BETTER THAN CURED--A SELF-GUIDE TO HEALING AND HAPPINESS

“My Own Strength and I”

2010-12-22T08:25:00.000-08:00

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

2010-11-28T21:51:00.000-08:00

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

2010-11-16T06:58:00.000-08:00

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

2010-11-09T22:56:00.000-08:00

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

2010-10-31T23:03:00.000-07:00

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

2010-08-28T23:24:00.000-07:00

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

2010-08-28T22:16:00.000-07:00

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.

Guideline 1--Self-knowledge/Self-awareness: the third segment of the Better Than Cured Self-Guide E-course

2010-08-11T22:18:00.000-07:00

The third segment of the Better Than Cured Self-Guide has been sent to those who subscribed for the e-course. Subscribing is easy: anytime you wish, you can enter your name and e-mail address in the sign-up box, and you will start the e-course from the beginning.

Thank you for being patient with me while I was working on this segment. At the same time, I was also working on another very important project for me. I have recently decided that I will transition to a paperless office. Taking advantage of the electronic medical records and electronic prescribing technologies, I have started this transition about ten days ago. Also using a scanner an a big shredder, I am now well on my way and I believe the transition will be completed soon.

I hope you will find this segment useful. I included here an excerpt from it, for those who have not yet signed up for the e-course but are curious about it.

Better Than Cured--A Six Point Self-Guide to Healing and Happiness
A Seven Part E-course

Guideline 1: Self-knowledge/Self-awareness

Everything begins with you. You are your own best means to create a happy, successful and balanced life for yourself and to extend that well-being for the benefit of others. You are at the center of your own inner world. By learning who you are, you can find your way to healing and happiness.

Self-knowledge and self-awareness are two mental processes at the foundation of knowing who we are—a complete sense of self.

Gaining self-awareness means becoming more objective observers of ourselves. It implies evaluating and contrasting our current behavior with our internal standards, beliefs and values. We need to compare and contrast our speech with our actions. It also means getting into the habit of paying attention to ourselves--to our feelings and our thoughts and our bodies. Practicing self-awareness sharpens our emotional intelligence and working memory, increases our abilities of reasoning and processing information.

Gaining self-knowledge helps recognize how we think of ourselves. It helps us realize our own identity, our true meaning, what makes us special, what motivates us in life, and how we appear to others.

Both are prerequisites for creating wholeness and happiness. Without self-awareness and self-knowledge, how can we possibly know what makes us feel good or how to make good choices? Without knowing what we want, how can we make plans to get there? And if we can’t build the life that we want, how can we ever be happy? If we don’t make an effort to get to know ourselves, how can we surpass our sorrow, guilt and ignorance in order to grow and evolve into better, kinder, happier beings?

From a spiritual point of view, gaining self-awareness and self-knowledge are the means to get in touch with our inner self and core being. They are means to actively find a way to rest our worries and catch our breath in the comfort and privacy of our own self. It means becoming fully aware of what is going on in our inner and outer world. These are important avenues toward balance and happiness in our own heart, where this transformation begins. From there, we can extend them to others through kindness and compassion—another important way to give our lives meaning and universality. How can we do all this? By opening our mind’s eye to observe and learn.

From a personal, individual developmental point of view, improving self-awareness and self-knowledge lead to building a renewed identity, realizing one’s true potential, understanding and utilizing effectively one’s strengths and talents, enhancing one’s quality of life and fulfilling aspirations and dreams.

Why are we even talking about gaining self-awareness and self-knowledge?
Because without self-knowledge there can be no self-improvement and no way forward. And without accepting the fact that everything changes inside and outside of ourselves, we will always be afraid of exploring the world outside of our limited patterns to make any progress. Accepting that we change along with the world that surrounds us will help us learn how to more consciously direct that change. Deny the possibility of change or try to stop it, and you will always find yourself fighting against the current, always trying really hard and unsuccessful to get things “your way,” always frustrated when that doesn’t happen. Accept change as inevitable, and you will swim along with the flow of your inner and outer world, the very current that was about to pull you under.

To read more, you are welcomed to sign up for the e-course.

Consider the e-course diagram and try adding to it words, pictures or drawings inspired by this section of the Self-Guide. You can e-mail it to me anytime you wish, even if it is only a work in progress.

Don't forget that you can leave your comments at the end of this post. I look forward to your thoughts.

"Climb down from the peaks of fear and panic!"--A Visualization Exercise

2010-07-26T07:41:00.000-07:00

Feeling trapped in the grips of a panic attack can be extremely debilitating. It is like running very quickly from sea level straight to the top of a tall mountain until, dazed and out of breath, you peer down into the abyss without being able to find your way back down.

You can only find the way down if you push the anxious emotions aside and regain your focus and ability and think, step by step, how to get all the way down into the sunny valley of a peaceful mind.

A few days ago, one of my patients who suffers from anxiety and panic attacks, was having a hard time overcoming certain difficulties at work. He was so intensely trapped in his fear of failure that he had a panic attack right there in my office.

Realizing that the only sensible thing to do was to help him relax then and there, I took him in front of my computer and we did the visualization exercise I will describe in this article. It worked very well for him. In less than 15 minutes he was feeling calm and was smiling. "How silly of me to worry so much," he said in the end. After he regained his calm, we were able to have a very productive session in which we discussed practical new solutions to solve the very difficulties that prompted the panic attack in the first place.

If you experience intense fear or even occasional panic, you can use this visualization exercise to climb back down from the peak of your fears and then, like my patient did, calmly figure out the action(s) you may want to take to correct the anxiety producing situation.

Visualization is a technique used in mindfulness psychotherapy and hypnotherapy and in certain types of meditation, to convey a certain message to our unconscious mind and transform pain, anxiety, sorrow--negative and unmanageable feelings and perceptions--into positive emotional energy.

One theory explaining why visualization works is that by activating the right brain, which stimulates creativity and non-verbal communication. Our psyche understands and reacts better and more directly to the language of images and symbols than to spoken or written language.

Here is how my patient and I used these images. If you experience high anxiety levels, you may use them the same way.

My patient and I sat in front of a computer screen looking at pictures, one picture at a time. I asked him to describe how he felt, beginning with his feeling very anxious and uncomfortable. Because I took these pictures myself during my trip to Tibet and Bhutan, I know how it feels to actually be there. My patient discovered that there is a great similarity between how one feels climbing from a sea level to 16,500 feet in one day, with how he felt during his panic attack. Climbing down from these tall peaks of the Himalayas is also similar to how it feels climbing down from the peaks of panic until reaching a point of calm and beauty at a safe lower altitude, in a verdant, relaxing valley.

This is how you can use this visualisation exercise by yourself:

I will tell you how it actually felt being at the site where I took each picture.

Underneath, I will write down how anxiety usually feels as it gradually decreases in its intensity, subdued by the power of your own will. Controlled by the healthy aspects of your mind, excessive worries, apprehensions and anxieties will melt away and leave your mind peaceful, stronger and healthier.

You can follow along and add your own commentary to each picture as you contemplate it one by one. Try to follow the description of how anxiety slowly but surely decreases in intensity and melts away in the end.

Allow yourself to be in touch with your own feelings and thoughts while you look at these pictures one by one. You can write down for yourself your experiences. If you know you are prone to have episodes of high anxiety, try to see if going with me on this journey down from the Himalayan mountains all the way into the Paro Valley of Bhutan will bring you some relief, some healing. If it does, you will realize that your inner being and your mind are always stronger than your fears.

Let us begin!

How it felt to be there:

It is very cold and windy at the peak; the air is so thin that the lungs expand desperately to inhale a great amount of air with very little oxygen content; muscles ache; head pounds; feeling of being in an unfriendly, hostile to humans climate; the soil is barren without trees or plants.

How anxiety feels:

Allow yourself to feel your anxiety in all its aspects even if it is uncomfortable. This will be the highest point of it. This is what we have to work it, to bring it down to manageable levels. From here on, your anxiety will get less and less intense until you become calm and in control.

You probably feel cold and clammy, have difficulty breathing, take in a lot of air yet feel you could not catch your breath. You may feel your heart pounding, a dull ache pressing your head. You may feel the world is closing in and leaves you no visible way to escape. In other words, you experience the peaks of your anxiety and panic. That is the unpleasant, uncomfortable and unnerving state of mind from which I invite you now to find your way back down again to a balanced peace of mind, to comfort and healing.

How it felt to be there:

Cold and desolate; hard to breathe; head pounding from lack of oxygen; hoping our Land Rover will not break down and strand us there for too long; mysterious, strange and fascinating at the same time; although uncomfortable, I wanted to take it all in. So this is how the "roof of the world" looks and feels like! It was impossible not to feel the majestic, mysterious and magical power of the mountain.

How anxiety feels:

Still uncomfortable at this level. Continue for 10-15 seconds to feel your anxiety. Although you are still uncomfortable, contemplate the power and the majesty of your own mind. You will use this power to find your way to a peaceful mind.

How it felt to be there:

As I was climbing down a few hundred feet, there is still snow and still barren soil. But here and there a tuft of pale grass breaks through the soil.

How the anxiety feels:

Slowly, barely felt, anxiety and panic begin to decrease in intensity. Your breathing is slightly easier. Your heart rate is slightly lower. Along with the physical symptoms, feel how your confidence that you will overcome this fear and anxiety increases. Just as the resilient grasses are breaking through the frozen ground, so your power of controlling your fear and anxiety emerges and grows more and more, with every passing moment.

How it felt to be there:

Going down another few hundred feet, I finally see the road that will take me down into the valley. It speaks to me of lower altitudes where I can breathe freely, and of gentle, green valley where I can find food and shelter and a hot shower. Still feeling short of breath, but at least I felt more hopeful now that I found, at last, my way down.

How anxiety feels:

Allow your mind to see the way down from the peaks of fear and anxiety. It is available and it stretches before you. It brings the memory of how it feels to be calm and comfortable and in control. It reminds you how good it feels to breathe freely, drinking up the fresh, vital air. You now know that you can climb down. All you need to do is allow your anxiety to go down a few more degrees while you relax a little more.

Go ahead and try it. Breath in and remember how good it feels to be relaxed.

How it felt to be there:

I keep climbing down. I've finally got under the snow level. I'm still having problems breathing, but the thought of clearly going down to safety and comfort is carrying me through. I know there are some miles to go but seeing the clear down slope of the road makes me more relaxed.

How your anxiety feels:

Look at the picture and focus on the downward slope. As the ground begins to slope downward, imagine how your anxiety takes the same route. See with your mind's eye how it is sloping down, releasing you from the snowy peaks onto solid ground. There is a lot of room before you feel relaxed, but at least the worst is over. You are now unmistakably headed toward your well deserved rest and comfort.

How it felt to be there:

The tall, snowy peaks were somewhat behind me. Keep climbing down, the ground changes colors. It is now green from moss and short grasses. A ray of sunshine shyly peers through the thick clouds. I was still breathing hard, but I was also much more hopeful.

How your anxiety feels:

Continue relaxed breathing and look at the picture. Use it to project into your mind how you leave your anxiety, panic and fear behind, clinging on the snowy peaks. The clouds of tension are breaking and rays of hope appear, hope that you will be well, that you will soon feel healthy again, hope that if anxiety comes to visit you again, you will know how to handle it before it takes over your body and your mind.

You are now turning your back on your old anxiety and fear, heading down into an increasingly more relaxed state of being. Feel how your muscles are relaxing in your neck, and face, and back, and arms... Keep scanning down your entire body and relax at will every muscle you find tense. See how well your body responds to your wishes.

How it felt to be there:

By the time I reached this level, I started feeling again the warmth of the sun. Still pale and chilly but it felt so good to see patches of clear sky, like a promise that I am on the right track. All I need now is to keep going.

How your anxiety feels:

Feel how your clouds of anxiety begin to give way and you begin to contemplate feeling free of them. Even if you are not completely relaxed yet, feel how you are on the right track. Disperse the clouds of past discomfort and begin to bathe yourself in the warmth of relaxation and well being.

How it felt to be there:

Finally there was a monastery where I could catch my breath. It was very rustic and stark, but it had such a magical beauty in the clear light of the Tibetan high plateau. The monks were friendly and smiling. If you look closely you will see one of them headed towards his house. Although hundreds of years old, the monastery is inhabited today as it has been for centuries. It is alive with the chatter of young student monks who live and study there. On their breaks, they sneak a curious look at the out-of-breath tourists.

How your anxiety feels:

You are doing so well that you can take a short break. Contemplate how, as you are consciously relaxing, you are breathing more freely. Rest here for a moment. Look at the picture. Try to imagine how life must be like at the monastery. In doing that, allow yourself to think outside of your anxiety and your familiar world.

Allow yourself to remember that the world is a bigger place than what you can experience directly every day. The world at large has many places where people, much like yourself, are searching for knowledge, love, fun, well-being and happiness, regardless of the altitude and geographical coordinates of the places where they live.

How it felt to be there:

As we were descending the hairpin loops of the trail, the unexpected beauty of this lake suddenly appeared. I was so much in awe, that I forgot all about my altitude induced breathing problem. I forgot I was uncomfortable and that my muscles were aching for the lack of enough oxygen. We were still at around 14,000feet and it was so unexpected to see this turquoise, crystal clear body of water at such altitude. Our Tibetan guide explained how in Tibetan tradition there is a powerful goddess living in this lake and how, because of this, it is one of the sacred places in Tibet. I was thinking that I would have never seen this sacred, magical place if I had not taken the road over the tall peaks of the mountain and managed all the inconveniences and discomforts in the process. To be in the presence of this lake was worth the long journey.

How your anxiety feels:

As you are getting more and more in touch with yourself and you witness how the anxiety is melting away at the power of your will, contemplate the positive lessons you have learned in the process. Think of how powerful your will is and how it can subdue even the most powerful anxiety attack. Think of your body unwinding and relaxing because you have changed the way you think. Think of the value of these lessons and the power of the visualization tool you are learning today to be able to control your fears anytime anywhere.

How it felt to be there:

Descending to lower altitude, I finally started to see trees again. I took a big sigh of relief. To my surprise, I realized I can catch my breath without working hard at it at all. Doing nothing more than bringing myself over the mountain to a lower altitude, I was able to breathe so much easier and better. What a relief! Suddenly, my headache was gone. My muscles stopped aching. I could walk twenty paces without having to stop for a breathing break. It felt so wonderful to be able to do that again. I felt such a surge of energy and that I jumped in the air several times just to test things out. Surprise! I can do it without pain or shortness of breath. How great!

How your anxiety feels:

Finally you are in safe teritory. You can breathe freely, you can relax and you can celebrate that you have indeed conquer your anxiety and panic. Feel how much better you are now. Get up, move around, shake your arms, loosen your shoulders. Breathe deeply in and out! Feel the comfort of your kind and reassuring thoughts to yourself. You did it! You got down from the peaks of anxiety and panic. You are now safe.

How it felt to be there:

After all this effort, this was Shangri-La for me: Paro Valley. It is most beautiful. Wide, green and friendly. Clear rivers with run through it. It has houses and lodges with warm dining rooms and hot chicken curry steaming on the tables. Soon, I will finally get to rest on a bed. What a luxury!

I breathe in deeply the scent of the forest. Green, fresh and alive. I can breathe now with ease and I am amazed at how much energy I suddenly have. It makes me very happy to feel my body regaining its usual strength. I feel excited and strong and proud that I was able to overcome my weaknesses long enough to get to a place where I feel good and safe again.

How your anxiety feels:

Make a mental check of how you feel, emotionally and physically. Isn't it great to feel healthy and free of past baggage? This is the end point of your journey. You are safe now and strong and relaxed. You feel in control. You can breath well and unhindered. With every breath feel how you become stronger and stronger. You made it to the end of this journey and you have learned a lot. You deserve a break and a reward. What would that be? In addition to feeling good and learning a lot, think of a small gift for yourself. It is your well earned prize. It is the reward at the end of the race, or the respite at the end of a long and difficult journey.

What is your Shangri-La?

Another look at Paro Valley! Nestled between the tall mountains of the Hymalaian range, it is a valley of peace and calm.

You can create your own Shangri-La and go there, in your mind, every time you need to be peaceful and calm. Everyone should have one such mental space where occasionally we can go to find comfort and healing, to rest and recharge.

The first two segments of Better Than Cured Self-Guide e-course

2010-07-13T09:29:00.000-07:00

The first two segments of the e-course:

How to use this self-guide

Practice exercise: Make peace with yourself

have been sent to subscribers.

How to use this guide (excerpt)
For you to successfully use any guide or piece of advice, you need to have complete control to decide how you use it and what results you desire. It is important for you to feel in control. Use this guide as you think and feel it will work best for you: you can skip the portions you already have dealt with, you can approach it in any order you want, you can do the suggested exercises or not, you can choose to read the suggested books or web links or not. If you have difficulties finding the time to explore the self-guide right now, make a mental note and save it for later. If you feel you are not quite ready to work with it at the moment, don’t force yourself. Perhaps later you will feel more ready or more motivated. Save it for when you feel it’s right for you. Take only what you need and discard the rest.

(To read more, please sign-up for the e-course.)

Practice exercise: Make Peace with Yourself (excerpt)
It is very hard, almost impossible, to look into the future with confidence and excitement if you are not at peace with yourself. If you don’t know how to forgive and be kind with yourself, how can you move forward and how can you give others love and support? Anger at yourself or others will turn against yourself. Most of the time it will hurt you more than it will ever hurt the people with whom you are angry. Anger is toxic and counterproductive. You will be able fully to use your inner power, motivation, intelligence and creativity to find your path to better things in life only if you can find an effective way to make peace with yourself.

(To read more, please sign-up for the e-course.)

For subscribers:
Please take your time to read it. If you would like to share anything with the rest of us, feel free to leave your comments and thoughts in the “Comments” section of this blog post. Please be mindful that this is an open forum for discussion and everything you write is public.

For those who are just now hearing about this e-course for the first time:

If you are interested, please familiarize yourself with this e-course by reading first the blog post “Better Than Cured—A Six Point Self-Guide to Healing and Happiness, An Introduction.”

You will find there an explanation about what this self-guide e-course is about. Then, if you like, you can join us anytime by signing up in the sign-up box.

It doesn’t cost you anything to sign-up and participate, and you can cancel at anytime.

Once you sign-up, the various chapters of the program will be delivered directly into your mailbox. You will be able to leave comments regarding the material and complete the diagram that accompanies the course. It is entirely up to you whether you do the exercises or not, or how much time you allow yourself to work through the six chapters.

If you do decide to join us, welcome! You are joining a group of people, open-minded and adventuresome, seeking new ways to find healing and happiness.

It will be great to have you, and I look forward to your feedback.

Punakha, Bhutan--the old seat of the government, built in 1637.

Better Than Cured-- A Six Point Self-Guide to Healing and Happiness, An Introduction

2010-06-29T00:01:00.000-07:00

For a long time I have tried to summarize the essence of my work with patients. If you had asked me a few years ago how I practice, I would have answered: "I do whatever it takes for my patients to get well." And they did. One of my patients thanked me for helping him manage a rough spot in his life by saying, "I am now better than cured. I am happy." For a long time I assumed patients had this kind of experience whenever they worked with a psychiatrist. I have learned that it is less common than I thought.

One of my cardinal goals is to push my patients' recovery beyond the absence of symptoms--normally defined as healed or "cured"-- and help them emerge from their suffering into an emotional realm of satisfaction and happiness. Equally important is to teach them how to fend off life's difficulties and emotional roller coasters as much as possible on their own.

I help my patients feel empowered again and in touch with the energy force present in each one of us--the inner core being--true engine of our actions, thoughts and feelings. I help them learn the pragmatic tools of realistic goal setting, planning and decision making, leading them more directly to where they want to be in their lives. I give them plenty of tools to handle their emotional well-being. That helps them understand themselves better, prevent and control their emotional reaction patterns and make better choices. I also teach them how to know how to prevent or avoid an emotional disorder episode, so that they will not have to spend months and months being emotionally despondent while losing important relationships, jobs, income and self-respect.

Even in the absence of an emotional problem, even when going to a psychiatrist has never been necessary, we are constantly looking for ways to achieve a better, happier life. I have distilled the essence of my experience into this self-guide for healing and happiness--a new and original approach.

A turquoise lake on the High Plateau of Tibet, at 15,000 feet altitude.

This guide can effectively assist you in your efforts, and give you a reliable framework you can easily use to achieve better results in return for your efforts.

I follow these guidelines in my own life and I find them very helpful. In exploring them, please remember that there is no right or wrong way of approaching them. No matter how you decide to try them, use them in a way that benefits you the most. This is the only rule. Avoid feeling guilty about the past and fearful about the future. The past cannot be changed and the future is in your power to design and construct.

Here is a brief introduction to Better Than Cured--A Six Point Self-Guide to Healing and Happiness:

1. Self-knowledge: Everything begins with you. You are your own best means to create a happy, successful and balanced life for yourself. Become your best friend. Get to know yourself well. Learn and respect what you like and make peace with or change what you don’t like about yourself. Learn how to comfort yourself and address yourself as you would your best friend. Make peace with your character flaws and forgive your missteps.

(You will find more details, examples and practical applications of this guideline in the upcoming e-course.)

2. Outer directed awareness: If self-knowledge refers to understanding yourself--inner directed awareness--awareness of the world is about understanding the world outside of yourself and your interrelationship with it--outer directed awareness.

Outer directed awareness begins with the world of your everyday life and expands, as your awareness itself expands, to the world at large. Preoccupied of our immediate world as we all are at times, we cannot afford to live in ignorance of the world at large because it affects us profoundly. Think, for example, elections or global warming. At a certain level, everything is interconnected. Our lives are interwoven in the fabric of our times; and because of that, we need to be mindful of the world around us. There is no need to feel overwhelmed. Steadily keep your eyes open, learn about it as much as you can and form your own opinion about what is going on.

Also try to develop a greater awareness of yourself in the context of your personal world. Carefully identify your place in it, the problems you are facing and the reasons why you are not happy or not moving forward. Be honest with yourself and stop being afraid of what you will see in yourself.

3. Self-help: Listen, read and learn how to use your creativity and imagination to find trouble-shooting solutions for dealing with life’s problems: dealing with a demanding boss or annoying neighbor; managing a bad date or enjoying a good one; finding new and healthy ways to relax; learning how to say “no” politely when you need to, rather than going along with something that makes you unhappy; being assertive but not abrasive, and so on. Don’t shy away from or ignore such problems. Start thinking creatively of possible tools you can learn to use, and try them one by one. Your creativity and curiosity will be stimulated. Your confidence will soar when you know you can handle awkward situations as they arise. You will feel more in control, more relaxed, and you will definitely have more fun.

Tibet--The High Plateau

4. Self-therapy: The tools of psychotherapy work in the psychiatrist's office, and they can work for you as well if you learn how to apply them to your own situation. Some of the well tested and most effective psychotherapy techniques are:

placing mind-over-mood--diminishes the emotional response and emphasizes the rational one instead--cognitive behavioral therapy or CBT

changing perspective to look at a problem from more than one angle, which will reveal other ways to approach and handle it for a better outcome--reframing therapy

understanding the meaning and motivation of your own behavior and reactions by paying attention to yourself, your feelings and your thoughts; become clued into how and why you are reacting to the world in a certain way and how you can reshape that interaction to establish a better relationship between yourself and others, between your actions and their impact on your life--insight oriented therapy.

You can learn how to use these techniques by yourself. They are widely used by leaders of all orientations and by highly successful people in general. You do not need to have an "emotional disorder" to benefit a great deal from them. But whether you are dealing with an emotional problem or not, your life can be significantly improved by learning these tools, and you will have an easier time navigating through life's challenges when you do.

If you need more help, consider working with a psychiatrist, psychotherapist or a counselor to further guide and assist you.

(In the e-course I will explain when and how to find this qualified help. You will also find more explanations, case examples and practical ways to apply these tools to your own situation.)

Tibet--The High Plateau

5. Be mindful of the vast ocean of choices available to you: At any given point, you are faced with choices. They can be many and they can be confusing. You can sort them out by keeping an open mind and learning as much as you can about each one of them. One such important choice is whether to use medication to help you manage an emotionally overwhelming situation after you have exhausted all other reasonable options.

Biochemical changes in the brain, spontaneous or created by certain environmental situations, can trigger strong emotional reactions of anxiety and/or depression . Their toxic effect on the brain can be decreased by using anti-depressant/anti-anxiety medications. About 60% of people suffering from depression and anxiety have inherited a genetic predisposition to these disorders. Other people never got the chance to learn better ways to handle difficult situations and stumble through life feeling more and more anxious and hopeless until they become long term anxious or depressed. Many have forgotten how it feels to be well.

After you have tried other options (self-help, therapy, counseling) and feel that you are still not moving forward or you are still plagued by overwhelming anxiety or depression, you may consider the temporary use of medications to help you better and faster overcome these obstacles.

To use the medication option you will need the expertise and help of a psychiatrist. But by learning as much as any reasonable non-specialist can learn about this option, you will be in a better position to influence your own treatment, including bringing in your pertinent observations and insights. This way, you will make better choices about what medications to try for how long. And you will have a far better idea of what to expect. You can become an active participant in your own treatment rather than a passive recipient, and the outcome will be significantly better.

As a general rule, if you are ever in doubt whether you should consider medications or not, don’t cut your options short. Make an appointment with a psychiatrist for a consultation and discuss the options. You may feel it is exactly what you need, or you may want to put this option aside and come back to it later if you still have difficulties. It is entirely your call.

(I will provide more examples and details about this complex subject, scary for many, in the e-course. You will become more comfortable with this option so that if you must use it, you will feel much better about it.)

Tibet--The High Plateau

6. Self-driven action: Change happens only when you shift from contemplating the change to taking real action. You are in the driver's seat. Keep your life in balance while you are moving forward. To build a happy life, understand that you are its architect, builder and owner--all at the same time. There are specific ways in which you can set healthy goals, and there are important skills you can use when designing effective strategies, which are action paths toward reaching your goals. But there is nothing you cannot learn once your mind is set on that path. When your emotions are in balance and you feel confident in yourself, you can make good use of all the opportunities life will offer. Remain open minded and unafraid of change. Adjust to new situations in healthy ways.

Does that sound like a lot? From the moment you start having your first victories and breakthroughs you will see how addictive it is to feel in control and to make good things happen in your life. It is exhilarating. It is so empowering that, when they get to this level, people usually feel there is no obstacle able to stop them from their course. Be mindful and remain true to yourself. Your life will gradually transform into a wonderful journey. Observe the transformation process. You will be amazed of how far you can go. Take enough time to make changes. Relax and enjoy your victories along the way. The journey itself and all that you will learn and experience will be valuable, fulfilling and joyous far before you will reach the final goal. You don't have to wait to be happy. You can begin this journey right now and enjoy its benefits from today forward. Take these guidelines to heart. Work with them and you will see the positive changes in yourself, just as I have seen them in my patients and within myself.

I will go into greater detail about each one of these guidelines and how to apply them to your own situation in the upcoming BetterThan Cured--A Six Point Self-Guide to Healing and Happiness e-course. To receive the e-course, you may sign up by entering your name and e-mail address in the sign-up box. One chapter a week will be delivered, for seven weeks, directly in your mailbox. It doesn't cost you anything to sign up, to receive or to use the course. Just work with it and, if you will, send me feedback about what works and what doesn't work well for you. I hope it will help you figure out some long sought answers and some viable solutions whatever you are trying to accomplish.

To better assist you in understanding this self-guide, I have created a visual image of it:

In the center of the diagram, I have used the symbol of the Zen circle to represent the inner core being.

The Zen circle, or The Enso, (Japanese for 'circle') is a Zen symbol of the absolute, the true nature of existence and enlightenment. It is a symbol that combines the visible and the hidden, the simple and the profound, the empty and the full. As an expression of infinity, it has links to the western lemniscate, and may be painted so that there is a slight opening somewhere in the circle, showing that the Enso is not contained in itself, but that it opens out to infinity. The enso, a simple circle drawn with a single, broad brushstroke, is the zen symbol of infinity. It represents the infinite void, the 'no-thing,' the perfect meditative state, and Satori (enlightenment.), according to the Dharma Memphis, a comprehensive web site on Buddhism you can visit when you click the above quote and link.

I have chosen this particular symbol not because of its religious aspect, although you may interpret it that way if you are so inclined, but because the Enso symbol is, to me, an invitation to introspection and self-exploration, perfectly aligned with the whole idea of a "self-guide": experiment and arrive at your own conclusion about everything.

I invite you to print out this image and use it as your personal work sheet.

The e-course will have practical exercises that will help you fill in the blank spaces of the diagram with whatever represents you--your life and your insight about introspection and personal choices.

The diagram is easy to understand and self-explanatory for the most part, so you can use it on your own as well as with the help of the e-course.

You can use images or words, phrases, lists of words or pictures--anything and everything that speaks to you. Use freely your creativity. This is not a contest. It doesn't have to be perfect. It has only the role of visually representing you in your own eyes. No matter what you do, you can never go wrong with it. It is only a tool to help you more clearly see what is missing in your life and how to make up for that missing part.

This is my own image of the Better Than Cured Self-Guide. Yours, I am sure, will look very different.

Let's work together:

Anytime you are ready, even if you are not completely done, you can take a picture of your visual representation of the Better Than Cured Self-Guide and e-mail it to me at betterthancured@gmail.com. I will keep track of these images and I will post them in a special blog post. You will even be able to vote for the one you like the best.

When you email me, please let me know if you would like me to use in the blog post, along with your diagram, your name, your initials or no identification at all. I will promptly respect your wishes and your right to confidentiality and privacy.

I look forward to your feed-back. Please do not hesitate to leave me your thoughts on this in the comment section below. I assure you that each and every one of your comments will teach me a great deal about how to fine tune and make this self-guide better and easier to understand and use.

Take the "Better Than Cured Self-Guide to Healing and Happiness" for a ride and see what it can do for you!

GODS AND MONASTERIES OF TIBET

2010-06-13T07:45:00.001-07:00

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.

There is no such thing as "Tibet at a glance." A culture thousands of years old, deeply rooted in spirituality cannot even begin to be understood by a foreign mind in only a few weeks. It takes years and years of studies, learning the language, living in Tibet among its people to catch a good glimpse of what Tibet really is. So forgive me for not pretending to be able to give you anything more than a snap shot of the people and the places that live and endured at the "top of the world," on the High Plateau of the Himalayas.

Traveling from the Tibetan-Nepalese border in a four wheel drive Toyota Land cruiser, one of the most reliable brands in those parts of the world, we passed by many Tibetan villages. They are usually small, only a few houses, and very isolated. They are completely dominated by the majestic landscapes surrounding them.

It was snowing at 16,000 feet altitude that day and almost everyday according to our guide.

The air was so thin that, although I was breathing deeply and more frequently than I ever remember breathing, I felt my muscles aching for oxygen even after walking 15 paces without a break.

This is one of the four guardians painted on the wall at the entrance of monasteries, in charge with keeping the bad spirits away. This guardian is from the Sakya Monastery, built in 1268 as a monastery and a watchtower.

Prayer wheels at Sakya Monastery. The colouring of the buildings are a characteristic ash grey with white and red, symbolising the Rigsum Gonpo--trinity of bodhisattvas--and distinctive mark of Sakya authority.

The road to Shigatse was steep. It was winding up and down the mountains in large hair-pin curves and sharp turns. The landscape was eerie, desert like, harsh and unforgiven. Being among these giant mountains I understood in a direct physical and spiritual way that I was only an aunt on this planet, a small particle with a life of a fraction of a second compare to these mountains that will endure for generations to come until the end of the world, piercing the sky with their peaks, indifferent to the passing of time--a very humbling perspective I will never forget.

At the top of the passes, people have hung prayer flags, for the high winds to take their wishes and sorrows the shortest way to the heavens and gods. Unable to carry with me a more comprehensive assortment of reference books on Tibet, I was consulting my little Lonely Planet travel guide about the Tashilhunpo Monastery in Shigatse. It was "built in 1447 by Genden Drup--The First Dalai Lama of the Gelugpa branch of Tibetan Buddhism. The Fifth Dalai Lama raised the prestige and standing of the monastery by declaring his teacher--then abbot of Tashilhunpo--to be a manifestation of Amitabha. Tashilhunpo became the seat of an important lineage: the Penchen ('great scholar') Lamas, secondary only to the Dalai Lama."

There is now a big controversy in the Tibetan world about the current Penchen Lama. The Chinese are trying to impose their own Penchen Lama, only a puppet in their hands--the faux Lama. The Dalai Lama recognizes a different Penchen Lama who is imprisoned and perhaps killed by the Chinese Communism regime. There is a good article on this subject in Asia Sentinel if you would like to read more.

This was by far my favorite monastery we visited. It looked almost like a medieval city. Many monks still live here. Their quarters are nestled in ancient buildings connected by a labyrinth of alley ways of broken stone crisscrossing the compound. The mountain right behind it dominates the whole complex, constant reminder of the smallness of people and all their enterprises compare with the power of nature.

Galleries inside the monastery.

The monumental entrance in the main temple.

Beating the clay to create floors harder and more durable than cement.

A guardian god at the entrance of the main temple.

Guardian lion god at the entrance of Pelkor Chode Monastery in Gyantse, a town of 15,000 people, at 12,000 feet altitude. Many of the mythical animals, like this lion, have never been seen in reality by the artists who painted them. They just learn to follow a painting tradition. That is why they often look very stylized and almost abstract.

The fortress of Gyantse.

Guardian god at the entrance of a chapel.

Guardian god at the entrace of the temple.

The Gyantse Kumbum, built in 1427. It has a spiral walk away you can take to the top and which is lined up with many small chapels, each one them the host of a treasure: statues of gods and goddesses, wall painting and mandalas.

Gods and Goddesses in the monastery.

A true treasure of the world: Buddhist manuscripts, fiercely guarded for hundred of years in caves during wars, and in the monasteries in the peace time. Highly revered, they are subject of study, research and great respect.

Lhasa--preparing to ascend into the Potala Palace, the former seat of the monastic government of Tibet until the Chinese have invaded the country in 1950s. Now a museum.

The Jokhang Monastery in Lhasa, one of the most revered monasteries in Tibet and final destination of many pilgrims.

Norbulingka Park--the former summer residence of the Dalai Lamas. This is one of the libraries.

Gate at Norbulingka Palace decorated with lion head masks.

The north gate of Norbulingka Park. The south gate that the 14th Dalai Lama used to escape the Chinese artillery fire in 1959 has been closed and never reopened again after his dramatic escape disguised as a soldier.

To learn more about Tibet and its struggles to survive the systematic work of assimilation and cultural annihilation done by the Chinese Communist government, you may start by reading Robert Turman's article Why Tibet Matters So Much.

There are places in the world of such dramatic natural beauty and compelling history that can only be truly experienced by being there and taking them in directly, through all the senses. Tibet is one of these places. Perhaps one day you too, my dear reader, will venture there.

WHAT MAKES US CHANGE?

2010-06-10T00:08:00.000-07:00

Recently I had two patients back to back that were facing the need of a major change—a job change—and kept postponing it.

For months they knew they needed to make this change. Yet they were not doing anything about it but worry. They kept searching for and finding excuses to justify the longer and longer delay in taking action. They avoided taking those decisive steps that could have taken them out of their professional misery and helped them feel excited again about their work and careers.

Meanwhile, their anxiety levels mounted. Their sleep became more fitful. They felt more and more hopeless and unsure of themselves. Their anxiety is getting worse. Much worse. The panic attacks are slowly creeping back after months of absence.

In therapy, these patients and I have been talking for months about this. Together, we have designed logical, step-by-step strategies of how to look for a new job using time tested life coaching techniques. We have contemplated the negative emotional implications of not changing jobs—hopelessness and burnout—using insight oriented psychotherapy. We have looked at this issue using the “cause-and-effect” methods of cognitive behavioral therapy. We have used antianxiety medications to take some of the fear out of the way. They were still unable to move forward with the inevitable changes they were facing and still took no action to change course, even as they watched themselves becoming more and more miserable.

Tibet--on the road from Kathmandu to Lhasa, approx. 14,000 feet altitude

Why would they do that to themselves? Why would anybody? What could ultimately make them take the actions they need to take to heal their fears and hopelessness?

As they took longer and longer to act, I was wondering what more, as their psychiatrist, I could do to help them. What did I do wrong? What is the engine that could help these people, and thousands like them, out of their inertia? Must I just sit back and witness the decline in their health and well-being until they hit some kind of an emotional “rock bottom” when pure desperation will make them spring into a stressful, panic driven action? I was using all the right tools and techniques of my field. Yet something important was still missing.

Contemplating this situation I realized that if I want to really help my patients act and change, I must devote my attention not only to presenting them with good choices but to also helping them find their inner strength, power, motivation and confidence to enable them to effectively work with some of these helpful choices I suggested to them. After all, according to the accepted standards of my profession, all the expert advice and professional support I can give them are just options of actions my patients may choose to integrate into their lives or not. In order to better help my patients I should find a way to go far beyond just presenting my patients with a series of possibly good choices.

In order for people to change, they need to get in touch with themselves at levels deeper than superficial logic or feelings. That level of self-awareness is the subconscious mind or core being. It is an inner place of powerful emotions and insights, a place from which many of our decisions originate. It can be accessed spontaneously when we experience a powerful emotion or when we allow ourselves to be calm and still. But it can also be accessed by getting into the habit of developing that awareness, of feeling and being closer and kinder to ourselves. The barriers that stop the conscious mind feeling fully connected to our core being are many: allowing fear to dominate us; keeping ourselves in denial of our true thoughts and insights; allowing ourselves to become too greedy for material possessions to the point of sacrificing everything in exchange and adopting a stressful life style that leaves no time for peacefulness and contemplation; moving away from nature; persistently ignoring and postponing listening to our own feelings, and many others.

Pelkor Chode Monastery with its famous Kumbum (tower)--Gyantse, Tibet

The deep seated fear barriers commonly paralyze people, especially the anxious, when life requires them to take an action for change: fear that they are not capable of making the right choices, fear that they cannot trust in their own judgment and way of thinking, fear that they have allowed their motivation to wither and die in them along with the energy that fuels it.

Thinking along these lines, it became clear to me that in order to help these people who struggle so much within the boundaries of their own fears and limitations, I need to help them access the deeper levels of themselves. Empowered by the knowledge that they are the masters of their own lives, they can make the choices they need to make to create their own happiness. This is the spiritual dimension within the Better Than Cured intervention path I have identified in my work with patients. Again and again I am reminded of the limitations of the medical or psychological model practiced by most psychiatrists and psychologists today. With all its scientific merits, it is often unsuccessful when not accompanied by also helping people to get in touch with their spiritual dimension of their core being—true engine of our actions and well-being.

As you read about my own insights in this matter, remember that there are many ways to learn how to become more in touch with your own core being. There are many spiritual leaders you can discover and follow; there are many books you can read on this subject. Of special inspiration to me are the works and words of the Dalai Lama, Thich Nhat Hanh, Lama Surya Das, Jack Kornfield, to name only a few. Whatever your own spiritual heritage or choice, there are many insightful teachers to help you on your journey of self-discovery. You may also find people around you who have the wisdom of discovering these important insights by themselves and are willing to share with you that wisdom. You yourself may have discovered how good it feels to be at peace with your inner self but didn’t know what it was exactly or how to find your way back to that state. This whole issue of inner or core being is a secret hiding in plain sight. It is intrinsically part of who we are. All we need to do is stop ignoring it and begin to acknowledge it so that our true selves begin speaking to us, and we feel happy and at peace with ourselves and our actions.

All these barriers to accessing the deeper layers of our beings and fostering the power to change are not only true for my patients—a small sample of the large population—but it is true for every one of us. Think of yourself. What made you finally go to the gym after months of knowing that it’s a good idea but doing nothing about it? What made you finally studying for a test after days or weeks of postponing doing it? Or making a phone call to an estranged friend you wanted to get back in touch with? Or making a bigger move that changed your life for the better and you wished you wouldn’t have taken so long to do?

So when do we really make a meaningful change in our lives?

· When fear of the unknown becomes less scary than a familiar, known situation which has become too toxic and too unhealthy to allow it to continue?
· When we feel empowered and aware that we have the energy and the “know how” to carry out the change?
· When we reach some kind of a “rock bottom” from where there is no other way forward but changing course?

The list can go on and on. Feel free to add your own thoughts to this list!

What makes you change?
Have you felt that powerful connection with your core being? If you did, how has that helped you in your life?
What was the trigger that shifted you in to an action mode and helped you solve a crisis?
Who, if any, has guided you out of a crisis?
What have you learned about yourself in the process? What have you learned from that experience overall?

The beautiful Paro Valley at the foot of the Himalayas, with its imposing Paro Dzong (a dzong is a complex of buildings serving as monastery, administrative center and fortress at the same time)--Bhutan

Back from the “Top of The World”

2010-05-26T07:03:00.000-07:00

I came back from my trip to Tibet, Bhutan, Nepal and Thailand last week. Being in awe for three weeks during the trip, it is hard to come back to the routine of everyday life in Los Angeles. I got used to being a tourist: kept wondering where I would get my next meal in a city I had never been in before and in a country where people don’t speak English; wondering if my next hotel room will have hot water, or how much I will suffer from the altitude sickness, or how many wonders I will see that day.

The trip had many highlights.

I was in Nepal when the Maoists called a national general strike and I had to travel across country to the border with Tibet during that event. I had to pass through protesters’ many ad-hoc Maoists check points where non-governmental Maoists were making the decision whether to let my group pass or not. Luckily they did let us pass but later on I found out that there were some incidents where the tourists got beaten. The tourists were disrespectful, the rumors went, and failed to stop at a check point.

Near the end of my trip, I was in Bangkok during the bloodiest uprising in the contemporary history of Thailand.

I walked on the streets of Lhasa avoiding at all costs looking suspicious to the Chinese soldiers in full riot gear stationed at many corners of the Tibetan section while the Tibetans were going about their business buying yak butter and vegetables, conducting business and sipping cups of yak butter tea in the tea houses.

I had a private audience with His Holiness Demjom Tenzin Yeshey Dorjee, a highly revered Rimpoche of Bhutan and talked about the shape of Buddhism in the West and how Buddhist ideas are merging with the industrialized world in a complementary rather than adversarial way and the role of spirituality in a technologically evolving world. His Holiness, open minded and visionary, believes that “compassion is the way to connect with one another and with the entire world in a meaningful way and the best way out of suffering.”

I went over mountain passes of over 16,500 feet altitude on my overland drive from Kathmandu, Nepal to Lhasa, Tibet, on the Friendship Highway, touching or gazing at the tallest mountains in the world in complete wonder while my lungs were desperately expanding to their maximum capacity in the thin air.

I was fortunate that the clouds cleared when I flew China Air over Mount Everest (8848 m) and K2 and was able to see firsthand the tallest mountains in the world.

In Tibet there are many powerful rivers, turquoise lakes at 14,000 feet altitude and patches of barley farms.

Our hotel in Lhasa--The Lhasa Yak Hotel, owned and run entirely by Tibetans--was in the Tibetan section of Lhasa, five minutes from the Jokhang Temple.

A street in Lhasa on the East side of the Jokhang Temple, the most revered religious structure in Tibet. Pilgrims come from great distances to prostrate in front of this temple. They also do koras, circumambulate around the temple while chanting prayers, most commonly OM MANI PADME HUM--the most sacred mantra of Tibetan Buddhism, which embraces generosity, pure ethics, tolerance and patience, perseverance, concentration and discipline of the mind and achieving wisdom to overcome suffering.

The snowy peaks you see above the clouds are the Himalayan range of mountains with Everest among them. But there are others. Seventeen of the tallest mountains in the world are there as well.

Potala Palace--the former monastic spiritual and administrative heart of Tibet before the Chinese took over in the 1950's, the winter residence for Dalai Lamas. Now it is a museum. All the rooms are empty of staff conducting business and of monks chanting and praying. There are only a few monks allowed to remain at Potala. They are considered not monks but "caretakers" of the place. They are also not allowed to wear the monk's traditional red robes but ugly, dark blue, knee long trench coats. Nevertheless, they still quietly chant while cleaning the windows or shining the silver bowls; and they bless, with a smile, the tourists peering at them in the shadows of the sacred chapels and corridors.

Monks debating at Sera Monastery in Lhasa. Every Tuesday, they have this big meeting where they debate various Buddhist concepts and existential dilemmas. They are animated, talking loud, clapping their hands in approval or disapproval of an answer they receive from the opponents. Our Tibetan guide explained that I if someone gives an uninspired answer, the other debater gives a hand jesture that implies with good humor: "Your brain is yogurt. Think harder!"

Completely dominated by the powerful landscape surrounding it, Lhasa has suffered a radical transformation. Outside the Tibetan sections, it has become a rapidly expanding complex of glass and cement--the vision of a "modern" city in the Chinese leaders' minds, who are erasing the Tibetan culture, tradition and unique architecture from the city.

The Potala Palace, as we are getting ready to climb the monumental staircases to go inside. Only a small portion of the rooms are open to visitors. The most moving for me was the section where the current Dalai Lama, the 14th, lived as a child and teenager. They are unpretentious and cozy. We saw his throne hall, his meditation room, the room where he was studying or giving private audiences. It seemed that everything was awaiting his return. In his "day room" we saw the clock he liked to take apart and put back together. He was and remains intensely interested in technology and science.

The Summer Palace of the Dalai Lama, in Norbulinga Park. It is a complex of summer residences of Dalai Lamas. It has a pond with swans and a large library. In this picture you can see the palace built by the 14th (present) Dalai Lama in 1959. This is the place from where he fled Tibet in the same year, under artillery fire from the Chinese, who were suppressing a large Tibetan uprising by shooting them at point blank range even as they sought refuge in the temples. To this day, the Dalai Lama has never been allowed to return. He only enjoyed his new palace for a few troubled months.

In this palace, I saw pictures of cats and dogs given to the Dalai Lama as gifts because his love for animal was well known. I saw two big radios from the 50s given to him by the President of Russia at the time because of his passion for technology was well known too. In his throne hall, there is a painting of the young Dalai Lama on one of the walls that tourists are only allowed to view from the distance. He looks like the Dalai Lama we know. He is surrounded by his family and he places his teachers above his head, portraying them as if they continue to give him guidance and teach him fundamental wisdom. Everything is taken care of by the Tibetans in deep reverence even though the Dalai Lama lives now in exile. A big part of who He is remains in the hearts of his people and in rooms and hallways of his old dwelling places.

I was surprised to see a painting on a wall of this palace depicting the Tibetan origins story of their people. They believe that a monkey and a goddess got together and had offspring that multiplied over time and populated Tibet. Could it get any more Darwinistic than that? I remembered then that the Dalai Lama often had said that Buddhism is not in conflict with science but goes hand in hand with it, and that spirituality and technological advancements--without going against each other--are both dimensions of the human mind and identity.

You can see in this picture Everest (left) and K2 (right), surrounded by the tallest peaks in the world, and a glimpse of the valleys below.

There is much to say. The list goes on. It will take me a long time to process what I have seen and experienced.

Some things can only be seen or touched to fully experience them. I can only say that being a globe trotter is amazingly enriching, however taxing, exhausting and expensive it may be.

Have you ever had an irresistible desire to visit a particular place in the world? Have you done it? What have you learned from the experience?

In Tibet, Bhutan, Nepal for Three Weeks--Back on May 17

2010-04-24T07:37:00.000-07:00

Research trip, vacation, pilgrimage--I can look at my trip in many different ways because it means all of the above to me.

Finally, today is the day! I am headed for Tibet.

The first leg of the trip is flying from Los Angeles to Kathmandu--about 20 hours travel time.

From there, there will be a three day drive to Lhasa over the passes (16,000 feet some of them) across the South-Western region of the Tibetan High Plateau--The Roof of The World.

I will visit Bhutan and Nepal as well in one big sweep of the region.

We have the Diamox ready, to prevent the altitude sickness, as well as sun glasses and sun screen because it seems that altitude and sun light are the two biggest hazards for tourists in that part of the world.

We will stay mostly at Tibetan equivalent of bed and breakfasts, own by Tibetans, to learn as much as we can about how is like to live there and about their culture and customs. We will visit many Hindu and Buddhist monasteries and meet with gurus and Buddhist Lamas and monks.

I don't know how well equipped the places I will stay at will be with Internet access. As often as I will get a chance, I will make sure I will "tweet." You can follow me on Tweeter and stay in touch.

I will resume my regular posts after I get back on May 17, so stay tuned.

So long for now.

STRESSED? WHAT TO DO ABOUT IT (PART 2: Access and Use Your Deeper Inner Resources

2010-04-18T19:37:00.000-07:00

BETTER THAN CURED INTERVENTION, Applied to Stress Management--A 10 stage Healing Process (cont.)

STAGE 3:

SOUL SEARCHING:

Tap into your deeper inner resources!

Creativity
Compassion
Wisdom and Common Sense
Intuition
Emotional intelligence
The power to choose your path
Gut feeling
Sense of wonder
Sense of humor

And the list goes on. These are the skills we do not learn only through training. They are part of the very fabric of our souls. Someone may be very intuitive while another may have the gift of instinctively understanding his feelings or those of others--emotional intelligence--while yet another may have an unbeatable sense of humor that helps him through hard times. We all have a special gift. Many of us may have not discovered what it is. In stressful times, when we need to mobilize all the outer and inner resources--all we've got--to overcome an obstacle, we will find our own strength.

But it would be helpful to know ourselves better before a crisis strikes, so that we will be better prepared to cope with it.

Here are a few examples:

Cultivate your Emotional Intelligence (EI)!

High EQ (Emotional Quotient)=
low insecurity=more openness

More openness leads to more flexibility to explore new solutions to a problem and more ease in dealing with other's emotions, denials and fears.

The essential premise of EI: to be successful requires the effective awareness, control and management of one’s own emotions, and sensitivity towards those of other people.

Learning to work with our EI at different levels, managing our own emotions, knowing how to motivate ourselves, acknowledging other people’s emotions, can help us and our teams become more productive and less stressed out while keeping a sense of balance, continuity and harmony.

Discover and use your creativity!

Creativity does not apply only to artistic endeavors. Teachers use their creativity to teach students knowledge.
Doctors use their creativity to combine different intervention and treatment options in the best possible way for each patient. The CEO uses creativity to manage the difficult economic situations of his company.

"Thinking out of the box" is an overused expression but its value remains: allow yourself enough freedom to think! You then may come up with a beautiful and completely unexpected plan to get yourself out of trouble.

Maintain a Sense of Wonder and a Healthy Curiosity!

Healthy curiosity is the mental process that makes the world go around. It jolts us out of the boring routine and propels us into the unknown. What can we discover there? New avenues for the future.

Einstein, when asked what character trait most led him to his discoveries, said it was his creativity.

The first hominid who broke a round stone into sharp pieces and then used them as tools must have had the same trait.

Todd Kashdan, clinical psychologist, psychology professor at George Mason University and a strong advocate of Positive Psychology, has written a whole book in which he explains how staying curious about life can make us happier and less jaded. His book is called CURIOUS? Discover the Missing Ingredient to a Fulfilling Life and it is a very interesting read.

"The greatest advantage of curiosity," he writes, "is that by spending time and energy with the new, increased neurological connections are made possible. Facts and experiences are synthesized into a web, paving the way for greater intelligence and wisdom."

Enhance Your Compassion!

"Compassion is the ultimate and most meaningful embodiment of emotional maturity. It is through compassion that a person achieves the highest peak and deepest reach in his or her search for self-fulfillment." --Arthur Jersild.

Why do we need compassion to better manage stress?

Because through compassion we can relate to ourselves and others with more kindness; we can more easily see that we are all beings engaged in a common quest for happiness. No mater what happens and no matter where we go, we will be surrounded by other people who have this trait in common with us. Tapping into what we have in common with others, rather than what we have different, will help us understand deeply our connection with others and relate to anyone from a common place.

Find and Trust the Wisdom of Common Sense
in Everything You Do!

Who says that in the current society as it changes at a fastest pace in history, common sense lost its value? It has become even more important. Yes we have new ways of communicating. We have virtual neighborhoods and shoot "tweets" and instant messages all day.
But everything I've read about "on-line etiquette" is exactly the same way my grandmother used to lecture me years before all this technology was available: be polite, answer nicely, find good ways of saying "no" but don't hesitate to do it if you strongly feel the need to, and so on.

In every profession, if you don't obey the "common sense rule" you will be lost for sure.
Everyday in my medical practice I am faced with many different answers for the same problem. How can I choose? I always try to pick the answer that "makes more sense." For example, an anxious patient may tell me that he is trying to find a solution to feeling "like drowning" every time he takes a shower. In addition to exploring his hydrophobia, I also told him to turn his back toward the shower. That way the jet of water will no longer come directly at him, hitting him in the face and making him hold his breath. He would then be able to breathe freely and his association between water and inability to breathe will greatly diminish.

This was a common sense solution. Hearing it, my patient was not only able to easily embrace it, but he laughed aloud at "how silly of me not to think of doing this for all the long years I had this problem and was ashamed to even discuss it with anybody." For those of you who don't know yet, laughter in psychiatry is a very good thing. It means a healthy emotional defense mechanism. It indicates one's ability to "rise above" a problem to better control it.

Talking About Stuff Helps!

This is another example of a common sense solution for when we feel overwhelmed. It's not scientifically explained yet, but we all know that when we feel heavy, upset and stressed out, we feel a great deal of relief by sharing our feelings with someone we trust. It may have to do with establishing a comforting basic human connection or with finding compassion in someone else when we lost, for a moment, our ability to be compassionate with ourselves. Done right, it always works.

It is a good idea to build around you a social circle where you can find understanding, acceptance, love and warmth. Try it! It will be worth your effort. You can create a support group from people who work in the same profession or from people who are going through the same challenges you are. There will always be someone out there, in cyberspace if not in person, that has gone at some point in his life through something similar to what you are going through right now and is willing to listen and hear you out. Reach out and find that person!

IListen

Like IPhone or IGoogle, a device should be invented to make us better listeners. It could be called IListen and it could save us the pain of miscommunicating with others.

While being able to verbalize and share your problems with people who will understand you is a very helpful skill to manage stress, so is being a good listener. Knowing how to listen to the underlying message in what you hear, will give you a warning about what to expect from the person talking to you. Only if you really listen to someone will you be able to understand his intentions.

Listen not just to the words but also to the tone in the other's voice; register his gaze and his body language; take him/her into account completely not just superficially. Becoming a good listener takes mindfulness and practice. Try to listen and really pay attention to what your girlfriend or your boss or your secretary is saying to you in your next conversation.

People do not like to go around saying negative things or talking about themselves directly. They will say generic things but in many different ways, leaving it up to you to get the true meaning of what they actually meant to say. When your girlfriend, for example, invites you to choose a restaurant for dinner by saying "I am happy to go anywhere. Where would you like to go?" means that she wants you to be happy, not that she doesn't know where she would rather have dinner that night.

Are You a Good Listener?

Try this little questionnaire. Don't just automatically say "yes." You may be surprised by your own answers.

I don’t rush to judge before I hear what the other has to say.
I don’t “zone out” while the other is talking to me.
I understand the other’s point of view.
I don’t start formulating the answer before I understand what the other is saying.
I hear what the other meant to say.

If you didn't truthfully answer "yes" to all the above questions, don't panic. Just begin training yourself immediately to become better at really hearing people. It takes some practice but you will be greatly rewarded.

Try it tomorrow at work. At the end of the day, take a moment and see how it went--how did you feel through the day and how did others reacted to your change in attitude.

The journey continues in the next post. Stay tuned. I would love your comments on what you have read so far.

STRESSED? What To Do About It (Part 1: Awareness of Stress and Basic Self-Intervention)

2010-04-12T01:17:00.000-07:00

These are excerpts from my recent workshop on stress management, which I presented to a group of 50-60 health care workers.

There are many ways to manage stress and stressful situations. Better Than Cured intervention suggests its own. It is structured in 10 stages, progressing in complexity from the awareness of stress and basic self-help measures, to more complex interventions: psychotherapy, medication, life coaching. Buddhist psychology is present in almost all stages because it deals with awareness, compassion, the quest for peace of mind and happiness--basic human needs. Buddhism deals with these issues from a pragmatic perspective. I have always found myself attracted to the Buddhist point of view in this regard. Buddhist principles make a lot of sense to me personally, but also to the hundreds of patients I have worked with and watched heal using these guiding ideas and principles.

Let's begin by understanding some basics about stress:

You may be surprised to realize that stress is not always bad.

Under a reasonable degree of stress, we may feel at first energized by it--stimulated and excited. It is a healthy reaction to a manageable, productive degree of stress. This type of stress is called Eustress. As soon as we learn how to manage it, we reach a comfort zone dealing with it.

But if the intensity of stress continues to rise, we reach a point where our coping mechanisms are exhausted. That point varies for different people, but everyone has a stress point at which his ability to cope is overwhelmed. Ideally, we do not push ourselves that far. But occasionally that happens. One of the first symptoms of stress becoming unmanageable is fatigue. Once we reach that point, we suddenly feel tired even doing our usual tasks. Taking a break and resting can reverse the toxic effect of stress at this point, and can help us regroup and return to our normal level of functioning.

But if we can't take a break from stress and the intensity keeps rising, we will soon reach the burnout stage. From there, if the process continues, we will become severely anxious, depressed and even suicidal, going into a crisis mode. At that point, something has to drastically change, however costly that may be, to recover our strength and return to our normal level of functioning.

Better Than Cured: 10 Stages To Stress Management:

Stage 1: The Awareness of Stress
(awakening to the problem at hand)

“Oh, my God! I have a stress problem!”

Stress awareness exercise:

"I know I am stressed out every time I…"

This was a phrase completion exercise I presented during the workshop. Feel free to do it too. It is useful to increase your awareness of how stress manifests in you. You yourself may be surprised with your answer. Some people say that they know when they are stressed out when their voice becomes high pitched, others when they feel tension in their neck and shoulders. Try to identify what your signal of being stressed out is. You probably have more than one such signal.

Another exercise:

Identify and balance the stress with the rewards for each difficult situation you find yourself in.

Thinking of the possible stressors and rewards you will likely encounter today, how does your balance look?
Thinking of long term stressors and rewards, is the balance between them steady? If not, can you add more to the rewards side or decrease the stress? Would that create an acceptable situation for you?

Feel free to try it!

STAGE 2: BASIC SELF-HELP:
Examples of immediate actions to ease stress.

SLOW DOWN THE BUSYNESS

TURN OFF THE NOISE!

We all do innumerable things that add to the constant “chatter" in our heads or in our lives. Turning the volume down by eliminating some of the redundant or obsessive dialogues we carry on with ourselves will have a relaxing effect. Try it!

DETACH AND OBSERVE
(gain a bird’s eye view)

Rise above a stressful situation. Imagine you are above it looking down. What do you see? Do you see different patterns of interaction between participants? Can you distinguish details that escaped your attention when you were deeply entrenched in it?

CREATE A SPECIAL,
PEACEFUL PLACE
OF REFUGE
IN YOUR MIND

You can create in your mind a peaceful, private space where you can relax. It may be a real place or an imaginary one. Whenever you are tired, frustrated or overwhelmed by the realities around you, you can find refuge, even if it is only for a few minutes, in this virtual quiet, peaceful place. When you return to face the same realities, you will feel much more rested and refreshed and better able to deal with the situation.

One of my coaching clients pictured a Japanese tea house because he was in love with Japanese art and culture. Another imagined a meadow she stumbled upon while walking with her mother in the woods as a child. The choices are virtually limitless.

Go ahead and try to create your own place of mental refuge. What does it look like?

SHAKE OFF HELPLESSNESS!

TAKE ACTION AND A LEAP OF FAITH!

Sometimes the only acceptable way to manage a stressful situation is to have the courage to escape it. Often when under intense stress, it is easy to believe that we will never be able to escape it. Feeling hopelessness is a common problem when overwhelmed by stress. But it is a death sentence to allow yourself to listen to that urge. Make a leap of faith and take action!

Like Ulysses who, had he succumbed to the song of the sirens, would have never found the strength to find his way home, so you may get lost in being sad and sorry for yourself and forget to fight your way out of a bad situation. Taking action will save you. Sometimes you need to be brave and take a real leap of faith. It can be scary and risky. But it will jolt you out of the inertia, you will set in motion different factors, and with a little bit of luck you will overcome the stressful situation that seemed, at first, so unmanageable.

I would love to have your feed-back. The journey continues in the next post.

My Newest Ezine Article: Qitting A Bad Job Doesn't Make You A Quitter

2010-04-10T08:52:00.000-07:00

While I am preparing for my lecture to health care staff on managing stress, I haven't had much time to keep up with my blog posts. But I have written this article for Ezine that I hope you will find interesting. It was inspired by a very dear patient of mine who, deeply committed to her job, did not register how her desire to make her job worthy of her efforts was blinding her to how the job was changing: her boss had no interest in listening to her suggestions or appreciating her work. Instead of pulling out, she was being even more dedicated, investing even more time in it in the hope that, finally, her work would be acknowledged. It never happened. You can read in the article how she, and thousands of others, could have avoided this ordeal.

Meanwhile, I am preparing for my lecture. It will be held at Nile Hall in Preservation Park, Oakland, and it is organized by Service Employees International Union - United Healthcare Workers West (SEIU-UHW) and the Joint Employer Education Fund. SEIU-UHW in association with Joint Employer Education Fund are committed to increase medical staff's awareness and education about important professional issues like managing stress on the job.

Although it doesn't make newspaper head lines, the type of stress specific to health care-- secondary stress--adds to the usual life stress and creates a faster burnout rates that can lead to depression and even suicide.

Secondary stress is defined as "the pressure that results from reaching out to others in need," according to Robert J. Wicks, the author of Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Professional and Personal Well-Being. You may not be a professional health care person, but you likely have experienced secondary stress in various manifestations at various times.

There are about 400 physicians who commit suicide every year, an average of one a day. This is a very serious problem that confronts the health care community.

There are many obvious explanations and many hidden, less obvious causes for this. Some obvious causes: pressure to perform; being overwhelmed by the pace and the volume of work; stigma about asking for help from a colleague who is a mental health care provider; the feeling that doctors always have to be in control and admitting a mental illness may ruin his/her credibility and authority in their own eyes and in the eyes of their colleagues; restrictions in getting or renewing medical licenses if there is a history of mental illness. And these are only a few of the causes.

One of the possible solutions is to help the medical staff learn how better to take care of their own needs in order to be able to adequately take care of the needs of their patients. With this idea in mind, I have designed an intervention based on the principles of Better Than Cured, that I hope the audience will find helpful in reducing their stress level and managing the demands in their personal and professional lives.

Are you familiar with secondary stress? How have you managed it? Or, if you haven't, what do you think would be helpful in learning how to manage stress in general and secondary stress in particular?

No More Tip-Toeing: It’s Time for Action!

2010-03-30T01:35:00.000-07:00

When Sam came to see me, he didn’t know anything about life coaching. He just had a problem and didn’t know how to solve it. A friend told him that I might be able to help him, so he made the first appointment.

Sam’s problem was this: he had a family business that was doing okay before the recession. Lately, the revenues started declining. He was contemplating retirement for awhile, thinking that it made more sense to him than to labor twelve hours a day for very little return, and this seemed for him a good time to finally take that step.

The problem was that he had ten employees that had been working for him for years and depended on their jobs even more than usual in this tough economy. He didn’t have the heart to tell them that he was thinking to close. Lately, his accountant was saying that he had to either come up with a new idea to revamp his business or he would run out of money by the end of the year. And the longer he waited to make a decision, the less money he would have left in his retirement fund.

Sam did not want to think about reinventing his business. He was done. He had worked all his life and now he was dreaming of a small house in Costa Rica where he could live part of the year in the middle of nature.

“How much longer,” he asked me in the first meeting, “should I tip-toe around my employees

before I break the bad news to them?”

“Do they know that anything is up?” I asked.

“It would be impossible for them not to have figured out by now that sales are down and we are running out of money.”

“If they already know things are bad, perhaps all they would like to find out from you is when they will be out of a job, not if.”

“Yeah, perhaps,” he said with a heavy sigh. “I just can not bring myself to set that meeting. Every week it’s on my agenda and every week I postpone it.”

“When you imagine yourself in that meeting, what makes you the most uncomfortable?”

“Their disappointed faces. The fact that I failed them.”

“Didn’t you want to retire anyway?”

“Yes, but I wanted to do it well, like my father did. He had this great party, then he left and the business kept going strong…” he said nostalgically.

We started talking about how being a business man implies making decisions that make sense from a business standpoint and how he needs to find a way to let go of the image of him retiring in the same fashion as his father. The times are hard and it isn’t his fault. He needed to take back the control of his business.

Holding in his mind’s eye the image of his cottage in Costs Rica where he will not have to deal with business decisions or money or spread sheets did help. Reviewing his ever decreasing saving accounts also helped. But what helped him make his move was the understanding of the psychology of his “tip-toeing.” And that meant understanding his own fear of change.

In fact, his “tip-toeing” behavior had a name: phobic avoidance. It means avoiding something that makes you fearful and uncomfortable, even when you know that avoiding it can cause you more discomfort and harm in the long run; if it is avoided for the moment, it’s a moment longer before you really feel the pain here and now. This was exactly what Sam was doing. He did care for his employees. Still he could have let them go months ago, with good severance packages and good recommendations—all he, as an employer, could be expected to do. They will have to take their chances out there in the work force anyway, as he was ready to retire.

Ultimately, this is what Sam did: he gave them generous bonuses and took the time to write individual letters of recommendation in which he highlighted the merits and qualities of each employee. He then organized a fancy retirement party at an expensive restaurant in town, which allowed him to feel prosperous and benevolent. It also gave him the feeling that he was still in control, even though he had to adjust to a bad economy and harsh business decisions. In other words, he faced his fears and took steps to overcome them.

Using his entrepreneurial instincts, he managed to rise above the situation and solve it.
To his surprise, his employees took the news very well. They said they knew it was time to close. Some of them were already looking for new jobs. Some of them thanked him for ending their agony of not knowing when and what would happen to their company and had a sigh of relief when Sam brought the situation into the open.

Everybody understood and supported his decision to retire. It turned out that, using his business contacts, Sam was able to be very instrumental in helping his people find new jobs even in the recession. No one felt let down by the time Sam was through.

At our last meeting, I asked him if he was happy.

“Things couldn’t have gone better,” he answered, patting reassuringly his shirt pocket where he kept his recently purchased Costa Rica plane ticket. “I can’t believe that after all these years in business, I still kept staying in my own way. I was the biggest obstacle to move forward--not the economy, or my business or my employees. I could have done this a year ago.”

“But you did it and it went very well,” I reassured him. “In fact, everybody, even the savviest businessman, has a soft spot. Yours was the concern for your people. Fortunately, you figured out ways to take care of them and at the same time did what’s right for the business. You’ve created a win—win situation. What would your father think?”

He just smiled.

“Thank you,” he said, and then he opened my office door and walked purposefully into his new life’s journey.

Occasionally I get a post card from Costa Rica. He is very happy with his new life. He still remembers our discussion about “phobic avoidance” as the thing that’s always best to be avoided.

Has it ever happen to you to tip-toe around an issue only to discover that the solution was much easier than the tip-toeing?

P.S. I think temporarily I suffer from a "post-Vancouver nostalgia." All the pictures you see in this post are from Vancouver.

GREETINGS FROM VANCOUVER

2010-03-20T23:52:00.000-07:00

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.

I am traveling to Vancouver this week for a conference on "wealthy thought" leadership. It has been the most illuminating conference and I am working on a full post on it. But for now, let's look together at some of the pictures I took from the city. I hope that, after you see them, you will understand, just as I did, why Vancouver is considered one of the top 10 most beautiful cities to live in in the entire world.

The English Bay--It is in the city and not on some isolated part of Canada. But this is Vancouver, not afraid to allow open spaces whithin the city. If this was Los Angeles, there would have been mansions and expensive condominiums up to the water line.

These birds with open wings are spread all over the city. They have many colors and patterns and pop up on the street when you least expect to see a piece of art.

Quiet Saturday morning on English Bay.

The vehicle of the future? Perhaps.

A psychodilic car we just came across on the street. No one knew its history or why it was parked there. But we were all intrigued by it.

An Inuit symbol is this: INUKSHUK. You see it everywhere. It is meant to look like a stylized man from the distance.

At the end of March, all the trees are in bloom.

The nature and the big city combine in an absolutely unimaginably beauty in Vancouver.

The Olympic flame is still burning. This time for the para olympics.

Hopefully you liked these images of Vancouver. And hopefully you too can visit it soon.

TOXIC STRESS AND HOW TO OVERCOME IT, Part 2

2010-03-14T20:42:00.000-07:00

UNHEALTHY CONSEQUENCES OF TOXIC STRESS

Toxic Stress—a generic name for prolonged stress with no apparent end in sight that makes us feel powerless, hopeless, depressed and anxious.

Physical manifestations of toxic stress:

· The increased adrenaline level no longer comes down. The blood pressure and heart rate don’t either, wearing down the circulatory system and leading to hypertension and heart failure.

· Chronic increase of stress hormones (steroids, adrenaline, nor adrenaline) makes platelets more prone to aggregate and mobilize energy in the bloodstream and increase the level of fat, glucose and LDL type of cholesterol which leads to the formation of atherosclerotic plaques.

· The muscles remain tense and ready for the “fight or flight,” but the prolonged tension is weakening them.

· Pain and headaches become daily companions.

· Stress hormones inhibit the formation of leukocytes by inhibiting the thymus function and inhibiting the innate immune response. Stress induces a miscommunication between the brain and the immune system, weakening the body’s response to infections and even cancer.

· Digestive symptoms like discomfort, alternating constipation and bloating with diarrhea

· Increased predisposition for ulcers and irritable bowel syndrome; changes in appetite, eating too much or too little

· Delays healing from wounds and other illnesses

· Accelerates the aging process

(For this section I used information from the book Why Zebras Don’t Get Ulcers by Robert M. Sapolsky.)

Stress and Cancer

Long hypothesized and intuitively believed to be a true link: Galen observed 2000 years ago that women who were melancholy were more susceptible to cancer than other females; Gendron, a British physician in 1700s emphasized the effect of “disasters of life” as a cause of cancer; Burrows, eighty years later, attributed cancer as a reaction to “the uneasy passions of the mind in which the patient is strongly affected for a long time”; in the nineteen century observations were made about cervical cancer more common in sensitive and frustrated individuals; Walshe in his treatise The Nature and Treatment of Cancer called attention to the “influence of mental misery, sudden reverses of fortune and habitual gloomings of the temper on the disposition of carcinomatous matter.” One hundred years ago Snow reviewed 250 patients at the London Cancer Hospital and concluded, “The loss of a relative was an important factor in the development of cancer of the breast and uterus.”

· Characteristics of cancer prone individuals: frequent feeling of hopelessness, helplessness, an inability to express anger or resentment, an unusual amount of self dislike and distress and the loss of a meaningful emotional relationship

· One hypothesis for the relationship between stress and cancer is that, under stress, according to Yamasaki’s article on non-genotoxic mechanisms of carcinogenesis: “Cancer can be regarded as a rebellion in an orderly society of cells when they neglect their neighbors and grow autonomously over surrounding normal cells.” In essence, the balance and communication at cellular level may be lost during severe stress.

· The good news: spirituality, feeling of social support, learning and practicing stress management techniques, visualization and reframing of stress can all help improve the cancer outcome, in some cases increasing survival rates: and, perhaps, for people able to manage stress effectively, may have a protective effect from cancer.

(I have used for these sections information from the well researched article, Stress and Cancer: Diseases of Civilization, Communication and Control by Paul J. Rosch, M.D., F.A.C.P., President of The American Institute of Stress. You can find it in its entirety on line at )

The effects of toxic stress on the central nervous system

· Amygdala is highly activated by stress and has an inhibiting effect on the hippocampus, which leads to memory impairment.

· The neural connections networks are disrupted, which leads to decreased memory and concentration and, ultimately, to neuronal atrophy

· Excessive and prolonged exposure to stress hormones ultimately causes neurological impairment

· Recent brain imaging research shows that, extremely stressful situations like torture and traumatic head injury produce structural deficits in the prefrontotemporal brain regions, associated with severe depression.

The effects of toxic stress on emotional health

· Anxiety with panic attacks, irritability, even angry outbursts

· Reinforcing the anxiety and avoidance brain circuit in the amygdalar region of the right hemisphere

· Inhibiting the optimistic, future-planning circuit in the prefrontal cortex of the left hemisphere.

· Major depression with anhedonia (lack of pleasure in almost anything), excessive guilt and hopelessness.

Neuroimaging of patients with major depression showed abnormalities in the anterior cyngulate gyrus of the left frontal lobe, the same area thought to be crucial to comprehensive forward planning and executive control. It is believed that the anti-depressants act at that site to boost its activity and by so doing, help the depressed person regain the executive control and ability to make rational plans. The electrical stimulation of the same area showed relief in the depressive symptoms and an improved connection with amygdala, leading to better emotional control. Certain types of psychotherapy, like cognitive restructuring therapy or reframing, may lead to the same neurologic effect.

· Patients with genetically reduced volume of the above mentioned area of the brain have shown an increased risk for developing depression and a weaker connection with the amygdala, giving them less executive control over anxiety and the avoidance-producing brain center.

· PTSD (patients with PTSD due to repeated stress have small hipocmapi. The more severe the history of trauma is, the larger the volume loss.)

(For these sections I used notes from the on line book Psychology: An Introduction by Russel A. Dewey, Ph.D.)

Common Stressors—The Life Stress Inventory

The most popular stress scale is the Holmes-Rahe Life Stress Inventory.
The first five most stressful life events are based on loss, considered to trigger some of the most powerful stressful reactions:
· Death of a spouse, considered the most stressful of all possible life events
· Divorce
· Marital separation
· Jail term
· Death of close family member

What stressors have you found the most difficult to cope with? How did you overcome them?
How do you react under stress to everyday stress?
How do you react to prolonged, long term stress?
How did you manage it?

Try this exercise:

The Navajo Chant:

Happily may I walk

Let there be beauty before me
(Think of one thing for which you are grateful today.)

Let there be beauty behind me
(Think of one thing for which you are grateful today.)

Let there be beauty below me
(Think of one thing for which you are grateful today.)

Let there be beauty above me
(Think of one thing for which you are grateful today.)

Let there be beauty all around me
(Think of one thing for which you are grateful today.)

In beauty it is all fulfilled.

I hope the flowers in my painting made this picture of toxic stress less gloomy. I didn't talk about toxic stress to make you sad or to bring you down. I just wanted you to see in how many negative ways our health at all levels is marked by stress. The good news is that we can do something about it. There are many interventions we can do to shield ourselves from these negative consequences. You will see those interventions in few days, in Part 3 of this series--How to manage stress successfully.

The Thinking Tree Is Shaped By the Power of Our Own Thoughts

2010-03-11T11:44:00.000-08:00

“If you leave me in the room without a computer or TV, I can keep myself busy for weeks worrying. I can endlessly think of everything I didn’t do, or I did wrong, or I completely forgot to do,” said Suzanne with a big sigh of frustration in one of our recent sessions.

“You are going to laugh at this,” she continued, “but sometimes I am thinking that all my thoughts take the shape of a tree. Something like…like a thinking tree. But I can see how badly misshapen mine must be. If every branch is a thought, then my thoughts are so much of the time so out of balance that it will only lead to an ugly, off putting kind of a tree, right?”

I imagine it will look something like this:

I wasn’t laughing; I was actually amazed at the power of her metaphor.

“So what can you do to shape this tree more beautifully?” I asked.

“I need to change the way I think; but of course if I knew how, I would have done it long ago.”
Suzanne is a young lady but she is no stranger to the struggle with anxious and obsessive thoughts. Often they don’t allow her to sleep, making her lay awake for hours “thinking,” as she calls it. They are all ruminating thoughts, filled with regret, guilt and unhappiness.

When she first came to see me a few months ago, I made the comment that antidepressant medications could help her quite a lot. But she wouldn’t hear of it. She felt that if she took medications, that meant she accepted her defeat against these anxious thoughts, and she wouldn’t have it.

We started talking about cognitive behavioral techniques and how to recognize and stop the negative, ruminating, emotional thinking with the power of the logical mind. She learned the 10 dysfunctional patterns of thinking from Dr. Burns’ book, Feeling Good, and gradually she became very good at catching herself when her negative emotions threaten to overcome her.

As we speak, she is in the process of learning how to control these emotions one by one, as soon as she identifies them. It’s slow and difficult work. But she is very brave and she decided that quitting is not an option.

I thought this would be a good moment for her to use visualization to help her better stop the negative thoughts. I used her own metaphor and applied to it the neuroplasticity theory. According to this modern and very sophisticated theory, our brains are remarkably adaptive. The brain has an incredible power to act, react and ever change its patterns according to what happens outside and inside of us.

What Suzanne didn’t know, which shows how creative her mind is, was that forming new synapses in the brain happens in a way that looks a lot like pruning and it’s called just that: “synaptic pruning.” Through this process, the brain can erase old connections and develop new ones—highways of information on which the neuronal impulses travel at amazing speed. Even more surprising is that these new synapses are molded, among other things, by the power of our thoughts and our own way of thinking. That is way, if we change the way we think, we break some old connections and build new ones—a lengthy process that requires a great deal of motivation and persistence. Suzanne has both. In addition, she has a sparkling intelligence.

“Imagine,” I said, “that your thoughts are like branches of a tree—the more beautiful and complex your thoughts are, the more intricate the branches’ patterns become and the more colorful the tree becomes, lighted up with bright, sparkling thoughts. Every time your thoughts go again and again over the same obsessions, you kill the spark. That area of the tree becomes gray and dead. But every time you stop that negative thought process and replace it with fresh, creative thoughts, you can light up that area of the tree, making it shine with colors. So you have a choice. What kind of thinking tree do you want to have?”

“The bright and colorful one, of course!”

“Then take care and don’t kill any portion of it. Use the power of your rational, practical mind and stop the obsessions. You do have a choice and it is up to you how beautiful of a thinking tree you create. And the good thing about having a beautiful thinking tree living in one’s mind is that the thinking will improve along with one’s actions and attitudes. If you manage to carry that kind of thinking in your mind, everyone will be surprised by your brightness of spirit, pleasantness and enthusiasm. ”

“Me like that? Doctor Forest,” she said with a slight irony, “who are you talking about?”

“Why, you, of course!” I replied, dead serious.

Then we made an agreement. I will paint the two thinking trees: one overcame by obsessions and dead branches, looking empty and sorrowful; and the other, a thinking tree brightened up by positive, enthusiastic, new and renewed thoughts--beautiful and diverse products of an active, spontaneously creative mind.

Her part of the bargain is to make sure that she will nurture and cherish her thoughts and her thinking so that she will know that her brain, just like my healthy thinking tree, will be light with beauty and liveliness.

She agreed with this wholeheartedly.

And here it is--my part of the bargain. We will see in due time how well she does.

If you want your own thinking tree to go from this:

To this,

dare to be curious, to ask yourself and the world questions rather than passively accepting reality, to decipher the mystery of life and to allow yourself to wander at the marvels of the world.

What has been your experience with changing the way you think in order to make better decisions or feel better about different situations in life? Have you has to change old ways of thinking or doing things? With what results?

TOXIC STRESS AND HOW TO OVERCOME IT, Part 1

2010-03-07T20:00:00.000-08:00

I have been working for the past two weeks on a paper on stress for a workshop I will be presenting soon. After giving it a lot of thought, I decided to divide it in three parts which will be the subjects of the next three blog posts:

Part 1: What stress is and what is a healthy adaptive reaction to manageable stress
Part 2: How much damage toxic (unmanageable) stress can cause us mentally and physically
Part 3: How to effectively manage toxic stress, overcome stress related complications of anxiety and depression, and how to find one’s way toward happiness

To help you better cope with this potentially stressful subject, STRESS, I have peppered the posts with details of my recent paintings. Hopefully they will lighten the subject.

Part 1:

What stress is and what is a healthy adaptive reaction to a manageable stress

What is stress?
In general, any change in our environment that requires or triggers a mentally or physically painful adjustment can be perceived as stressful.

Types of stress:

Eustress: Dr. Selye coined the term Eustress to differentiate positive stress from toxic stress. Eustress—the optimal stress level of each individual. It is commonly perceived as a feeling of “rush” and excitement, like skiing fast down the mountain or riding the bike with the wind blowing in your hair and you only want to go faster and faster. Eustress is a manageable type of stress that leads to taking on and conquering new challenges or getting excited about performing well on a project or on the stage. It drives positive changes in one’s life.

Try this:
Can you think of examples from your own experience of “positive stress?”
How did it feel? What were you able to accomplish in that state?

Acute Stress: brief, intense, stressful episodes like narrowly avoiding an accident or dealing with the mess in your teenager’s room.

Episodic Acute Stress: recurrent, repeated episodes of stress creating a chaotic day-to-day life; leads to feelings of being overwhelmed by the never ending “small stuff.”

Chronic Stress: a long term stressful situation like a dysfunctional marriage or chronic illness that seems inescapable and without an end in sight; usually leads to burnout if no intervention is made.

Burnout: the feeling of inescapable stress with no end in sight; inability to function; feeling paralyzed mentally and powerless to make the changes that will solve the problem; usually accompanied by anxiety and/or depression.

Major types of stressors:

Biological: an illness or physical discomfort
Life situation: breakups, marriage, divorce, empty nest syndrome, the death of a parent
Behaviors: addiction, poor coping
Cognitive Activities: mental challenges like sitting for an exam,
Occupational stress: losing or starting a job, coping with the corporate world, patient’s demands and distress, finding the balance between the empathy we feel for our patients and our inner emotional resources to avoid burnout.

The nature of stressors:

The impact of stressors depends on how they are perceived by each individual who experiences them:
Importance assigned to a stressor: a breakup versus losing a job
Duration: we may manage one week but one day more than that may become too stressful
Cumulative effect: having a demanding job and a difficult boss and tight deadlines
Multiplicity: job change plus illness plus relocation
Imminence: how soon the stressor will end
Expectation: we expect a stressor of one kind, but we get hit with one that we have not anticipated; or we expect one stressor to last a certain time, but it ends up lasting much longer.

Try this:

In managing stress it is useful for you to know what your stress level is on average.

Take your stress temperature: think about the last five days. What was your stress level by evening of each day, on a scale of 1 to 10?

This simple exercise will help you develop more awareness of your stress. Be honest with yourself. Acknowledging your feelings, even feelings of stress, anger and fear, is not a sign of weakness but of strength. Only by being aware of your feelings will you be able to take corrective actions.

HEALTHY RESPONSE TO MANAGEABLE STRESS

Nervous system’s reaction to stress:

Activating the sympathetic response of “fight or flight” reaction:
• Dilates the pupils to improve vision
• Quickens blood clotting to reduce bleeding from lacerations and other possible wounds
• Raises the blood sugar level by mobilizing the glucose and fat from storage tissues and thus provides fuel for the muscles and brain
• Increases blood flow to the brain to facilitate decision making
• Diverts the circulation from the internal organs, like digestive system, into the muscles to provide them with oxygen, glucose and rapid disposal of metabolic waste to ensure best conditions for muscle strength to prepare for combat

Endocrine changes induced by stress:

The stress hormones are adrenaline and steroids. Their effects potentiate each other’s actions and complement the nervous system’s reaction to prepare the body for “fight or flight” reaction:
• Adrenaline rush within seconds triggers the fight or flight response with vasoconstriction, increased heart rate and muscle tension
• Increase in glucocorticoids, steroid hormones, will continue the effects of adrenaline for minutes and hours facilitating the stress response by enhancing the power of heart pulsations and mobilizing energy resources like glucose, which make energy available to the muscles to do their job
• Increase in prolactin in stressful situations inhibits the release of sexual hormones during the “fight or flight” state—thinking of sex while running for your life could get us killed
• Increase in vasopressin, which contributes to an increase in heart rate and blood pressure
• From the pituitary gland and the brain, endorphins and enkephalins are secreted, which blunt the pain perception
• In some women, the oxytocin secretion increases—dulls out the aggressive instinct and induces a “let’s befriend my enemy instead of fighting him” type of reaction (perhaps the biological basis of passive aggression???)

(For this section I used information from the book Why Zebras Don’t Get Ulcers by Robert M. Sapolsky, professor of biology and neurology at Stanford University, who dedicated his research to stress and stress related problems in humans and primates.)

Try this:
What has been your experience with the “fight or flight” reaction? How did you manage it?

How did or would you manage this reaction in your patients? Have you had any incidents you would like to share with the group?

Learn how to listen to your body: Where does your body feel tense?

Follow your breath. Take five slow, deep breaths and watch what happens. Are the tension areas loosening up a bit?

Cognitive response to stress

• “Freezing”—being unable to think straight or remember important information
• Tendency to simplify one’s thoughts, feelings and actions, which reduce them to a minimum because the brain needs to focus on the stress (emergency) and shoots down other functions not involved in managing the stress
• Stress triggers an intense negative emotional reaction.
• The importance of learning how to cope and adapt to stress, which triggers in the brain the formation of new connections, highways of information, leading to actually changing the inner structure of the brain—neuroplasticity.

Emotional Response to Stress

• The instinctive emotional reaction to stress was first presented by Dr. Selye in his classic General Adaptation Syndrome (GAS): stage 1: alarm reaction—the first encounter with stress in the form of novelty or threat; stage 2: recovery or resistance—the organism repairs itself and stores energy trying to get back in balance; stage 3: exhaustion—if the stress continues burnout sets in, represented by emotional flatness, loss of drive and motivation, dulling of responsiveness to the needs of others.
• Challenging events are stressful “only when accompanied by negative emotions” according to Arnold Lazarus (1993)
• When we feel in control of a stressful event, the event becomes less stressful
• Stress is not an inevitable consequence of a particular event but rather depends on how we appraise and interpret the event
• Trying to appraise stress realistically and learn from it transforms the negative emotional perception into constructive lessons
• Managing the expectations of a stressful situation contributes a great deal to managing the situation itself. Stressful events that are expected, anticipated, and in some ways prepared for emotionally, have less damaging consequences.

(For this section I used notes from the on line book Psychology: An Introduction by Russel A. Dewey, Ph.D.)

Many Thanks to "This Stop Willoughby" for hosting my post

2010-03-07T19:10:00.000-08:00

I offer my deepest thanks to "This Stop Willoughby" for hosting my post BULLDOZE YOUR WAY THROUGH LIFE AND YOU WILL BECOME A VICTIM OF YOUR OWN ANGER.

From the very beginning of my blogging adventure, she has been extremely supportive of me, and I am very grateful to her for that.

I am an avid reader of her blog, which is filled with sensitive insight, practical advice and warm kindness.

Check out her blog. You will enjoy it a lot!

Dear "This Stop Willoughby," this picture is for you!

I konw should have thanked you much sooner, but I was too absorbed in my research for my paper on STRESS (see the next few blogs). I was also feeling guilty that I have not posted on my blog for two weeks--way too long. My sincere apologies to you and to all my readers. I have absolutely no intention to let you down. I will do my very best to post at least once a week.

BULLDOZE YOUR WAY THROUGH LIFE AND YOU WILL BECOME A VICTIM OF YOUR OWN ANGER

2010-02-22T19:39:00.000-08:00

Martha stepped into my office very flustered and unhappy.

“Remember I told you how I can’t keep my mouth shut?” she rhetorically asked as soon as she sat down. “Well, it happened again.”

“Earlier today I had a doctor’s appointment at 9:00 AM. I got up and went there early. I got there about 8:30. My husband gave me a ride and was waiting for me to be done with it because he had an important meeting at 11:00. OK, I thought, no problem: I get there early, I am done with my appointment by ten at the latest, he will have time to take me home and make it to his appointment on time. Good plan, right? So I get there early and wait. Around 8:50 this woman comes in, all in a rush, saying that she had an 8:30 appointment, she was late and she was terribly sorry. She said something to the receptionist and, suddenly, I see that they are taking her in before me.”

“I was sitting there stewing. I could feel my blood boiling. I was watching the clock. It was 9:10, then 9:15, then on toward 9:30, ticking away toward making it impossible for my husband to keep his appointment. I was getting angrier and angrier. When I couldn’t take it anymore, I got up and asked to talk to the nurse.”

“It’s not fair, I said, surprised how angry and strange my own voice sounded even to me. For me to come here on time, even earlier, hoping to be done on time and now, look, I have to change my entire day for this person who is late. Couldn’t you take me instead of her? She had her appointment time set and she was late. Why can’t you take me now? The nurse did what they always do, apologized, and said they were short staffed and that the doctor decided to do it that way. But that generic answer only made me angrier. I kept saying it wasn’t fair, finding myself short for words. I remember I wanted to stop repeating that, but I couldn’t. My anger was more powerful than my will, and all I could do was to keep going with how unhappy I was and how unfairly I was treated.”

She paused, frustrated and short of breath.

“And then what happened?” I encouraged her.

“Nothing. They asked me if I wanted to talk to the manager. I said no, I wanted to have my appointment. Did I want to reschedule? No, I came to my appointment; I wanted to have my appointment.”

“Did you get to see the doctor?”

“Yes, at 9:45. The doctor was very short with me. I don’t think he even heard me through. But he did do what he was supposed to do for me. I knew I created a lot of mayhem in the office. But I was very concerned about my husband’s appointment.”

“Did he missed it?”

“Yes, he had to reschedule it for later in the day.

Actually, he was very nice about it, which made me feel like an idiot for being so worried about him. When I saw all the concerned and stressed out faces of the receptionists and nurses and the doctor being so cold with me, I felt really bad. I felt guilty and very angry at myself because I couldn’t handle this problem better. I feel very bad about my behavior. I wish I could stop bulldozing people like that. But I can’t keep my mouth shut. I just can’t,” and she ended her story with a big sigh.

She looked hopelessly at me, as if she were saying: Now it’s your turn; tell me how to fix it.

“So,” I started, “you had your appointment when they were able to see you despite your anger, and your husband ended up rescheduling his appointment anyway. What have you accomplished by being angry and trying to bulldoze everyone in the doctor’s office?”

“Nothing!” she said frustrated. “I accomplished nothing in the end. But how can I stop myself from doing it? I have pushed away many people behaving like this. I may have even lost my job because of it, I don’t know, because my latest boss was a certified bastard anyway. But I want to stop doing this. It drives me crazy.”

Obviously, as much distress as she may have caused in that doctor’s office, it was nothing compared to the pain and guilt she caused herself. Because she wasn’t a bad person, usually she cared about upsetting people. But in those circumstances when she was unstoppably driven by her anger, she could not veer away into a more reasonable behavior.

“It’s not your mouth that has to learn how to stay shut,” I said. ”It’s your mind that needs a different framework. For example, how do you know what delayed the woman with the appointment before you? Maybe she had an emergency in her family, or who knows what may have happened in her life that she had no control over. Maybe they were short of staff in the office. Maybe there were many other reasons that no one was telling you about. Have you thought of that? It’s likely you haven’t. You were so focused on yourself.”

“No, I didn’t focus just on myself. I wasn’t selfish. I was worried about my husband.”

“You see? Your worries, your husband, your appointment, your sense of things not being fair. And in the end, who suffered the most distress? The other people will do their best to forget they had to deal with an angry patient and move on with their day. But look how upset you remained. You can’t quiet your anger even now. Actually, its effect upon you is worse now when it’s mixed with guilt.”

“Yes, I can see that even though I was right, I behaved in an uncivilized way. I do that all the time. How can I change?”

We started talking about how the angry person often does the most damage to herself in anger. That is not the intended effect, but when most of us examine incidents of our own anger, we find this to be true.

As a matter of fact, when was the last time you were angry? Who suffered the most damage—you or the other person? Was it worth it in hindsight? Be honest with yourself.

I told Martha that preventing anger is infinitely more achievable than controlling it once it is unleashed. Taking things more at face value will help; for example, yes, maybe that late patient was late because she was careless, but isn’t it just as likely, maybe even more likely, that she had an emergency or an unforeseen complication that made her late for her appointment?

We also talked about the negative transformation of the angry person’s appearance: contorted face, clenched teeth, red face. But even more profound are the internal biological transformations related to anger and stress, like increased heart rate, shallow breathing and excessive release of cortisol—a stress hormone that in excess, leads to a decrease in immunity (the likely reason why we develop more colds when we are under stress), decrease in bone density, muscle tissue, memory and concentration and an increase in blood pressure and blood glucose. Research has shown that high levels of hostility persisting long term can lead to many biological changes, including more rapid aging. There are many toxic physical reactions to the mind’s anger and hostility.

Martha herself came to see me initially, “Because I am very anxious and I don’t have any friends.” She had never seen a psychiatrist before, but the level of emotional discomfort was so intense that she decided to take this “unusual” step, as she put it, of finally seeing a psychiatrist. She was also suffering from muscular pain, especially in her lower back--another indication that her anger translated into physical symptoms. It turned out she did meet the diagnosis criteria not only for anxiety but also for depression. She benefited from antianxiety/antidepressant medications and a mild sedative to help her as needed to faster decrease the intensity of her anxiety and depression symptoms. But her biggest problem was learning how to manage her anger—the likely source of her emotional and physical discomfort.

Anger is the most negative of emotions. It is nearly impossible to control it by suppressing it or simply deciding to “keep my mouth shot.” Cultivating patience and kind understanding of others helps us to avoid saying hurtful things to others and has a protective influence on our own physical and mental health.

The Dalai Lama said about anger, that wealth, power, or even education alone cannot give us protection from the destructive effects that anger has on ourselves. He stated in his bestselling book The Art of Happiness “The only factor that can give you refuge or protection from the destructive effects of anger and hatred is your practice of tolerance and patience.”

When I told Martha that changing the way she thinks will take practice, she looked at me puzzled. “Practice?” she said, “That is going to be hard.”

“Do you want to stop being angry at yourself whenever you act ‘uncivilized’ as you said?” I asked her.

“Yes,” she answered quickly, “I am very tired of that.”

“Do you want to be at peace with yourself?”

“Yes! Who doesn’t?”

“Well then, you already know how important these things are. You also need to know that they don’t just happen. The people around you that are polite and ‘civilized’ are like that because they made a conscious decision to be patient with others and not lose their cool. As this doesn’t happen by itself, you will need to practice it every day if you want to learn to be that way.”

“How can I practice? Where do I start?” she asked, looking for a practical way to proceed.
I took one of my prescription pads and wrote: I will treat people with kindness even when I don’t understand why things happen differently than the way I want or expect. Patience and kindness is the antidote of anger and hatred.

I handed the prescription over to her. She took a long look at it.

“I can’t fill this at the pharmacy, can I?” she said, half smiling.

“I am afraid not. But this is the prescription to help you in your practice. In the long run, it works much better than a pill.”

“I have been looking for a solution to this problem all my life. Could it be this simple?”

“It’s a start. Following this way of thinking, you will discover many other methods to control your anxiety, frustration and anger--like meditation, increased awareness, yoga or aerobic exercise, and relaxation techniques. You will select, in time, what works best for you. You have been absorbing this anger for over forty years. You will not be able to undo it without effort; and it will take more than a month or two of practice. But every day of your practice, you will get better and happier. People around you will relate more kindly to you. You will stop beating yourself up because of angry encounters. Instead, you will be proud of yourself for being able to control your emotions, decrease your anxiety and your depression and gain peace in your mind.“

“Promise?” she asked scared and excited at the same time.

Are you always on time? If not, are you late because of carelessness or mostly because of unexpected events? Do you think you deserve the benefit of the doubt when late? Do you extend the benefit of the doubt to others that are late for you? The truth is we all find ourselves in that position at one time or another. And how grateful we are to the person who extends kindness and patience to us!

I hope these pictures will set your mood toward serenity and peacefulness. This painting is my latest in the "adventures in watercolor" series.

"WHAT DID YOU MEAN BY THAT MY LOVE?"

2010-02-15T22:48:00.000-08:00

I hope you all had a happy Valentine’s Day.

If you are not sure about that, here are some tips that might help you in the future.

I often find myself "translating" for my patients what their partners really were trying to tell them but failed to do so in a way that the other could understand. That usually creates a great deal of frustration both ways, frustration that can be easily alleviated by understanding the underlying meaning of what the other is saying--translating the spoken words into their true meaning.

Here are some examples:

One partner says to the other: “I am stressed out and I don’t know what to do.”

Translation: “I need your help. I need someone to encourage me, to be supportive and tell me I can still go on. It would be nice if that someone gave me permission to take a break or a day off to recharge.”

Best advice: Listen to what he/she says and, depending on the situation, be that supportive person who possibly suggests a break. If you know enough about the problem she/he is confronted with, cautiously venture to make some suggestions starting with, “Have you thought of doing…”

She says: “I don’t know if you really love me. I don’t know if you are happy in our relationship.” He replies: “But I am here!” in an exasperated voice. She looks puzzled: “And what does that mean?” she asks exasperatedly, completely missing his point.

Translation: When a man says, “I am here for you,” usually it means, “I love you and I am willing to tolerate your shortcomings; otherwise, I would be long gone.”

Best advice: Accept his awkward declaration of devotion for what it is. Understand he is there of his own volition and, in his way, he is telling you that he loves you, he is solid and he wants to be supportive of you. Although he may not always know how to do it and what to say, his presence is a material way of saying all these things.

Your girlfriend insists: “Please, you choose the restaurant this time.”

Translation: Don’t think she doesn’t know where she would like to eat. She is trying to tell you: “I want you to be happy and fully enjoy yourself. I will find something to eat on any menu, and I want you happy with the food.”

Best advice: Make the best educated choice in terms of what she, as well as you, might also like, not just what you would prefer. If you sense she doesn’t quite like the place, go out of your way to find items on the menu that she could be happy with. Don’t forget to order dessert. It will score you some good points even when the rest of the dinner wasn’t quite to her liking.

At the end of a date, she or he says words to the effect: “You are a nice person, but I am not ready for a relationship yet.”

Translation: For reasons unknown to you, and sometimes unknown even to the person saying it, it’s not going to work. You may never find out why. Try not to take it personally. This is most likely not about you. Most of the time it has to do with a barrier already present in the other person’s mind or life, likely even before he/she met you. The other person is letting you know, in a rather awkward way, that you shouldn’t expect anything further from him/her.

Best advice: Run! Do not insist on finding out why because he/she is unlikely to be honest with you at that point and you only humiliate yourself. Do not fool yourself by thinking, “It might work if I just…” It will not work. It’s time for you to move on, grateful that you didn’t waste any more time on that going nowhere relationship. Take it as it is and just move on. Close that chapter and do not look back.

You or one of your friends is thinking: “I don’t quite like him, but I don’t want to be alone.”

Translation: You are afraid that you will not find someone better.

Best advice: Quiet your fears. It’s not worth being with someone for fear of being alone. It’s not enough of a glue to keep a relationship together. In fact, forgiving someone’s shortcomings just for the fear of being alone is a recipe for a possibly abusive relationship. Usually people who have the courage to leave a bad or even a so-so relationship, find someone better. Almost every time.

Your new date is silent.

Translation: Silence is often hard to read. Many times though, it doesn’t mean anything bad. It usually does not mean that the other person has nothing to say. Often it is shyness that makes people quiet.

Best advice: Try to make your partner feel at ease. Do not rush to fill the silence, verbally articulating any random thought that comes to mind. Relax and take your time. Give the other a chance to collect himself/herself. Give the other plenty of time to speak. Men in general are not very good at small talk. I have often had to practice “small talk” or “how to break the ice” with my male patients. But if the silence extends for too long, or you feel your partner doesn’t have or doesn’t want to say much, then you need to draw your own conclusions from there. If you feel it doesn’t work, just walk away. Move on.

Using this way of looking at what is being said to you and what to do about it, you can come up with your own examples. Be honest with yourself even when what you discover is not to your liking. It will help you understand others better and adjust your own expectations more realistically.

Don’t feel bad if you make mistakes. Just try to practice going beyond the spoken message and figure out the meaning behind it. Often just being aware of the existence of an underlying message makes us better listeners—and translators of words into meaning.

How about your adventures in communication and miscommunication? Have you said something only to realize, a moment later, that it was misinterpreted? Have you misinterpreted something someone said to you? What were the consequences?

The pictures are details of my latest "adventures in watercolor" series. I hope you enjoyed them as a romantic post-Valentine's Day echo.

PLACEBO BIAS IN THE DEBATE ABOUT ANTIDEPRESSANTS

2010-02-07T11:21:00.000-08:00

Depression is real. More than 25 million Americans suffer from it. Less than half of people suffering from depression, are seeking help. Depression can affect people of all ages, ethnicity and income bracket. Many suffer in silence, discouraged, hopelessly waiting for a miracle and a cure. Why? Because many people don't know whom to trust in choosing various treatment choices. Fortunately, there are many good ways to treat depression, even when severe. We should not close our minds and reject any available option. One of them is the antidepressants. This is the topic of a new article stirring a hot debate in the media. If you are depressed and looking for answers about the treatment for depression, do not discourage. Read both sides of the antidepressants debate.

The work of Irving Kirsch, Ph.D. in psycholo gy, is the basis of an article, The Depressing News About Antidepressants, written by Sharon Begley and published in Newsweek Magazine, on February 8, 2010. Kirsch claims that, according to his statistical analysis of 38 research studies regarding the efficacy of antidepressants, they do not work much better than a placebo in the treatment of depression; therefore, they are an unwarranted way of treating depression.

The placebo effect is the mental effect of experiencing something only because we believe in it--a mental trick, if you will, that our complex minds play on us sometimes. For example, when depressed patients are given a “sugar pill” and are told that it is an antidepressant that will help them with their depression, the symptoms of depression get better based only on the person’s belief and not because of an actual effect of a chemical substance like medication. This is what Dr. Kirsch believes accounts for the beneficial effects of antidepressants.

Bias is an attitude that always favors one particular way of feeling, acting or thinking without considering other aspects of an issue. In other words, a subjective interpretation of reality--another type of mind trick that our minds play on us, making us blind to data or information or aspects of reality that are not in accordance with what we want to believe. The placebo effect and bias are produced unconsciously by our minds. If we become aware of them when they happen, they become a free choice.

Was Kirsch biased and therefore unconsciously trying to prove once again his theory that the placebo effect is the true basis of antidepressants when he meta-analyzed the data from the 38 research studies done by others?

Meta-analysis is a statistical process that combines the results of several studies addressing a set of related research hypotheses. The advantage of it is that it can draw general conclusions from the studies. But a big disadvantage of it is the fact that it leaves ample room for bias. Meta-analysis relies heavily on studies done and published by somebody else, under his own set of biased circumstances. The decision to include or to exclude certain studies from the meta-analysis is also highly subjective, as is the chosen scope of a specific meta-analysis. In medicine, these drawbacks are so significant that the results cannot be regarded, by themselves, as the definitive conclusion of a scientific debate, because meta-analysis leaves too much room for the bias and error of the researcher.

The conclusion of the article that antidepressants are not much more effective than a placebo, and therefore their use not justified, is the result of a second attempt of Kirsch to prove his point. His first attempt was in 1998. Both times he has used the meta-analysis statistical technique of taking research data and crunching them in a certain way. Is it possible that Kirsch may have wanted to prove that he was right all along since 1998 about this subject?

Kirsch is also known for his research on the placebo effect and expectancy theory. According to this theory, people’s experience depends partly on what they expect to experience. This theory has been applied to understanding not just depression but also anxiety, pain, addictions and psychogenic illnesses. Is it possible that Kirsch, the researcher who believes that the placebo effect is a very powerful element of the human psyche, has been biased by his own prior flawed research experience to attribute to the placebo effect qualities and powers that are, in reality, not quite there?

His position on depression is that it is not the result of a change in brain chemistry. Kirsch is a doctor of psychology. He is not a physician, he is not a neurobiologist, he is not a psychiatrist. And, to my knowledge, he has never been clinically depressed and tried antidepressants himself. In my opinion, he has limited expertise to make the assumption that depression is not a "real" disorder and that antidepressants don’t work any better than a placebo. Antidepressants do work. So many people can testify to that from their own experience. There is no global antidepressant conspiracy.

Patients of mine who suffer from depression are often so exhausted that rising from bed is a genuine struggle. Many think their lives are not worth living, and feel incapable of having any hope that they will ever be healthy again. Does Kirsch seriously believe, as he asserts in his article Antidepressants: The Emperor's New Drugs?, that they will get better only with physical exercise, self-help books and talk therapy at this point? Maybe not. Don’t forget prescriptions for “sugar-pill” placebos.

Unfortunately, while in crisis, the person who is contemplating suicide or the person who can barely leave his bed because of depression, will not be up to considering these other interventions, much less following them. And people suffering from depression do not have to be suicidal to know they have deal with a serious problem. Being too depressed to be able to function in everyday life is enough to make people plunge into despair. Antidepressants are very helpful in these situations. When the crisis has abated some by using antidepressants, there are various other interventions that are important and helpful—even essential. But they can not be implemented and followed by a depressed person who's symptoms have not been first quieted down with antidepressants. In order for the treatment of depression to be effective, it has to address all the symptoms of depression, not just some of them. Untreated or under-treated depression can lead to long-term disability, loss of job, income, relationships and life style.

Further complicating things, the majority of patients suffering from depression also meet the diagnosis criteria for other mental illnesses like anxiety, attention deficit or bipolar disorder. Their treatment will have to address these other problems as well. Their recovery process will look very different than that of people who suffer from depression alone, a minority. The subjects in the research studies that Kirsch has looked at were carefully selected patients that met specific depression symptoms criteria without additional complications and complexity, but they hardly reflect the reality that most people are confronted with in everyday life. Broaden the perspective on Kirsch’s statistical analysis and one finds a frightening oversimplification of the medical challenges presented by depression with its complications, complexities and dire consequences. His conclusions do not reflect and cannot be generalized to the vast majority of people suffering from depression.

Presenting a point of view based purely on meta-analysis (a statistical process) of others research studies, as Kirsch has done, while ignoring the complex clinical aspects of depression, is a grave mistake. It is a disservice done to real people, readers suffering from depression that need to consider the antidepressant option because their health depends on this decision. If they could benefit from the medication, but reject that option only because they have read the conclusions of Kirsch on the subject, and become more severely ill, that is a tragic consequence of a limited point of view too forcefully propagated by the media, without appropriate explanations for the layperson to clearly understand what it means, the pros and the cons.

I find Sharon Begely’s article both biased and narrow. And it is a disservice to their readership that Newsweek examines the controversy with seven pages presented on one side of the issue and a single page on the other side. What happened to the objective journalism? Shame! I expected so much better of Newsweek on such an important issue of health.

It is true that antidepressants are not perfect. It is also true that they have been used inappropriately sometimes and that they do not represent a magic bullet. But they do work and represent a viable option among many others that can be used to treat depression. And yes, the pharmaceutical companies have made a lot of money selling medications, not only antidepressants, especially in this country, where there is no maximum price cap as there is in Canada for example, where the government negotiated a maximum acceptable price.

There is a well researched new study from Northwest University in December 2009, saying that the SSRIs, the serotonin reuptake inhibitors, the most common kind of antidepressants used today, not only produced a marked improvement in depression compared with a placebo, but also improved patients’ behavior and personality traits unrelated to the direct improvement of depression, including an increased ability to cope with life difficulties, to see things as they are more accurately, and to have less of a doom-and-gloom attitude.

Some people are upset about antidepressants in principle. Some are upset with them because they had a negative experience using antidepressants or other medications. Many people have their own biases and fears about this issue. Also a lot of people have false expectations of medications and are bitterly disappointed when their expectations do not come to fruition.

More and more patients expect a quick fix from medication. When I tell these patients that even if they take the pill, they will still have to change their behavior or learn how to cope with stress or remove themselves from an emotionally toxic environment, they usually look at me in amazement and say, “But I thought the medication is supposed to do that for me.”
Depression is a complex problem. There is not one magic bullet that will effectively work by itself. In my clinical experience, what works well for depression, alone or linked with other mental illnesses, is a combination of interventions that are tailored carefully and specifically to fit the needs of each individual patient. This combination can include but is not limited to, mindfulness therapy, cognitive behavioral therapy, life coaching and medication--the last only if and when deemed necessary in the clinical context.

Kirsch’s comments come at a time when there is an explosion of knowledge in the field of psychiatry, neurobiology, psychopharmachology, psychology and mental health. Psychiatrists are talking more and more about genuine and lasting recovery from mental illnesses, rather than only an improvement in symptoms. New types of psychotherapies are now used on a larger scale, like cognitive behavioral therapy, acceptance and commitment therapy, mindfulness therapy, and others. Life coaching is gaining more recognition. Western medicine is beginning to be more open to complementary medicine--herbal remedies, homeopathy, acupuncture, massage therapy, yoga, etc. Patients suffering from depression or other mental illnesses need not choose between medication or therapy, but have the option of taking advantage of both, in a balanced, harmonious way.

Without trying to minimize the importance of the placebo effect, I would like to warn the readers of Kirsch that bias is also a powerful mental state and that, unconsciously, we may be inclined to read the statistics of research studies or a magazine article and register only the information that fits our beliefs. Perhaps the truth is somewhere in the middle:

· the placebo effect is real but also real is the experience of millions of patients who have benefited from the effects of antidepressants in order to heal and move forward in their lives;

· antidepressants are not the only way to treat depression; psychotherapy and other interventions are powerful and efficient treatment options;

· the competition between antidepressants and psychotherapy is an obsolete point of view; the two are not opposing but synergistic methods. Both aim to maximize patients’ healing and to enhance their quality of life and well being--whether used by themselves or in combination.

Healing from depression is possible. If you are depressed, talk to your internal medicine or your primary care doctor about it. Look for a psychiatrist. Find a psychotherapist or a counselor. Get a referral from a trusted friend or ask your insurance company for a list of mental health professionals.

Do not fear the antidepressants. They have their own role in the treatment of depression. To get full benefit from them, antidepressants have to be used wisely and cautiously.
Your doctor will help you balance the pros and cons of various medical research studies with your particular situation and needs.

Most importantly, you need to get the treatment that is right for you. You are not a statistic or an anonymous number in one research study or another, but a human being facing specific challenges and problems. That type of individualized care you can only get by working one on one with your own doctor, who will help you make an informed decision about the treatment choices available. There is no reason why you should continue to suffer from depression, alone and unaided.

NEVER IGNORE THE EMOTION FACTOR WHEN YOU MAKE A DECISION

2010-02-01T23:25:00.000-08:00

“I do understand what my wife is saying,” said the frustrated husband. “She feels that instead of remodeling the garage, we need to remodel the kitchen. But here is why remodeling the kitchen is the wrong thing to do…” and he begins to tick off on his fingers one by one all the reasons why hers is not a good idea for the tenth time that session.

I see these conflicts more often lately. When the money is tight and a couple needs to choose between one thing or another, the woman becomes emotional and the man does not compromise.

One way out, would be to accomplish both goals; that way no one gets upset. But in this economy, we need to learn, again, how to prioritize.

With all this talk about recession, one important element is often completely ignored and left out of the debate: emotions. In tough times, people are expected to behave “rational,” to make “well thought out decisions,” and follow them without wavering; no hard feelings, just good decisions. The problem is, we are not computers. We have a great deal of feelings that, recession or not, still influence our “rational thinking,” whether we acknowledge them or not. Ignoring emotions leads to heated, endless arguments about who is “right” and who is “wrong,” when, in fact, both are being “emotional.”

During these arguments, I have frequently observed in the couples I work with that the two partners end up speaking two different languages. She said: “I feel betrayed by your decision to buy a new car when we needed new carpet.” He said: “Let me tell you why we don’t need a new carpet: the old one works just fine,” completely missing her point. Truth is, if he can figure out how to make her feel less misunderstood, she will probably stop resenting him for buying the car instead. But no, he will do this the “rational” way, when, truth be told, they shouldn’t have taken on either project because they had to borrow money for either.

Decisions need to be made together. When one partner is talking the language of feelings and the other thinks he is talking only the language of reason, ignoring all along each other’s point of view, both partners are talking the complicated, indirect and bewildering language of emotions.
I often find myself in a referee position, suggesting to the couples I work with revolutionary concepts like: “Have you thought of a compromise? What would be the one thing you can agree on together, even though neither of you gets his way?”

There is always a fair compromise that can be, with care, reached. A plan can be made to stagger the expenses, or scale back on the amount spent for each project or both. Or both projects may be delayed until there are savings for both. Or one may compromise for a concession that does not even involve money. Or another solution can be found. Good relationships and marriages can work out this compromise for the benefit and happiness of their life together. But if there are any fissures in that relationship or marriage, this will be time when the cracks will stare both partners in the face.

The moral of this story is: when you need to make a decision that involves someone you love, do not forget to take emotions into account. Those of both of you.

How do you work out compromises in your marriage or relationships? When you can’t, do you use a referee? Who would that be?

EVEN HIGH ACHIEVERS GET ANXIETY AND DEPRESSION

2010-01-25T20:48:00.000-08:00

Who are the high achievers? The general idea is that the high achievers are those people with a great deal of motivation and free will, creative people that see an opportunity when everyone sees just a closed door and a turned down request. They tend to be extremely motivated and do not spare any effort to achieve their ambitious agenda. They do things that surpass their condition and they are not just CEOs and directors of departments; they can be anyone with these characteristics. But all these quality come, as usual, with a price. They often have to work harder to have full lives and not just successful careers and nothing else. Their identity is built around the things they do or they achieve, which makes them vulnerable to not being able to handle setbacks very well. Even the high achievers need to learn how to handle their emotions.

Anyone pushed hard enough, hit hard enough by life events in the most vulnerable areas of his beliefs and identity, can have a strong negative emotional reaction that translate into anxiety and depression, a very common combination. Although it takes a great deal of bad news to get them so down, high achievers are also vulnerable to the ups and down of life. The severity of these emotional reactions depends on the intensity of the trigger, its duration and the degree of hopelessness inflicted by it.

In high achievers, often the first symptom detected is an uncharacteristic decline of motivation--

a clear departure from their usual functional state. Gradually, if the problem persists long enough, they find that their confidence is waning. The innovative ideas they were famous for seem to dry up. They are overcome by an increasing, completely uncharacteristic, sense of hopelessness.

Because these feelings are new to them, often they do not recognize them as a reaction to the circumstances, but as a “weakness” and a sign of their own “inadequacy.” Their logic often tells them that one can’t possibly be well equipped to handle the job demands a few months ago and then, suddenly, be incapable of doing so a few months later. What has changed? They know just as much now as they did a few months ago. The only thing that changed is their emotional reaction and the way they now “feel” about things and about themselves.

Because high achievers are used to manage a fair amount of stress on a day to day basis, they initially use their usual coping mechanisms in an attempt to handle these overwhelming feelings: take one extra day off, talk to a trusted friend, pushing themselves even harder, in the hope that they can solve the problem and move on. But when these coping mechanisms that served well before are not enough to help them get out of the “funk,” they become extremely disillusioned.

Often, by this time, the depression and anxiety begins to take physical manifestations. They start having insomnia almost every night. Their appetite is diminished and they lose weight at a fast pace. Their shoulders slump and their backs stoop. All the lines of their faces are now pointing down. They forget to smile. They stop enjoying things they used to enjoy. These are changes a high achiever will often deny are happening, in the hope that they will soon find a way to make them go away. But they can’t find the way out because anxiety and depression affects the very emotional engines one needs to recover from anxiety and depression. What usually happens now is their emotions become engaged in a negative spiral they can’t escape on their own. They reach a point when they desperately need help. Usually at this point, someone in their family, most commonly the spouse, witnessing how their loved one is wasting away, finally sounds the alarm.

The high achievers will delay making the phone call to a psychiatrist not because they have something against psychiatrists in principle as long as other people need them, but because high achievers still convince themselves they are not “that bad.” Recognizing the magnitude of their emotional problem is regarded by them as a personal failure, and failure for high achievers is the biggest disaster imaginable. It is exactly what they spend all their lives finding creative ways of avoiding.

As you may imagine, by the time the high achievers find their way to the psychiatrist’s office to get help, usually with a great amount of nudging and diplomacy from their families, their symptoms have worsened significantly. That makes their recovery longer and more difficult. When I get a new high achiever patient, I know that we both will have to put a great deal of effort and care in getting him well.

The good part is that these people, by their nature very smart and creative, understand quickly the elements of the intervention plan. They ask good questions and they like to feel in control in making important choices in their recovery plan. The more initiative they take in trusting and completing these steps of the intervention, the more trusting and invested they become in its success. This is when their strongest qualities come into play. Their determination and propensity for hard work is coming to life again. They have a new goal now. They thoroughly engage on the healing path, with their eyes firmly focused on the hope of being whole again, which now feels within their reach.

My intervention in these cases is based on my Better Than Cured model. Using a combination of tools, from medication to cognitive behavior therapy, spirituality and life coaching, Better Than Cured has offered great results in helping my high achiever patient. Often, an anti-depressant/anti-anxiety medication is needed to stop the progression of symptoms (anxious feeling, hopelessness, insomnia, lack of appetite, etc.) and to start reversing them. The cognitive behavioral techniques help him learn to dominate anxiety by using the logic of his own mind. When he improves even more, we talk about insight, the driving forces of his motivation and how he relates to goals and ideals higher than himself through spirituality.

As my high achiever patient continues to feel better, he has more energy to go through the day. Getting up to go to work becomes less of an effort and the creative “juices” start flowing again. He feels more grounded and more insightful. This is usually the point when using life coaching tools we start talking about the practical steps he could take to manage the very problems that generated the emotional turmoil. Now that his mind is no longer clouded by excessive negative emotions, he can usually see many new ways out that were hidden from him before. He is now engaged on the positive spiral, where every positive step, builds on the previous one, helping him climb out from under the cloud of hopelessness. He gradually starts feeling more and more in control again—one of the most powerful antidotes against anxiety and depression.

Helping high achievers overcome their anxiety and depression is very rewarding for me. All my patients in this category have been exceptional people who found their way to wellness. Once they recover and become themselves again, it’s easy to understand how they achieved the successes they have achieved in their lives. Whether they have an unusual ability to interpret facts and to connect the dots when most people can make neither head nor tail of that information, or they have an uncanny ability to come up with solutions when most people have given up, or they have an extraordinary capacity to never give up facing rejections and setbacks, they are remarkably talented and creative people in their own fields of interest. Work and career for high achievers is even more important than for other people, the source of great satisfaction and pride, the skeleton on which their entire identity is built. This is why, when unable to perform at their usual high level at work, they feel their entire lives fall apart.

If you are a person in this category or know someone close like this, be aware of these issues. No one is immune to developing an anxiety and/or depression problem. Take corrective measures as early as you detect the signs. An early intervention leads to a faster recovery. Anxiety and depression are not character flaws. They are reactions to life is challenges or to internal struggle. They can be treated and resolved. When you have exhausted all the coping skills you usually have, and still feel anxious and depressed, do not hesitate to ask for help. It’s just like asking for a guide when you get lost in a new city. There is absolutely nothing wrong with it.

Thank you for reading this post. I am extremely interested in what you think about this issue. Your comments will help me better understand and help my patients. Please do not hesitate to write your opinions in the “comment” section below. Thank you.

I took all these pictures at Lotus Land, Santa Barbara, a very romantic property who belonged to Ganna Walska.

WORDS HAVE POWER: WE CAN PSYCH OURSELVES UP AND WE CAN PSYCH OURSELVES DOWN

2010-01-21T10:23:00.000-08:00

I cringe every time someone says things like “Oh, I am so depressed! My hair dresser canceled on me today” or “I must be paranoid! I thought I saw my best friend’s husband with another woman!”

In psychiatry, when we talk about depression, we don’t refer to the momentary feeling of frustration one feels when things don’t go her way. Depression is a very serious condition that requires specific interventions to improve. When I hear the word “paranoid” I think immediately of schizophrenia, another serious mental illness. Maybe the passerby who thought she was “paranoid” was referring to being too afraid to admit that a certain unthinkable situation could happen. It’s not paranoia; it is flat out fear. Why, I wonder, do people misuse words so badly? And what kind of effect does that have on them when they do?

When one talks about herself as “paranoid” or “I am such an idiot to have sent that e-mail without spell checking,” she makes herself feel that she can’t do anything right; she can’t trust herself that she saw a painful reality and dismisses it thinking what she sees because it is so unlikely. Unlikely but not impossible. People have affairs and get caught all the time. Why put yourself down? Why induce in yourself a state of mind of mistrust and self-deprecation? Isn’t it better to call it as it is? “I have seen my best friend with the husband of another friend. I wonder what that is about.”

Another expression people use all the time is, “I need to put myself out there.” I don’t know about you but every time I hear it, it makes me think of some terribly embarrassing situation I have to put myself through in order to get a job interview or a date, two of the most common contexts in which it is used.

One of my patients suffering from severe anxiety kept saying how “stupid” she was because she was blurting out exactly what she was thinking in moments of frustration, coming across as “nasty” and very “rude.” At a closer look, it turned out she wasn’t doing it because she was “nasty” but because her anxiety was making her so overwhelmingly frustrated that anxiety was taking away her social filters. It was such a powerful, unbearable feeling that she had to release it immediately. Unfortunately for her, she was releasing these feelings by lashing out angrily at whomever happened to be around. It didn’t matter if it was the delivery man, her husband or even her bosses. Afterwards, because she was really a very nice person, she would torture herself with guilt and embarrassment.

Once we understood that this behavior was a manifestation of anxiety, I assured her that as soon as we got the anxiety under control, she would stop doing it. She was very uncertain about that and she said it in a quite hostile, angry way. Then she clapped her hand over her mouth and said: “See? I did it again. Do you now understand what I mean?” I know she felt really bad she was angry with me. But it was too late. Once something is said, it can’t be un-said. Her anxiety won, yet again, the battle over her best judgment in her mind. In the end, we decided she will learn to quiet down her anxiety and she agreed to take a small dose of an anti-anxiety medication. Also, we composed a short sentence she can say to herself whenever she gets impatient or irritated with others. That phrase was: “I can say everything I need to say, at anytime, and to anybody, in a polite and courteous way.” She wrote it on a piece of paper, repeated it a few times, folded it neatly and put it in her wallet.

Two weeks later, she came in excited, saying: “The medication is working! I did not blurt out my anger in two weeks, not even to my teenage niece who got in a fender bender with my husband’s car.” She then told me all about how she kept her cool throughout the unpleasant discussion the family had with the niece, who was crying and feeling miserable; and how, even though upset, she did not lash out her anger at the girl. Being more patient with her niece helped see how genuinely sorry the young girl was for getting herself in the accident, and it melted her heart.

“It’s brilliant! How did you do it?” I asked, surprised.
“I think it’s the medication.”
“I really doubt that, since Celexa needs at least two to three weeks to work.”

I knew it wasn’t the medication. It was rather the fact that she kept repeating in her mind the sentence we agreed upon, every time she was about to lash out at her guilty but repentant niece. In other words, she used powerful words to control her anxiety and change her behavior, avoiding adding more drama to a bad situation.

Why did it work? Because words have power. They can send our subconscious mind positive or negative signals which determine automatically the choice of words or behavior. This is how she avoided a potentially disastrous fight with her niece. Feeling very proud of herself was an extra bonus.

The take-home point here is, please, try to be kinder with yourself. Soften your inner dialogue. Say you are “disappointed” rather than “depressed;” say you will do an extra proof reading next time you need to send an important e-mail rather than “I’m such an idiot.” When you make a mistake, any mistake, don’t ask yourself, “How can I be so stupid?” Try instead: “Whoops! I made a blunder. But I am learning. I will do it better next time.”

Don’t think “I will put myself out there and date;” but rather, “I will try to see if I can find me a good date tonight.” Read both versions! How does each make you feel?

Have you used the wrong words in a situation and, filled with regret, not known how to correct the damage done? If you did, what did you tell to yourself at that moment? How did that make you feel?

MATISSE INSPIRATION by Christine Forest, Jan. 20,2010

(my first water color adventure)

Medication by Itself? Not the Whole Answer (follow-up on previous blog)

2010-01-14T11:58:00.000-08:00

Thank you all for the insightful comments you left on my post, “Why you don’t need to be afraid of anti-anxiety medications.” Your comments are extremely helpful for the readers of this post and for myself as well. They made me think, and I want to share with you additional thoughts on the matter.

While there are now more and more treatment options available, the number of people suffering from anxiety and seeking treatment is still less than half of the number of all people estimated to suffer from anxiety today—40 million in the U.S. alone. Anxious people tend to avoid situations that make them uncomfortable and therefore more anxious. That includes asking for help to treat and heal from anxiety itself. If you are on the fence about this, I urge you not to wait very long before deciding to ask for help. If you feel you can no longer manage your anxiety on your own, do not be afraid to admit it. The sooner you step up the interventions to address it, the easier and faster it will be for you to fight the anxiety and recover. Fortunately, the range of effective interventions available is expanding more and more every year.

Despite many voices in the media blaming the anti-anxiety and anti-depressant medications for being the “source” of emotional problems or for not “working” at all, a consensus is emerging that the real problem is not that the medications are not effective, but that they are not always effective alone and that people do not yet take full advantage of the help they can offer, a point made very well in this article in The New York Times.

People are not well informed about the treatments available for anxiety. Many mental health and other specialists stand on opposing sides of the mental health question, claiming that one intervention is more successful than another. This is how the PhDs put down the PsyDs discussed in this article published this week in Los Angeles Times. The psychiatrists tend to discount the value of psychotherapy, trusting too much the “medical model” of treating emotional illnesses, while other specialists like life coaches, spiritual and various support group leaders are trying to do their best to help people coming to them for emotional support and guidance. These specialists lock themselves in rigid knowledge boxes, narrowing their views to their own field, and deliberately choosing to ignore the value and the experience of others.

Instead of using one type of intervention at a time, a combination of interventions utilizing the knowledge and tools from different fields of expertise will be far more effective. It is possible to create highly individualized intervention strategies that will fit like a perfectly tailored suit the neurobiological profile, personality, life experience and spiritual views of each individual suffering from anxiety, depression or other mental illnesses. That will indeed lead to a more holistic healing and to a much smaller risk of relapse.

The idea of combining interventions to address mental health problems with respect to the complexity of a human mind is not new. In the early 90s Mark Epstein, the author of “Falling to Pieces without Falling Apart,” was initiating a groundbreaking theory at that time of combining psychotherapy with Buddhism. Talking about how unsatisfying he found the use in his work of only theories like “separation and individuation” or psychoanalytic/psychodynamic techniques which, at that time, were the norm and the rage in practicing psychiatry, he started looking toward Buddhism to find additional insights. In his view, Buddhism “is actually answering a basic question that psychotherapy has struggled over the past 100 years to answer, which is how to help people be more present, more tolerant, more generous, and more loving in their lives, and that there is a method that the Buddha articulated that psychotherapy can learn how to blend and use in its own way.” Combined interventions!

Coming from the medical model, which is now all the rage, which considers mental illness strictly a medical condition and arrogantly ignores the intricate psychological and spiritual aspect of the human mind, I have discovered firsthand how unfulfilling, sterile and less effective this approach is when used by itself. The best results using medication alone is improving the symptoms of anxiety by 60 %. This is considered an acceptable standard in psychiatry today. But who wants to be only 60% well? The medical model is a gross oversimplification of mental health problems like anxiety. No wonder the public recoils every time psychiatrists and neurobiologists start talking about the “chemical imbalance of the mental illness.”

Disappointed by the results I was getting by treating my patients only with medications, I started looking for other interventions I could offer to help them better heal. This is how I discovered and learned about the cause and effect relationship between thinking and feeling in cognitive-behavioral psychotherapy; the “real life” practical strategies of life coaching; the solutions offered by Buddhist spirituality regarding accepting ourselves for who we are and being fully present in our lives. Studying the phenomena of human creativity, I realized the enormous potential for healing that the human mind has, taking in the available subjective and objective information and processing it in a radically new way, opening a whole new universe of possibilities toward healing and happiness. Using these combined techniques, my patients not only recovered from anxiety or depression—became cured, but going far beyond that, they became empowered, aware and insightful individuals, much stronger emotionally, setting their recovery goals higher and higher, firmly engaged on their individual road to happiness, becoming, in other words not only “cured” but Better Than Cured. With great success I have tested Better Than Cured intervention for over ten years with thousands of patients in my psychiatric practice. The techniques and principles I use are congenial with who I am: my training, background and my own way of thinking. But Better Than Cured is by no means the only combined technique that could work.

There are many other possible combination techniques that will be highly successful in treating anxiety and mental illness. We only need to start looking at all the methods available today in a new way.

For example, in addition to the revolution in neurobiology and the availability of many new psychiatric medications, there are new methods of psychotherapies emerging, like Acceptance and Commitment Therapy (ACT) and Mindfulness Therapy. Yoga is increasingly more accepted as beneficial for anxiety. Non-medical stress reduction techniques (massage therapy, aerobic exercises, and relaxation techniques) are now more and more recognized as helpful in the treatment of anxiety and depression. Herbal remedies and acupuncture are also gaining more acceptance as viable interventions for stress, anxiety and depression. Western medicine is beginning to pay attention to supplements, even considering their concomitant use to boost the benefits of medications; for example, using Lexapro (an anti-anxiety/anti-depressant medication) in conjunction with St. John’s wort, allowed the use of smaller doses of Lexapro to be effective for depression with fewer side effects. Different types of supplements, like vitamin B12 or vitamin D, omega-3 fatty acids and amino acids like L-tryptophan are now accepted by much of the medical world as helpful in the treatment of depression. This is an article talking about how natural products can be used as adjuvants to antidepressants, written by James Lake, M.D., from the Arizona Center for Integrative Medicine, The University Caucus on Complementary, Alternative, and Integrative Medicine (http://www.apacam.org/) The previous "alternative" medicine is now "integrative" medicine. Reputable medical journals, like Psychiatric Times, have now special sections on integrative medicine. Here it is one of the most recent articles on this.

The coming decade, and certainly the rest of this century, will be marked by increased acceptance and cooperation among many types of experts working together, converging their expertise toward a more lasting and complete healing from emotional problems. Blending their knowledge will create a larger array of choices for people in need, making mental illness less stigmatizing and leading to far better results.

WHY YOU DON’T NEED TO BE AFRAID OF ANTI-ANXIETY MEDICATIONS

2010-01-10T19:48:00.001-08:00

Many anxious people come to see a psychiatrist when they can think of nothing more to do on their own. I can’t tell you how many times I hear, “Doc, I feel so bad that I figured I had nothing more to lose by coming to see a psychiatrist.”

Why is it that the psychiatrist, trained specifically to deal with emotional illnesses, is the person people go too as a last resort?

I am aware of the stigma associated with mental illnesses. It often comes from lack of understanding of what anxiety and other mental illnesses are. I am also aware of how little psychiatrists have done so far to reach out to the people in need, the direct beneficiaries of their knowledge and training, and explain to them how much we now know about how to heal their suffering; that anxiety is nowadays a treatable condition; people no longer need to suffer silently and be ashamed of it.

I often talk to my patients about when is the right time to consider anti-anxiety medication as an additional aid in treating their anxiety. Some examples of the clinical criteria are:

· When the symptoms of anxiety are overwhelming--panic attacks, feeling out of control, crying or being irritable, even angry, almost all the time, or when anxiety interferes with one’s ability to get through the day.
· A common complaint of anxious people who could benefit from anti-anxiety medications is: “I can’t relax no matter how hard I try or what I do. I feel I am wired and tense day and night. I feel exhausted and I don’t know what else to do.”
· Sometimes people first try psychotherapy or “talk therapy.” It can be very effective. When it isn’t, and people feel they are “spinning their wheels,” making no real progress, it’s time to consider the medication option in addition and not instead of therapy.

Anti-anxiety medications are very effective. The problems people usually have with them are because of the way they are used. Just as driving a car can get you where you want to go, but it can also get you into a tree if you are not careful, so the anti-anxiety medications can work for you or can create problems if they are not used carefully. Patients can help their psychiatrists with the selection and adjustment of the medications. They can give their doctors an accurate account of their past experiences with medications, if any, and they can provide them with important feed-back about how the medication is or isn’t working. The psychiatrist, in turn, needs to explain to the patient what to expect from the medication, its benefits and possible side effects. If a psychiatrist doesn’t address all these issues right from the beginning, or does not listen to the patient’s feed-back, the patient will be better off finding another psychiatrist that is more perceptive.

The three major groups of medications used to treat anxiety:

Benzodiazepines: These are the “as needed” medications. People use them in various specific situations, for example if they get anxious in planes or closed spaces. They can be used when the anxiety becomes sharp and unbearable—panic attacks. They work only for a limited period of time, 4-5 hours for Ativan or Xanax and 7-8 hours for Restoril or Valium. The most common side effect is sleepiness. Because of that, driving is not recommended after taking them. Care should be taken by the patient to understand exactly what “as needed” means for him. Benzodiazepines could be addictive.

Selective Serotonin Reuptake Inhibitors (SSRIs) are the medications from the Prozac’s family: Zoloft, Paxil, Celexa, Luvox, Lexapro. These medications need to be taken every day in order to work. With the exception of Lexapro, which works faster (about seven to ten days), all the others need about ten to fourteen days before they start working. They are used when high anxiety levels are experienced almost all day every day, with or without panic attacks. In these cases, an “as needed” medication will not be helpful enough. The SSRIs tend to increase the serotonin in the Central Nervous System and by doing that, they help “the brain relax.” The exact way of how that happens is still under research.
The possible side effects tend to be mild and transient: mild headaches, restlessness, nausea, sleepiness, to name only the most common ones. These medications are usually highly effective and well tolerated. If one of them causes side effects, switching to another medication in the same class may solve the problem.

Selective Serotonin-Norepinephrine Inhibitors (SNRI): These medications work on two receptors at the same time: serotonin and the norepinephrine receptors. They tend to have more side effects because of that. These medications are Effexor XR, Pristiq, Cymbalta. The SNRIs are not necessarily better than the SSRIs. The decision to use one versus another is made according to the severity of symptoms and past history of each patient. As always, the balance between the benefits and the potential side effects needs to be carefully considered.

None of the above medication should be taken without the advice and supervision of a physician, preferably a psychiatrist.

Whatever the medication plan decided upon, it needs to be followed consistently. Mixing any of these medications with alcohol or recreational drugs is a very bad idea. It will increase the propensity for side effects and it will decrease the efficacy of the medications.

Common mistakes in using

anti-anxiety medication:

· The starting dose is too high and the patient has side effects. Usually the side effects are not life threatening but can be very annoying: low grade headache, insomnia or excessive sleepiness, nausea and restlessness, etc. Reducing the starting dose and slowly going up to a more effective dose will help.
· In the desire to get a quick response to medications, psychiatrists sometimes increase the dose too fast. Increasing the strength in smaller increments and assessing the efficacy and the side effects at every level, will take care of this problem.
· Lack of communication between the patient and the psychiatrist can cause a great deal of mistakes in managing the medications well. The psychiatrist should encourage the patient to express his concerns. The patient should initiate a discussion of any and all concerns of his relevant to treatment and prescriptions.

The "Feeling Lost" Disorder

2010-01-04T14:19:00.000-08:00

Do you have friends who keep saying they will do something that in reality they never do? For example, they could be saying "We always wanted to go to Paris. That would be lovely," yet every time they book their vacations, they invariably choose Chicago. Or have you heard of someone who is married for ages but always talks about divorce every time she is asked whether or not she is happy in her marriage--never divorcing, never even having an affair?

If you know people like this, you should know that they are not the exceptions but rather the norm. Often people dream of something they don't have or they would rather have, without taking any action to make that happen, and, of course, without ever being happy with what they already have. These people tend to be seriously disconnected from themselves and often very unhappy. Often people chasing the ghosts of unfulfilled dreams realize at some point they are feeling, in fact, lost in their own lives.

Whenever one of my patients starts talking about these never happening fantasy, I remind them that they are doing nothing to change. The general feeling that they are wasting their lives one way or another is, in general, prevalent.

Making new plans and getting ready to change will pave their way toward fulfilment and ultimately happiness. Using for guidance the often ignored post signs pointing them in the right direction, or the mild nudges from their best friends, they can find their way to either love what they already have or change to what will make them happier and more alive.

The good news for people suffering from the "feeling lost" disorder, is that better ways to live one's life are always available. Just open your eyes, look carefully around, expand your horizon, try a few new things and you will find your trail.

As a remainder that the right path for you is never lost, just hidden, I will give you a small gift. A talisman, rather:

This is a clover trail marker of the Clover Creek Trail, in Sequoia National Park. You can copy it and place it in a visible place, a reminder of the paths that are always there, even when you think you feel so stuck that you can't see, for a split moment, any way out. The truth is, a good way out is always there... Can you see it?

SUNDAYS IN MY CITY--THE GIANT FOREST

2010-01-02T23:14:00.000-08:00

Do you know Unknown Mami? She's awesome and she's started a fun Sunday theme inviting you to get out and take pictures of your city to share with the rest of us. Click here for details and her logo and click here to see Unknown Mami's City today. She has initiated this series of posts based on personal travel impressions, a very informal and personal travel log from people all over the world.My friend Joanna, author of a wonderful blog, "The Fifty Factor" that you can check out at this address, put me on this path and I am grateful that she did.

THE GIANT FOREST

This year my husband and I ventured for Christmas into the Sequoia National Park. It is a beautiful region in the southern Sierra Nevada Mountains, east of San Joaquin Valley or "The Central Valley"--one of the most fertile regions in the US. The gateway to the park is a quaint little town, Three Rivers, situated on the Kaweah river. From there, the road climbs to an altitude of 7,000 feet, going through the forest of giant Sequoia trees and descends on the other side of the mountain. A large part of the park is not accessible by car. Some of the peaks reach above 14,000 feet and can be seen all around from the road.

The real entrance in the park is at the "Four Generals"--a group of Seqoias guarding the road.

It's very hard to talk about the Sequoias. Being among them feels like being in a cathedral, not built by an extraordinary architect, but made out of living things, in the wild. I was so overwhelmed, I found myself whisper in awe, the way I would do in a place of worship, when I feel acutely the supernatural presence of a power much higher than myself.

I have found this description of the Sequoia trees in Wikipedia. I included it here for the technical details. But the incomparable majesty of these trees can not be accurately described in words. The feelings stirred up by being in the presence of these trees can only be experienced by being there. They are the largest and the oldest living beings on the planet and they only grow in this area of the Sierras--Sequoia National Park and Kings Canyon National Park, adjacent to each other.

Description

Leaves of Sequoiadendron giganteum
Giant Sequoias are the world's largest trees in terms of total volume (technically, only 7 living Giant Sequoia exceed the 42,500 cubic feet (1,200 m3) of the Lost Monarch Coast Redwood tree; see Largest trees). They grow to an average height of 50–85 m (165–280 ft) and 6–8 m (18–24 ft) in diameter. Record trees have been measured to be 94.8 m (311 ft) in height and 17 m (57 ft) in diameter.[1] The oldest known Giant Sequoia based on ring count is 3,500 years old. Sequoia bark is fibrous, furrowed, and may be 90 cm (3 ft) thick at the base of the columnar trunk. It provides significant fire protection for the trees. The leaves are evergreen, awl-shaped, 3–6 mm long, and arranged spirally on the shoots. The seed cones are 4–7 cm long and mature in 18–20 months, though they typically remain green and closed for up to 20 years; each cone has 30-50 spirally arranged scales, with several seeds on each scale giving an average of 230 seeds per cone. The seed is dark brown, 4–5 mm long and 1 mm broad, with a 1 mm wide yellow-brown wing along each side. Some seed is shed when the cone scales shrink during hot weather in late summer, but most seeds are liberated when the cone dries out from fire heat and/or insect damage (see Ecology, below).

Giant sequoia cones.
Giant sequoia regenerates by seed. Trees up to about 20 years old may produce stump sprouts subsequent to injury. Giant sequoia of all ages may sprout from the bole when old branches are lost to fire or breakage, but (unlike coast redwood) mature trees do not sprout from cut stumps. Young trees start to bear cones at the age of 12 years.
At any given time, a large tree may be expected to have approximately 11,000 cones. The upper part of the crown of any mature Giant Sequoia invariably produces a greater abundance of cones than its lower portions. A mature giant sequoia has been estimated to disperse from 300,000-400,000 seeds per year. The winged seeds may be carried up to 180 m (600 ft) from the parent tree.
Lower branches die fairly readily from shading, but trees less than 100 years old retain most of their dead branches. Trunks of mature trees in groves are generally free of branches to a height of 20–50 m, but solitary trees will retain low branches.

This is how the home of the Giant Forest looks from the distance.