Archives for posts with tag: Mental Health

I am grateful for my blessings, really, I am. And I have a multitude of blessings. I work hard to be a happy and balanced person. Most of the time my daily life makes sense to me. Most of the time my responsibilities feel bearable. Sometimes, like today, I feel worn out. I feel like I am living a life that requires 150% of me. People, each of us only has one whole self, which is 100%. 110% only exists on those stupid business motivational posters.

One of the things that I tried to change about my life after my cancer diagnosis is expecting myself to work near 100% capacity every day. I need to rest like every one else. I need balance and rejuvenating experiences.

I have been working myself hard since November. Really really hard. My family life has been hard and my work life has been hard. My health, thank goodness, has been good.

When I was younger, working more than is healthy, held certain seductive powers. I felt accomplished, strong, and self-sacrificing, the last of which giving a moral edge or some kind of “get out of jail free card”.

It’s so easy to work too hard. It’s hard to rest, to have ease. I hate that. I hate that having ease takes so much damn work. Easy shouldn’t be hard but it is.

Last year, I had two periods, each a few days long, when I felt transported into a fun, easy world outside of my work and family responsibilities. Both times, I spent time with friends and mostly without my family. It was fantastic. It was easy. Then I got back to my normal life, which although rich with blessings and meaning, landed on me like a ton of bricks.

The work on moving my psychology office occurred over two major holidays, some tough parenting issues, and financial stress. It took a lot of time and money in amounts far exceeding what I wanted.  Although I am very happy with the outcome, I am worn out. I need a break. Yesterday, I was working on some summer plans. They became complicated quickly. At this time and place in my life, it hit me hard and I was sad. I was disappointed. I was sad and disappointed not with myself or anyone else, but with the lack of ease in my life. I was teary when my husband came home. I explained in a few sentences. He totally understood; after all, we share a life together.

It’s not easy to be easy. I guess I will keeping working hard on that.

As a clinical psychologist, an important part of my job is what is called “forming a therapeutic alliance”. This is a bond of rapport, trust, and understanding. It is a necessary component whether I am doing a short term assessment or long-term psychotherapy. I work with difficulties that require a team to effectively address.

As a child and adolescent psychologist, the size of the team is bigger than it is for adult clinicians. Although my primary alliance is to the child or teen, I must also form working alliances with parents, teachers, other mental health providers, and physicians. It is also not uncommon for me to have to interact with school principals, individuals with a school district or with the state superintendent’s office, occupational therapists, speech/language pathologists, or grandparents. I am fortunate in that my contact with child protection, case workers, and police enforcement is rare, but it does happen.

I work with the “it takes a village” kids. And I often take on the role of training the adults who are with the child daily about how to best support the child’s unique needs. The members of the village with whom I have the most contact are parents.

Parents are in a very influential position withe the kids I assess and treat. They often feel helpless. They often feel guilty about their children’s challenges. They often take out these painful states on the people they love the most, their children.

And to my patients, the teens especially, I often look like another adult who is going to tell them how they are screwing up their lives and making everyone miserable.

Because I primarily do short term assessment, I have to work fast. I don’t have the luxury of letting relationships and alliances develop slowly over time. In some ways, this is an advantage as the time limited nature of the process creates a sense of urgency to enact change, assuming the family is ready to make changes. Part of working quickly is that I need to communicate directly, I need to make recommendations, and I need to communicate hopefulness but also urgency not to continue to let problems worsen. Some of the kids I assess have long-standing undiagnosed and untreated difficulties leading not only to a worsening of the primary conditions but to the development of secondary disorders.

I don’t work for a system like a hospital or community health center. I have my own little private practice office. I don’t work in a prison but I do work to prevent children and teens from getting involved in juvenile justice. I don’t work in a mental hospital but I work to prevent teens from being hospitalized or help them transition back to the community from the hospital. I don’t work for the welfare office but I do work to support my patients’ educations as much as possible so that they can complete high school and perhaps even complete college so that they can become reliable members of our country’s workforce.

This is my long way of saying that my job involves a big team and a long view towards the future as well as responding to the present issues. Sometimes I forget how hard my job is.

What I do remember more easily are the times I felt like I needed to break an alliance in order to protect a child. Now I don’t mean calling child protective services, though that would certainly be an example. I am talking about other instances that are not as clear cut as making a suspected abuse report.

I am talking about times I have to give someone very firm direction or feedback when it is a risky thing to do and I have either exhausted other strategies or there are no other strategies available. Sometimes it means writing an email and leaving a voice mail with my patient’s psychiatrist who has been unresponsive despite our mutual patient’s level of depression, saying, “You need to communicate with me more frequently. _____ was talking about killing himself just three months ago. He is not doing well. I know you are busy, but I need to hear from you as soon as possible.” (I heard back within an hour.)

I am also talking about responding to a mom of a teen, adopted from another country. She was mad at him and told him that she was going “to give him back.” Since I had already conducted the background interview and he was there for testing. In other words, she was supposed to be in the waiting room, not in my office. I empathized with her frustration but told her that the next step was to do assessment. She kept telling him how horrible he was. Then I told her that her job was to “make things better instead of worse” and suggested that she go take a walk to regain her composure. She kept yelling. I told her that she had to leave. Believe it or not, I think that she really loved her son. I didn’t think she was a bad person. But she was not well herself, depleted, making bad decisions, and her behavior was hurting her son. It was not her fault that her son had the challenges that he did. But it wasn’t his, either. And it was her responsibility to be the adult.

I was pretty sure I would not see that family again and I didn’t. I knew I had hurt and angered that boy’s mother. I saw the opportunity to do was to let that boy know that the way he was being treated was unkind, unfair, and harsh. It was the best I could do at the time.

Most of the time, I am able to navigate these sometimes conflicting alliances.  It is complicated but doable. One of the things that makes it easier is that my professional relationships are not reciprocal. In other words, my patients and allied health professionals are not responsible for taking care of me.

This is not, however, the case in much of my personal life. In my personal life I have reciprocal relationships with friends, my husband, or with professional colleagues. And that’s where alliances get even trickier. Because now my expectations, my wants, and my needs enter into the equation; they become part of the team of my relationships.

With expectations comes fulfillment and disappointment.
With need comes receiving and hurt.
With wants come desire and loneliness.
With dependence comes relief and uncertainty.
With honest communication comes raw hurt and vulnerability.

Relationships bring the best and the worst to our lives, even with the right people. I am kind of impressed that people keep trying and that many people have strong and resilient relationships. This makes me hopeful. Just because my relationships can be difficult doesn’t mean that I am doing them wrong.

Some animals, like bees, are eusocial. They live in highly organized social groups, each with a job to do, and all for the survival of the group. Adult bees are drones, workers, and for one unlucky female, the Queen.

This would all seem so complicated except for one thing. Bees have tiny brains and they don’t live very long. In other words, it is unlikely that more than the tiniest bit of learning goes into this process and I’d say it’s safe to say that no thinking goes into it. Bees follow instinct. They do their jobs, they don’t change roles, and when they communicate, they send messages that are easy for everyone to understand.

People are also social animals but from an evolutionary standpoint, we are driven for individual survival, not group survival, a quality the ethologist Richard Dawkins called the “selfish gene“. Evolution is not everything. There are other forces at work and some of them even motivate us to get along with one another and nurture each other for the greater good.

But people have big brains and live a long time! We learn to play many roles and carry out many responsibilities. And these roles and responsibilities are not predetermined at birth. Unlike bees, we are not born into an inflexible caste.

Living in a group is really complicated. We communicate with our words and other behaviors. We don’t always say what we mean. We don’t always know what we mean. Our roles overlap and our goals may be at cross purposes.

Bees have very organized relationships. However, they don’t have intimate relationships. People bump and scrap with each other all of the time. We protect ourselves from real and perceived slights. Most of us put a lot of energy into individual survival as well as to helping our loved ones.

I try to live a peaceful life. I try to be a helpful and nurturing person. I try to belong to the community of humanity and to contribute to its health. But I often fail to do so and sometimes spectacularly so.

I am a nice person but I am not always nice. I am a caring person but sometimes I try to protect myself at the expense of others. Sometimes, I use my intellect to come up with fancy justifications for my behavior when in my heart of hearts, I know that I am doing wrong. I am a happy person but sometimes I am irritable and sometimes I lose my temper and yell at the very people that in my hearts of hearts, I love the most.

Almost every time this happens it is because I have neglected my self-care. I have pushed myself too hard, worked too many hours, not eaten well, not taken time to myself, and not exercised. When I think of myself last, it is because I am looking outward to what I think my family needs, ignoring cues from myself that a good deal of my distress is simply because I am not caring for myself.

It is at the times I make these seemingly altruistic sacrifices, I am most prone to behaving selfishly.

I am not perfect. That is okay. Expecting myself to have no needs is not okay. Being selfish is not okay.  I am not perfect. That is okay.

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I remember when I was starting grad school in my 20’s. One of my classmates was from the sunny city of Miami. I noticed that although she was actually younger than me, she had crow’s feet, those wrinkles people get around the corners of their eyes. I figured that since she already had them, I would get them fairly soon. But I didn’t.

The first wrinkles I noticed were above my left eyebrow. I can lift my left eyebrow above my right, just like Spock on Star Trek. I did it A LOT as a teen and a young adult. My younger brother and I laughed about it a lot. It was something I did when I was being silly and having fun.

Wrinkles are signs of aging. The first time I looked at myself and thought, “I’m not young anymore” was in my late 30’s. I was looking at the backs of my hands. They weren’t as smooth as they used to be. In other respects I still looked young. I’ve done a lot of work with my hands over the years. Writing, gardening, knitting, cooking, and caressing loved ones. My wedding and anniversary rings are on my hands.

When I was putting on make up this morning I saw them. I have crow’s feet that don’t go away when I stop smiling.

I’ve done a lot of smiling in my life. And I’ve squinted at the sun when I was in the mountains, the tropical rainforests,  and kayaking on the sea. I spend a lot of time outdoors, which makes me happy. I spend a lot of time with people who make me happy.

The lines I have, by and large, are not remnants of the bumps in the road of life, the wrinkles we have to smooth out. My wrinkles are from the best bits. They show the happy and productive moments that I have enjoyed. If I am lucky, they will continue to broaden and deepen, I hope.

When I was young my face was smooth. Now the lines tell a story, one that is meaningful and full.

Life lines is what they are.

Warning: Smiling can cause life lines! (Also, I told you that my husband puts his camera close to my face.)

Warning: Smiling can cause life lines! (Also, I told you that my husband puts his camera close to my face.)

As a psychologist, I work with a lot of parents who disagree about how to best address their children’s problems or often, whether there is a problem to address at all. A good deal of the time, these perpetual conflicts are a result of the couple trying to solve a different problem than the one they think they are trying to address. The real problem might be feeling like a bad parent and trying to solve it by deflecting blame to the other parent.

But what does it really mean to be good or bad? Kids often tell me that “bad kids” are the ones who get corrected by the teacher or who hit or who learn differently. In other words, “goodness” is defined by actions and abilities. A lot of the kids I see think of themselves as “bad”, which is an extremely painful state of being. I say, “I’ve worked with thousands of children in my life and I’ve never met a bad one. All children are good. Sometimes even grown ups get confused about this. They think that there are good and bad people.” When I say these things to children, I am not just trying to ease their pain. I mean it from the very bottom of my heart to the very top of my brain.

We make good and bad choices. We have skills at which we are good and those at which we are bad. We perform good and bad actions. These statements are true for all of us on a daily basis. We do good things and we do things well. We do bad things and we do things poorly. Every day. Every person. Are all of these good’s and bad’s equivalent in terms of importance? Of course not.

People are beings, not actions, skills, or decisions. Actions, skills, and decisions are capacities, not entities. I believe that every living being is a miraculous creation. A miraculous creation is a good thing. Every person is a miraculous creation. Why is this so hard to accept?

I spent a good part of my early life worrying about being “good enough”. The hardest times were when I was depressed. There were some things I learned getting myself out of those depressions, though. A very important lesson was that even having failed at happiness by becoming depressed was not the end of my life. I came back from the illness. I was more resilient than I had realized despite my imperfections. It was an important step in stepping away from the question, “Am I good?”

Stepping away from “Am I good?” is a really important part of self-acceptance. I don’t believe that self-acceptance is a absolute. It is a process toward an idea. I believe that I have traveled close enough to it to make a very large positive difference in my life.

I am discovering the freedom in self-acceptance, in stepping away from the question, “Am I good?” It allows me to more frequently see myself and others as whole people with beauty and mess. I am a messy imperfect but loving person. By accepting this, I am actually better able to make good decisions, engage in good actions, and learn good skills. I have a lot more time and peace as I learn not to berate myself. I don’t devote energy to fancy justifications for my actions.

Getting wrapped up in that question can cause so many problems. Even if you don’t believe that people are miraculous beings and inherently good, perhaps you might consider that classifying oneself and others as “good” or “bad” is really not helpful to anyone.

What does it mean to be good? It means that we are here. It means that we can move on to more useful questions, ones that bring love and compassion to our lives, instead of keeping us stuck.

 

In my job as a psychologist and a diagnostic specialist, I am asked to answer questions and make recommendations. Answering diagnostic questions can be really hard, especially in my areas of specialty. I sift through multiple data sources, try to find patterns of behavior, and predict how behaviors change across settings and over time. Meanwhile, I have to remember that diagnoses do not define children and that their functioning at school, home, and in the community vary as a function of many many other individuals and environmental factors.

Often however just asking the question is harder than answering it. Yesterday, I received the following email:

We have a 13 year old son who is struggling in school. His main challenge is executive functioning and spacing out in class. We are not interested in assessments or medications but do want to understand how to get at the root cause of the lack of motivation. Do you think this is something you can help us with?

This email was obviously written by a very loving parent. The parent has also done some reading, I suspect given the terminology used in this letter and the reference to medication. But it is hard for me to help when I am asked to help solve a problem without finding out what it is. Asking the question, “Is there something wrong with my child?” is sometimes even more frightening than asking, “Is there something wrong with me?” Parenting hits us in the tender places in our heart. For many of us the two questions are really the same question, “Am I a bad person who is passing off my inherent badness to my child?” Some of the variations of this question are less severe but it boils down to fear of coming up short in some very critical way.

Fear of asking the question, “What is wrong” can lead to all kinds of odd little dances. So often, people try to solve problems without knowing what they are. Some people even try to solve problems without admitting that there are even problems. This sounds silly but problems have real consequences with which we are left to cope. You can’t make a problem go away by not believing in it.

Parents often feel responsible for their children’s issues. And honestly, as parents we are responsible for a lot. But we aren’t responsible for every part of our child’s reality. It is particularly hard for people who appear to be successful and high functioning on the outside but fear being exposed for the horrible people they fear themselves to be. I have met many parents who think, deep down, that they are awful people. And you know what? They are never horrible people. And some of them are quite wonderful people who nonetheless feel fundamentally flawed.

The saddest part is that when people refuse the help I can give them because they fear themselves, it perpetuates bad decision-making and bad problem solving. Then they just feel like really bad people and are even less likely to seek help for themselves and their children.

I believe that I am a worthwhile person, a good wife, and a good mother. I believe I am good at my job. But like everyone else, I am deeply flawed. I am a kind person but I hurt people and sometimes I do it on purpose. I am a loving person but sometimes feel contempt for others. I am a generous person but at times act with keen selfishness. It has never been easy in my life to engage in constructive self-reflection. At times, I have sought professional help but with great difficulty. At other times, it was not so hard. It was pretty easy to be open to seeing a psychologist after my cancer diagnosis. After all, who am I to begrudge myself support for CANCER? But I have seen psychologists multiple times in my life for individual, parenting, and marital purposes. I am happy for all of the experiences. They were extremely valuable. I did it because I felt like I owed it to myself and my family to be a well-adjusted person. Because truthfully, unhappy people are hard to live with, especially when a very unhappy person resides in your own heart.

I will keep working on myself and I wish all of you the happiness that comes from seeing yourself, the good and the bad, working on things knowing that things can get better but not perfect, and being okay with that. Self-acceptance is an amazing power and I have been happy to have gotten more and more glimpses of it as I continue through life as a beautiful and flawed human being.

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My dear friend, Rachel, just posted a comment on Facebook, “I think I’m about to get in trouble on a friend’s page. Best shut my yap.” My response was the following comment: “Do a cost/benefit analysis and then proceed accordingly. I saw my comment in print and thought, “And to think I used to write poetry.”

But when it comes to sticking our necks out and debating, it is probably pretty good advice. As I have described elsewhere, I am naturally argumentative and love a good debate. You may recall from an earlier post that my fellow grad school mate, Penny once described me in her amazingly wonderful Appalachian drawl, “Elizabeth would argue with a post.”

Some of those arguments were transformative and some were just fun. At other times, they were draining, left me in a lingering state of emotional turmoil either because I felt hurt and/or that I felt that I had hurt someone else. I am not a mean person but I am a quick thinker and when hurt or angry, I can use my verbal ability in a very aggressive way. This was particularly true in my teens. One of my high school teachers wrote in my senior year book, “I will miss your acid tongue.” I don’t think he missed it because he ignored my Facebook friend request when I put it out there a couple of years ago. And I could see that he was active on Facebook and friends with other students.

An excellent lesson I learned during the horrible work situation that led to my first of two major depressive episodes was to trust myself and choose my battles carefully. I spent nearly three years at that workplace, surrounded by some amazingly competent and dedicated people and others, well not so much. And since the folks in the “not so much” category were in management, even us amazingly competent and dedicated underlings misbehaved. I spent a lot of time in conflict with managers and coworkers because I felt both personally and professionally attacked and unable to do my job. I was given two managers, with totally different training, and totally different goals. In other words, it was a structural set up for failure. Before I fully realized how futile my situation was I spent a lot of time questioning in my head, “Is it me or is it them?”

Sometimes arguing for me is an intellectual exercise or sport. At other times, it has been a way of seeking reassurance when I am anxious. I did a lot of that kind of arguing at that place of employment. The illogic and chaos of the place was so disorienting. If only I could explain my ideas logically or counter criticisms in a reasonable manner, the universe would become organized again.

The universe didn’t reorganize itself until after I was laid off from the job in a very nasty way. But it was freeing. I got my depression treated. I got my Washington state psychology license and planned to start a small private practice in case my research career, the one I had fought to achieve and maintain over the span of 20 years, wasn’t viable. I wrote a small grant with a software company that designs web-based training, using a rather ingenious curriculum design developed by a professor at mid-west university. The grant was from the U.S. Department of Education to develop a pilot educational program. This was truly exciting as I had been working in computer-based parent education program research and development since my doctoral dissertation. Telehealth was a new, growing, and much needed research area. I live in a metropolitan area but I spent my training years, six years in North Carolina, one year in northern Florida, and two years in southern Indiana, working with rural families with very little access to even the most basic parent education on how to help little kids learn to cope with the difficulties in life in ways other than hitting, kicking, or throwing tantrums.

For my doctoral dissertation, I had carried out an independent project (as opposed to working on a professor’s project) a clinical trial evaluating a parent education program that I developed along with my husband, who is a software engineer. The results of the trial were modest, but positive and statistically significant. Working with an established professor translating parent education to his web-based instructional design meant continuing a line of research using technology as an additional mental health service delivery method.

You know I love writing about context. This is why I am not making a long story short. If you have not yet gotten my message, I was REALLY invested in my line of research. Getting help to under served populations. Preventing the really treatment resistant mental health problems that can develop in folks who don’t get early intervention, many of whom end up being “treated” in our penal system. This may sound overly self-important or idealism bordering on delusion, but I really viewed it as a vocational calling of sorts.

Back to the grant. We spent the $50,000 the government provided very very well. The pilot project was a success and something of which I will always be extremely proud. The parents who used the program loved it and they also provided me with very positive feedback regarding the email-based discussion thread moderation and coaching I provided to them as they completed our little program.

Although I enjoyed working with my co-principal investigator, the Big Time University Professor, I was extremely unhappy with a key staff member at the company, with whom I interacted daily. I think it basically boiled down to his taking a different role on the project than the one that he had been accustomed to, which was being in charge functionally if not officially. In other words, management had been very hands off. He really did not like this and fought me over everything including the program content and learning objectives.

I also disliked managing a project being carried out in the Midwest while I lived in on the west coast. It was time to write the “big grant” the one that was the follow up for the pilot grant (the granting mechanism was defined as a two-stage grant, the little grant followed by the big grant.) If the government were to funded the second grant, it would have been a $250,000 grant, which is not enormous in the research world but it is significant and a huge amount for a researcher at my career level.

I knew people in Seattle with relevant production and project management experience. REALLY GOOD PEOPLE WITH WHOM I’D WORKED WELL IN THE PAST. I’d contacted nationally known researchers, primarily psychologist and they had agreed to serve as consultants on the grant with no financial compensation. (That is standard, by the way. Psychology professors do a lot of stuff for free.) The pool of possible Internet programmers in Seattle was huge compared to a small university town in the Midwest. The professor and I set up a meeting with the company C.E.O. I wanted to request that I hire a Seattle crew to carry out the project, should the grant be funded. Big Time University Professor thought this was a grand idea, in fact I think he was even the one who suggested it.

C.E.O.’s response was a surprisingly loud and angry, “You work with the team you’ve got or we part ways.” I REALLY wanted to write that grant. But I was clear about what I was and was not willing to put myself through in order to get that chance. He had made a bold and seemingly bullying move. I calmly replied, “If the only choices are to keep this team or to part ways, then we will part ways. But I think there are other solutions to this problem. Let’s discuss those.”

I didn’t argue but I stood my ground. The small grant was over. I was back to collecting unemployment. My family needed for me to make an income. It wasn’t just about my idealistic goals or my career. It was about putting food on the table. The meeting ended on an ambiguous note something along the lines of “Let’s keep talking about this.”

My gut told me to get out and that what looked like a wonderful possibility would not be in reality. The C.E.O. was not a bad guy but he was disrespectful and I had no confidence in his ability to treat me like someone with something of value to offer the company. They were also struggling financially, had been through a number of rounds of lay-offs, and a few years later, the company folded. So he was also trying to protect existing staff rather than to expand the company into Seattle.

My husband agreed with me and I declined to write the grant. It was disappointing but felt like the exactly right decision. I ended up getting on research staff at the University of Washington and starting my psychology practice. I ended up loving both jobs, the former as long as it lasted, which was three years.

These days, I keep my arguments with posts (figurative or literal Facebook posts) to a minimum. I try to think about the costs of acting as well as the costs of not acting. I think about what things I will not get to do if I am busy arguing. I think about the fairness and strength of my argument. I consider the other side. I consider other solutions to the problem. I think about whether I am trying to solve the right problem.

Conflict is a fact of life. Some conflict is even necessary for life, especially if one has relationships with at least one other human being. But conflict as a way of life? No, thank you. I’ve got too many other things I want to do with myself.

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George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. He is now Director of the Center for the Neural Mind & Society (cnms.berkeley.edu).

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