Saturday, December 12, 2009

"Getting Bitch-Slapped By The World" or "Don't Get Cocky, Kid"

Hello Friends:

Fair warning, this is a pretty 'triggering' post for those with sickness related OCDs, hypochondria, fear of V*, and such. I'm not sick, myself, but witnessed it and it has me pretty rattled. So if you don't want to read my somewhat graphic rant, you better stop right now.

The end of the cruise went great. No serious problems, and then we even found a half day excursion around Puerto Rico to fill in time before going to the airport. I was liberally patting myself on the back for making it through all the hard parts while only freaking out a few times during the entire week.

Never, never say that.

I was doing a good job of keeping my mind off of the upcoming flight. But eventually we got to the airport, and through aggie inspection (called USDA of course, but that just makes me think they are scanning for steak). And then into the excruciatingly but not totally unexpectedly long line to get through security.

I have a very tough time with lines. People get antsy. Stand too close to me. Fail to control their children. Cough or sneeze on me. Try to jump in front. You name it. A lot of people simply don't leave enough time to deal with airport issues. This is San Juan airport, not someplace really on the ball. You have to expect you can run into an hour long line. I didn't want to, but there it was. Not surprisingly, after an already stressful week, I was totally on edge. Shaking, rocking, and working hard not to dissociate. As the hour wore on, it got hotter in the line, and tougher to stay mentally present. But I kept it together, if only just, until we got into the area that was roped like Disneyland. Normally, I don't like the roped off lines, but at least they do let you know exactly where to go and do stop the line jumpers, for the most part. If you don't mind the trapped feeling ....

Now what is it that makes someone sick, and I mean really sick, try to fly? Nothing, and I mean nothing, is going to be worth not only the risk to your health, but that of everyone around you. These people are morons. Did they get the whole flu season and H1N1 epidemic news? Do they enjoy endangering other people? I suppose I should say I have sympathy for the sick person who is sick and all that, but I don't have any sympathy for needlessly being put in a position where I'll be in OCD hell for the next two weeks, waiting to come down with the incredible wretched crud that had infected the woman two people away from me.

Because right there in line - three people away from the boarding pass screening - she puked all over the floor. You know that sound of that splatter? She had barely bent, and so it cascaded everywhere. People were bolting. We were forced against the ropes as far as we could get from her, but couldn't get out of line.

After about two seconds I dissociated almost completely. Feeling terrified and numb, staring around and seeing almost nothing. Except hyper sensitive to this new, horrifying contagious threat. Of course I have no idea if she had anything catching, or simply couldn't hold on to her hamburgers. Or whatever.

But she didn't stop. One puke. Then two.  And then she stood there. And then puked some more. And would you calmly be standing in line casually puking your guts out, showering the nearby patrons with viruses? She didn't try to leave the line or run for a restroom or anything. Just stood there and puked yet a fourth time. By then, my spouse and I had made it around the situation, more or less, and gotten to the main entrance to the security screening. I was so out of it I had tunnel vision, was shaking, and could only fixate on one thing at a time. All I could think of was that statistically speaking, I and my luggage were now covered in micro-droplets of God only knew what. Simple food poisoning? Bird Flu? Who even f*cking knows.

I was too far gone to hear the exchange behind me, and only put it together from conversation with spouse afterward. Believe it or not, puker and her SO were going to try to get in line behind me and spouse to go through scanning. My spouse blocked them and said, 'No'. And she tried two more times, and he simply pointed to the other line, 'You go there. You will not go here.'

Fortunately by then the idiots at San Juan airport stepped in and put puker and SO through a special line. But I can't believe they let them through security at all. There was a woman on a flight to Hawaii taken off just because the crew had an idea she might be sick. And there this woman threw up four times in line, and they let her through security. I do not f*cking get it.

So not only did I get to fly for 4.5 hours with possibly puked on shoes, I got to spend that time doing every cognitive trick in the book trying to get myself to keep from having a full blown panic attack. And trying to reassociate my mind and body so I wouldn't build up any more new trauma from this than necessary.

And now here I am. Finally, finally at home. But scarred. I'm scared. The world is so scary. Everyone on the plane was coughing and sneezing and I'd been nearly barfed on. Probably had been in a microscopic fashion. It'll be two weeks before I can be sure I didn't pick anything up from that unbelievable episode. And it might be a lot longer than that before the terrible backlash from this finally works its way through depressive rebound and all the rest.

I'm throwing out my suitcase.  By the way.

Any advice?  Kind words?  Whatever ... I could use it.

Your Hostess With Neuroses

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Monday, December 7, 2009

More Fun Cruising With OCDs

Hello Friends:

Ah, the glories of travel. I love being in new places, I just hate getting there. Which makes one wonder why I yet again chose to go on a cruise. A cruise is like “all getting there and never being there.” You never stop moving, and there is a strange, new port every day. And for some inexplicable reason, I get seasick more easily than I used to. So the cruise is a little bit more of a challenge than I thought it would be.

Included in the downside of cruising is the general fear of the dreaded tummy flu. These viruses have, in the past, run rampant on a few cruises. But oddly enough, the fear of H1N1 may actually drive the chance of getting sick way down. For the first time, I’m seeing people actually take the “wash your hands” advice seriously. And by my estimation, at least 70 percent of the passengers are using the instant hand sanitizers that are all over the place. Hopefully they don’t think they work in place of hand washing. But people can be right stupid, so who knows.

I, of course, came prepared for my usual “room decontamination ritual.” I bring my own rubber gloves and a huge stash of Lysol wipes. And then I proceed to wipe down every single surface in the cabin that gets touched. All tables, the phone, all switches, the hair dryer, facets, door handles, drawers, all of it. I use up the whole canister, making sure that everything stays wet for the requisite ten minutes for decontamination. Yes, those are my hands cleaning my stateroom phone in the picture there.

I also keep a canister of more skin-friendly handi-wipes by the door, and wipe my hands on the way in or out. I wash my hands all the time, which is nothing new so that’s easy. And I keep a stash of handi-wipes on me to use before and after eating, to clean off any surfaces I put my computer on, etc. I do not touch elevator buttons – I have a spouse for that.

And that’s where I have to cut myself off. Once I’ve performed these rituals and allowed myself some concessions, then no more worrying, (if possible, heh). I know that unless I draw a line, I’d be looking for a million different ways to ensure my illness-free state, which we all know is impossible. And since I don’t want to go any crazier than I am now, that’s how I handle my illness fears. I do the stuff I said above, and then that’s it. It basically works. I get twinges when I hear someone cough or sneeze nearby, but that’s also nothing new.

Pluses for cruising include being able to go to new places and not have to break in new hotel rooms. One room. It gets the decontamination ritual, and then I’m done for the trip. And the stateroom attendants tend to be religious about cleaning. They don’t want a flu outbreak, either. Probably less than the passengers do since they live on these boats for months.

Also, no new restaurants to learn about. For food and eating related anxieties, there is nothing like having the exact same table with the exact same servers every night. You learn the routine, and then meals are really stress free after that. And, since all the food is prepaid, you can send anything back that does not work for whatever reason. Chicken look underdone? Send it back and get the lasagna. No problem. They’ll bring you both right from the get go, if you want.

Oh, another downside of cruising. Internet rates are like 37 cents a minute, minimum. So you end up typing out your whole post before jumping on line quickly and posting it, hoping you don’t have too many typos.

Your Hostess With Neuroses

Thursday, December 3, 2009

The Sanity Score - I Love a Good Quiz

Hello Friends:

I love online quizzes and surveys. Especially if I can see metrics for my craziness. I'm still in that phase where defining and categorizing my mental illnesses makes me feel like I have more control over them. I thought I'd point out a survey I just took that was actually marginally helpful, and then see if I could talk any of my dear readers into taking it and sharing their own fun.

The survey is The Sanity Score on PsychCentral. It is a pretty comprehensive little test for an online evaluation, with about 80 questions covering the gamut of your usual diagnoses. For someone who is not currently in any kind of therapy, it might be of use to see if maybe you ought to be. And for those of us who are actually seeing a psychologist, it can be a tool for tracking progress.

Now, of course this sort of thing is very crude. I took the test twice in fifteen minutes, and got Sanity Scores ranging from 85 to 91 (from 0 to 288, where 288 is totally f#cked up.) Also, within the sub-categories I had major issues pointed out that had score ranges, as well. Sub categories are scored as 0 to 100, and major issues are anything above fifty on that scale. I scored OCD 56 to 63, PTSD 50 to 67, Phobias 50 to 67. Amazingly, I scored Anxiety 45 to 49, which is just below being a critical issue. But honestly I think there are some confusing questions where Anxiety and Phobias could get mixed up. I also score other issues right on the line, with General Coping 43 to 46, Depression 47 to 50, Self Esteem 42 to 50, and Physical Issues steady at 50 on both.

These numbers have me thinking. I am right on the edge for a large number of sub-categories. They are just below the 'critical' mark. This makes sense to me.  Last year I think I would have tested above critical on all of them, and that was reflected by my near total breakdown. I wish I had a score from that time. I'm doing better now, although not really 'good'. Yet I am coping a little better, and am less symptomatic. I'm surprised my OCDs rate so high, but maybe that's a general reflection of how I am during flu season; afraid of touching doorknobs and the like. Otherwise I'd have predicted my general anxiety to be much higher than OCDs.

The test lets you save your score, so you can go back and check any change with time. I intend to come back in six months or so and see if anything enlightening can be tracked.

So Adventurers, game to take a little plunge? How did you score? Any surprises? Did you think it was useful at all? Post a comment and let me know.

Your Hostess With Neuroses

Image credit/info: / CC BY-SA 2.0

Thursday, November 26, 2009

OCD's and Scrupulosity - Obsessive Religion

Hello Friends:

We now interrupt our previously scheduled post (the second part of my PTSD and Spiritual Crises series) to take a step back and ask, so what?  So why do I care so much that I'm not spiritually well-defined, anyway?  I mean, I know this is a symptom of PTSD, but is it really necessary to work through this religion stuff at all?  Aren't flashbacks, say, much more of an issue?

Well, yes and no.  As I said in the last post, it seems that all PTSD symptoms are related to the same prime causes, and therefore working on one is likely to help with another.  And it may be impossible to ignore one utterly and expect some other issues to heal up just nice.  So constructing a consistent and meaningful world view may assist with mitigating flashbacks, and vice versa.

But it's more than that, at least for me.  I suffer from a form of 'scrupulosity'.  This is a specific aspect of my OCDs that emerge in the realm of religious and spiritual thinking and rituals.  I found a great description of it here, and excerpted the following (gender change is mine):  "For certain individuals, religious beliefs become compulsive, joyless behaviors.  The individual may constantly worry that she might say or do something blasphemous.  She may fear that she has committed sin, forgotten it and then neglected to repent for the sin.  She may spend long hours searching her mind to try to ferret out evidence of unconfessed sins.  She is unable to feel forgiven.  Specific obsessions and compulsions vary occurring to the individuals religion.  An Orthodox Jew might worry that he did not perform a particular ritual correctly.  He might obsess about this for hours.  A Roman Catholic might go to confession several times a day.  Another individual could believe that anything she does might be sinful.  This individual might become so paralyzed with doubt, that he or she becomes afraid to do or say anything at all."

My issues are not that I tend to perform rituals; I don't have too many religiously compulsive behaviors.  It is that I obsess about how I'm going to hell, and am constantly looking for the right set of 'rules' to follow so I don't have to worry about going to hell anymore.  I'm not sure it is possible.

My religious background is pretty varied within different brands of Christianity.  But the most lingering bad effects came from the time I was attending a fundamentalist church.  These are dangerously seductive for those with OCDs since, on the surface, they seem to present a perfectly defined set of rules that anyone can follow and 'know' they are saved.  But then, when church pulls you in deeper, you realize that instead they always leave you guessing.  Wondering.  Always needing to come back and check.  You are constantly admonished to be vigilant against 'backsliding'.  You must confess your sins to God constantly, and are only assured of being 'saved' until you commit the next sin.  For this sect, thoughts can be sins, and we've already discussed the difficulties in telling yourself not to think about something.  It became a nightmare of trying to meet a set of rules that never really did the trick.  You were never quite good enough.  (Been given the gift of tongues yet?  No?  Hmm ...)  In addition to all of this confusion, you had to take responsibility for the souls of people around you.  If you weren't actively trying to convert them, then you were sinning.  If they died unconverted because you didn't talk to them, that was on your head.

In spite of having left this church behind years ago, damage has been done.  I mentioned in my post on Trying to Make Sense of God, that I'd had a final 'break' with God over what I read in a book.  I accepted that there was no way I could do everything necessary to be sure I was going to hell.  And since the lack of knowing is unbearable, it is easier to say, 'screw you' and know you are going to hell.  Strange, I know.  But there you have it.

Knowing now that this confusion is fed by PTSD, I have some new hope.  Maybe there really is a way to look at this situation more compassionately.  More 'realistically' just like the way I look at all the rest of my OCDs.  I've had success there.  Maybe I can have some success creating a new view of the world where things 'make sense'.  Where there is justice.  Where there is a meaningful spirituality.

I don't know if I can, but as you see I have some motivation to try.

Your Hostess With Neuroses

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Sunday, November 22, 2009

PTSD and the Crisis of Faith: Part One of Two

Hello Friends:

Well, here's another installment in under my tag of 'spiritual struggles'. I mentioned in Spiritual Crises: Trying to Make Sense of God that at this point, I'm pretty much at ground zero as far as God goes. Ya might want to take a look at that old post since it is the background for what I'm going to talk about here.

Now tell me, how is it that I've been looking for great resources on PTSD for a solid year and missed what is apparently one of the classics? Maybe I'll review the book, formally, in the future. But for now I'm going to use it as the basis for my look at spiritual crises and what to do about it.

The book in question is Trauma and Recovery by Judith Lewis Herman, M.D., and was first published in 1992. I have used it here because I wanted to see what the psychologist's model is for a person actually getting 'better' from PTSD, and specifically, what that means for their spirituality. All quotes below are from this book.

The punch line is that there is indeed a model and a path. The caveat to the punch line is that it is an integral part of the whole recovery from Complex PTSD as a process. You can't just say 'hey, I'll get my situation with religion in order first, then come back and deal with the rest of it.' But I plunge ahead doggedly, anyway. Here's my analysis.

The specific symptom we are concerned with is that Complex PTSD causes "alterations in systems of meaning" resulting in "loss of sustaining faith and a sense of hopelessness and despair." Right, okay, I have that symptom. Check.

But why? What exactly is it that the trauma does to undermine a sense of faith? Or worse, to ensure that no sense of faith can really develop or remain unchallenged? The answer to that (as far as this book is concerned, anyway) comes from the nature of the "damaged self."

"Trauma forces the survivor to relive all earlier struggles over autonomy, initative, competence, identity, and intimacy. The developing child's postive sense of self depends upon a caretaker's benign use of power. Traumatic events violate the autonomy of the person at the level of basic bodily integrity. The belief in a meaningful world is formed in relation to others and begins in earliest life. Basic trust, acquired in the primary intimate relationship is the foundation of faith. Trauma creates a crisis of faith. Damage to the survivor's faith and sense of community is particularly severe when the events themselves invoved the betrayal of important relationships."

Yikes. Okay, this also makes sense, but it makes me cringe. Thinking back on the nature of the 'primary intimate relationship' i.e. Mom. (Zo, tell me about your mother.) How cliche. But there you have it - having a neglectful and abusive mother directly impacts the ability to develop a belief in a meaningful world. For us who suffered repeated trauma from the primary caregiver, the world makes no sense, has no meaning, and there is no one who can be trusted.

Here's a passage from the bible I quote a lot, except I'm going to reverse the gender to make the point, "If a daughter asks for bread from any mother among you, will she give her a stone? Or if she asks for an egg, will she offer her a scorpion? If you then, being evil, know how to give good gifts to your children, how much more will your heavenly Mother give the Holy Spirit to those who ask Her!" (Luke 11:10-13 NKJV)

Well ... I got a scorpion.

So of course I don't trust God to give me something ostensibly good. Why would I want my heavenly father (mother) to give me anything at all? I'll pass, thanks. I'll go find my own egg.

So, how to fix this attitude? How to bring yourself to a point where you can create some kind of meaningful world view? "The fundamental stages of recovery are: (1) establishing safety, (2) reconstructing the traumatic story (which includes remembrance and mourning), and (3) restoring the connection between the survivor and her community (reconnecting with ordinary life)." "Recovery is based upon empowerment of the survivor and creation of new connections. It can take place only in the context of a relationship."

Um. Okay. Safety ... right. With my OCDs nothing is safe, really. But this idea of safety includes more than just a sense of physical safety. It means having the worst of the symptoms under control (by meds or CBT or yoga or what have you), having developed at least a vague sense of control of yourself and your life (again, by therapy or whatever), as well as having some established support network. I basically have all this, so I'll give myself a check for stage one.

Then the tough part. Stage two, which has two nasty aspects. The first is recounting and remembering the trauma. Bleh. "The goal of recounting the trauma story is integration, not exorcism." Ah, right. Well, I've remembered a lot of nasty stuff. But I don't think I've actually reprocessed it all. Besides, the second part of stage two is mourning, and I am really, really stuck on that. But the book says "The reward of mourning is realized as the survivor sheds her evil, stigmatized identity and dares to hope for new relationships in which she no longer has anything to hide." Holy crap. Really? Sounds good. Also sounds like pie in the sky. Stage two, no check for me.

Not to end on a down note, but seems like a good place to sit and ponder. I think I'll address both the reprocessing and the mourning later. Next post, I'll finish with step three, even though it's going to be a while actually getting there. So I might as well post about it ...

Your Hostess With Neuroses

Image credit/info: / CC BY 2.0

Wednesday, November 18, 2009

Feeling Totally Crazy - Am I A Dweeb?

Hello Friends:

I am feeling kind of like this picture.  Crazy, and yet sort of a mix of spacey and startled.  I don't really have anything profound to say (do I usually?) but felt like posting.

See, I've found a forum on the net that I really like.  And this is a surprise because I've tried a lot of forums and have not felt like there was really much going on.  Not much sharing.  But I found this one at, and I really like it.  So I set up an account and spent a day reading different threads, trying to get to know the community, and posting like seven posts.  And you know me, people, I do not post short posts.

And its funny, at first it was all good.  Thinking I was learning and sharing all nice like.  And then ... then you start to hear the voices.  Not real ones (since I don't think I'm on the psychotic end of things, but you never know) but those inner voices that say, "Wow, that was a dumb post," and "Holy cow, that thing you said was probably really offensive," and "Man, what makes you think anyone wants to read that huge post anyway?"  On and on.

Then I really start to get worried.  See, I've posted here in my blog before about my parents, and I was answering a post there about someone else who now found herself estranged.  I was going on and on, as I usually do, about how my parents drove me crazy and how it's probably better we all went our separate ways.  And then I realized I'd called out my mother's BPD, Narcissism, and my dad's alcoholism quite specifically.  More second guessing ... did I just offend someone?  Do I look like I judge people based solely on their mental illness diagnosis?  Am I coming across as an insensitive lout?  Am I an insensitive lout?

Then you wonder what the #$%@ made you want to post your ideas anyway.  What were you thinking?  I mean ... what was I thinking?  Why get involved in a forum where your idiocy is just hanging out there for all the world to see?  (Are you seeing the irony, yet?)  Took me a while, and then of course I realized I post my idiocy regularly right here on this blog.

But it is different.  After all, if you, reader, find my blog ewwwy, you can go elsewhere.  If someone on a forum thinks I'm ewwwy, then they might think I'm stinking up the whole forum.  Or at least the threads I am posting on.  Still, I do recognize this paranoia as part of my own mental illnesses.  Things like this have their stages, for me, anyway.  First there is that giddy feeling of "hey this is new and fun."  Then the phase of "I think I just put my foot in my mouth" which is the same as the"'I just said something so boring" phase.  Phase three is the "Why don't I quietly slink away and never come back" phase.  Then phase four, the phase where you finally have to chose if you are going to run from the pain of your own foolish face, or try to face up to reality and accept you are a human being.

I'm in phase four.  Wanting to go back and be a part of things, and trying to accept that I'm going to look like a dweeb sometimes.  I do not want to be a dweeb, and yet, are not we all dweebs, every now and then?  Sigh.  I want it all clean and happy and perfect.  And then I show up and make it all real and sticky and messy.

I'd be interested in input.  Do you have these experiences with emails, phone calls, or forums, etc.?  How do you get back on the horse after you've said or done something you either only think is stupid, or had someone comment on saying "that was stupid" or "you hurt my feelings"?  I'd like to know ...

Your Hostess With Neuroses

Monday, November 16, 2009

Cans - Part Two of Two - Triumph over Can

Hello Friends:

In my post Cans - Part One - Cans are Scary, I mentioned why it is I seem to have this problem with cans; associating cans with Botulism at a ratio of one to one.  I also talked about how I hadn't opened a can and eaten the contents (without any help) in 17 years.  And even with help, I still haven't opened more than a handful of cans in all that time.  Well, on Friday, one can met its end.  Your Hostess - 1.  Can of pumpkin - 0.  Triumph.  Small, but telling.

Here's how it went.

I woke up with this very strange and unshakable desire for pumpkin pancakes.  I have never made pumpkin pancakes.  I make pancakes all the time, but if you are me then  adding pumpkin means getting an actual pumpkin, chopping off the top of its head, pulling out the stringy insides, and roasting it.  Then removing the skin, chopping it up, and running it through a food processor.  This is needlessly complex.  Roasting your own pumpkin makes for very good pumpkin, but it is an incredible time sink.

So, no pumpkin pancakes for me.

Except ... there was this can.  See, last year at Thanksgiving I did buy two cans of pumpkin so I could make pumpkin pie for my sister that was vegetarian, as well as soy-free, egg-yolk-free, and malt/barley-free.  I actually bought a can opener to do it, since I most certainly didn't own one.  I made the pie( after getting lots of approval on the contents of said can) and then did not eat any for two days.  Then I managed to eat a piece, although I worried for the whole day, and spent the whole time checking for illness and any strange symptoms of 'I'm just not feeling right.'  Which is fricken always.

Well, the pie only took one can of pumpkin to make.  And the other can got shoved into the back of the pantry.  So when I wandered down on Friday, thinking about pancakes and pulling the baking powder down, it caught my eye.  Usually when I see a can I get a vague nauseous feeling and look away.  This time, I got the sick feeling, but didn't turn.  It was ... tempting.  I had a can of pumpkin.  Hmmm.

Just to test the water I picked it up and checked the date.  Another two years left.  I inspected the can thoroughly.  Dents?  Strange sticky spots?  Bulges?  Ripped label?  No.  Nothing.  It was pristine and perfect.  So I figured, well, might as well open it and just see ...

Took me five minutes to find the can opener.  Another three to remember how to use it.  Then I crimped it onto the can and cranked it around.  The inside smelled very pumpkiny.  Smelled good, actually.  No weird scent or strange colors.  I sniffed it several times and held it under the light.  Still I was unable to find a reason to dismiss the contents.

I set it aside, and went to work putting together my usual pancake recipe.  But before I added any of the liquids, I looked back at the can.  What the hell.  I dumped it into my mix and then simply adjusted the amount of liquid until I had something that resembled batter.  I've never found pancakes to be particularly tricky.

And from that point, it was surprisingly easy.  I put in a lot of spices; cloves, two kinds of cinnamon, allspice, ginger, Chinese five spice powder, nutmeg and a few other things I can't remember.  Then I cooked them up.  They smelled GOOD.  And I really, really wanted to eat them.

And I did.  Now, I can't say that I haven't had a twinge since then.  In fact, every time my tummy has been the slightest bit off, I've thought about those pancakes.  But I have not had a panic attack, haven't needed to call the CDC, and haven't lost any sleep over it.

What I've been left with is this desire to really know WHY.  Why is it that I had this success?  Why have things changed enough to allow this to happen?  Lower stress levels, or meditation, or good therapy, or proper dose on the meds, or better diet, or doing lots of writing ... etc?  I've done all of that, made all of those changes.  So there is no way to know.  It probably isn't a single cause, anyway.  If it were that easy, I'd make a mint selling the secret.

Whatever it was.  I am still smiling about it.

Your Hostess with Neuroses

Image is the actual can in question, crushed in defeat.

Saturday, November 14, 2009

Cans - Part One of Two - Cans are Scary

Hello Friends:

Cans are scary because in my mangled mental state I believe that 'all cans have botulism'.  As with my issue about rabies (i.e. all bats have rabies, all squirrels have rabies) and tetanus (all pins, needles, and nails can give you tetanus) I am not quite rational in my fear of botulism.  I had an interesting encounter with a can recently, which prompted me to go ahead and create this post about one of the "Big Three" fears of my psyche.  I posted the Big Three post to introduce the topic, and then I dealt with my rabies fear in my second post about bats, Bats are Scary.

So let's talk about botulism.  Wheeee!

Okay, my fear started in high school, when I read a caption to a figure in my science textbook.  It said something bizarre, like only 2000 'molecules' of botulism are necessary to kill someone, and it implied that the only result of being infected was death, or very rarely, if you survived, total paralysis.  All this stuff isn't true, by the way, but I didn't know that then.  So when I read that caption, the information settled down somewhere into the irrational part of my brain that keeps facts ready for my later torture.  When my OCDs and panic burst forth fully formed in my early twenties, they tapped into this reservoir of ready-made fears, and botulism came up as one of the top three, beleaguering me for the seventeen years or so since.

The practical result is that since the age of 24 I have been unable to open a can and then eat the contents.  Very rarely, and by that I mean a handful of times in the last seventeen years, I have been able to open a can and use the contents if someone else pronounced it 'good' and then ate the contents first - and then if they didn't die for a day after eating it.  I have literally opened only six cans in seventeen years.

Interestingly, this fear has centered almost completely on metal cans.  For whatever reason, they have bothered me much more than jars.  Although I went many years unable to open a jar, even a glass jar of bottled juice, I have at least been able to use jars with some regularity in the last five to seven years.  Metal cans, though, no go.  (Additionally, for almost two years I couldn't eat frozen food, either, as it somehow became guilty by association.)

Of course, everyone but me uses cans in cooking.  And I can eat at someone's house and at restaurants just fine, as long as I don't see the can.  If I see an open can on a counter, that's it.  I can't eat the food.  This has meant a lot of very embarrassing incidents, and even perceived offenses, where people think I 'don't trust them' because I can't eat the food.  That has played directly into my social anxiety, exacerbating that already chronically bad condition.  Eating dinner at someone's house can be potential nightmare, so I've often avoided it.

Anyway, so that sets the stage for a new look at the big 'B'.

So let's see some facts for a change.  The bacteria that cause botulism are naturally occurring in soil.  They tend to thrive in low-oxygen environments (anaerobic).  This means they colonize generally when contained, as in sealed cans and jars, but also occasionally inside wounds or someone's intestines.  The latter usually only happens to infants.  I always knew of the anaerobic nature of this bacteria, and so have been nervous in any situation that has a container that has been closed for a long time - for example, having to clean out a cooler that was used on a camping trip after it had sat closed with water in the bottom for many months.  The chance there was danger of botulism in that scenario?  About zero.  But as I've noted in the past, if it were a rational fear I wouldn't be on meds.

Botulism is super rare.  The CDC says (emphasis mine), "In the United States, an average of 145 cases are reported each year.  Of these, approximately 15% are foodborne, 65% are infant botulism, and 20% are wound.  Adult intestinal colonization and iatrogenic botulism also occur, but rarely. Outbreaks of foodborne botulism involving two or more persons occur most years and usually caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black-tar heroin, especially in California"

WebMD says the following, "Any case of foodborne or unexplained botulism is considered to be a public health emergency because of the potential for toxin-containing foods to injure others who eat them and because of the potential misuse of botulinum toxin as a biological weapon. State and local public health officials by law must be informed immediately whenever botulism is suspected in a human patient."  This is another point underscoring the rarity, since I don't have a lot of memories of 'botulism' emergencies - certainly not like the E. coli. emergencies that seem to happen all the time.

On top of the rarity of the disease, my idea that it was instantly fatal was not quite true, either.  It is true that a survivor can face weeks, months or even years of rehabilitation from the paralysis.  But it is possible, and more likely than ever.  Again, the CDC says, "Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 3-5%."

The CDC article goes on to indicate the specific ways one can drop their risk of botulism to near zero.  Don't give infants honey - the bacteria can exist in honey, and infants are at risk in a way adults are not.  Don't use drugs.  Duh.  Be exceptionally careful with home-canned food, and "Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety."

And there it is.  The fear and the facts.  As usual, the facts are not of terribly good use in fighting the fear, but they are useful.  I am now able to use jars, like those above, on an occasional basis (although if they are 'home canned' instead of 'factory canned' I still can't touch them.)  The longer I live, the less I fear dying in general.  After all, I've managed to get the first forty years down, and I can now imagine that if I kept doing what I have been, I figure I should have a pretty good shot at another forty.  And if not, I have this idea that botulism isn't going to end up being the problem.

Your Hostess With Neuroses

Tuesday, November 3, 2009

Book Review: Radical Acceptance - Embracing Your Life With the Heart of a Buddha by Tara Brach

Hello Friends:

This book gets five out of five 'wings' from your Adventure Hostess.

One of the best books on 'healing' I've read in ages.  The 'self-help' book that tells you that you are not broken, and even gets you to believe it.  However, calling this a 'self-help' book is a disservice, as the text grapples with our views on life and death, grasping and denial, love and self-hatred, and much more.  It might have really rated a 4.8, since no book is perfect, but rounding up the score is pretty obvious in this case. 

Radical Acceptance - Embracing Your Life With the Heart of a Buddha by Tara Brach was published in 2003, and I wished I'd found it earlier than 2009.  But until this year I would not have picked up a book with the word 'Buddha' on the cover, thinking it would only apply to people with that mindset or that religious perspective.  But I was wrong.  It has a lot to say to anyone interested in what it means to start accepting yourself for who you are right now.  I also would not have picked up a book with 'Radical' in the title, since I would have assumed it was one of those misguided 'Optimal Health' type books that get my perfectionism hackles up.  But don't be put off, there are no 'ten steps to perfect' anything in this book.  This is real life.

Some of What's in the Book

The subject of the book is obviously the author's idea of finding 'radical acceptance' with ourselves based on the idea that we are, inside, already exactly who we are meant to be.  She works from a premise called 'The Trance of Unworthiness'; that people who feel the need to 'fix' themselves are actually responding to a storyline in which they are always unworthy.  They are always trying to measure up, to be better, to earn the right to be treated with respect and compassion, especially by themselves.  We all come by our belief in this story in different ways.  But in the end, the 'Trance' comes down to the unshakable conviction that 'something is wrong with me.'  Brach writes, "Underneath our fear of being flawed is a more primal fear that something is wrong with life, that something bad is going to happen."

Brach makes convincing arguments that this is not true.  And shows some ways to begin to think and feel differently. "The two parts of genuine acceptance are ... seeing clearly (mindfulness) and holding our experience with compassion."  Brach's text gives concrete suggestions for manifesting both of these parts, including meditations, pausing, reflections, listening to body messages, and more.

This is a long read.  The book is a dense, idea packed 330 pages that I've now read four times and I am still finding passages I didn't absorb on previous reads.  The list of chapters is wordy, but gives some good insight into the content and so I'm going to list them here.

The Trance of Unworthiness
Awakening from the Trance: The Path of Radical Acceptance
The Sacred Pause: Resting Under the Bodhi Tree
Unconditional Friendliness: The Spirit of Radical Acceptance
Coming Home to Our Body: The Ground of Radical Acceptance
Radical Acceptance and Desire: Awakening to the Source of Our Longing
Opening our Heart in the Face of Fear
Awakening Compassion for Ourselves: Becoming the Holder and the Held
Widening the Circles of Compassion:  The Bodhisattva's Path
Awakening Together:  Practicing Radical Acceptance in Relationship
Realizing Our True Nature

Every chapter contains stories and anecdotes from the author, friends and family, and patients in her psychotherapy practice.  Each chapter ends with a guided reflection or meditation.  And these are not afterthoughts, but important exercises that help bring about the change she discusses in the chapters.  And so that you don't end up thumbing through the book trying to find that mediation you liked, she has them listed at the front of the book right after the table of contents.

Yes, the book is built off of the key ideas in Buddhism and from the nature of insight meditation as a practice.  But if you are not of that (or any) religious bent, don't be scared off.  The book does not challenge or force a religious perspective.  Other doctors-as-authors simply excise what they want from a religion and pretend they don't know where they got it from.  Brach presents the context happily and keeps a deep sense of reverence and respect for all religious traditions but without any preaching.

The author states that radical acceptance is "... accepting our human existence and all of life as it is.  Imperfection is not our personal problem - it is a natural part of existing."  She is quick to point out that acceptance does not mean giving up.  "Radical acceptance is not resignation ... Our deepest nature is to awaken and flower."  The book guides us through our natural fears of loss and even death, as well as our habits of "clinging to experience, that must, by nature, pass away".  The reverse of this is being so terrified of any kind of pain that we run from it the instant we spot a trace.  And some of my earlier posts deal with the complete uselessness of suppressing and avoidance, and how mindfulness-based therapies (the guts of which we see in Brach's text) help counter that.

What I Liked

Almost everything.  A key idea in Buddhism, especially Zen, is 'don't take my word for it, don't take anyone's word for it, experience it for yourself.'  Radical Acceptance follows that theme - you don't have to take the author's word for anything.  You can read the text, practice the meditations, and see how the world appears to you.  Do what works, and ditch what doesn't.  The author suggests, "In making choices on our path, it is important to ask ourselves whether or not they will serve awakening and freedom."

The tone is accessible without talking down to the reader.  Scholarly without being cold and distant.  The author speaks from personal experience of 'being in the Trance' so she presents the material with compassion for the reader.  I feel that the author cares about people who are suffering from all the results of being sure they are wrong, mutated, and broken.

Brach uses very compelling language and incisive references to make her points, and many resonated with me.  "In contrast to orthodox notions of climbing up a ladder seeking perfection, Jung describes the spiritual path as an unfolding into wholeness."  Another comment helped me articulate some of my own experience with PTSD, "Dissociation, while protective, creates suffering.  When we leave our bodies, we leave home."  And one I adore, "Longing, felt fully, carries us to belonging."  This isn't a platitude, but a result of the author's own experience of allowing herself to feel terrible longing, rather than running from it and the associated emotional pain.

What I Didn't Like

Not much, but there were a few things.  It's a minor one, but the title drives me nuts.  As I said, anything in a book title like 'optimal power', 'unlocking the code', 'ultimate solution', 'uncovering the secret', 'revolutionary anything' and on and on, will always trip my bull$h!t radar.  'Radical' sounds too much like a word for an extreme sports broadcast.

There are redundancies.  Things said multiple times.  Over and over again.  Sometimes it helps, since the ideas can take time to sink in, but other times the book drags when this happens.

Some of the stories and anecdotes seem to ... miss a little.  They make interesting points, but do not seem to always underscore the point I thought the author was trying to make.  And some of the stories seem to lack depth, sort of present a concept in a somewhat superficial manner.  The book could have been tightened up by removing some of these stories, and thereby reducing the redundancy issues, as well.

Summary and Final Comments

I think this is a great book.  This is a 'mindfulness-based therapy' book that lacks all of the bad aspects of therapy and self-help books in general.  I would recommend it to anyone, even people who may not say they feel the 'Trance' themselves.  The text is informative, uplifting, and original.  The meditations are useful and give the reader some insight :) when practiced.  And for people interested in a different portal for viewing the continued evolution of Buddhist mindfulness in America, it's perfect.

Your Hostess With Neuroses

Friday, October 30, 2009

Healing Feels Weird

Hello Friends:

We all want to heal, of course, however we individually define that term.  But as you may know from personal experience, or the reports of a friend, healing can feel ... weird.

The post yesterday on one of the regular sites I visit for PTSD was Can We Plan for Healing PTSD?   The issue in question for that post was - healing can be strange, so how we can anticipate and plan for it so that we have a smoother transition?  This reminded me of a few things I've read recently about the out-of-kilter feelings that healing can bring.

From my perspective, this sort of parses into three different issues, which I think are all related.  The first is that healing itself feels different and therefore weird.  Nothing feels 'right' even though you may now feel 'right' for the first time.  The second issue is that fear of 'losing' the healing.  We might not know how it was we really started feeling better, anyway, so what's stopping it from going away?  Third issue is the identity crisis.  We often identify ourselves with our feelings and our experience.  So if I'm not the person feeling angsty all the time, then who am I?  

In Prozac Diary, the author Lauren Slater recounts her early experiences with the drug.  The sense of things feeling more right, and therefore 'wrong'.  She says to her doctor, "I don't feel like me.  I mean, I feel more like me in some ways and less like me in others.  I'm scared.  I'm really worried."  I resonate with that sentiment.  I now have transient times of calm and peace.  Which last until I realize I'm not worried about anything.  But that's too weird.  Feels wrong.  So even though I don't want to, I immediately spin my wheels looking for something else to worry about.  Shouldn't I worry about something?  I'm always worried about something.  Apparently I don't know how to ground myself without worry.

The 'fear of losing the healing' thing is one of my favorite anxieties.  Or at least it should be if statistics alone determined 'favorite'.  The author of the post above, from Heal My PTSD writes, "I didn’t believe this relief would last. I expected it to go away at any minute. I waited for it to abandon me."  Yep.  Whenever I am happy in any way, I have to stop and try to figure out WHY.  I need to know what caused it, and how I can keep it.  Which is folly, since nothing lasts forever, and a lot of the time there is no 'reason' we are happy.  Like any emotion which can come and go, sometimes you are happy or not and you have no idea what's going on.  Also, if you haven't been happy much, the feeling of happy is like a drug shot right in the vein.  Wow.  The need to grasp it and hang on to it is intense, and so with it the fear that it'll slip away.  Which is exactly what it does when you start obsessing about it ...

As for identity.  I've seen myself as a combination of the tortured artist who 'feels deeply' and the crazy-clever scientist who 'knows things'.  I learned how to use some of that mangled and crazy energy to produce writing and work.  Well, some of those feelings are gone now.  I just don't feel quite so drama-queen anymore.  Again to Prozac Diary, where the author asks, "Do you think (Prozac) can take away your creativity?"  I happen to think the answer to that is no - I've been plenty creative since I've been coming through this last depressive episode.  But the tenor has changed; the nature of the creative urge.  I'm not very tortured or crazy right now, and so who am I, exactly?  Tortured artist is cool.  Occasionally put-out or moderately miffed artist is not so very cool.

So this brings me to my point.  I think.  (Did I have a point?)

What I think it means (at least for me) is that there is, in fact, some grieving of past self to be done here.  Oddly, I think I'm actually sad for those parts of me I've managed to heal.  In order to make the continued journey on the healing path less scary for myself, I need to acknowledge that I need to grieve for what's gone.  For example, I need to accept that I can't be a tortured and bleeding artist at the same time I'm a balanced and mindful meditator filled with equanimity.  Doesn't mean I can't make good art anymore, but it does mean I have to find new avenues for channeling my creative energies other than a downpour of emotional screed in the form of ink on a page.  So I need to grieve that loss.  The requirement for that change.  The need for that adjustment.

But as I've said before, change is good.  I love change.  Something new and different.  I'm a little tired of constantly unearthing new things to grieve about, but I suppose the act of doing that at all is already a change for the better.

Your Hostess With Neuroses

Image is 'Hand to the Ether' from Orin Zabest on flikr via Creative Commons.

Monday, October 26, 2009

Writing Like Crazy

Hello Friends:

I've chosen not to carry full time work for more than a year, now. This is the first time I've gone through a major depressive episode and have also backed off on my 'day job' at the same time.

A couple of reasons for this. Reason 1 is that I experienced my first three episodes of major depression when I was a student in one form or another. I didn't get my Ph.D. until I was 30. I found the life of a student to be generally conducive to hiding mental illness. Reason 2 is that you can't just quit your job and still pay the bills. During my forth major depression, this was a serious, serious problem. I was almost unable to function at my regular day job. I desperately needed a break, and could not take one.

So, some comments on student-and-depressed situation. It is amazing what you, and the people around you, will overlook so that they don't have to deal with the truth of depression. For example, I went from valedictorian of my high school class to being on academic probation in college within the span of a year. This might indicate a problem to anyone paying attention, but since I managed to retake a few courses, pass them over the summer, and then get back to straight 'A's by my junior year, no one really got what was happening. It was chalked up to 'adjustment issues'. The major depressive episode I had in grad school was covered up by the fact that I was out of formal classes and doing research lab work most of the time, on the night shift. Not too many people saw me during a regular day, and as long as I collected data and wrote a few abstracts, again, no one really got how sick I was. (Including me, really. I was in therapy for my OCDs by that time, but did not understand how the PTSD was ruling me.)

I have had two major depressive episodes since I've been working 'real' jobs. The first of these was the worst of my life. I was between the proverbial rock and hard place (usually my head) - we needed the money, but the job was killing me. Almost literally, since this particular episode, which lasted about 2.5 years, had me suicidal for about six months of that time. It was that which pushed me to take meds. I really didn't have a choice since I felt I had no options left to me. I couldn't take a break from work to put my dwindling energies into getting better, and I couldn't kill myself (because my husband didn't want me to). I probably would have completely lost it, except that my husband was offered a great job elsewhere, and we moved.

Which brings up depressive episode number five, i.e. what I'm in now. After the move I had a couple of years where I felt pretty damn good. I didn't go back to working for someone else full time, instead I was able to put together a 'job' for myself with temporary contracts, teaching classes, writing, doing workshops, and more. And it was great. But the only reason I could do that is because the financial pressure was off. My husband could now carry us both.

So when episode number five began to take it's toll (and of course at that time we had no idea we were in this episode - you never do until you are well on the way) I figured I could simply cut back on the work until I could handle the load. Turns out I've been so messed up this time around, that unless I wanted a repeat of number four, I had to drop almost everything. I dropped my professional volunteer work, my teaching, my workshops and contracts, and kept only the writing. This was very, very hard for me to do. It felt like failure. It still does, really. So much of my self worth and self image is wrapped up in work, in getting a paycheck, and in doing what it was I spent all that time in school for. And my perfectionism makes it very hard to accept the fact that some days I'm just not going to produce excellent work.

So here I am, having just turned in the last bits of the book I've been poking at for quite some time, now. It's my first textbook, and without my husband as coauthor it never would have happened. The first year was so steeped in my depression that I got almost nothing accomplished, but as I've been coming out the other side through the last six months, it began to come together.

And when it gets published I'm going to be afraid to look at it. Because I know it won't be perfect. I'll find typos and things I could have said differently and probably issues with some of the diagrams. I'm trying very hard to focus on the fact that I actually DID IT. My first book, and through one of the worst depressions of my life. Instead I'm seeing what I didn't do, on the book, and more importantly, with any other work.

So I'm looking for some ideas from the readership here. How do you deal with your anxiety, depression, and other mental illness when you are trying produce something you get paid for? How do you deal with the imperfection, missed deadlines, dropped balls, missed calls, and unreturned emails that are a part of being too depressed or anxious to think straight?

Your Hostess With Neuroses

Image is via Creative Commons from flikr: 'highlighter pen - photocopied text - 9Mar2009.jpg

Thursday, September 3, 2009

Book Review: Feeling Good - The New Mood Therapy by David D. Burns

Hello Friends:

This book gets two out of five 'wings' from your Adventure Hostess.

I almost gave it three, but I can't, simply can't, get over my biases against this book. Everybody else loves it. It's sold a ba-gillion copies or some such thing. And is one of the books commonly suggested by therapists to their patients with depression.

Which I find very depressing.

I know I said I would review a more recent book, first. But then I figured I'd go back to the 'beginning' in order to have some kind of a basis for comparison. And I don't want people thinking I only give out four and five wings. Nope.

Feeling Good - The New Mood Therapy by David D. Burns is not a new book. My copy is dated 1980. The most recent version of the book was released in 1999, almost 20 years later, with a new introduction and a guide in the back to anti-depressant drugs. Otherwise it is the same book as mine. How this therefore remains the "new" mood therapy is something of a mystery. It was, in fact, suggested to me by my therapist in '93 as the core book for the general public about Cognitive Behavioral Therapy (CBT). And so I bought a copy, read it, and found it both useful and insulting.

Note that I am specifically reviewing the book, here, not all of CBT. This book is one portal into the understanding and use of CBT to treat depression. It is not the only book, nor does it completely over all the ways and means CBT is used in other diagnoses, such as anxiety, panic and OCD.

Some of What's in the Book

The book is a pretty hefty 450 pages of mass market paperback. It is split into several parts: Theory and Research, Practical Applications, 'Realistic' Depressions, Prevention and Personal Growth, Defeating Hopelessness and Suicide, Coping with the Stresses and Strains of Daily Living, and The Chemistry of Mood. There are a few 'quizzes' you can take while reading the book that help pinpoint if you are in fact depressed, how badly depressed, what areas of your life are the most difficult for you to manage, how easily you get angry, etc. And in true CBT style, there are many examples of different ways to count thoughts, list thoughts, organize thoughts, challenge thoughts, and find new thoughts, all as informal 'worksheets'. The emphasis is on writing it all down in order to become aware of what you are thinking, and then implementing strategies to stop negative thoughts and instead substitute positive ones. Ideally, this breaks the endless cycle of rumination, and allows for a 'cure' for depression. The book maintains a philosophy that if we really and truly see how irrational our negative thoughts are, we can eventually dismiss them and be free of depression.

What I Liked

Early in the book there is a standard multiple choice quiz used as a indicator for the severity of depression. When I first took it in '93 it helped me see immediately how really depressed I was. At the time I was in what I called an "interim" between truly bad depressive episodes. At that point in my life, if I wasn't actively thinking about ways to kill myself, then I figured I probably wasn't that depressed. The quiz was quite valuable as a tool for me to get a handle on just how much pain I was in, and that I was plenty depressed even if I wasn't wishing I was dead each and every moment.

(Interestingly, when I retook the quiz a few days ago, my score was almost exactly the same. Some things seemed better, and others worse. But I'm convinced my score was higher on some items in the past because I was quite ignorant of just how I was thinking. I was quite in denial of how much I hated myself, for example, and I'm not repressing those thoughts anymore. So generally I'd say I was a few points better, overall. Something, anyway.)

If you are looking for a strategy, anything at all, to try, then there are many examples in this book. The author often suggests that the reader suspend disbelief about the efficacy of the methods and simply try them themselves. And some of the suggestions that might seem trivial do have power. For example, the idea that you inevitably have to be less happy if you are alone can be challenged my making predictions and then trying things alone. Then you can see for yourself if you actually do enjoy things less, or if that expectation was not actually correct.

What I Didn't Like

Oh, oh where to begin. Before I start ranting, a few concrete points.

The number of different kinds of strategies and possible variations of approaches is confusing, especially for someone who can barely get out of bed in the morning.

The section on anger management has what I consider to be a key gap. Very little time is spent on how help depressed people who cannot express any anger at all. The section instead deals with people who are constantly irritable, and easily lose their cool. For many of us with depression, we never lose our cool, and have no temper whatsoever. Any time something happens to us that a normal person would get angry about, we immediately translate that to self-hatred. I was not allowed to get angry as a child, or display any sense of irritation or to challenge boundaries. I therefore did not develop good boundaries. If I feel angry, it is because I did something wrong. That's the logic of it. It has taken a lot of work to reach find this anger and feel it when situations arise where one might actually get angry and have it be a positive means of affirming; a means for a functional insistence on healthy boundaries. This aspect of dealing with anger and depression is not addressed in the book.

The author does not show consistent respect for his own patients. He says things which either in real life or in imagined role playing that make a reader wonder what it is he thinks about these people when not in the office. "Not all my patients are as difficult as you!" and "Her contrariness made my work with her challenging and more than a bit frustrating at times."

So now I'm gonna start ranting. When I re-read the book last week so I could do this review, I went through and underlined passages that stuck out, and then bent the corners of the pages so I could find them again. I needn't have bothered since every other page has a bent ear. Example:

"... you can overcome it (depression) by learning some simple methods for mood elevation." The methods may be straightforward, but they are not simple, and even just putting it this way trivializes the problem. The author often makes statements like this, and then backpedals, saying he does not mean it in some kind of bad way. But that retraction is ineffective since the words are already out there and having their effect on the reader. I did all these exercises religiously for years, and while they offered some occasional relief, they did not deal with the underlying problems causing the depression. The methods outlined in this book provide a strategy for symptom control (bad moods) but do not target the core problems created by a childhood of illness, neglect, and abuse.

Over and over, the author describes depressed people as "pouting", "moping", and "whining" (as on page 70 where we are told "Cope - Don't Mope!") I don't think I need to explain why that bothers me. This follows along with the rest of the general tone of the book which comes over as flip and uncaring, not casual and friendly.

More insults for those of us who have nearly busted our rumps working to find a way out:

- "... the most crucial predictor of recovery is a persistent willingness to exert some effort to help yourself. Given this attitude, you will succeed." Exert some effort? That's not a little condescending, is it? This goes along with "If you are willing to commit some regular time and effort to this program, you can expect success proportionate to the effort you put in." Snort. I should be the sanest person on the planet.

- "It doesn't occur to you to challenge the validity of the perceptions that create your feelings." It has. I did. Still depressed. Again, I'm not upset that CBT has limitations, I'm tweaked at the way all of this is presented in this book.

- "When the two don't match (reality and the idea of what it should be), you condemn reality. It doesn't occur to you that it might be infinitely easier simply to change your expectations than to bend and twist reality." This one really gets me. Apparently changing one's expectations, created by twenty five years of abuse, is not terribly difficult. And even so, trying to do so has not occurred to us. So my inability to change my expectations is therefore my fault. Because I haven't put in enough EFFORT.

Dealing with the ideas of what we are responsible for (i.e. we are not responsible for other people's feelings, which is true enough).

- "... it dawned on her that she was acting irresponsibly not because she 'let him down' but because she was allowing herself to become depressed." Allowing. This to me implies we have a lot of control over if we 'choose' to get depressed or not. I do not agree with this. We can certainly choose to fight it, we can't choose to win.

- (emphases are mine) "No wonder you developed the the bad habit of looking down on yourself every time someone disapproved of you. It wasn't your fault you picked up this tendency as a child, and you can't be blamed for growing up with this blind spot. But it is your responsibility as an adult to think this issue through realistically, and take specific steps to outgrow this particular vulnerability." Oh my. So looking down on myself is a bad habit I need to outgrow? Well, I managed to stop biting my nails, so this should be a piece of cake.

- "Keep this in mind. Overcoming your fear of criticism will require a moderate amount of practice." I ... I can't even go there.

On the hit parade of perfectionism, the author offers: "Have the courage to walk away from an unfinished task!" (emphasis his) Yeah, that's what I don't have. Enough courage. Even I'm not depressed enough to believe that. I'm still alive at 41. I'd like him to try that with my starting material. Can you see why I don't like the book? I could go on and on.

Summary and Final Comments

The core principles of CBT are all in this book: the emphasis on lists, plotting, worksheets, tracking, etc.; the 'talk-back' to yourself techniques; the substitution of functional internal messages for dysfunctional ones, and more. If you wanted get a general look at how CBT is used to help those with depression, then it isn't a bad read. If you had never heard of CBT before, and wanted to get the gist of it, it isn't a bad read. Other people think that it is also a good read if you are currently depressed and need help. I am not so certain about that.

I found the book to be insulting and belittling, and lacking in any overt sense of compassion. When I was finished doing all the worksheets and the rest, I was more down than ever, now convinced that it was all my own fault that I was depressed since I couldn't "think" my way out of it as easily as the examples in this book. There are a now lot of books on the market about CBT. And CBT has helped a lot of people, including me. But you don't need this book for that. This is technically the "classic" but as such has been superseded. I can't recommend it without serious reservations.

Your Hostess With Neuroses

Saturday, August 29, 2009

Suppressing Does not Work - Part Two of Two - Searching for Something that Does Work

Hello Friends:

There's a post on Psyblog called "Why Thought Suppression is Counter Productive" that follows along similar lines to those I'm addressing in Parts I and II here. So either I'm a really trendy blogger, have come late to the party, or (the worst) I'm a conformist. Egads.

Anyway, they cite some of the same studies (including the famous one with the white polar bear that I changed to chocolate; Wegner et al. 1987). And come to the same obvious conclusions - suppression does not work. Suppressing thoughts is (a) impossible, and (b) makes you think more about what you are suppressing, and (c) makes you feel like a failure for not doing the impossible.

The amount of research suggesting that thought and emotion suppression = bad is pretty overwhelming, and this is just from doing simple searches for the stuff on Google. Like this article in the October 2008 Journal of Aggression, Maltreatment, and Trauma (there is a journal for everything out there) entitled A Preliminary Examination of Thought Suppression, Emotional Regulation, and Coping in a Trama-Exposed Sample. They find that "Thought suppression, emotion suppression, and avoidant coping strategies were positively related to psychopathology." And this one from the Association for Behavioral and Cognitive Therapies published in 2005 entitled Rebound Effects Following Deliberate Thought Suppression: Does PTSD Make a Difference? In this study they found that all groups, regardless of PTSD diagnosis or not, "showed a rebound in trauma-related thoughts following deliberate thought suppression. This rebound was associated with increases in negative affect, anxiety, and distress ...."

On top of the difficulty with trying to avoid thinking about something (again, not at all surprisingly) it is even more difficult to stop thinking about something if it is emotionally charged in some way. Like say those people from the second study above who were trying to suppress thoughts about their car accidents, and subsequently suffered yet more anxiety and distress. This in the end makes it even harder to suppress the thoughts, since they can be associated with additional anxiety from just trying to suppress them. And then iterate until you are seriously messed up. This has direct application for us anxious/depressed folks from the get go, since we have very strong emotional associations with things other people might not. For us, there are huge challenges in trying not to ruminate over thoughts and memories tied to emotions of shame, failure, humiliation, sadness, anger, despair, and fear. Say that three times fast. (Side note - Kinda like Carlin's old skit of the Seven Words You Can't Say on TV. Dated and dirty, but then again most things are.)

So what to do? Well, the result of all this research, and plenty of other stuff as well, is the new focus on the 'third generation' therapies which include the concepts of acceptance and mindfulness. ACT, for example (described nicely in this article from the 2008 edition of Social Work) is a therapy based on accepting what is happening instead of running from it. MBCT (described poorly on the MBCT site, since I'm assuming they'd prefer you bought their book) targets using acceptance and mindfulness to try stop the downward mood spirals that they believe lead to recurrent depression.

These 'accepting' based therapies are not saying "I'm disordered, I accept it, and am stuck with it". Accepting here is more like non-judgmentally admitting and acknowledging. It is the starting point that supposedly lets you stop brooding. There is no longer any 'point' to feeling bad about being depressed, or feeling embarrassed because you have OCDs. In the therapies you hypothetically learn to accept yourself the way you are now, and realistically determine: what really can't change, what can change in the future, and what can actually be changed right now.

This is essentially why I've been checking out Mindfulness, Zen Mediation, and stuff as a new way to try to help myself. I think there is some great stuff in these therapies. And I also think there are some serious problems, but I'll talk about those in detail when I do my book reviews on the subject, especially the MBCT book. Which I actually did buy.

And now, should I go meditate, or watch some Carlin on UTube?

Image is Trinity from Katie Tegtmeyer on Flikr via Creative Commons

Friday, August 28, 2009

Suppressing Does Not Work - Part One of Two - Behavioral Rebound

Hello Friends:

For the next five minutes, you can choose to do one of two things - you can talk about chocolate, OR you can specifically talk about anything BUT chocolate. Five minutes. Go.

If you are like the people in this 2007 study, by doing either of these things, you will have changed your eating behavior towards chocolate compared to a control group that got to talk about whatever they wanted. If you talked about chocolate (and were male), you wound up eating more of it than the control group. If you suppressed talking about chocolate (and were either male or female) you wound up eating more of it than the control group.

No way to win, here.

The point from my perspective, anyway, is that while you might guess ahead of time that talking a whole bunch about chocolate would make you want some, you'll want chocolate if you specifically don't talk about it, as well. This is a form of behavioral rebound. The idea isn't new - it's classic folk wisdom that when you're told not to do or want something, you want it that much more. But the folk wisdom plays out as true in the research, as well.

The implication for behavior, perhaps especially to sticking to an eating plan, is pretty clear. Any kind of focus on something you don't want to do, either by indulging in it or trying to run from it, could actually make it more likely that you'll do it in the end. I found this out the hard way one year when I gave up chocolate for Lent. Very dumb, since right at the end of Lent someone hands you a big basket of candy that almost always contains a solid 1 lb milk chocolate bunny. The bunny was gone from this Earth in about fifteen minutes. And then I was sick for the next two days. Unlike getting sick from drinking, which can put you off the alcohol in question forever, I didn't give up chocolate afterwards. I gave up Lent.

So getting to the point. Suppression/deprivation probably changes our behavior because it changes our thoughts first. The experiment above directly related to behavior, that is, talking and then eating. But, you don't have to measure how much chocolate was consumed to see the difference, you can go ahead and look directly at your thoughts. Example ... with apologies to
Wegner et al. 1987.

Exercise 1 - For the next three minutes, do not think of chocolate. You can think about anything else but chocolate. Three minutes. Go.

Did you think about chocolate? Much? More than usual?

Exercise 2 - Okay, now you can take the next three minutes and think about whatever you want, chocolate included. Go.

Right. Did chocolate come up again. Much? More than usual?

If you are like most of the population, the first exercise borders on ridiculous. Like the behavioral rebound, there is a sort of thought rebound. It’s impossible to not think of something you’ve been told not to think about. It seems the very act of trying to suppress or avoid the thought makes it more likely to come up. And, as it turns out, it makes it more likely to turn up later (as in the second exercise) than it would have if you hadn’t been forced to ‘avoid’ it earlier. Either way, it seems that trying to avoid thinking about something is a rather good technique for making yourself think about it a lot.

If you are like me, you’ve encountered this fact plenty when trying to ‘fix’ yourself regarding your disorders. For example, my 'bad' thought is "I’m a failure". Saying to myself “stop thinking that” is useless. I have wanted to stop thinking it all my life, and I’ve tried very hard to stop. I still think it all the time. My usual response, when the idea comes up, is either to wallow in the truth of it or try to smush it ruthlessly.

While I could imagine wallowing in it to be counterproductive (even if unstoppable) I also imagined that smushing ruthlessly (on those occasions I manage to do that) to be productive. According to the research, this isn't so. Trying to stomp on and toss out 'bad' thoughts seems to give them just as much life and energy as ruminating or brooding over them.

I would find this discouraging if I hadn't read it in the context of a way to do something other than run towards or run away from thoughts. And I'll post about that in Part II.

But for now I gotta go. I really need some chocolate.

Your Hostess With Neuroses

Image from kspodder on Flikr via Creative Commons

Wednesday, August 19, 2009

Mindfulness and Being Emo

Hello Friends:

Had an exceptionally depressed day today, but in the spirit of my "I'm going to post even if I'm so depressed I'm not funny anymore" resolution, here is my post. And an emo picture to create the right atmosphere.

Today is one of those days when I am convinced I am using up other people's precious oxygen. When I wished I'd never met anyone so I wouldn't have to go through the hell of letting them down. Not meeting their expectations, you know? When you have a day where you can't even get in the shower, you are not going to be meeting anybody's expectations. Certainly 'my' body was expecting a shower. It's SOL.

Fine, enough of that. I didn't want to write about that. What I'd planned for today was to write some more about 'Mindfulness' (see my last post, Zen and the Art of Sanity Maintenance, if you don't know what I'm talking about.) So in spite of feeling like doo doo, I'm gonna write it. So there.

For example, one of the professional journals I'm reading with some consistency (because it is conveniently available from my psychologist) is Depression and Anxiety. In the in the June 2009 issue there is a paper entitled "Effectiveness of Mindfulness-Based Cognitive Therapy as an Adjuvant to Pharmacotherapy in Patients with Panic Disorder or Generalized Anxiety Disorder" by Kim et al. Yes, I read this for 'fun'. Can't help it. This is what grad school did to me.

As I mentioned, I originally got pointed towards mindfulness when I heard about it as part of a treatment for BPD. That treatment is DBT (Dialectical Behavioral Therapy.) But there are a slew treatments now being implemented for issues across the board including mindfulness-based stress reduction (MBSR), acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT). MBCT is the one that has most recently caught my eye because (as noted here in this 2009 paper), it was originally used to "target cognitive vulnerabilities associated with the repeated relapse and recurrence of major depressive disorder". Something that is being used in both depression and anxiety therapy seems like a direct hit for me.

In the research described in this paper, they actually excluded those with comorbid depression since they just wanted to see how the MBCT did with 'pure anxiety'. They put some of their people through an MBCT program, and some through a basic ADE program (basic education in what anxiety and panic are, how they function biologically, etc.) They made a point of making sure the ADE group did not do any mindfulness related work. Both programs lasted for eight weeks. At the end of that time they used a standard criterion for 'anxiety remission' to see if there was a difference between the groups. Of course, a study is only as good as their criterion for judging differences, but researchers are stuck with using whatever is documented and reasonably reproducible. I won't quibble with their definition of 'remission'.

Anyway, they had 16 people in the MBCT group meet the criterion for remission after eight weeks, and none in the ADE group. Hardly a surprise for the poor ADE people, since I hardly stopped having panic attacks myself just because I learned what they were. But having sixteen people go into 'remission' from a group of say 30 to 40, and after only eight weeks of MBCT, sounds very interesting.

They also happened to check the MBCT group's before and after scores on certain depression indicators. Which sort of makes no sense since they were trying to eliminate that variable. Anyway, their MBCT group showed significantly more improvement on those scales than the ADE group, as well.

So the upshot of the paper, which is consistent with almost all the other research I have read, is that "MBCT reduces anxious and depressive symptoms in patients with PD or GAD by moderating worry and rumination." They also state, which may be a little bit of a reach, that "these results are consistent with previous studies which concluded that meditation can reduce phobic and obsessive-compulsive symptoms."

It sounds a bit too good to be true. Reminds me of all that past broo-ha-ha surrounding anti-depressant medications like Prozac. The magic bullet. Har.

Still, I'm now several weeks into my own Zen meditation class, and it certainly isn't doing me any harm. I haven't been doing anything as structured as a full up MBCT program, so I can hardly expect to note 'results' of my own by now. But I have gone ahead and bought the book "The Mindful Way Through Depression" by Williams et al. so I can take a closer look at MBCT.

I'll report back on that when I've run more experiments on myself. I wonder if anyone will publish that paper?

Your Hostess with Neuroses

Image is "With Messy Hair" by nyki_m on Flikr via Creative Commons

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