Are you a human being or a human doing?

When I make a mistake, forget something, mess up something or miss an appointment… is it just what I do sometimes, or does it say something about who I am? This is a crucial question whose answer can make a difference between a healthy or a not so healthy opinion of one’s self. Answering the question requires an understanding of the difference between “being” and “doing.” It is the being that determines a person character, true personality and, ultimately, his or her true self. It is the doing that often is out of character and does not accurately reflect the personality or the true self. The problem is, the doing is often confused with the being. Said another way, what a person does is often confused with who that person really is. Think of it this way: mistaking the doing for the being can lead to a misunderstanding of the person in almost every case. Take for example the immoral, cheating, antisocial individual who writes a large check to a charity and then receives a public recognition of generosity. Or, the church-going, honest, and caring individual who drives by a person in need and does not stop to render aid. Both individuals simply do or don’t do something in a specific situation. Their doing, however, can be interpreted by an observer as representative of the individual’s character, personality or true being, without it being the case. When the doing is not sincere or reflective of the true being of a person, it does not stand the test of time, the test of consistency, or both. In the first example, the evil nature of the individual may never become known to the charity that received the donation, but it is certainly going to be known to anyone who interacts with this person on a regular basis because the true being can never stay hidden for very long. In the second example, the good nature of the individual may not be reflected in the failure to stop and help but it would be known to others who see this person being good in many other situations. So, as far as a person’s social image is concerned, the difference between what people occasionally may do and who they truly are is straightforward: time and consistency will always tell the tale.

There is, however, another more significant problem that affects all individuals who do not understand the difference between what they do and who they are. They tend to misinterpret their own occasional or inconsistent actions as being reflective of their true being. In one scenario, they may form an opinion of themselves which is narcissistically positive by focusing on their occasional good deeds and conveniently ignoring their more frequent missteps. In another scenario, they may have an overwhelmingly negative view of themselves by focusing on their occasional (but perceived as too frequent) missteps and ignoring their good nature, sound character or engaging personality. Either positive or negative misinterpretation of a person’s true being is produced by focusing attention on infrequent, occasional, or inconsistent behaviors. Evaluating a person, or one’s self, based on too few observations (or data points) can lead to the wrong conclusion. A good example of this type of evaluation is that of a new couple who has just fallen in love with each other. Both parties, temporarily blinded by love, need, want, passion, lust or a combination thereof, may gather very little “hard data” on the other person and pay an inordinate amount of attention to what the other person does, misunderstanding his or her actions as being consistent, stable over time, and reflecting of the person’s true nature, character and personality. In many cases, thank goodness, this turns out to be true: he or she IS truly wonderful, and not just temporarily doing wonderful things. In some other cases, however, after the honeymoon is over and things settle down, the behaviors that are inconsistent with the person’s true being become rarer, while the behaviors that are reflective of the person’s true being become more frequent and consistent. At this stage, either the couple accept each other’s finally discovered true being, or they break up.

The hard truth in all of this: the opinion that I have of myself and others must be based, to be valid and usable, on time and consistency of behavior. The good news: this opinion can be changed (and indeed should be changed) on the basis of acquiring additional information on the true nature of the self or on that of others. In individuals who suffer from low self-esteem the opinion they have of themselves is often distorted by a negative observational bias: what they “do wrong” matters far more than who they truly are. The perverse reality in this is that, often, what they “do wrong” is based on their own poor observational skills, on a misinterpretation of motive, or a harshness toward the self that is frequently unjustified. They will say negative things to themselves such as, “I am such a failure, I always mess things up, I can’t get anything done, I am so stupid,” at every turn, many times, every day, no matter the circumstances. What they do becomes a definition of who they are which is far from being objective, measured or consistent with their true being. How many otherwise fairly successful, decent, good human being are walking around believing themselves to be otherwise and are therefore fighting depression, anxiety, and pessimism?

To break this cycle of despair, to change one’s opinion to a more balanced view, to truly find out that what we sometimes do is not the same as who we consistently are requires introspection. It is only by taking a look at our actions in context that we can see the many variables that have caused us to behave a certain way: the lady did not stop her car to help the person by the side of the road because she was traveling through a neighborhood that she deemed unsafe, or because she was running late to pick up her son, or a variety of other legitimate reasons. The man who gave to the charity did so to gain the advantage that an image of generosity could provide to him in certain business deals, or to impress a would-be girlfriend, or to soothe guilty feelings caused by a previous misdeed. Ascertaining our true self also requires honesty of intent, whereby we seek objectivity in knowing who we really are so that we can change what we can, accept what we cannot, and have the wisdom to know the difference.

What is true forgiveness?

We evaluate violations of psychological or physical boundaries in terms of the the amount of injustice perceived. Usually, there is a difference between the way we would like to see the violation resolved (e.g., “I’d like to see him admit to his wrongdoing and ask for my forgiveness”) and what we expect to actually happen (e.g., “He’s uncaring and has no remorse. I expect him to hurt me again”).

More serious violations are the hardest to accept and generally produce an inability to forgive in the wounded party. Unforgiveness is a feeling that encompasses a constellation of negative emotions, such as resentment, bitterness, hostility, hatred, anger, and fear. Over time, and as long as the violation remains unresolved or unforgiven, this feeling attacks a person’s well-being and may end up being more harmful to the wounded party than to the offender. Only true forgiveness can make these emotions go away.

The simplest definition of forgiveness is a mindset that recognizes the violation but chooses to no longer hold it against the offender. This mindset may inspire certain behaviors: in the offender, who may be moved to ask for forgiveness; in the wounded party, who may be communicate forgiveness to the offender; in either party, who may be able to talk to each other about the violation and its forgiveness.

Forgiveness is not reconciliation. Whereas forgiveness is a mindset that changes the wounded party’s feelings, reconciliation is the restoration of trust between the two parties. Forgiveness can occur without reconciliation ever taking place.

Researchers distinguish between two types of forgiveness: decisional and emotional. Decisional forgiveness consists of making the decision to change one’s feelings from negative to positive. This decision is made even if the person desires revenge but intentionally chooses to handle the matter in a positive way. Accordingly, decisional forgiveness is not a process: it is a deliberate, conscious, intentional decision to adopt a different mindset. The wounded party may hesitate and even resist making the decision to forgive, for minutes or even for years. When the decision to forgive is made, however, it is final and complete.

Emotional forgiveness may occur at the same time as decisional forgiveness, but generally it does not. The wounded party may forgive decisionally but fail to experience emotional forgiveness. Conversely, the wounded party may try and forgive emotionally without ever making the conscious decision to forgive. Emotional forgiveness is a process that unfolds over time and which generally begins by identifying feelings of unforgiveness and gradually reducing them by replacing them with positive feelings. Emotional forgiveness is not a behavior, inasmuch as it is an intentional replacing of negative unforgiving emotions with positive emotions toward the offender. The most common positive emotions that are involved in this process are understanding, acceptance, empathy, sympathy, compassion, and love.

True forgiveness includes arriving to a point when decisional forgiveness has taken place and the process of emotional forgiveness has been completed.

Forgiveness is at the core of the Christian faith. Jesus’ sacrifice paid the full cost of the injustices against God. God compassionately and lovingly forgives any person who accepts His forgiveness. Jesus tied God’s forgiveness of individual sins to a person’s forgiveness of others (“Forgive our trespasses, as we forgive those who have trespassed against us.”) In others words, God commands us decisional forgiveness, but also highly desires our ability to achieve emotional forgiveness.

Theo Pallake at Stresshacker.com

Top 11 reasons to love yourself

You must love yourself because…

1…you’re the only one you’ve got

You were born, you grew up, you became an adult…and there you are…you!  There’s no escaping the reality of it.  You are the only one in the world who is… you. Your uniqueness, your particular blend of talents, skills, shortcomings, idiosyncrasies, background, and experience is unmatched by anyone else on the planet. Doing something positive with this unique treasure of a life begins by accepting that you are the only one you are and will ever be.

2… it is a prerequisite to loving anyone else

If you are a Christian, and even if you’re not, you may have heard that Jesus said, “Love your neighbor as you love yourself.”  The key word in that sentence is the shortest word, the word “as.”  It means that unless you know how to love yourself, and are capable of loving yourself, you won’t know how to love anyone else, nor will you be able to.

3… it makes you happier

If you’ve ever wondered how some people just seem to be much happier than others with the way life is, and how they seem to manage their problems and adversities so much better, others have wondered the same thing. This has prompted a significant amount of research on happiness and on what makes it happen, what maintains it, and what it takes to have it.  While there are many factors that contribute to happiness, there is one characteristic of happy people that seems to be there across cultures, times and personalities: happy people do not hate themselves. Instead, they are rather fond of who and how they are, and many actually have a healthy love of self that doesn’t make them arrogant or conceited.

4… it adds to your lifespan

Happy, well-adjusted people seem to prefer lifestyles that add to their longevity rather than detract from it.  Perhaps one important explanation is that they cherish their lives, truly enjoy being with themselves, and are able to form lasting and secure bonds with others.  These are all protective factors that may help explain their longer lifespan.

5… it ensures better physical health

Loving yourself means first doing no harm. To the person who respects the fragility of the body, the need to ensure its optimal functioning, and the precious and irreplaceable gift of good health, harming the self is not even an option. This is why love of self generally leads to good decision-making skills on matters of alcohol and drug use, nutrition, exercise, medication, and risky behaviors. Love of self is also an extremely important component in avoiding major depression, in reducing the impact of stress, and in ensuring better mental health.

6… it agrees with those who love you

Sadly, many people who don’t care very much for themselves often argue with those who care about them. It is not unusual to see people suffering because a loved one insists on maintaining a harmful lifestyle, bad habits, and unhealthy behaviors. To accept someone else’s love, to accept that you are lovable enough for someone else to love you is the greatest joy for those who love you…and for you, too!

7… it helps you get over pain and hurt more quickly

A healthy attitude toward your life’s inevitable challenges comes from a good degree of self-confidence, which helps muster your available resources when the time comes.  Knowing that you can handle a crisis because you believe yourself to be strong, capable and good enough to manage it is the key to reducing the impact of the momentary hurts and pains of life.

8… you can’t be anyone else

Much effort and sorrow may go into trying to be someone you’re not. This effort produces very limited results at best, and at worst it can lead to tragicomic choices.  The reason?  It doesn’t fool anyone into believing that you are actually someone else.  Ultimately, everyone still knows that it is just you, trying to be someone you’re not. And how could it be otherwise?  Think about how much more credible and acceptable to everyone is to be just who you are.

9… it is easier than hating yourself

Hate takes a lot of work. I’ve heard it compared to a cancer that eats away at you from the inside. It is probably something very much like that, at the mental and often even at the physical level. Being unable to forgive yourself for your mistakes, being unable to accept your shortcomings, hating your looks, despising your personality…all this takes an enormous amount of emotional and intellectual energy that could be used towards more productive and enjoyable aims.

10… it makes you look better

When unhappy people are portrayed in movies, plays and novels they invariably are made to look unattractive either in obvious or more subtle ways.  Scriptwriters and authors put something in their demeanor, in their eyes, in their voice, in their mannerisms to indicate that we are seeing someone who is in pain. Self-loathing is visible to others: facial muscles are tense, actions are often contrived or insincere, and stress barely lives under the surface.  Contrast this image with that of someone who has a healthy love of self, and you will see someone who is comfortable with just being and who conveys this sense of comfort to everyone else.

11… it makes you more lovable by others

Who doesn’t love being with someone who can laugh, who can cry, who can be genuinely present?  And who doesn’t dread being with someone who’s always gloomy, depressed, unhappy, or self-critical?  The choice is yours to be one or the other.  Certainly, we all know that positiveness begets positiveness, love begets love, and happiness is truly contagious. Won’t you be that person who is so easy to love because you obviously know how to love yourself?

I need to change… right now!

Many clients who come into my office for help with relationship problems or individual issues are seeking a change of some sort, in themselves or in their situation, and they need the change to occur right now. It is not unusual for someone to come in and expect that one session of counseling, i.e. a conversation that will last about 45 minutes, will be sufficient to solve a serious problem, identify the change that is needed and make it happen right there and then. It is also not unusual for some clients to quit counseling after one or two sessions, because, in their perception, there is no change happening or no immediate resolution.

There are some inescapable, well-documented truths about the process of change. Here are six of them that are worth keeping in mind:

1. Change, of the psychological kind, is a process and not a sudden event. Old habits, bad habits, ingrained patterns, repetitive or automatic behaviors, unconscious beliefs or attitudes are notoriously resistant to change. Even with the best intentions and the best help, it takes time for psychological change to occur–certainly more time than one or two hours of counseling.

2. Change becomes necessary after a dysfunctional pattern that is causing distress and loss of functioning has set it for some time, often for many years and in certain cases since childhood. The dysfunction can be very entrenched: it stands to reason that changing it will require more than good intentions or a brief, superficial effort.

3. We are not always ready for change, even when we think we are, and especially not when someone else says that we are. I see clients who come in at the urging of a significant other, a parent or a friend, who by themselves are not yet motivated to identify the changes that are necessary and, more importantly, are not yet motivated to invest the time and effort that is necessary for the process of change to occur.

4. It takes an average of six to eight weeks to begin to see behavioral changes (i.e. for the individual to begin to act differently) from the time the psychological mofification of underlying beliefs and attitudes is well understood and accepted. This is independent of an individual’s motivation and intention, although when these are positive they facilitate change without necessarily speed it up.

5. All meaningful change has a cost associated with it. Included in the total cost is an investment of time, personal effort, and money. This cost may be seen by some as painful and somehow avoidable, however there is ample evidence in repeated, short-lived, and failed efforts to back up the old adage, “no pain, no gain.”

6. To be worth the cost, a change must be permanent. To be permanent, change must reach deep into the individual’s mind and emotions. To reach deep enough, time and efforts are required. To use the time well and make the effort count, hiring a good, experienced guide is very often necessary.

In a nutshell, to expect something worthwhile to change for a zero investment is a losing proposition. To initiate and sustain change and to be willing to pay the price for it, that’s the stuff winners thrive on.

Stressful Patterns: How Your Attachment Style Can Help or Wreck Your Important Relationships

When it comes to relationships, your attachment style can mean the difference between bliss and torment. But what is your attachment style? Where does it come from? How does it work? To understand the concept of attachment, we must go back to the cradle and to the world which the infant first inhabits. It is a world where primary needs (food, shelter, warmth, cleanliness, security, and human contact) reign paramount. Anytime the infant must experience hunger, disconnect, isolation and pain, a little trauma is the result. When those needs are frequently left unattended, a “primal panic” can be the result, depending on the length and severity of the deprivation. Of these primary needs, the need for closeness with other human beings is the most deeply felt by the child’s mind and spirit and it can be, at times, at least as important if not more important than physical needs. It is not unusual for couples in counseling to express their intolerable distress and deep sorrow about their disconnect from their partner. For example, Jennifer says, “I just can’t seem to reach him. That is why I get so mad. I feel so alone all the time. I can’t bear it.” Or Jeff may say, “She doesn’t even seem interested in talking to me anymore, let alone have sex. All she cares about is the kids. I really don’t have a wife.” These are adult manifestations of the same longing, a cry for help in the face of a painful deprivation of emotional needs for closeness and security.

A secure attachment style results from infancy, childhood and adolescence characterized by positive, attentive, and nurturing care. A secure attachment produces individuals who are well-adjusted, who can form and sustain long-term relationships, and who are not easily defeated by any difficulties that may arise between them and significant others. Far from being overly dependent on others, they can give and take from their relationships with balance and fairness, while remaining strong, confident, and truly themselves. In this sense, a relationship that provides secure attachment can become a safe haven, a secure shelter from life’s storms of anxiety and stress. It also provides a secure base from which to explore, change, play, learn, and grow. Amy says, “Whenever my fear that I may lose my job rears up, I don’t just get angry or overwhelmed. I know that I can always can go to him and get a hug. He is there for me. I can count on him.” A partner’s emotional availability and responsiveness is at the core of establishing secure attachments.

When the infant has the misfortune to experience a caregiver who is frequently absent or unavailable, this intermittent pattern of caring and not caring is traumatic, and produces an insecure attachment style. In time, this translates into a message of rejection, devaluation, scarce importance, as if the caregiver were saying, “Your needs do not matter to me, you are not deserving of my attention, and there is only a fragile connection between us.” When children experience this type of caregiving, their reaction follows a predictable pattern. First, there is distress, crying, and emotional pain, which are the only means available to the infant to get attention. In couples, this would have Marie say, “I cry, even poke him, and poke him again. I know I nag him. Anything to get a rise out of him.” When the frantic attempts to get attention fail, the symptoms of separation distress begin to appear: angry protests, dashed hopes, desperate disappointment, negative cycles of demand and distancing. In children, this can result in acting out behaviors, physical violence toward inanimate objects, highly physical “games” in which the anger of feeling neglected can find its expression. In adult relationships, this insecure attachment may produce angry demands for attention, or the starting of trivial arguments as a way of connecting with the other even if only in a negative way. In time, these cycles of angry pursuit and defensive withdrawal become almost infallible predictors of separation and divorce. Evidence-based research by Gottman has shown that the happiest couples know how to ask for what they need from their partner in a softer, more vulnerable way and they can stay emotionally engaged even when the other partner is temporarily unavailable or distressed. On the other hand, the stonewalling that signals a complete lack of emotional response between the partners almost invariably leads to anger, contempt and then to complete withdrawal.

What can be done to remedy this toxic situation? An understanding of attachment theory and the styles exhibited by each partner is the necessary first step. Understanding alone, however, is not sufficient. Explaining, offering advice and problem solving can only go so far in soothing a partner’s emotional needs. A more indirect approach that offers emotional recognition and contact, one that says, “I am here and I get you. I have your back. Do not be afraid,” is much more likely to be effective. I have heard many spouses complain that their partner is very quick to come up with a fix, when all they want is a loving and caring emotional presence.

Within the two basic attachment styles (secure or insecure), attachment theory further identifies three sub-types of insecure attachment: anxious, avoidant, and fearful/avoidant. In the anxious variant of insecure attachment, individuals become anxiously attached and are constantly worried about the relationship. They are flooded with anxiety and alternate between angry demands and the frantic pursuit of reassurance, which often has the effect of driving their partner farther away. In avoidant attachment, individuals learn (as a defense mechanism) to minimize their emotional needs, to numb their emotions and to focus on others matters, such as work or children. With their partner, they seldom acknowledge their needs and generally do not ask for emotional connection, which often produce anxiety and deprivation in the other partner. Lastly, some individuals exhibit a mixed pattern of behavior that combines anxious pursuit and fearful avoidance of closeness. While this can give a very confusing message to their spouses, “I need you desperately—don’t get near me,” it is quite often evidence of severe childhood, adolescence or adult trauma that was experienced in relationships with significant people. Often, these are individuals who were abused or violated by attachment figures and who are now caught in the painful dilemma of seeking comfort from someone whom they also fear as a dreaded source of danger.

In couples counseling, as well as individual counseling, an exploration of each partner’s attachment style can yield surprisingly accurate results and can help explain relationship difficulties, as well as offer a way forward toward healing and emotional fulfillment.

Heed the Message, Don’t Shoot the Messenger

VirginIslandsNP_EN-US154535774The messages provided by the stress reaction that something is wrong, or dangerous, or simply requires our attention are often very powerful, even debilitating. Just think of the feeling we get in our gut (seat of the enteric nervous system) when something is not quite right. Even though we might not identify the threat right away, the stress signal activates our body’s defense almost instantaneously and we become fully alert. In the absence of a clearly identifiable threat, or upon identification of a threat that we cannot immediately escape, we may choose to treat stress itself as if it were the enemy. The common phrase, “I have too much stress” should in fact be restated as, “I have people, situations or circumstances that are an emotional, physical or mental threat to my well-being.”

Turning off the stress alert system is possible, especially with the use of powerful drugs or alcohol, at least for time. In fact, this amounts to unscrewing the warning lights on a dashboard so as not to be bothered by what they signal. The stress messenger conveys valuable information in the form of neural signals (mediated by the limbic system), sensations, and subjective feelings. The messenger does its job, the way it should, to ensure our survival. Nevertheless, the repeated stress signals may rise to a high and uncomfortable level of intensity, depending on the perceived dangerousness of the situation. That noxious feeling of being stressed is trying to give us a priority notification, to make sure that certain signals (which represent an important message) grab our full attention. Refusing to heed the signals of stress, or simply shutting them off or ignoring them, is not an appropriate response.

The best use we can make of stress messages is twofold:

  1. Use its intensity and the timing of its occurrence to become aware and acknowledge that a psychological or physical threat exists, and gauge its significance. For example, an immediate physical danger will elicit a more immediate and dramatic body reaction than a psychological threat that may occur in the future.
  2. Identify and address the cause of the stress reaction (which is usually accompanied by more or less severe anxiety) and focus our attention on it, with the aim of confronting, reducing or eliminating the stressor. For example, in a relationship that isn’t quite working the way it should the stress signal is the anxiety and worry over it, the stressor is that painful aspect of the relationship that needs to be confronted, reduced or eliminated.

In short, stress is the message, the stressor is its cause. It is much more productive to focus our efforts on the stressor, rather than just unscrew and throw out the red light bulb.

Type A and Hi-Tech: A Dangerous Mix

Tower of Babel by Bruegel at Stresshacker.comWhat does the relentless push of technology into our lives do to our ability to manage stress and to our health in general? It depends on the personality. For individuals who have a type A personality, multiple e-mail addresses available from any platform, high-speed anywhere Internet access, smart mobile phones, tablets, and e-readers have enabled even greater flexibility and mobility in teleworking and telecommuting. In effect, traditional boundaries between the different roles at work, in the family, at leisure have been blurred or even removed.

In addition to the advancing technology, economic conditions have made short-term employment, work on time-limited projects, and working two or even three part-time jobs simultaneously increasingly more common.

Type A individuals claim that this new rhythm of life has produced beneficial effects in terms of greater task variety and flexibility. Thanks to these ubiquitous and always-on hardware devices and the software tools they provide, there often is no break of continuity between work and non-work states, between being somewhere dedicated to work activities and being somewhere else, where relationships or relaxation are possible. Again, for the type A personality, this is just fine–at least in theory and by their own admission.

Type A Individuals Thrive…At Their Own Peril?

Type A personality is characterized by an extreme sense of time urgency, frequent impatience with one’s self and others, high competitiveness, and more frequent aggression and/or hostility (either in the form of overt outbursts, or constricted and internalized through tight behavioral control). Clinical evidence indicates that there is at least an increased risk of stress in these individuals due to their proneness to work overload, disruption of natural circadian patterns, role conflicts, lack of time for relationships, for sufficient rest and energy replenishment through sleep or relaxation activities.

This particular personality type, given the current availability of communication and connection devices, appears to thrive in this environment that promotes maximum efficiency, high productivity, a faster pace of work output, and competitiveness.

Is this a competitive advantage for individuals who happen to possess these personality traits, or is this a potential problem? Apparently, higher productivity and efficiency are desirable outcomes. From a business efficiency point of view, they most definitely are. This may explain why significant technological resources are being devoted by an increasing number of companies toward making this always-on-the-job state of affairs a reality for their employees. It is seen as a competitive advantage over other companies (which are fewer and fewer) that shut down at a reasonable hour and do not work on weekends.

Most type A individuals proclaim to “love” this uninterrupted access to the marketplace and the instantaneous availability that is demanded of them.

There are however potentially serious health consequences, unless the individual can set and maintain reasonable and appropriate boundaries.

Type A personality have long been known to be at risk in terms of elevated blood pressure, increased heart rate, higher blood lipids, and near-continuous catecholamine (stress hormone) output. Intensive, frequent, and sustained activation of these physiological stress responses can contribute to the atherosclerotic process and to blood clotting. This prolonged state of arousal can cause, with type A behavior, an elevated risk of myocardial infarction. A longitudinal study by Barefoot et al., found that medical students with high scores on the Cook-Medley hostility scale of the Minnesota Multiphasic Personality Inventory (MMPI)–which would indicate type A personalities– had a six fold increase in mortality when followed up 25 years later, mainly due to coronary heart disease.

The negative psychosocial and socioeconomic factors in which type A behavior appears to thrive is associated with increased risk of serious illness and mortality because of the elevated activity of the hypothalamic-pituitary-adrenocortical (HPA) system and the increased secretion of the stress hormone cortisol. A very high workload, such as regularly working more than 10 hours of overtime per week, is also associated with markedly elevated cortisol levels. Prolonged and sustained activity of the HPA system is related to a series of endocrine and metabolic effects, causing, among other things, increased storage of fat in the abdominal region.

It is a mixed blessing, to say the least, for type A personality to see modern technology facilitate and indeed augment their relentless rhythm of activity. Is the risk really worth the reward?

Ultimate Stressors: Public Drama, Private Pain

charlie-sheenRecently televised interviews with Mr. Charlie Sheen appear to have focused attention on the symptoms and manifestations of the manic phase of bipolar disorder. A public display of inflated self-esteem or grandiosity, profuse talkativeness, increase in goal-directed activity, psychomotor agitation, and the excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish investments) are the textbook criteria for a manic episode. More privately, the individual in the grip of mania also experiences a decreased need for sleep, flight of ideas or racing thoughts, and distractibility. When this disturbance is sufficiently severe, it can cause marked or total impairment in occupational functioning, usual social activities and relationships with others and may necessitate hospitalization to prevent self-harm or harm to others. Episodes of mania, whose symptoms are the opposite of those denoting depression, are rarely seen alone. Usually, the manic state is preceded and followed by depressive periods in an alternating fashion, with each state lasting from many months to a few weeks, the latter being described as ‘‘rapid cycling.’’

This constellation of symptoms was known, until a few years ago, as manic-depressive disorder. Nowadays, it goes by the somewhat more cryptic label of bipolar disorder. The neurochemical basis of bipolar disorder is not exactly known. One of the most valid hypotheses regarding the neurochemical mechanisms of bipolar disorder is the synergy between two neurotransmitters that determine mood states, whereby a lower than normal release of norepinephrine produces a disordered mood (significantly higher or lower than the normal range), while the levels of serotonin determine the direction the symptoms will take, i.e. downward toward depression or upward toward mania.

What Bipolar Disorder Feels Like

The subjective experience of these intense mood swings ranges from abject despair and hopelessness to not entirely distressing and almost pleasurable. Depression produces a pervasive
and relentless sense of gloom, inadequacy, rumination, guilt, and worthlessness. No logic, willful effort or remembrance of wellness seems capable of dispelling these cognitive and emotional experiences, often for prolonged periods.

Mania reverses and accelerates upward from the disappearance of depression, through a state of well-being that can be considered a normal mood state. Normality soon becomes exuberance, enters into a state of unexplained euphoria, and finally culminates into a chaotic state of racing, incomprehensible, disconnected thoughts, and bizarre behaviors. Given a choice, the individuals so affected report that they much prefer the state of mania, in which they experience a release from inhibitions, a hedonistic focus, and a pursuit of pleasure and gratification that can be nearly devoid of accountability or restraint. Self-medication with alcohol and illegal drugs is often present in the manic phase, which sets up a circular relationship that exacerbates its symptoms and impedes treatment and recovery.

An individual in a state of mania can be frightening, annoying, or amusing to the casual observer. It is perhaps easy to overlook the nature of the behavior, especially when there is an assumption of intent. In most cases, however, the individual has virtually no control over thoughts, words and behaviors and little if any insight into their bizarre, provocative, and sometimes dangerous presentation. The loss of reality testing, judgment and moral restraint of bipolar disorder is sure to cause psychological pain to the people who experience it and to the people who love them. Mr. Charlie Sheen has been variously portrayed as victim and perpetrator, and variously diagnosed by experts and entertainment reporters.

Bipolar Disorder: A Brief History

The first connection between a manic state and depression as belonging to the same neurochemical disorder was established in 1686 by the French physician Theophile Bonet, who observed individuals who appeared to cycle between high and low moods, and described their presentation as ‘‘manico-melancolicus.’’ In the middle of the 19th century, two other French researchers, Falret and Baillarger, who had independently observed the same cycling of moods in their patients, arrived at the same conclusion that the symptoms must be two different presentations of the same illness. Falret described the disorder as ‘‘circular insanity’’  and hypothesized a hereditary component to the disorder. In the late 1800s to early 1900s, German psychiatrist Emil Kraepelin elaborated the description and classification for manic–depressive illness that is considered the standard presentation that we see today.

It was John F. J. Cade, a doctor in the Mental Hygiene Department of Victoria, Australia, who introduced and promoted the belief that manic–depression was a biological disorder of the brain. On the basis of his research on neurochemistry, Cade administered a lithium salt preparation to several highly agitated manic patients and observed a remarkable reduction in symptoms, with a near return to a normal mood state. Lithium is currently the standard of care for the pharmacological treatment of bipolar disorder, and still the most effective in the management of its symptoms.

Marijuana Linked to Earlier Onset of Psychosis

Manifesti_LotteriaTripoli_194_mMarijuana (cannabis), thanks to the powerful depressing action of its active ingredient tetrahydrocannabinol (THC), is one of the oldest and most widely used means of self-medication against acute and chronic stress. THC users report experiencing a pleasurable state of relaxation, with heightened sensory experiences of taste, sound and color. In addition to its psychological effects, THC produces alterations in motor behavior, perception, cognition, memory, learning, endocrine function, food intake, and regulation of body temperature. The common perception is that, of all illegal drugs, marijuana may be the safest and least addictive—despite significant evidence that it causes side effects of fatigue, paranoia, memory problems, depersonalization, mood alterations, urinary retention, constipation, decreased motor coordination, lethargy, slurred speech, and dizziness, in addition to increased tolerance and addiction.

Impaired health including lung damage, behavioral changes, and reproductive, cardiovascular and immunological effects have been associated with regular marijuana use. Regular and chronic marijuana smokers may have many of the same respiratory problems that tobacco smokers have (daily cough and phlegm, symptoms of chronic bronchitis), as the amount of tar inhaled and the level of carbon monoxide absorbed by marijuana smokers is 3 to 5 times greater than among tobacco smokers. Smoking marijuana while shooting up cocaine has the potential to cause severe increases in heart rate and blood pressure. – NHTSA Fact Sheet

New research suggests that marijuana use may play a direct causal role in the development of psychotic disorders, including schizophrenia. An extensive meta-analysis of more than 443 studies comparing the age at onset of schizophrenia in individuals who used marijuana with the age at onset of schizophrenia in non–users yielded most sobering results.

Investigators at Prince Wales Hospital and the School of Psychiatry at the University of New South Wales in Sydney, Australia, found that the mean age at illness onset was more than 2.7 years earlier for cannabis users compared with nonusers. The age of onset did not significantly differ between alcohol users and nonusers. These results were published in the February 2011 issue of the Archives of General Psychiatry.

The results support the hypothesis that cannabis use plays a causal role in the development of psychosis… (and) suggest the need for renewed warnings about the potentially harmful effects of cannabis. – Matthew Large

In presenting the findings, lead study author Matthew Large, MBBS, Department of Mental Health Services concluded that the meta-analysis provides strong evidence for a relationship between marijuana use and earlier onset of psychotic illness and of a direct causal role in the development of psychosis in some more vulnerable individuals.

Hear and Feel Your Stress Drift Away

aavanGogh_1888_ArlesDanceHallCan music reduce stress? Yes, and the evidence is strong. Music can reduce stress, lessen pain, diminish hostility and have a positive effect on emotions and cognition. Beginning with an experimental study by Hatta and Nakamura (1991), researchers have continued to investigate the effects of relaxing music on psychological stress, finding good evidence of its benefits. Rhythmic music may change brain function and treat a range of neurological conditions, including attention deficit disorder and depression, suggested scientists who in 2006 gathered with ethnomusicologists and musicians at Stanford’s Center for Computer Research in Music and Acoustics. The diverse group came together for the symposium, “Brainwave Entrainment to External Rhythmic Stimuli: Interdisciplinary Research and Clinical Perspectives.”

Music with a strong beat stimulates the brain and ultimately causes brainwaves to resonate in time with the rhythm, research has shown. Slow beats encourage the slow brainwaves that are associated with hypnotic or meditative states. Faster beats may encourage more alert and concentrated thinking… Most music combines many different frequencies that cause a complex set of reactions in the brain, but researchers say specific pieces of music could enhance concentration or promote relaxation… Studies of rhythms and the brain have shown that a combination of rhythmic light and sound stimulation has the greatest effect on brainwave frequency, although sound alone can change brain activity. This helps explain the significance of rhythmic sound in religious ceremonies. – Stanford University News Services, 2006

Music therapy is now considered a useful adjunct in the treatment of many illnesses including cancer, stroke, heart disease, headaches, and digestive problems. There are numerous reports that music played before, during or after surgery reduces anxiety, lessens pain, reduces the need for pain medication and reduces recovery time.

In 2010, Wesa, Cassileth & Victorson published evidence in Focus on Alternative and Complementary Therapies Journal that music dramatically decreases distress for women hospitalized in a high-risk obstetrics/gynecology setting.  In 2009, a group of scientists headed by Thaut & Gardiner confirmed that music therapy can improve executive brain functions and contributes to better emotional adjustment in traumatic brain injury rehabilitation. Their study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons and a control group. The patients who received the music treatment showed a statistically significant improvement in executive function and overall emotional adjustment, reduced depression, lessened sensation seeking, and lower anxiety. Control participants, who did not receive the music treatment, showed decreases in memory, less positive emotion, and higher anxiety.

An extensive study by Good, Anderson, et al. (2005) tested three non-pharmacological treatments—one of which was music therapy—for pain relief following intestinal surgery in a randomized clinical trial. The 167 patients were randomly assigned to one of three intervention groups or control. The results showed significantly less pain in the intervention groups than in the control group, resulting in 16-40% less pain.

Finally, a just published German study offers case-study evidence that music therapy has positive effects on basic vital signs, the reduction of pain and on neurological development in newborn babies with health problems. At the other end of life’s spectrum, a very recent study of patients suffering from dementia of the Alzheimer’s type who exhibited disruptive behaviors showed that weekly session of live music therapy- and occupational therapy-based structured activities over 8 weeks resulted in a significant improvement in disruptive behaviors and depressive symptoms.

Sigmund Freud: What a Funny Guy!

freud-of-the-pampas_357025Sigmund Freud lived and worked in the Austrian capital, Vienna until the Nazi Anschluss of 1938 placed him and his family in great peril. Freud was allowed to leave Austria with his family through the intercession of his patients Princess Marie Bonaparte and William Bullitt, and diplomatic pressure by the United States. One condition imposed by the Germans for his safe conduit was that Freud state that he had been treated with due respect. In response, Freud is reported to have declared, ‘‘I can heartily recommend the Gestapo to anyone.”

Freud viewed humor as an outlet for discharging psychic energy and reducing the emotional impact of negative events. He regarded humor as one of the most adaptive defense mechanisms.

The essence of humor is that one spares oneself the affects to which the situation would naturally give rise and overrides with a jest the possibility of such an emotional display. Freud, S. (1916)

In his groundbreaking study of humor, Jokes and Their Relation to the Unconscious, Freud hypothesized that jokes and dreams serve to satisfy our unconscious desires. Jokes provide their unique pleasure by allowing a temporary release of inhibitions and permitting the safe expression of sexual, aggressive, playful, or cynical instincts that would otherwise remain hidden and inexpressible. Laughter is the release of defensive tension that has been aroused by the circumstances that precede it. Tension can be elicited by behaviors, feelings or thoughts associated with anger and sexuality—in situations where their expression would be inappropriate. When ego defenses that inhibit their expression become unnecessary, as when the joke’s punch line is revealed, the energy that would be normally suppressed can be released in laughter.

There are two ways in which the process at work in humor may take place. Either one person may himself adopt a humorous attitude, while a second person acts as spectator, and derives enjoyment from the attitude of the first; or there may be two people concerned, one of whom does not himself take any active share in producing the humorous effect, but is regarded by the other in a humorous light. To take a very crude example: when the criminal who is being led to the gallows on a Monday observes, ‘Well, this is a good beginning to the week’, he himself is creating the humor; the process works itself out in relation to himself and evidently it affords him a certain satisfaction. Freud, S. (1928)

Freud also wrote “Humor” (1928), a brief paper in which humor is distinguished from wit and comicality, whereby humor represents an internalized form of forgiveness that changes one’s perspective and provides some relief from emotions associated with disappointments and failures. Likewise, humor permits the reinterpretation of failures as being of lesser importance or seriousness than initially believed, thereby transforming such failures, said Freud, into “mere child’s play.”

Stress and the Female Brain Advantage

drlouannbrizendineIn 1994, Louann Brizendine, a neuropsychiatrist at the University of California, established the Women’s Mood and Hormone Clinic in San Francisco—one of very few such institutions in the world—and focused her attention on the etiology and functioning of the female nervous system.

In 2007, she published The Female Brain as the culmination of her 20 years of research and a compendium of the latest findings from a range of disciplines. It is a fascinating and, in some ways, startling revelation of the most noteworthy particularities that characterize the human female brain.

Size Does Matter… and So Does Density

Women and men have very nearly the same number of brain cells, even though the female brain is about 9% smaller than men’s. This fact had been known for some time and had been, more or less jokingly, interpreted as meaning that women were not as smart. Dr. Brizendine reveals a much simpler explanation: women’s brain cells are more tightly packed into the skull.

To further dispel any notion of masculine brain superiority, she says, women have 11% more language and hearing neurons than men and a larger hippocampus, the area of the brain that is most closely associated with memory. Much more developed in female brains than male’s is also the circuitry for observing emotion on other people’s faces. Dr. Brizendine concludes that, when it comes to speech, emotional intelligence, and the ability to store richer and more detailed memories, women appear to possess a richer brain endowment and thus a natural advantage.

The amygdala in males, on the other hand, has far more processors than in females, which could explain men’s greater intensity in perceiving danger and their higher proneness to aggression. The male body is much quicker to mobilize to anger and take violent action in reaction to an immediate physical danger.

Are women not as capable of reacting to danger? Dr. Brizendine says that a woman’s brain is as capable to perceive danger or deal with life-threatening situations, but that it mobilizes the body’s resources in quite a different way. The female brain appears to be wired to perceive greater stress over the same event than a man’s. This greater arousal and more forceful stress reaction appears to be a natural way to ensure adequate protection against all possible risks to her children or family unit. Brizendine suggests that this ancestral reason may account for the way a modern woman may view unpaid bills as catastrophic and naturally perceive them more intensely threating to the family’s very survival.

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MRI scans have pushed knowledge much higher by allowing the observation of the workings of the brain in real time. The brain lights up in different places depending on whether it is stimulated by love, looking at faces, solving a problem, speaking, or experiencing anxiety. What lights up, where and when, is different between men’s and women’s brains. Women use different parts of the brain and different circuits to accomplish the same tasks, including solving problems, processing language, and generally experiencing the world.

This is a fascinating book for the scientist and the novice alike, well worth reading. It is the Stresshacker Recommended selection for this month.

How to Get a Larger Brain

aaMonet_WaterLiliesHow do you increase the volume of gray matter in your brain? Mindfulness-Based Stress Reduction (MBSR), one of the most widely used mindfulness training programs, may be the answer. MBSR is receiving increasing attention for the significant morphological changes that it appears to produce on brain structures. The most recent results come from a controlled longitudinal study completed at Massachusetts General Hospital and published in the January 2011 edition of Psychiatry Research. Researchers at MGH investigated pre–post changes in brain gray matter concentration in individuals who participated in an 8-week MBSR program. Changes in gray matter concentration, measured using voxel-based morphometry, showed increases in gray matter concentration within the left hippocampus, as compared with a control group of individuals who did not meditate and showed no such increase. Whole brain analysis also confirmed gray matter increases in the MBSR group only, which were located in regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking, such as the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum.

Earlier studies conducted in the last five years at Yale and Harvard have shown that mindfulness meditation increases the thickness of gray matter between .004 and .008  inches (in proportion to the frequency of meditation) in parts of the brain that are responsible for attention and processing of sensory input. It also appears to slow down the brain deterioration which is a part of the natural aging process.

Yoga and tantric meditation, mantra or transcendental meditation, and mindfulness meditation are increasingly popular forms of stress management. The therapeutic value of meditation in producing positive effects on psychological well-being and ameliorating symptoms of a number of disorders has become widely accepted. Research on the neural mechanisms that underlie these beneficial effects and actual morphological changes produced by these practices offers encouraging new avenues of study that further validate their effectiveness.

I’m Bored: Does This Mean I’m Stressed?

aaEscher_RelativityBoredom, like pain, is an entirely subjective experience mediated by personality, needs, wants, past history and contingent upon one’s perceptions of the experience, and thus very difficult to describe with precision and quantify. The state of boredom has been variously described as a dullness of the mind, mental inertia, sloth, or ennui. Its characteristic features are a lack of interest in the ordinary and a lack of delight in the extraordinary. The forcibly approximate label of boredom often changes into something more precise when it can be examined without prejudice. Often, there’s an unpleasant or stressful feeling lurking in the shadows just behind boredom. Individual perception and the subjective assessment of a situation play a significant role, as the following little parable illustrates.

Sometime ago, in the Middle Ages, a traveler approached a group of stonecutters and asked, ‘‘What are you doing?’’ The first responded, ‘‘I’m cutting stone. It’s dull work but it pays the bills.’’ The second stonecutter said, ‘‘I’m the best stonecutter in the land. Look at the smoothness of this stone, how perfect the edges are.’’ The third man pointed to a foundation several yards away and said, ‘‘I’m building a cathedral.’’

Boredom is perhaps most vividly experienced at work, although its impact is rather more ubiquitous. When a work task (be it that of the chief executive or the firefighter) does not provide the opportunity to sufficiently use or develop one’s skills and abilities, most individuals can feel undervalued and underutilized, and therefore bored.

Boredom, Stress and Aggression

In time, boredom may result in apathy and lead to poor morale, irritation, depression, job dissatisfaction, and absenteeism. In more sustained cases, the stress of frustrated ambition, unfulfilled goals, and unmet expectations can cause reactions that degenerate into destructive behaviors. Examples of destructive coping strategies against boredom include workplace vandalism, sabotage, alcohol and drug abuse, and binge-eating habits.

Perhaps the most important source of aggression and destructiveness today is to be found in the “bored” character. Boredom, in this sense, is not due to external circumstances such as the absence of any stimulation, as in the experiments in sensory deprivation or in an isolation cell in prison. It is a subjective factor within the person, the inability to respond to things and people around him with real interest. In some respects, the bored character resembles those in chronic, neurotic depressed states. There is a lack of appetite for life, a lack of any deep interest in anything or anybody, a feeling of powerlessness and resignation; personal relations–including erotic and sexual ones–are thin and flat, and there is little joy or contentment. Yet, in contrast to the depressed, chronically bored persons do not tend to torture themselves by feelings of guilt or sin, they are not centered around their own unhappiness and suffering, and their facial expressions are very different from those of depressed persons. They have little incentive to do anything, to plan, and at most can experience thrill but no joy. To use another concept, they are extremely alienated. For these reasons it seems preferable to establish the concept of the chronically bored character as distinct from the depressed character. Milder forms of characterological boredom are usually not conscious, as long as the boredom can be compensated for by ever-changing stimuli. This seems to be the case with a large number of people in industrial society for whom the compulsive consumption of cars, sex, travel, liquor or drugs has this compensatory function, provided that the stimuli either have a strong physiological effect, like liquor and drugs, or are constantly changing: new cars, new sexual partners, new places to travel to, etc. This consumption pattern keeps people from nervous–and industry from economic–breakdowns, and precisely for this reason they are addicted to consumption. — The Theory of Aggression, written by Eric Fromm to introduce his book The Anatomy of Human Destructiveness, first published in The New York Times Magazine, February 1972.

The Time Dimension of Boredom

lastminuteResearch studies on boredom have uncovered that easily bored individuals generally perceive time as passing very slowly, paradoxically, even when they are busy performing a task. It is not surprising to learn that institutionalized individuals, whose days are highly regulated and monotonous, say they experience time as painfully slow. Individuals suffering from depression often say in clinical interviews that they perceive a slowing of time. Cancer patients, who experience high levels of anxiety, have been found to routinely overestimate the duration of treatments and report that hours and days never seem to go by fast enough. In general terms, these studies highlight the distress felt in situations when individuals are not emotionally or cognitively engaged, which draws attention away from meaningful thoughts and actions and focuses it on the passage of time.

Is Ours the Age of Boredom?

It has been said that today’s pervasive boredom is a manifestation of cultural disenchantment. The great danger of boredom, as Fromm surmised, is that it can lead to pursuing irrational thrills in an attempt to relieve it. German philosopher Martin Heidegger, best known for his existential and phenomenological explorations of the concepts of being and time, sought to explain boredom not as a subjective intrapsychic experience whose possible causes might be a matter of interest to psychology, but as a mood in which time becomes the focus of attention. Heidegger distinguished between three forms of boredom: The first, being bored by something, is the most common and easiest to understand. In the second, becoming bored with something, it is not always easy to determine what it is that is boring. The third, when nothing in particular is boring per se, is a profound, unexplainable boredom with existence itself.

In profound boredom, utter anonymity of self, wholesale meaninglessness of world, and total unrelatedness are fused together to create an existential extreme.—Martin Heidegger

Boredom, Stress and Health

Chronic boredom, and the chronic stress it provokes, are associated with undesirable health outcomes. Boredom often complicates and sometimes compromises the course and treatment of physical and mental illnesses that require extended care in treatment facilities. A recent study by McWelling identified sustained boredom as a contributor to the onset of postpsychotic mood disturbances, increased risk-taking and substance seeking behaviors, the exacerbation of positive symptoms such as paranoia and hallucinations, changes in distractibility and overall cognitive efficiency, and a hypohedonic state of highly generalized lack of interest. Who said that boredom is not stressful?

Why Hardiness Is Faster Than Competitiveness

aaBruegel_HuntersSnowDo you know someone who deals with stress by working harder and faster to produce more in a shorter time? These so-called type A personalities appear to have a stronger than average sense of urgency, can be more highly competitive, and may be frequently and more easily angered when things don’t go their way. Stress reduction and stress management is perhaps one of their most urgent needs, yet these individuals are perhaps the least likely to take the time to learn effective self-management techniques.

Unfortunately, as discussed in our recent post on the impact of stress on the heart, type A personalities suffer from a significantly higher rate of cardiovascular disease than type B personalities. The former may be more successful at getting things done faster. Type B’s may be slower and somewhat less effective, but they can play and relax without guilt, are much less hostile and unlikely to exhibit excessive competitiveness.

Hardiness Matters More Than Speed

The evidence for the difference in health outcomes between type A and type B originally came from groundbreaking research by S. C. Kobasa of the University of Chicago. Dr. Kobasa looked at personality as a conditioner of the effects of stressful life events on illness by studying two groups of middle- and upper-level 40- to 49-year-old executives. One group of 86 individuals suffered high stress without falling ill, whereas the other group of 75 individuals became sick after experiencing stressful life events.

The results of the study showed that, unlike the high stress/high illness executives, the type B group was characterized by more hardiness, a stronger commitment to self-care, an attitude of vigorousness toward the environment, a sense of meaningfulness, and an internal locus of control. These “slower-paced” individuals appear to view stressors as challenges and chances for new opportunities and personal growth rather than as threats. They report feeling in control of their life circumstances and perceive that they have the resources to make choices and influence events around them. They also have a sense of commitment to their homes, families, and work that makes it easier for them to be involved with other people and in other activities.

SH_Rcmds_smAccording to Herbert Benson and Eileen Steward, authors of Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness, the incidence of illness is much lower in individuals who have these stress-hardy characteristics and who also have a good social support system, exercise regularly, and maintain a healthy diet.

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This is a stress management book well worth reading, because it specifically targets hardiness and better stress management with type A personalities in mind. It is the Stresshacker Recommended selection for this month.