protein content and no grains (grains are potential allergens for cats as they are for people). He gave us a vitamin supplement. He also did energy work on Karma (same as for people). He told us to give him water from a porcelain bowl rather than a plastic one because bacteria can colonize the porous structure of the plastic and can cause infections and allergies. When we implemented all these recommendations, Karma finally found relief from his allergies and we all took a big sigh of relief.

This is Karma, when he feels good.

3. One of my psychotherapist friends discovered therapick, a website where psychiatrists and psychotherapists can post a three minute video about their practice along with other useful information for prospective patients. What I really have to say about how I practice is not that much different from what I talk about in this blog. But saying it in front of the dark and mysterious eye of a professional video camera is a completely different experience. It took more preparation than you might imagine to do that three minute video; but here it is, submitted to your scrutiny: my first adventure into video recording my ideas. I hope you will find it interesting.

4. After taking classes for over three months on Lingnan style Chinese brush painting, I finally managed to complete my first homework. Why? Because this is a very unique, spontaneous style, where every brush stroke has its own energy and meaning. There are no drawings. You have to do every stroke in the right order and in the right way to create an expressive painting. Often the teacher recommends taking a deep breath before beginning to paint, to relax and allow the hand holding the brush to "just go." But before it knows where to go, there is a lot of practice needed. I do not know how many times I have torn the rice paper into pieces in a state of deep frustration. But now, finally, I've got my first painting in the Lingnan style done. The teacher liked it enough that she wanted me to enter it in an amateurs' exhibit that was soon to take place. Unfortunately, the deadline to get the painting mounted, framed and submitted to the commission was only four days away, not enough for me to get it ready. Still, I am encouraged to move forward in my efforts.

5. Although I got my flu shot as I was suppose to, I fell sick with a terrible cold (still, better than a flu) that has grounded me for nearly a week. I couldn't do my Pilates, nor my swimming. Today is the first day that I have less cough, fewer chills and a less clouded mind.

I thought of you, my readers, everyday that I was unable to keep up with my blog and in touch with you. Now that some things are more under control, I will resume my posts. I took lots of notes these past weeks and I have many exiting new topics and ideas I want to share. So keep this site bookmarked. There will be many very interesting posts comming.

Stay tuned! It is business as usual again at Better Than Cured.

Extrovert and Itrovert Anxiety: two original coping strategies

Anxiety is not the same for everyone.

Extroverts and introverts have different ways of manifesting their anxieties; therefore, they have different ways of coping with them.

For the extrovert, anxiety is turbulence, thick clouds of emotions with lots and lots of drama overwhelming everything and everybody around. So loud, convoluted and confusing can an extrovert’s anxiety become, that even she has difficulty finding the reasonable, rational ground. In the throes of such anxiety, it can be very hard to differentiate the ground of reality from the stormy emotional clouds.

An anxious extrovert:

· not shy talking about her feelings, and does it a lot

· is defensive, justifying her point of view over and over again even when nobody challenged it

· seeks constant approval; when that doesn’t come promptly, she becomes annoyed and even irritated

· often thinks and talks in circles, rehashing again and again details of an event or thought as a self-assurance that she did not make a mistake

· her thinking is dominated by fear: fear of not being liked; fear of not succeeding well enough in her intentions or failing miserably; fear of becoming irrelevant or obsolete while being secretly laughed at; and many other nameless, purely subjective fears.

For the introvert, anxiety is like a deep, painful internal churning. The introvert carefully hides his anxiety from other people’s eyes by remaining silent about it. He is often overwhelmed by it. He is ashamed of not knowing how to cope with it. He is overridden with guilt for keeping such a secret from those who love him and could help him, yet the humiliation of having a problem he knows not how to solve stops him from sharing it with them. With silence and time anxiety grows like an infection.

The more he allows himself to dwell in guilt and shame, the more overpowering his anxiety grows. At some point, the anxiety becomes so deeply rooted in his being, that it begins to work its deadly poison quietly and steadily outwards, slowly infecting the whole of the bearer's emotional being. Eventually he often fails to distinguish the real situation from his very distorted view of it.

When I hear one of my patients describing his anxiety in these terms, I think of a medical analogy of his anxiety with a very invasive infection produced by anaerobe bacteria that thrives in closed spaces of the body and in the absence of oxygen. While for most organisms oxygen is essential to their survival, for the anaerobe bacteria it is lethal. These infections can be produced by minor cuts or random contamination so the infected person may not even be aware when it happens. These infections begin in a localized area, but they spread very fast if not treated quickly. Carried in the blood stream, they can end up affecting the entire body and produce very difficult to treat abscesses with a potentially lethal outcome.

When my anxious introvert patients talk about their anxiety, in my mind appears this image of a figurative abscess produced by a highly aggressive “anxiety bacteria.” It is as deadly for the mind as the poisonous effect of an anaerobe abscess is for the physical body. The question then becomes: How much damage has the “anxious bacteria” already produced in my patient’s mind and emotional life?

What can the extrovert and the introvert do to quiet the mind and get rid of anxiety?

If we continue the metaphor, we can find two different ways to deal with it:

a) "Clouds or Ground" --for the extrovert with anxiety

b) "Fresh Oxygen" --for the introvert with anxiety.

The "clouds or ground" method helps the extrovert bring the calming winds of reason into their emotional storm. Getting in touch with reality and reason is calming because reality is nearly always better than what an anxious person fears--the worst case scenario—which is intensely feared but seldom happens in the real world.

If you are an extrovert suffering from too much anxiety, ask yourself “What is real?” It is a simple question people with anxiety don’t usually ask themselves. Their anxiety has substituted itself for and has become their reality. As the anxious emotions cloud every thought, the anxious extrovert becomes confused about what to believe: what he feels is true or what he reasons is true. Questioning anxiety distorted reality and contrasting it with rational reality is an important reality check exercise. It can greatly reduce the power of anxiety over mind and allows the power of your own mind to grow and take over the thought process instead. That’s why, when in doubt, call for help and trust your rational mind. Under the calming, steady wind of reason, the clouds of anxiety part and it becomes easier to separate the agonizing worries from reality--the airy, emotional "clouds" from the solid “ground" of reality.

"Clouds or ground?" To an extrovert suffering from anxiety, this can become the key question to confront the anxiety and diminish its power.

As soon as you question your anxiety, its convoluted clouds start to clear and the solid ground of reason begins to appear.

For the anxious introvert, I recommend using the "fresh oxygen" method.

How does a doctor in an emergency room treat a closed abscess produced by anaerobes? He opens it up. The most deadly antibiotic for these bacteria is oxygen. If the abscess is still localized, opening and cleaning the wound usually is enough to save the patient.

For the anxious introvert, the mental abscesses produced by anxiety also need to be opened and exposed to the refreshing “oxygen” of realistic thinking. Allowing the anxious feelings to surface, overcoming the shame and guilt they produced, and discussing them openly with loved ones or a therapist or a counselor or a very good friend is the equivalent of feeding “fresh oxygen” into an anaerobe abscess and sterilizing it. The anxiety ceases to hurt as much; and when confronted with an objective perspective of reality, it greatly diminishes in strength.

If you recognize yourself as an introvert dealing with anxiety, you may consider opening up about it-- initiating and conducting an objective reality check. Because of the subjective nature of anxiety, it will not survive rational thinking. Trust what your rational mind recognizes to be true, and the anxiety will loosen its grip on you. If you continue on this path, you will eventually clear all the fears and anxiety away from your mind until they no longer can hurt you. And if some new form of anxiety or fear tries to sneak in again, instead of nursing it in silence, you will know how to give it a healthy dose of “fresh oxygen” so that it will not be able to poison your mind again.

I hope these suggestions make sense to you. Try them and see if they are right for you. Feel free to modify them so they better fit your own needs. I am eager to hear your feedback about the experience.

Using the FingerPaint application on my iPad, I have done all the drawings in this post. I hope you have found them helpful and fun.

Visiting Kathmandu

Is a series started by the inventivity of Unknown Mami. She is amazing. Check out her blog! Click on the image of "Sundays In My City" and you will see other travel stories along with her own.

A visit to Kathmandu, the historic capital of Nepal is an adventure. It feels like going back thousands of years in time visiting the historic heritage places, many dating from 1000 AD and earlier, and it feels like a contemporary booming town visiting the modern areas of the city, which explodes with modern buildings built at a break neck speed, internet access everywhere, tremendous traffic and ubiquitous cell phones.

The Durbar Square,UNESCO World Heritage site, is considered the heart of the old town. It has been in active use since 1000 AD.

Here people continue to live in the "old ways," women still spending hours staying in line to get water from the water well.


The streets are lined up with shops selling Kashmir shawl, silk, hand made paper and many other things.

The ruins, palaces and temples, are monumental.

People who live there and and the visitors from around the world mingle among the ruins as a matter of fact, making this ancient place part of the present life, keeping the past alive.



Another water well. While women stand in line, they often chant or socialize.

Manufacturers of Durbar Square are master wood-craftsmen, transmitting their craft from generation to generation. They carve the wood so skilfully that it looks like lattice or lace.







Powerful mythical animals, like this lion, are placed as guardians at the entrances of the temples and palaces.



Another impressive site is The Great Stupa of Boudhanath, one of the largest stupas in the world. The Boudhanath neighborhood is home to many Tibetan and Sherpas refugees who have built homes, shops and restaurants around it giving it a Himalayan feel. This is the most frequented site for all Buddhists living in Nepal. There are scores of pilgrims circumambulating (walking around the stupa in a clockwise fashion) and chanting.


On each side of the stupa is painted a face with eyes looking in the four directions. They symbolize the eyes of the Buddha looking at the world and seeing it for what it really is. There is the third eye, in the middle of the forehead, symbolizing the divine power of God. In the middle of the face is a symbol that could be interpreted as the nose but it is also the Nepali symbol for number "one," which for Buddhists represents the one and only way out of suffering in life--following the Buddhist path.





Another important site is Swayambhu. It is believed that the history of the Kathmandu Valley begins with Swayambhu, a sacred spiritual site dating from the fifth century AD. It is believed that the site was chosen by the Bodhisattva Manjusri who marveled at the beauty of a lotus flower he saw growing in the lake that used to be here. The stupa and the temples around it have been built, neglected, rebuilt, destroyed in 1349 by a Muslim invasion and built again over the centuries.

Here is a panoramic view of the sacred mountain.




There are also many stands selling trinkets.


A beautiful Buddha statue dating few centuries ago. Right next to it, a contemporary painter selling his work.

The site is also the home of many wild monkeys who lived here for centuries. They are very playful with each other but don't appreciate the interference of tourists. For our safety, we followed a well known tourist rule: admire but don't touch.



I hope seeing these pictures rekindles your spirit of adventure and places Kathmandu on your map of interesting places to see, smell, taste--be there and experience it.