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Tag Archives: Anxiety

In Transition

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If you’ve been reading my blog for a while, perhaps you remember my inner infant–that part of me that gets anxious for apparently no reason but has no words to tell me what she’s upset about. I am still like a new parent who is getting to know their child for the first time. It is a very slow, painstaking process. But I came to a realization last week that has been helpful in being more compassionate towards this anxious baby, who I will call Amygdala for scientific reasons that are too technical to get into, but if you’re interested, you can check out this article.

Every morning when I’m getting ready to leave for work, Amygdala gets anxious and I have to say my standard mantra to her: It’s OK. Everything’s going to be OK. You’re fine. Everything’s going to be fine. And when I’m frustrated, I add although I have no idea what you’re anxious about!  Which is not very compassionate, and therefore not very effective in soothing her.

For some reason, last week I realized that Amygdala gets anxious when I am in transition–from sleep to wakefulness, getting dressed, getting into the car, getting out of the car, leaving work, going to play tennis. I imagined what it would be like for a baby during these times, and I could see why Amygdala would be anxious.

For example, when I am spending the night in a different place for the first time, I will often wake up and have a split second where I don’t recognize my surroundings and not remember where I am. Then I’ll be like, oh yeah. I’m at districts. But babies don’t have very good memories, because their brains aren’t fully formed. So for them, every time they wake up, they probably don’t recognize their room. Or they could have been moved to a different room while they were sleeping. And they’re probably like, where the hell am I?! (If it were a baby that cursed, that is.) What am I doing here? Where is that person who is supposed to be taking care of me?!

Or like how when my niece was younger she never wanted to go to dance class, even though she loves dancing and always enjoys it once she’s there. I never understood why kids do that, since I’m not a parent. But I do know what it feels like to be all content doing whatever you’re doing and then having to get up, change clothes, drive somewhere, and see people, even if it’s to do something I love, like play tennis. It’s hard to overcome the inertia of doing nothing. So I can see why that might be upsetting.

But since I’ve realized this, I’ve figured out something more compassionate to say. Whenever Amygdala cries because I am in transition, I tell her that it’s OK, she’s just anxious because we’re doing something different, but once we get there, everything will be fine. And it usually is.

So maybe I’m becoming a better parent after all.

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I found this while I was looking for quotes on transitions. My inner infant has no idea what it means but she thinks it’s funny.

A Compassionate Take on Why Misery Loves Company

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A few years ago I had the pleasure of listening to the the President of Washington and Lee University speak to the parents of the freshman class that year, appraising them of some of the things they could expect to encounter in their child’s first year of college. A frantic call in the middle of the night about something. The transition to being a little fish in a big pond. The Turkey Drop–which happens over this very break, when some poor girlfriend or boyfriend is informed that this long-distance relationship thing just isn’t working out. Hope we can still be friends.

Students in counseling often talk about “losing the breakup.” I like that term, because it so accurately captures that feeling of being left behind with your heart broken, stalking your ex on social media as they post pictures with their new significant other. If I have to suffer, they should have to suffer, gosh darn it! I hope they get what’s coming to them.

It’s true; misery loves company. And sometimes it’s because people who are miserable want other people to be miserable so that we can all feel sucky together. But sometimes it’s not because people are mean and hateful. Sometimes it’s because we don’t want to be left alone in our pain and suffering.

In self-compassion speak, this is called common humanity. It’s one of the things that comforts us in the midst of our pain in suffering. To know that getting your heart broken is an inevitable part of experiencing love. It sucks for everyone. It did not happen to you because you are uniquely unlovable. And it’s not your fault that it hurts so much that your friends are tired of listening to you talk about your ex.

As I mentioned in my last post, it’s that time of year when my inner demon of depression rears its ugly head. It’s better this year. I’ve made it to work every day so far. I have not fallen into a pit of despair. But it’s still painful.

One of the best and most unexpected benefits of having a mental health blog is that, in the midst of my lows, some reader will reach out to me and thank me for sharing my pain because they have known that pain, too, and it’s comforting to know that they are not alone. It is as therapeutic to me as it is to them to know that there are people in the darkness with me, reaching out to me so that I know that they’re there.

Last week, as I was describing to one of my clients the types of obsessive thoughts that often go through people’s heads, she asked me if I knew what this inner dialogue was like because I studied it or from first-hand experience. I was a little taken aback. I’d never had a client ask me directly if I had an anxiety disorder. But I told her the truth. It’s both. I know her pain because I studied it, and I feel her pain because I, too, struggle with it.

I know what it’s like to suffer alone. So I became a therapist. Because misery loves company.

Perception is Reality

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In “A Beautiful Mind” John Nash, a Nobel Laureate in Economics, talks about how he learns to cope with his hallucinations by ignoring him. That is a pretty amazing thing to do for someone who has schizophrenia. There are several disorders in which the person’s thoughts are so convincing, despite being false, that it is difficult to cope with them by deciding that you’re not going to listen to them.

For example, someone with anorexia may truly see herself as being fat, even though intellectually she knows that she is not. But her inner critic is so persecutory in its insistence that she not eat, not take up space in the universe, that she ultimately gives in. People with eating disorders often conceptualize their inner critic as having a relationship with ED, and ED is the most abusive partner I have ever met in therapy.

Or someone who is psychotic might be convinced that he is going to win a million dollars because Publisher’s Clearing House has told him that he may have already done so. And despite the fact that the check has not arrived in the mail after several years, he makes outlandish purchases based on the prize money that he is convinced is on the way.

I do not have delusional thoughts, but sometimes my obsessive brain tries to convince me of things that are not as insidious but still cause me to suffer. No one gives a crap about me. I am incompetent. Sometimes I can convince myself otherwise with objective evidence, but sometimes my inner critic is relentless in trying to convince me of the veracity of these assertions. It will repeat them hundreds of times a day. The effort to refute them is exhausting.

My psychiatrist tells me that I should put myself out of my misery at the beginning of this barrage by taking an Ativan as soon as the thoughts begin. But often I don’t because, despite all I’ve said about the importance of taking meds, sometimes I still don’t want to. And because, unlike depression, anxiety feels so normal that sometimes I forget that it is not. The meds definitely help. Most of the time I know that when the thoughts come, they are not true. But sometimes it takes a lot of work to keep them at bay.

Practicing mindfulness helps, too. One of the benefits of practicing is that it helps you understand the nature of the mind. Even for “normal” people, this is how the brain works. Random thoughts will pop up. They may not be based in reality, may not reflect what you actually believe. And in the next moment, the thoughts may be completely different.

But it’s really hard. Maybe if I dedicated my life to meditation like Buddhist monks do, my inner critic would be less effective in undermining my self-worth. Or maybe Buddhist monks don’t suffer from mental illness.

But my psychiatrist supports my mindfulness practice, in addition to my meds. He confirmed that it works, even for people with mental illness. But it takes a long time, and it happens very slowly. I know it works because I remember what I used to be like. And now when I go several days without meditating, in my moments of weakness the thoughts creep in and become more convincing.

So I continue to practice, and in the moment, I feel loved, competent, and worthwhile. So I’m writing this post to remind myself that this is true because, in the next moment, I may feel differently.

Strength and Weakness

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In a previous post, I wrote about how using post-apocalyptic strategies to motivate yourself by turning everything into a crisis is not an effective way to manage your psychological resources. If you use shame and fear to motivate yourself–Get up and go to work, you loser! You’re just being weak and lazy!–it may work, but there’s a high price to pay.

Last week my 40 year old brother, the one who struggles with depression and anxiety, had a mild heart attack and had to undergo quadruple bypass heart surgery. They said it was amazing he was walking around at all, given that his arteries were 99% clogged. The only reason he saw a doctor is because he felt guilty for being too weak to go to work and wanted medical evidence to verify that he wasn’t just being lazy.

In fact, because he thought he was just being weak, he tried to overcome his fatigue by drinking Red Bull and forcing himself to do rigorous cardio workouts.Willing himself to commute 2 hours to and from work, to override his anxiety about his job with drill sergeant self-talk. And it almost killed him.

I’m beginning to think that reincarnation isn’t just about life after death. It’s about the opportunities for rebirth, here on earth. That’s why we celebrate the new year. Birthdays and anniversaries. That’s why people who go through personal tragedies often say that the experience saved their life.

Before the surgery my brother felt like his life wasn’t valuable because his depression and anxiety made it hard for him to hold a job. He’s not married and doesn’t have kids. He hasn’t done anything heroic. The thing that he was the most proud of was his physical strength. But right now plugging in the charger to his phone is challenging and leaves him out of breath.

Apparently it’s common to feel depressed after heart surgery, and given that he’s already prone to depression, I was worried about what his mental state would be. Surprisingly, this is the most at peace I’ve seen him. His goals are different now–to give up stressing about the little things, drill sergeant strategies, and other people’s definitions of success. He is more appreciative of the small things, like being able to sit without being in pain. And, perhaps most importantly, he finally understands how strong he is.

This ordeal has been helpful to me, as well. I still struggle with feeling weak and pathetic because I can’t do the things that other people do. My colleagues are able to handle their case load and responsibilities without becoming depressed and suicidal at the end of the term. Our services are in high demand, which is good for job security but not good for setting limits. I feel pressure to push myself beyond what I know I can handle, and I berate myself when I crash and burn.

But to see the undeniable evidence that my brother was insanely mentally and physically tough when he felt weak and irresponsible reminds me that I am strong, too. I don’t need to prove it by pushing myself to my breaking point. Trying to live up to other people’s expectations isn’t worth dying over. I’m going to accept my limits without being ashamed. I’m going to start standing up for myself. I’m going to say no when I know it’s too much.

One of the most valuable lessons that my brother learned from this experience is that you don’t have to train yourself for every possible crisis to prove that you’re strong. You can just have faith that when you need it, you will have the strength to face whatever comes your way. That you already have everything you need to survive.

The Cost-Benefit Analysis of Pain and Suffering

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It was 7 years ago that I had my most severe depressive episode. It began because I decided to try to wean myself off my meds. It was a reasonable thing to try; I had been stable for a while. I got off them very gradually. By the time I was completely off them in January, I could feel the difference immediately. I was a little more easily irritated without them. Things were a little more painful. But I was willing to live with the pain if it meant that I didn’t have to be on meds.

But then things got worse. I remember being on vacation in February and screaming at my husband over fairly insignificant things. I don’t even know how he put up with it. And the last straw was some tennis drama thing in March that would not seem serious enough to make my mind unravel, but that’s how depression is; sometimes it doesn’t make any sense.

It took a long time to get back to “normal,” and I often berated myself for this costly mistake. For sacrificing my mental health so that I didn’t have to take that little pill every day. Now I have to take a bunch of them every day, twice a day, but I do so religiously, because I will do whatever it takes not to feel that way again.

Lately, since I’ve been practicing self-compassion, it strikes me how the road to recovery is complicated by our unwillingness to give up our suffering. Who knows why. Because we don’t believe we are really suffering. Don’t believe we deserve to be free of our suffering. Think we should be able to free ourselves on our own, without help, without drugs.

So taking each of those steps is a long and arduous process. I was depressed in high school but didn’t go to my first therapist until I was 25. The first time I went on antidepressants I was 30. I went back on them when I was 35 and went off them again when I was 39. By the time I was 40, a good 25 years after I first experienced depression, I accepted that I needed to be on meds for good.

Before this last depressive episode, I used to present a more neutral position on medication to my clients. But now I encourage them to give it a shot. I tell them that everyone is willing to tolerate a certain amount of pain in order to be able to say that they are not on meds, but I encourage them to ask themselves at what point this is no longer a good tradeoff.

Had someone phrased the question to me in that way, perhaps I would have taken them sooner. But I did not know how to practice self-compassion back then. I did not understand the concept of being kind to myself because I was in pain. I was not motivated to alleviate whatever suffering was under my control. Because so much of anxiety and depression are not in your control. But asking for help, going to therapy, taking your meds, and learning how to care for yourself are in your control.

I’m not going to lie–depression and anxiety still cause me quite a bit of suffering. Anxiety, in particular, has been kicking my ass today. And being diligent about all of the things that I have to do to strike that delicate balance of mental stability is effortful and time-consuming. But in a cost-benefit analysis, it’s still worth it.

Moving Beyond Post-Apocalyptic Strategies for Motivation

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When I’m teaching clients how to practice self-compassion, I tell them that they cannot rely on using fear and shame to motivate themselves. And I should know, because I do it all the time.

If you read my blog, then you know I often say things like, other people have spouses and children and are still able to go to the grocery store and make dinner. So what the hell is your problem? This has the effect of making me feel like crap, but it doesn’t do much to make me get off the couch, even if I am hungry.

With my clients, I’ll use examples like, why do you keep watching episodes of The Walking Dead? Get in there and work on that paper! Do you want to fail? Because that’s exactly what is going to happen!

The problem with fear-based motivation is that, even when it works, which is usually a few hours before the paper is due, you still won’t feel good about yourself. Because your inner critic will say, well, if you had started the paper earlier, you would have done a much better job. 

So my brother is still anxious and depressed. His primary motivational strategy to get himself to go to work is the zombie apocalypse. How do you think you’re going to save your family when the world is ending when you can’t even log in? It worked for a while, but you can only motivate yourself with fear for so long.

What people don’t realize when they create a crisis to motivate themselves is that we don’t always fight. Sometimes we take flight or freeze. And once we’ve shut down, no amount of fear can make us act. So we get stuck in this vicious cycle of shame in which we avoid everyone and everything.

Fortunately, a recent episode of The Walking Dead echoed these same sentiments, which added to my credibility. Since I don’t watch it, I’ll quote his epiphany:

Even Rick Grimes has had to take a break from berserk mode on the show. He became a man of peace for an entire season when he realized how misguided his young son had become; someone who was too quick to resort to violence & unwilling to give diplomacy a chance. It served a lesson relatable to life—if even our heroes during the zombie apocalypse cannot remain in crisis mode, then it certainly can’t be a winning formula for us during normal times. My problem is I’ve motivated myself through such extreme emotions—anger, resentment, fear—for so long, that I’m left with no clue as to how I can jump-start my resolve right now.

So what do we do if we’re not going to motivate ourselves with fear? We motivate ourselves with love. So obvious when we think about how we motivate the people we care about, but it rarely occurs to us to do so with ourselves.

Unless you’re some enlightened being like the Dalai Lama or Pope Francis. I’m sure they motivate themselves with love.

This morning was the first day that I did not want to get out of bed. It’s that time of year when it happens, shortly after daylight savings time ends. So I tried to practice what I preach and thought about how I could make it easier to get up and get ready. I played my favorite song. Turned up the heat. Talked to myself in a loving way. And today it worked.

Maybe it won’t always work. It’s a long time until spring, after all. But even when being loving doesn’t get me out of bed, it still uses up a lot less energy than berating myself.

Cultivating Hope

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Despite my struggles with anxiety and depression, I actually feel like I have been blessed with a good life. In fact, this is true for many people with anxiety and depression. Yet instead of feeling like a blessing, our demons use our good fortune against us. We don’t deserve to be depressed and anxious. We haven’t earned it.

I am often accused of trying to save the world, and I have to admit, I don’t see why that is such a terrible thing. Other than the fact that it’s impossible to achieve. But moving up to 4.0 in my tennis rating may also be impossible to achieve, and I still try to do that. And I will live if it never happens.

Sometimes I think I try to help other people because of something akin to survivor guilt. God has always answered my prayers. I know that many people don’t feel that way, and I am not going to dismiss their bad fortune by saying they deserve it or that they’re not trying hard enough or whatever. I don’t really know how to make sense of all the unfairness in the world.

But I feel like the least I can do is to make good use of my good fortune. I can use my time on earth to alleviate other people’s suffering. Help them to believe they can make it to the other side of pain.

I’m not going to pretend that this is purely motived by altruism. At some level I’m saying, look God! I’m doing all these good things! Please let me continue to be blessed with good fortune. And a part of me feels like I have to pay God back for all that I have been given. Theoretically, I get the idea of grace; I’m just not sure I deserve it.

I think that’s why I have been drawn to practicing compassion. Surely a practice whose very name includes pain and suffering must teach you how to get rid of it. Which is why when I did the self-compassion retreat, I was disappointed to learn that practicing self-compassion does not actually get rid of pain. Damn!

I kind of already knew that. I tell clients this all the time. That our goal is to learn how to sit with our pain, be kind to it, wait patiently for it to pass. But obviously, at some level, I was still secretly hoping I could get rid of it.

I have gone through enough episodes of despair to know that, despite the fact that it may feel as though my pain will never end, it eventually does. That didn’t do much to make the pain go away in the moment. And sometimes the wait seemed endless. But I guess I must have always had hope. And practicing self-compassion seems to help me to cultivate hope, which has made pain and suffering a little easier to bear.

Maybe that’s why there was hope at the bottom of Pandora’s box. (Which was actually a jar.) Even if all of the evils of the world are unleashed upon us, having hope may be enough to survive them.