Depression: The Opportunistic Little Bugger

What I believe makes Insight, Outside In unique from other blogs about mental health is it is run by a mental health professional who also has a diagnosis of Major Depression, and is therefore a patient.  I couldn’t write this blog with any sense of honesty or integrity without also writing about my own mental wellness and illness.  I am having a depressive episode.  It started about 24 hours ago.  I began to have negative thoughts about an event that had just happened.  I had spent the afternoon with a friend.  My friend was recovering from being sick, and had very little energy.  We didn’t spend as much time together as we would have normally, and during our visit, my friend was pretty checked out, mentally.  We’ve talked here about how mental illness can be an opportunistic little bugger.  Mine is no different.  My brain started spinning over how my friend must not want me around.  This person was obviously annoyed by my very existence, and why wouldn’t they be?  I have nothing to offer.  There’s nothing anyone could ever like about me.  Just like that, we’re off to the races!  In the past 24 hours, I have continued to struggle with negative thoughts about myself.  I also start crying just randomly, for no reason, other than the fact that I am having a depressive episode.  I want to sleep all day today.  I would probably still be in bed were in not for the same friend messaging me earlier and saying, “get up, and come over.  You need to get out of your house.”  My friend knew because of a text message I’d sent earlier with three words: “having depression symptoms.”  I sent the same text to other supportive friends and family.  I have also left a message for my therapist.  I already had an appointment on the calendar for tomorrow with my psychiatrist, just by coincidence.  

My plan is to continue blogging through this episode.  I am putting other topics on a temporary hold while I deal with this.  I believe the best way I can be credible and accountable is to be honest with my readers, my family and friends, and myself.  I don’t normally blog every day.  My goal is three entries per week.  However, I will try to post an update daily until I return to baseline  (Updates will most likely be deleted once the episode is over).  All right, I’m going to go over my self care plan.

Be well

September 11th

Friends,

Today is September 11th.  It is the 15th anniversary of the terrorist attacks on the United States of America.  Rather than write about it, I simply want to encourage each of you to take care of yourself in whatever ways are right for you.  There are posts on IOI about trauma and PTSD, media saturation, and dealing with panic attacks.  Please feel free to post here in the comments, or on IOI's Facebook page.  If you have any thoughts of self harm, PLEASE seek help.  You are loved, wanted, and needed as part of the IOI community.  Take care of yourselves and each other.

Be well

Emotional Abuse: More Than Sticks and Stones

Friends, today’s entry is about psychological abuse, also known as emotional abuse.  As with anything on IOI, I encourage you to use your best judgment and keep yourself safe.  This entry will give information about what emotional abuse is, why it is harder to identify, and suggestions of what to do about it.  

For the purposes of this article, “emotional abuse” and “psychological abuse” will be used interchangeably.  Emotional abuse is characterized by exposing or subjecting someone to behavior that may cause psychological trauma.  This psychological trauma caused may result in Anxiety, Depression, and/or Post-Traumatic Stress Disorder.  Attempts to scare, control, or isolate the victim are forms of emotional abuse.  Some examples of how an abuser may do this are:

• Monitoring the victim’s activity and whereabouts all the time, or most of the time
• Accusing the victim of infidelity 
• Preventing the victim from seeing or contacting family or friends
• Attempting to prevent the victim from going to work or school
• Causing the victim to doubt their own memory, thoughts, or experience.  This is sometimes referred to as “gas lighting,” or “crazy making.”
• Getting angry in a way that frightens the victim
• Controlling how the victim accesses and spends money
• Belittling the victim, especially when the victim discusses feelings, thoughts, opinions, goals, or accomplishments 
• Humiliating the victim in front of others
• Threatening to harm the victim, loved ones, or pets
• The abuser threatening to harm themselves if the victim leaves or seeks help.
• Saying things like, “if I can’t have you, no one can,” “no one else would want you,” or otherwise insults the victim
• Making decisions for the victim that you can, should, and want to make for themselves

This list is by no means comprehensive.  Other forms of abuse are also emotional abuse.  Physical abuse and sexual abuse also harm the victim emotionally, and also scare, control, and isolate the victim.

Let’s get something straight right here and now: 1) Abuse is never the victim’s fault.  2) We don’t do victim blaming on IOI.  Ever.  3) No one has the right to harm another person EXCEPT in cases of self-defense.  

One of the more challenging things I have seen for a victim of emotional abuse is for the person to be able to acknowledge that what is happening to them is, in fact, abuse.  This is especially true if the victim no longer trusts their own thoughts, memories, or experiences.  The effects of physical abuse are harder to hide after the fact.  The victim may be injured, items may be broken, walls may have scratches, dents, or holes.  These are harder to ignore.  But when all the evidence the victim has exists between their ears, it gets tricky.  

If you believe someone is in an emotionally abusive relationship, it can be a very helpless feeling.  We never want to see someone we love and care about be harmed.  Emotional abuse is harmful.  An outside party may feel stuck watching the victim retreat inside themselves as they shut down emotionally.  The abuser has trained the victim not to be who they are.  They are belittled for having the personality traits that we love about them.  Here’s what you can do:

• Love them.  No matter what, show them that you value them.  Thank them for things they do for you.  Praise what they do well.  It doesn’t have to be huge or overt.  
• Stay in it with them.  Even as they may pull away from you, do what you can not to pull away from them.  If they cancel plans with you 20 times, schedule the 21st time anyway.  Understand that they are going to cancel, if that’s their pattern.  But their abuser is telling them that no one cares about them anymore.  Even if they stop making plans, an email or a Facebook message that says, “hey! Just thinking about you!” can plant a seed of doubt in the harmful messages they are getting. 
• Validate their worth and dignity as a human being.  They are in your life because you love them and want them.  They are being stripped down and belittled by the abuser for anything that makes them who they are.  The victim deserves love and caring.  They also need it right now more than just about any other time in their life.  You can absolutely show them that love without saying a single word against what’s happening to them.
• Listen.  It’s going to be really hard to hear sometimes.  But it’s not about you, it’s about them.
• Avoid judgmental statements, or telling them what to do.  Ask questions instead.  “What do you think?” “How do you feel about what happened?”  “How are things with (abuser’s name) now?”  
• Do not speak negatively about the abuser to the victim.  This is also a really tough one.  Remember, the victim has to go home or hang up the phone after talking to you.  If the abuser knows the victim was taking to you, they are going to ask what was said.  
• If the victim wants to leave, it’s going to take time.  It’s also very likely that the victim will return to the abuser, possibly multiple times, before they leave for good.  Even after they leave the abuser, focus conversations on moving forward, not on trashing the abuser.  If the victim goes back, there will likely be a honeymoon period, when things will be really good.  The victim may share your conversations with the abuser during this time.  
• Encourage the victim to seek outside help, if possible and safe.  
• Above all, you MUST take care of yourself.  Utilize your own self-care plan.  It’s okay not to answer the phone if you are going to end up being more distressed, and less able to help.  It’s okay to talk to your own mental health professional about your experience with the situation.  In doing so, you are actually modeling healthy boundaries.  

You are loved and cared for.  You do not deserve harm.  You have a right to be happy, healthy, and safe in your relationships.  

Be well. 

Tipping My Hat to You

I wear many different hats.  There's my blogger hat.  Then there are my clinician and student hats. I'm somebody's child, sibling, spouse, cousin, and friend, each with its own hat.  I've also worn mentor and employee hats. No wonder I have a headache!  Each of us assumes many different roles in our life, usually multiple roles at once.  Some of these we choose, and some we don't.  Each calls on us to use different skills and access different parts of ourselves. 

Sometimes a certain role takes priority over others.  This is both normal and necessary.  For example, the role of parent will be a higher priority than that of friend, especially when the child is very young.  Most parents feel they never truly take off the parent hat.  Any role we assume in life has potential to be fulfilling or draining.  Most are a combination of both.  So my question to each of you is this: In which of your roles do you find personal fulfillment and satisfaction?  

A particular role that gets neglected the most is that of self.  This hat gets the most use, but is often the most tarnished.  We justify and rationalize that other roles require more of our attention or that we will get to our role of self later.  Whenever I work with someone who is experiencing a great amount of stress, I always ask this question: What are you doing to take care of yourself?  Some will answer that they are engaging in self care, and be able to tell me how.  I love that.  It makes my job so much easier.  Often though, I am told that self care will just have to wait, or at least remain at an inadequate level.  My next question is, “until when?”  What has to happen to get us to that point when we will make ourselves a priority?  I know someone who will push themselves until they begin to experience flu-like symptoms, and will have to stay in bed for a couple days.  This person describes it as having a “bug.”  After about 48 hours of downtime, this person feels so much better!  I know I am not a medical doctor, but I don’t believe this person would be helped one bit by antibiotics, antivirals, or a flu shot.  I think it’s their body’s way of saying, “I’ve had enough, you’re going to rest.  Now!”  This is an example of how we can get unintended boundaries set for ourselves.  What would be better would be if we could be proactive and set boundaries with intention.

When we apply Maslow’s Hierarchy, we can see how things that we may believe are optional are actually very necessary.  When we have a physical need, the need goes away once it is met.  We feel better.  Psychological needs, however, continually need to be met.  It is only in doing so that we are able to keep growing and learning, and eventually reach self-fulfillment.

My suggestion is to find a way to balance the roles that are the most draining with roles which are fulfilling.  Can you take a class you might enjoy?  Is there a group you’re interested in joining?  What about a hobby that’s fallen by the wayside.  Make it something to really look forward to.  Get excited about it!  For me, it’s drawing.  When I need to, I make my drawing time a special reward, a treat.  I get big glass of water, open all the windows, and put my favorite music on.  I make a point to use my favorite art materials and find a subject that makes me happy to look at.  It’s all for me.  If I need to, I schedule it.  

It’s always important to continually take stock of the hats you wear.  In what condition is each one?  How are you doing at that spouse role?  What about parent?  PTA secretary?  Congregation member?  Are you getting more, or giving more in each?  Is that okay with you?  There is almost always something that can be done to change the dynamics of a relationship.  It may not be easy.  Usually the ones that are the hardest to change are the ones that need the attention the most.  The changes don’t have to be big ones in order to be helpful.  Maybe the change is just what you’ll do differently in your relationship with yourself to help you feel better about other roles.

No matter what it is, we all need to spend time working on the relationship with ourselves in order to reach self-fulfillment and self-actualization.  All relationships take work, and this one is no different.  It’s one of the most important relationships you will ever have.  It will be life-long.  Just like any relationship, it is multi-faceted.  It can be easy to deny the mind-body connection when we are in the thick of particularly draining or challenging roles.  But we cannot take care of the body and not the mind, or vice versa.  Psychological needs and self-actualization needs are just as much a part of our existence and experience as physical ones.  Your only get one "self" hat, and it has to get you through your entire life.  Give it the care it deserves.

Be well.

Maslow's Hierarchy

I’ve got an article ready to go on the roles we play in our lives.  I was getting ready to publish it when I realized I need to introduce a concept first.  It’s a pretty easy one, but it’s so important: Maslow’s Hierarchy of Needs.  This may look familiar: 

Starting at the bottom is our base, our foundation.  These are our physiological needs: air, food, water, shelter, warmth, and rest.  If these needs aren’t being cared for, nothing else matters.  If we don’t have any one of these, life is pretty much over!

Now that we’ve got our physiological needs met, we can focus on the second level, which is our need for safety.  We need to be safe from harm.  This includes protection from the elements, security, order, and freedom from fear.  At this second level, things like relationships, self esteem, and critical thinking don’t matter.  We have to be able to sustain life and be safe.  These first two levels are our basic needs.

Then we can focus on the third level, belongingness and love.  This encompasses friendship, intimacy, affection, and love.  This can come from a number of relationships including friends, family, work relationships, and romantic relationships.

Next, our needs begin to take an inward focus.  The fourth level is our esteem needs.  We need to achieve and feel good about ourselves.  This can come from mastery of a task.  We may earn prestige and respect from others.  This also happens as we achieve independence moving through appropriate developmental stages.  The third and fourth levels are our psychological needs. These are not optional for wellness!

Finally, we achieve self-actualization.  This comes from realizing personal potential, growth, and experience.  We experience self-fulfillment.  This is also a necessity for wellness.

So when we look at Maslow’s Hierarchy, other concepts we’ve discussed on IOI become clearer.  When we talk about a person needing to accomplish necessary tasks to move to the next developmental stage, it’s not much different than this.  Just like you need to trust people before you can achieve autonomy, you also have to be able to eat before you can focus on feeling safe.  It’s really important to keep this in mind when we have expectations of people.  Is there a need that’s not being met?  If a child is coming to school hungry, they are not going to be able to learn.  

Maslow addresses us at a basic, almost primal, level.  Since first publishing his theory, other stages have been debated and added.  I thought it would be good for IOI to have a good handle on the theory in general.  The take-home message is that the stages are progressive, and that if a person’s basic needs are not being met, they will not be capable of higher-level functioning.  Not capable.  It’s not that they’re unwilling, or doing things to spite you.  It’s that they are doing what they can.  

Next up, I’ll be writing about the different roles we have in life, and how we manage them.

Be well.

Insight, Outside In is on FaceBook!

Come on over and like the IOI FaceBook page for blog updates, and relevant information about psychology and anything other really cool stuff I find for my fantastic readers!  It's also more interactive.  Discuss, debate, and learn!  Yes, I see the irony in posting this right after an article about social media.  Why not come talk about it?

https://www.facebook.com/insightoutsidein

Be well!

Social Media: Computers v. Conversations

I have spent the past couple days working on promoting Insight, Outside In.  I worked up a logo, and started a FaceBook page.  At one point, I was also posting to Tumblr, but that’s fallen by the wayside.  I still need to create a Twitter account for it, and have no idea if I need an Instagram account too.  I tell you all of this to introduce the topic of social media.  When I was in school, and I am dating myself here, we had two options: writing someone a note, and the telephone.  That phone was attached to the wall, and shared by everyone in the house.  Getting a phone in my bedroom was a big deal.  Getting my own phone line and phone number in high school was HUGE!  

We have an overwhelming number of options today.  Before Facebook, there was MySpace.  Before MySpace, Friendster.  Now we have social media sites for just about every facet of our lives.  It’s hard to do just about anything without it.  I believe there is a lot to be said for social media, and what these sites enable us to do.  I have family that lives far away.  We are in contact far more often because we are all on FaceBook.  We know what is going on in each others’ lives.  We share pictures, information, and ideas.  I won’t have to explain my blog next time we are all together.  They’re being inundated with emails and FaceBook requests consisting of shameless self promotion.  (Sorry, family.  Love you!)

So let’s jump into the purpose of social media.  A highly scientific and detailed long-term study, also known as a google search, results in the definition, “Social media are computer-mediated tools that allow people, companies, and other organizations to create, share, or exchange information, career interests, ideas, and pictures/videos in virtual communities and networks.”  We’ll go with that for the purpose of this entry.  First off, we are creating, communicating, and sharing.  As a mental health professional, I like all of these.  I’m all for communication…to a point.

These concepts are extremely broad.  As human beings we have certain needs.  Abraham Maslow developed a theory of these needs known as Maslow’s Hierarchy of  Human Needs.  I’ll do another entry exploring these at a later date.  First, we have our physiological needs: food, water, warmth, and rest.  Next, we need safety and security.  But right above that is belongingness and love.  We are social animals.  We need to feel that we belong and are accepted.

What’s the payoff?  Social media carries with it a random reinforcement schedule.  Will someone have liked my photo while I was asleep last night?  Is anyone commenting on my latest status update?  Or did I really hit the jackpot: Did someone share my post, and now it’s going viral?  A post going viral hardly ever happens.  It is akin to winning the jackpot on the slot machine.  It’s probably not going to happen.  But the payoff is something that touches us on a much deeper level than money: the third level on the hierarchy of needs, belongingness and love.  When we put the two concepts together, we have a random reinforcement schedule with an instinctual need being met.  Random reinforcement is the most effective reward schedule, and the internet provides it in abundance.  

I don’t believe social media is inherently good or inherently bad.  It’s like most things, it’s what you do with it.  Sites like FaceBook enable people to stay in touch and share in each others’ lives like never before.  But by the nature of web surfing being a solitary activity, it also fosters secrecy and deception.  Children have access to the world at their fingertips, and are able to learn about people and places on the other side of the world with a few clicks of a mouse.  But people who would harm those same children also have access to their targets just as easily.  A 16 year old can research colleges. This same high school student can create an online profile stating they are 19 years old, and access websites they are not psychologically equipped to understand.  Like all social issues, there’s not one easy, clear-cut answer.  What will work for one person or family will not work for another.

Early in the blog, I wrote about media saturation: http://insightoutsidein.blogspot.com/2016/07/a-new-spin-on-tmi.html  This entry was in the context of exposure to news media, and its effects on mental health.  Much of the same applies to social media.  It’s important to know when enough is enough.  For me, issues of social justice are a surefire way to get my blood boiling.  There’s certainly more than enough of it being discussed on Facebook, and just about everywhere I look.  I get to a point when I start to feel frustrated and helpless.  I feel like one person, and wonder if I have any hope of making a difference?  This is when I know it’s time to get off the computer.  I need to focus on what’s around me that fulfills me and brings me joy.  I have no shortage of ways to get my need for acceptance and belonging met. 
Lastly, social media carries with it a large of ambiguity.  A FaceBook status has no tone or volume.   It's easy to misunderstand or misinterpret what someone is saying.  There is also a level of bravado that comes with the distance put between us.  When we can't see someone's reactions, we are not as likely to take them into consideration.  There's a level of distance between us and our audience.  Unfortunately, this means that we aren't with someone to explain what we mean.  Even if it had nothing to do with the offended party, the damage is there.  

I am a huge fan of healthy relationships.  My line of work is all about them!  No matter whether it’s through a keyboard or the person sitting across from you, start there.  Let social media be about enhancing the relationships that you already have.  There’s always going to be a time and a place to branch out, but remember where you’re going to return, both mentally and physically.  When social media is prioritized over in-person relationships, it stands to reason that in-person relationships will suffer.  Connections to the world at large can better equip us for day-to-day life.  I’m going to sign off now, and go engage with people for whom I want to be present.  

Be well.