Mental Health Monday - Surviving Seasonal Stress

For kids, the weeks leading up to Christmas may seem like an eternity, but for adults there’s rarely enough time to get the decorations up, the cookies baked, the cards mailed, the shopping done—let alone get all gifts wrapped and under the tree. Keep in mind, these activities are meant to be fun and draw families closer together, but the stress that many people experience leading up to the holiday can make a Scrooge out of almost anyone.

There are several factors that can contribute to holiday stress. First, the time crunch: when we try to cram too many activities in the span of the few short weeks between Thanksgiving and New Year’s, it’s no wonder time passes so quickly. Remember the saying “less is more,” and cut some things out of the schedule so you’ll have more time to truly enjoy those holiday traditions and activities that are the most important to you and your family. Plus, you’ll still have time to handle your other responsibilities that don’t stop just because it’s December.

The financial burdens of buying all those presents is another major source of stress around the holidays…and, in some cases, a source of ongoing stress well into the New Year as we work to pay down holiday debt long after the presents have been opened. If this applies to you the solution may not be fun, but it sure is simple: cut your spending. Make a budget for gift buying and stick to it. You don’t have to spend a lot of money on someone’s gifts to show them how much you love them.

The holidays are often depicted in movies, television, and song as “the most wonderful time of the year.” This can certainly be true, but in some situations the holidays are the most painful time of the year…particularly for people dealing with the loss of someone important. For as much joy as the holidays can bring, they can also serve as powerful reminders of what—or who—is missing from our lives. Sometimes the bluer we feel at Christmastime, the guiltier we might feel for not sharing in the seasonal cheer we’re “supposed” to experience during this time of year. But you can’t force happiness any day, including Christmas Day and the days leading up to it. Allow yourself to process the true emotions you’re experiencing and recognize your grief rather than try to suppress it, but don’t do this alone. Confide in a person you trust to help—a friend, a family member, or a therapist.

The holidays can be hard, but Christmas is about celebrating the joy in our world. Here’s hoping that keeping your perspective on the real reason we have Christmas will alleviate your seasonal stress

Mental Health Monday - Don't Just Stand There!

When people have knowledge of something going wrong yet no one takes action to stop it, important questions are raised after the fact. “How could this happen?” “Why didn’t anyone stop it?” “Couldn’t more have been done?” Social psychologists often try to answer these questions by explaining things like “bystander apathy” and “diffusion of responsibility.”

Much of the research involving these theories stems from the tragic case of Kitty Genovese, a 28-year-old woman who was sexually assaulted and ultimately murdered in a densely populated area of Queens, New York. Reports indicated some 38 people heard or witnessed the attack on Genovese, but no one so much as picked up the phone to call the police until 45 minutes into the attack. By that time, Genovese was dead and her attacker and fled. Clearly, psychologists need to study the behaviors related to this tragedy and others like it in order to learn what kept anyone from intervening on the victims’ behalf. In the case of Genovese, it’s understandable no one wanted to become directly involved for fear of themselves being injured, but what harm could come from phoning the police?

After Genovese’s murder in the mid-60’s, researchers Latane and Darley created “emergency” conditions in laboratory settings to see how participants responded to the presence of smoke when they were by themselves, with other participants, or in the presence of a research assistant. The assistant essentially ignored the smoke that began to fill the room where participants were waiting. The participants were most likely to report the smoke when they were alone, significantly less likely to report the smoke when they were with other participants, and even less likely to report the smoke when the assistant was present, as participants apparently followed the cue of the assistant to ignore the smoke. 

From this and other research into the bystander effect, Latane and Darley identified steps that must be taken to enhance an individual’s likeliness of taking action rather than inaction in an emergency situation: the person must notice the events are happening, interpret the situation as an emergency or threat, and take some degree of personal responsibility to intervene. 

The lack of a sense of personal responsibility for someone else’s welfare is a fascinating and frightening phenomenon. A former boss of mine was fond of saying, “Don’t wait for the other guy, BE the other guy.” I remind myself of these words often, because they’re helpful in so many situations. In fact, the phrase is an anti-apathy slogan. Take responsibility and do the right thing because when it comes to bystander apathy, no one wins. Not even the winningest coach in all of college football.

Dinner of Dysfunction

“Every year my family and I spend Thanksgiving at my sister’s place, and every year for the last several she and I have ended up fighting. Last year we didn’t even make it through dinner! What can we do to make this Thanksgiving different?”

Like turkey and dressing, for many families the holidays are stuffed with dysfunction. Rather than enjoying a delicious meal together, the day for giving thanks can become a day spent arguing, avoiding, or sitting in awkward silence. The only thing many people end up feeling thankful for is the ride home…but it doesn’t have to be this way. You have options. You can call it good, call a truce, or call it off.

Call it good. This option involves making up your mind and adjusting your attitude. You know you don’t get along with your sister; you haven’t for the last however many years and are highly unlikely to suddenly become best friends. Accept this and move on. You can’t control her any more than she can control you, so stop trying. When you accept her for who she is you are not condoning her personal choices or lifestyle or treatment toward you, but you are releasing your drive to mold her into someone you would like better. Try it and see—you may be surprised to learn how much power there is in letting something go.

Call a truce. Whereas calling it good involves making a personal commitment, calling a truce entails having a conversation with your sister. Note that the point of this conversation isn’t to “hammer things out,” but instead to acknowledge to your sister that although you have your differences it is time to put these issues aside (and leave them aside), for the sake of the family and for your own enjoyment of the holiday. By the way, there’s nothing to lose with this option….if it doesn’t work out due to your sister’s resistance, you can just fall back on option 1 and call it good. Or, if you know you’re not going to be able to pull off calling it good or calling a truce at this point, consider option 3:

Call it off. The holidays are built on tradition, which can slice both ways. There is, of course, much allure in tradition and it is ideal to spend time with your family. But just because you’ve spent the last several Thanksgivings at your sister’s doesn’t necessarily mean you have to do so again this year. Take the year off and spend the time with your own family, and maybe you’ll feel up to going back to her house next Thanksgiving.

Note that this option doesn’t really solve anything, but neither do the first two. The best, healthiest outcome for everyone would involve a rational, assertive discussion of your differences with mutual resolve to work things out—something that is highly doable when both parties are committed to bettering the relationship. If you do not feel ready to do so, I would encourage you to spend some time thinking about what’s holding you back. Maybe it’s time to work toward forgiveness—which is no doubt the best gift you could give yourself this holiday season. More on that later.

Mental Health Monday - New Guidelines for ADHD

The use of medications such as Ritalin or Adderall in children with Attention-Deficit/Hyperactivity Disorder (ADHD) continues to rise, and the American Academy of Pediatrics (AAP) is expanding the age range for the diagnosis of the disorder to kids as young as 4. However, the AAP is also urging parents to implement behavioral changes to address ADHD symptoms, especially with very young children.

The National Institute of Mental Health offers the following suggestions:

·         Keep your child's everyday items -- such as clothing, toys and backpack -- neatly organized.

·         Create and maintain a consistent schedule each day for homework, meals, bedtime and other activities.

·         Use organizers to keep homework in order. Encourage your child to write down all assignments, and to bring home all of the necessary books.

·         Offer rewards and praise when your child behaves well.

·         Communicate all rules consistently and clearly.

The Centers for Disease Control and Prevention estimates more than 5 million children in the U.S. have been diagnosed with ADHD. Symptoms include inattentiveness, impulsivity and hyperactivity; students may be unable to pay attention in class, or may spend a lot of time fidgeting in their seats. Although most kids display this type of behavior at one time or another, symptoms become especially problematic when they occur most of the time, according to the National Institute of Mental Health.

Although the suggestions above will not cure ADHD, many experts agree a combined approach of medication and behavioral interventions is the best plan of attack for treatment.

To learn more about ADHD, visit the National Institute of Mental Health.

Mental Health Monday - Adverse Childhood Experiences

An important study of more than 17,000 individuals in southern California is changing the way psychologists and medical doctors alike approach the treatment of traumatized individuals. Drs. Vincent Felitti and Robert Anda investigated the relationships between adverse childhood experiences (ACEs) and the development of psychological and health problems in later life. The overall conclusion of the study was not really very surprising: childhood experiences are powerful determinants of adult behavior. What was rather surprising, though, was the extent or magnitude of the impact of ACEs on the physical and emotional health of adults.

The researchers identified major categories of ACEs: recurrent emotion abuse, physical abuse, sexual abuse and neglect were the primary categories, but the researchers also considered the following behaviors of adult family members as ACEs: substance abuse, contentious or bitter parental separation/divorce, chronic depression, suicidal ideation, domestic violence, incarceration, and the death of a parent.

Of the 17,000 participants, 25% were exposed to two of the ACEs categories; 1 in 16 was exposed to four categories, 22% were sexually abused as children, and 66% of the women experienced abuse or violence in childhood. Across the board, the higher the ACEs scores the greater the likelihood of problems in adulthood, including:

• Depression (460% more likely among adults with an ACE score of 4 or higher)
• Suicide attempts (3000% more likely among adults with an ACE score of 7 or more; 5100% more likely among children and adolescents with an ACE score of 7 or more)
• Domestic violence (women with an ACE score of 4 or more are 500% more likely to become victims of domestic violence. Should the victims’ children become aware of this violence, the children’s ACE score will rise. And the cycle continues…)

You may be familiar with the phrase “Correlation, not causation,” which is to say these statistics describe relationships but do not prove that exposure to adverse experiences in childhood cause depression or suicide attempts later in life. However, Dr. Anda—one of the primary investigators—describes relationships of this magnitude as significant and rare in epidemiology.

A growing trend is underway among mental health professionals to become more proactive about recognizing and treating the effects of traumatic experiences. Trauma-informed practitioners are now beginning to ask “What happened to this person?” instead of “What’s wrong with this person?” Adults who were traumatized in any number of ways can begin working through their adverse childhood experiences today with the help of a trained professional. Children and teenagers who are currently experiencing ACEs need not suffer from the effects of these traumas the rest of their lives…but the professionals need your help. Break the silence and tell the person who’s treating you everything you can about the pain you experienced early in life. It’s not easy to do, it’s definitely not fun to do, but it can completely change your life for the better.

Mental Health Monday - Projectile Thinking (Part IV)

Over the course of the last few weeks, “Sound Advice” has focused on the Freudian theory of defense mechanisms, defined here as an individual’s attempt to psychologically protect him or herself from emotional hurt. These mechanisms come in a variety of shapes and sizes, and they can be adaptive or maladaptive, mature or neurotic. Today we conclude this look at defense mechanisms by considering a personal favorite: projection.

Everyone uses projection every day. It can be positive or negative as we transfer our own “stuff” onto others. Perhaps most commonly, insecurities we have about ourselves are affixed to other people via the perceptions we have about them.  Say, for example, you are not happy with your physical appearance for whatever reason and you “take it out” on other people by being overly critical of their appearance in your thoughts. Or imagine you have a small problem with lying. Rather than taking ownership of your dishonesty you pass it off on others, as in, “Whatever. Like he ever tells the truth!”

As mentioned, projection also has a good side. Kind, well-adjusted people tend to readily see traits of kindness and positive adjustment in other people consistently. However, the dark side of projection is problematic on a couple of levels: first and foremost, bad projection is based on a skewed perception of reality (which is rarely psychologically healthy)—if you’re seeing the nastiness you feel about yourself in other people wherever you look, it’s really time to do something about that nastiness. Get a self-help book. Write in your journal about it. See a therapist.

The other problem with bad projection is that it easily interferes with our interpersonal relationships. Essentially it comes down to admitting, “It’s not you, it’s me,” but this can be very hard to do—especially when defenses are strong. To stop projecting and to start accepting requires one to step back and become more self-aware. If you find yourself having negative thoughts about others—whether it’s your spouse, your spouse’s ex, or perfect strangers—ask if the thoughts are fair, what purpose they might serve, and consider if thinking negatively about others might be less about them and  all about you.

Mental Health Monday - Overcoming Adversity (Part III)

Life, as it turns out, isn’t always easy. Whether the hardships we encounter are due to our own choices, random chance, or predestination, sometimes life just plain sucks. Philosophically, the problems we encounter make sense--if we consider the world as a classroom, there are going to be tests. Grade schoolers don’t get to spend all day in recess and students who party too much in college tend to fail; life can be fun but ultimately we are here to learn and learning can be extremely challenging at times.

We may not choose our difficulties, but we do get to decide how we respond. Yesterday, you probably heard, was the 10^th anniversary of the terrorist attacks of 9/11. I’m still amazed by the heroes of that day, the people who chose to run into burning buildings that were about to crumble, the people who chose to fight back and crash United 93 into a field in Pennsylvania before it could reach its target in Washington, the people who spent months shifting through the rubble which was no doubt a smoldering pile of carcinogens. Where do people find the strength and courage to do these things?

This month Sound Advice is focusing on defense mechanisms, the ways in which individuals attempt to protect themselves from emotional hurt. As noted in previous posts, most of the Freudian mechanisms are believed to be neurotic and unhealthy, but some are quite positive. The primary healthy or mature Freudian defense mechanism is sublimation, the redirection of negative experiences into something good, creative, or productive. Sublimation is making lemonade when given lemons. Examples include journaling about painful events, writing poetry or making art, or giving of oneself for the good of others.

Consider Camp Haze, a one week all-expense paid summer camp specifically created for children who lost a loved one at the World Trade Center. Janice and Chuck Hazelcorn founded the camp after their son Scott died on 9/11. Scott loved children and dreamed of leaving his job at Cantor Fitzgerald to work with kids. When Scott died, his parents were able to channel their despair and no doubt anger into a positive force that lead to the creation of Camp Haze. Now they provide an annual summer refuge for the children of September 11^th, a service they perform in the memory and honor of their son.

The Hazelcorns found meaning in their suffering in the same way we can all find meaning in life: through serving others. Perhaps such service is the ultimate example of sublimation. Every day there are opportunities to put the needs of others before our own, and we don’t have to wait for tragedy to strike to transform our troubles into triumphs.

Mental Health Tuesday - The Defenses of Displacement & Denial (Part II)

Denial, it’s been said, is more than just a river in Egypt. It is another classic defense mechanism used unwittingly to shield oneself from psychological pain and emotional hurt. It is the first stage of Elisabeth Kubler-Ross’ well-known stages of grief, the initial protective barrier to the life-altering news that life itself is about to end. It is the elderly person in poor health who refuses to go to the nursing home, the student who is sure there must have been a mix up on the SAT results, the divorced man who refuses to date because he’s sure his ex will eventually change her mind.

If you think about it, denial sounds a lot like hope. It is the elderly person who hopes her health will improve so she can continue living at home; it is the student who hopes there is an SAT score that better represents his academic abilities; it is the divorced man who hopes his ex will change her mind. So where does hope end and denial begin? Probably when the line that separates fact from fiction and reality from fantasy begins to blur. Hoping that the diagnosis is wrong is one thing, but continuing to live as if nothing is wrong is more indicative of actual denial (including, perhaps, not pursuing critical care due to the belief “that doctor didn’t know what he was talking about!”).

Displacement is another commonly used defense mechanism which refers to the projection of an emotion (usually anger) meant for one person onto someone else. That “someone else” in many cases is someone safe, such as a loved one, who has nothing to do with the source of the emotion. For example, a middle-aged shoe salesman who is berated by his customers may come home to take his frustrations out by yelling at his wife and kids (“Married with Children” anyone?!). In a much more extreme example, the victims of high school bullies at Columbine may have taken guns to school to seek revenge on everyone, not just the bullies. There are, of course, many more factors involved in school shootings besides displaced anger, but this is an important concept to keep in mind.

People who present with either denial or displacement may ultimately be looking for understanding. Someone in denial about his or her circumstances needs help understanding the impact of the predicament, and someone who is displacing his or her emotions needs understanding about why they’re feeling the way they’re feeling. This can be hard to do, because if someone treats us unfairly our instincts kick in and many people become defensive (i.e. “Hey, don’t take it out on me! It’s not my fault you..."). The more therapeutic response is to tell the person it looks like they’ve had a bad day, and ask if they want to talk about it. Whether someone you know is in denial or displacing their feelings, keep in mind these are defense mechanisms meant to protect the ever-fragile ego. Do your best to show such a person compassion and support, and see what happens next.