Psychiatric Philosophy

One of the things you hear said a lot from those who have depression is that it is a "disease." You usually only get the two opposing views of it; either it's a disease or "it doesn't exist." You are either crippled or you are just lazy, and neither of these views are particularly helpful.

If you are in the mindset I discussed in the previous post, then the disease model sounds the most accurate: it is crippling, you're not faking, and for many people, it feels like a "forever" thing.

Before I go any further, I just wanted to let you all know that I'm not suddenly going against the disease model just because of what my therapist told me on Tuesday. This is a question I've been struggling with since I was coached in Behavioral Activation: if depression is a disease with real, biological causes, how is it that something like getting out of the house more often can be "prescribed" by real doctors--isn't this just the medical equivalent of "just get over yourself?"

Well...the answer is a resounding kinda.

Depression, as far as we understand it, is caused by a combination of bio-psycho-social influences. This means that there is a physical (biological) component, a social component (where the people around us as well as the environment itself have influence), and a psychological component (our thinking habits, to put it simply). 

It is these three things that combine to make us depressed. Once one or all of these become a little too strong or a little too "depressive" in nature, then we start to spiral down. This can happen slowly or all at once, but it is something that snowballs, meaning the individual components stack up against you if you let them.

Obviously, we can't change our genetics. If depression runs in our family, then there is a good chance we're going to become depressed. It's not set in stone exactly, but the possibility still remains. For the other components, however, we have some control.

In a perfect world, we have loving, supportive families that accept us no matter what and always have our back. We have many close friends that help us to better ourselves and see the good in the world. We have a loving significant other who it is always a joy to be around. How many of you are laughing cynically right now? Yeah, that's what I thought.

BUT we can make sure that toxic relationships (SOs who abuse us, friends who degrade us, and family who uses us) are cut out of our lives. We can also take the lead when it comes to finding new friends. This is one area where behavioral activation comes in.

This is obviously easier said than done, especially when in the middle of a depressive episode. Also, depending on how deep you've gotten, this may very well be impossible for the time being. So then, aside from getting psychotropic drugs (which I really do recommend if you need them), you have your thought patterns left.

This is where CBT, or cognitive behavioral therapy, comes in. This is where you take every thought you have and analyze it until it is no longer harmful in nature. I won't go too in depth about it right now, but basically you try to get yourself to stop thinking distortedly. 

So how does this get you better?

Imagine for a second that your brain is a lump of clay and your thoughts are pressurized water streams. Right now, as a depressed individual, you have certain ways of thinking (depressed thinking) that are the easiest to you. These thoughts run a specific course (hypothetically) in your clay-brain, and this course is the path of least resistance, pre-carved for you by a lifetime (or whatever) of those pressurized water streams blasting away at specific spots.

Now think about if you try to get yourself to think differently, more positively. It's still a stream of water, and even at the same pressure as the depressed thinking, but it's trying to go through a pathway that's either not there at all, or at least very narrow and unused. But the more you keep at it, the more you are going to carve yourself a new way of thinking. These ways will be just as easy to use as the old, depressive ways. 

This process will be made a lot easier if you make other changes: to your environment, to your physical chemistry (through drugs), to your social circle, and to your physical health (through proper diet and exercise, sun exposure, etc.). It takes a lot of work, but depression doesn't have to be the end of your life. It doesn't have to control you. 

And don't think for one goddamned second that this post invalidates your suffering: this shit is real and harmful and it sucks. But just like having to relearn how to walk after an injury, you can relearn how to be happy again (or even for the first time), it just takes a shit load of practice.

I hope this helps you understand depression a little better, and maybe helps a couple of you get the help you need and set you on a path to recovery...

~ <3

Weird and Wonderful News

My last psychology appointment was on Tuesday the 6th, and I was told something I had never heard before: I was at a good enough place, mentally, that we could forego making another appointment until I felt I needed another.

This is, obviously, good news. But it's strange all the same. Those of you who are depressed or have been depressed will totally understand this line of reasoning: it is very hard to admit that you are getting better.

So many people (well-intentioned or not) will be quick to point out that depression is just a "phase" or just a fleeting "bad mood" that will pass just as quickly as it came. We have to fight to be taken seriously, so it is hard to show others when we have our occasional good day. A good day is very often taken as fodder for why depression really isn't a "thing" and so we should just snap out of it because we "totally did it the other day."

None of us want to be depressed, but partaking in Behavioral Activation can be misconstrued as "bucking up." The very methods for getting better are loaded situations, and this makes for an even harder recovery. It's bad enough trying to recover with someone who understands it having your back!

So to be in a situation where I have been free to try out different methods, to get better, to celebrate the good days instead of hiding them...I have finally gotten to a good place. My wonderful, fucking amazing husband has supported me and I have had an awesome, knowledgeable doctor, too, so I am indeed extremely lucky.

To those of you who are struggling to get better, know that it is possible. Know that it may take years, and so much trial and error that it all feels like a mistake, and there will be pain and hardship and idiots that stand in your way, but it is worth it, and you are worth it. Trust me, if no one else, okay?

I started this blog long into years of therapy and drugs and research and I don't want to misrepresent what a recovery looks like. Hell, that road looks different for every person anyway. And there is something else to remember, too: I can't stop here. There is a lifetime of monitoring ahead, and when (not if) that fails, the inevitable battle to get back to where I am today. I'm also still not 100%, either, I'm just good enough right now that I don't need a therapist holding my hand.

I have taken these things into consideration and, though it wasn't required, I went ahead and made an appointment for a month from the last one, just in case. I know myself enough to know that I might slip between here and then and may need some encouragement (beyond my husband's capabilities), and if there is no appointment scheduled, I'll just put it off. And put it off. Until I'm back again, hiding under a blanket, locked in my closet, wishing I were dead.

I don't want to get to that point again. But I could. Knowing that about myself is the most important step, tied with admitting that I may be on that path again. And really, that's what mental health is all about: learning enough about yourself that you can take every step possible to make sure you stay okay or are working to get there. Even those who have never had problems need to keep tabs on their stress levels.

So everyone who is reading this right now, do yourself a favor: pay attention to how you feel. What your moods are telling you, what your body is telling you, what your friends are telling you...it could literally save your life. Or at least save you a hell of a lot of money and misery!

Journaling Hows and Whys

Okay, so after having my terrible Wednesday and taking Thursday to chill (and work, admittedly), I feel like it's officially okay to attempt this again.

When it comes to the internet (and official literature that didn't have a paywall), so many people say that journaling is a good idea. It is a good idea for psychoanalysis, CBT, treating PTSD, behavioral activation, migraines, and just regular life among a million other applications as well, I'm sure. However, it's not necessarily something one is apt to do naturally. It feel silly, if I'm honest, at least until you get used to it. I only got really into it in the past year or so and even then it took awhile to get somewhat consistent about it.

I guess, technically, it was always "journaling," but it didn't feel that way. I had read somewhere that you can improve your working memory if you always write everything down. Supposedly this allows your brain to stop trying to hold on to a bunch of unnecessary information so you can focus better on what matters. So I wrote everything down. Grocery lists, schedules, room numbers, directions, idle thoughts, story ideas, complaints--everything. It was mostly on loose leaf paper in my school binder, but eventually I got little notebooks that I could carry around. This might be the beginning of my "pretty journals" obsession...Anyway, this note-taking led to journaling. Kinda. I didn't notice an increase in my mental powers, so I tapered off fairly quickly. When I switched over to journaling about my day, I completely stopped. Eventually I stopped carrying a notebook with me. I didn't really start back up until a couple years ago, and it didn't really get serious until last year, I think, when my depression bottomed-out again.

So what do I journal about now? Anything. Everything. I write about my day, my thoughts, I bitch about people/classes, I record my physical as well as mental health (though not as much as my doctors would like). I evaluate how I handled different problems and why, I make plans for Christmas decorations...

Do you want to start? Find a notebook that you like, or bind some loose leaf together in a folder. Then...well...start. There are a bunch of different techniques you can try, but research has shown (if you read any of the six links up top) that the most beneficial way to do this is to write about potential gains from problems you face. Basically just re-evaluating shitty situations and trying to find anything you could learn or grow from. This keeps you focused on more reflexive topics while not just dwelling on the negative.

If this deeper writing isn't for you, you can try more surface things like the route I took, writing everything down. There is also even more subtle things where you simply record the weather for each day. You can even take the more CBT-focused route and just record thoughts and feelings that you have.

If you are more creatively inclined (you don't have to be good at this, just enjoy it), you can start something called an art journal, too! Basically you take a topic and you draw/paint/photograph/sculpt/modge podge/collage it. It can be something really emotional such as a break up, or it could be fairly simple like taking a concept ("freedom") and making an entry representing that. To get the most out of this, I would suggest writing something alongside these entries so you can have something more concrete to look back on.

And for the most benefit, make sure you do look back! You can compare and see how you've grown or find patterns that are destructive. And if you have a therapist, then I would suggest bringing up your journal with them and seeing if they want to go over certain things with you. Having a trained second set of eyes can help eliminate some bias that may blind you to certain defenses or faults.

I think I might start posting journal topics for you guys either on a separate page or on the side bar, I don't know.
There is now a journaling topics page! Last update to it was on 11/25 at 1:26 am.

Have you had any experience with journaling you'd like to share? Maybe pictures of your journals themselves (I'm a sucker for a nice notebook)? Please comment below!

Dental Work, or: Why Positive Psychology Can be a Pain For the Depressed Client

Teeth cleaning. This phrase may cause some of you a little anxiety, but for the most part, nothing's wrong with it, right? You go in, someone pokes around in your mouth, and eventually does what you do every morning and night but with industrial-grade tools and a little more efficiency. Overall this is an important part of one's health. It should even be done twice a year to keep tartar under control and check for early signs of problems. 

But now imagine that you have an abscessed tooth. Pain radiates every second of every day--so bad, it's literally almost deafening. Now imagine your dentist recommends that all you need to fix it is a good cleaning. If you have had the displeasure of an abscessed tooth, then you just screamed at me. The pain a cleaning would cause is probably a sufficient excuse for murder in some states, so why would any self-respecting dental patient put themselves through this?

They wouldn't! Unless they just didn't know better.

The past semester I have been in a Positive Psychology class (if you couldn't tell from everything else I've written here), and the topic is fascinating. I love the idea of improving everyone's quality of life so that mental illness is largely prevented...but what about those who are "legitimately" depressed? Those who cannot make it through an entire day without anti-depressants, or those who self-mutilate due to the numbness caused by dissociation? What about those who stare at themselves in the mirror, begging their reflection to finally give them the strength to commit suicide? Are they going to benefit from understanding the intricacies of human happiness? What about the Hedonic Treadmill? 

A lot of what I learned in positive psych, as far as exercises and therapies go, are the psychological equivalent of getting one's abscessed tooth hit with a water pick. This is NOT to say that positive psychology cannot help someone with depression; I just think it would be in everyone's best interest if this somewhat new form of therapy was parsed out in such a way that it can be used by depressed individuals without doing more damage than good. 

But, really, you ask. How can you be so certain that positive psychology could hurt anyone? I mean, positive is right in the name! 

Well, I know because I have an abscessed tooth...of the brain. (?) Okay, so the metaphor broke down a little there, but you know what I'm saying. I am a "depressed individual" and I have just gone through months of unbridled exposure to positive psychology: its concepts, its background, its possible and future applications...and let me tell you--the days where I wasn't simply enthralled with it, it sucked.

How can I make a list of three good things everyday, when I am literally trying to find one good reason not to slit my wrists?

How can I think of ways to enter/maintain a state of "flow," when I haven't found a way to make myself shower for the past week?

And don't even get me started on the despair that can come when trying to think of someone who is a fourth degree of separation from yourself (how far someone has to be from you before their happiness stops affecting your own) when you haven't spoken a single word to someone other than your spouse in over three months.

[Disclaimer] I'm doing much better now, don't worry (hell, the biggest evidence of that is that I'm actually writing something for the first time in forever). And to my positive psych teacher (who will inevitably read this), don't you worry, either. I don't hold you nor this class responsible for any ill health I may have been experiencing. If anything, it has been my responsibility for not re-framing all the information in a way for my depressed mind to digest. Re-framing is something I'll have to master anyway, if I plan on making it through the years of learning psychology and counseling, intact. 

But my point is that, while positive psychology is AWESOME at getting people from a "0 to a positive 8," getting someone from a "negative 8 to 0" is a whole other process. This process is a delicate one--so delicate, in fact, you have to go to school in order to be legally allowed to help with it. So to those who are practicing or plan to practice psychology at some point...just keep this in mind. I plan on laying out suggestions as to how to do this in the future. These suggestions will be full of assumptions and conjecture, but perhaps will help design a "test plan" for an experimental treatment of depression one day.

The Hedonic Treadmill vs. the Eudaimonic Staircase

The hedonic treadmill model is one of my favorite concepts. I heard about it a long time ago, and ended up forgetting what my source was (probably something like cracked.com), but it stuck with me even then as an important construct. What researchers say is a "pessimistic conclusion" (Waterman, 2007), I sought refuge in: we cannot truly impact our lifetime happiness in any permanent way (Brickman & Campbell, 1971). Some see this as we will always be our same, depressing selves no matter what we do or buy, but I thought of it as a license to take risks and a comforting mantra for when life got hard.

Diener, Lucas, and Scollon (2006), wrote an article discussing the pessimistic nature of the hedonic treadmill and how to revise it, focusing more on "qualifying" certain aspects of it. The changes revolved around two main ideas: that individuals are different (coping strategies, individual set points), and that this affective adaptation is not as bad as it sounds (set points are not neutral, happiness set points can change). In the spirit of half-done classwork, I was going to stop there. I decided, however, to gather at least one or two other sources for the hedonic treadmill idea so I wasn't basing all of my ideas on one article.

I am really glad I did that.

In response to the originally assigned reading, A. S. Waterman (2007) wrote about a concept I had never heard before called eudaimonia. While hedonia is the pursuit of physical pleasures, eudaimonia is the pursuit of pleasure through the mastery of self and one's skills. To reference my precious article about "flow," eudaimonia is essentially the lifelong pursuit of flow experiences. Eudaimonic happiness is suggested by Waterman to be much longer-lasting and sustainable, and the adaptation process for it is much better understood. He was the one that used the term "staircase" in this situation, as "the opportunities for increasing levels of challenge in any endeavor are almost limitless" (2007).

This information has sent me down a rather exciting rabbit hole, but that's for a different article. In the meantime, I will still think of the hedonic treadmill as being comforting (as I currently like my happiness set point), but will also think about taking the "staircase" much more often.

References:

Brickman, P. & Campbell, D. T. (1971). Hedonic relativism and planning the good society. In M. H. Appley (Ed.), Adaptation level theory: A symposium (pp. 287-302). New York: Academic Press.

Diener, E., Lucas, R. E., & Scollon, C. N. (2006). Beyond the hedonic treadmill: Revising the adaptation theory of well-being. American Psychologist, 61, 305-314.

Waterman, A. S. (2007). On the importance of distinguishing hedonia and eudaimonia when contemplating the hedonic treadmill. American Psychologist, 62(6), 612-613.

The Value of Positive Emotions

Week two readings for my class started with:

Fredrickson, B. L. (2003). The value of positive emotions. American Scientist, 91, 330-335.

This article is also aptly named. The basic summary is that Fredrickson has done research on the short term and long term effects of emotions, both positive and negative, and looked at it from an evolutionary perspective.

According to this researcher, negative emotions have been studied more than positive ones for a couple of reasons: a) they are easier to differentiate, and b) they negatively effect humanity (imagine that). Therefore we have much more information on what these emotions do to us mentally and physically.

The theories behind negative emotions and why we have them, all come down to survival. Fear sends a larger amount of blood to the extremities, facilitating the "fight or flight" response. Disgust invokes a need to "expectorate" (such a nice word!) Anger prepares the body for an offensive attack (2003).

Tree rings show minimal or "narrowed" growth in the winter
and accelerated or "broadened" growth in the summer. 

The big mystery was why do we have positive emotions? The leading theories had still revolved around survival, that positive emotions were just a signal that there were no threats around. But Fredrickson has conducted and studied others' experiments that give a little more insight. Inducing participants with a positive affect seemed momentarily to broaden their thoughts, increasing creativity and creating mental "room" to think about larger concepts. This would suggest that positive affect would allow for our ancestors to switch from the narrow concept of survival to broader ideas of growth, curiosity, and a pursuit of novelty. This is a lot like tracing a tree's growth through the winter and summer; the darker, thinner rings are due to slowed growth in winter as the tree merely "survives" (actually goes dormant, but you get the idea), with accelerated growth in the summer.


The long-term effects of positive emotions seem to be building a resilience against negative events in the future, protecting one from depression. I mentioned this before, kinda, in the "article #2" post:

In the first sentence of the article, it talks about preventing pathologies "that arise when life is barren and meaningless" (Seligman and Csikszentmihalyi, 2000).

"Don't you mean, perceived as barren and meaningless?"
To say it any other way implies that people with meaningful lives simply cannot develop mental illness, and while I believe (and evidence suggests) that meaning in one's life can help to prevent or lessen mental illness, it still happens. Or am I just wrong about this?

 However, I do stand by Fredrickson's conclusion on this topic. She talks about resilience, not about whether or not our life has meaning. Which, by the way, I believe to be a really subjective measurement. What makes me believe my life has meaning may not at all be what you think gives my life meaning (if you even think my life does have meaning).

Another long-term effect is an "undoing" of what negative affect does to us. When we are in the "fight or flight" mode mentioned earlier, the increased cardiovascular activity damages our heart and blood vessels, leading to atherosclerosis. Positive emotions and experiences helps to repair ourselves (Fredrickson, 2003)--which makes a lot of evolutionary sense: get chased by tiger, harm body; outrun tiger, have a laugh with our monkey buddies, recover body and repair damage. There are, of course, a lot of other physiological problems caused by stress that can be repaired in time with a positive affect, but this is the particular example (minus the monkeys) that the article touches on.

The author ends with saying that an artificial injection of positivity with humor or something similar may be beneficial, but not always appropriate in hard times. She suggests "finding benefits within adversity, [...] infusing ordinary events with meaning, and [...] effective problem solving" (2003).

Image provided courtesy of nuttakit / FreeDigitalPhotos.net

Doc and Chaps: Normalizing Psychology and Implementing Prevention Strategies

I've noticed quite a few articles that talk about prevention (including the first two articles for my positive psych class) and also trying to spread the word that psychology is not "just for crazies." But how do we do this?

The real life attempts I've seen have been interesting. Mental health fairs, talking posts, and advertising campaigns involving posters with a simple message: anyone can go to a therapist. But if you search for these terms, you'll see a lot about "awareness" themes focusing a lot on suicide and depression, or even just everyday stress. But these topics (while absolutely relevant and important) are the very reasons why the general public get scared away from us! 

Think of all the reasons why people don't want to see a therapist: 

• Freud. He is popularly known as a perverted psycho. While this may or may not be true, this is how a lot of people still see psychotherapy as a whole. They don't want to lay down on our couches and talk about how they want to bone their mother. That's just weird.*
• Avoidance. People spend a good portion of their lives trying not to think about sad or scary things. And, since this is what people think therapists are for, they try to avoid them. It's not necessarily healthy, but you can see where they are coming from, right?
• Misinformation. I'm sure that, if you are in the field of psychology or have told friends and family that that is what you are studying, someone, at some point in time, has asked you if you can analyze them or asked if you can read their mind. They feel like you are going to start probing their thoughts or some other crazy stuff (that would make therapy a lot easier, I bet). 
• Finally, a big part of it is that people feel like if they are associated with a therapist, they will be judged. A big movie trope is the lunatic who starts a date off with, "well, my therapist said..."

How can we change this?

Well, my first thought goes to the Navy, and the stark contrast between Naval physicians and chaplains versus the psychologists. "Doc" and "Chaps" were like local rock stars: they would walk around high-fiving, fist-bumping, telling jokes; even in their intimidating officer uniforms, you felt safe talking to them. When they just acknowledged your existence you felt special. But the psychologists, uniforms or no, hunkered down in their offices. They were stiff and uninviting, and if you had to go see them, it was usually because you were in trouble. 

So:

What if we took this route? In schools and colleges and even in larger workplaces, have a different kind of "Doc" running around? Obviously, they wouldn't be seeing patients all the time, but they would be a kind of "ambassador," if you will, to the rest of the psych department. Someone to monitor morale and spread the word about these "mental health fairs" and "talking posts." But they wouldn't have to focus just on mental health, either. They could be the ones to announce different club meetings (at schools) and occasionally hand out treats, or whatever. 

The only real drawback I see is if this person can't be seen as genuine. If it's too forced, it'll be obvious; introduction of this person would have to be slow. But I think if this idea is implemented all over the country (even the world, really), psychology as both a means for healing and for prevention could truly benefit. 

What do you think?

*Not judging, just sayin'.