Black Friday Also A Day of Listening

could say therapists are professional listeners. That doesn't mean we don't need to be
reminded to shut up and put our listening ears on, especially when it comes to our own families.
That's why I love that some clever person had this idea to
create a National Day of Listening.

The writer Studs Terkel practically invented oral histories. He listened to common folk, survivors of the Great Depression,
tell their stories.
He revealed the truth, that everyday people are the
true heroes of history, as much as generals or presidents. I wish I had had the forethought to record the fascinating stories my parents had to tell of their younger days, especially my mother who delighted in telling tales from her childhood.


Happy and Safe Thanksgiving, Everyone!

Humor! The Secret to Handling Holiday Stress

2316790301_5689642dddIn yesterday's post, When Spending the Holiday with Family is Like Walking Into a Minefield, suggestion #5 reads: See the humor whenever you can.

Humor is a magical de-stressor. We get so serious and intense about our lives we often fail to lighten up. I know it's time to unplug and restore when I lose my sense of humor. For me, as I've said before, it's the canary in the mineshaft. If that goes, I can say sayonara to everything else and hello to irritability, grinding teeth and peevishness. I become the annoyed and annoying at the same time. Yuck!

Much more fun to step outside the situation, observe and not care so much. So what if Uncle Milton has to dig up that tired, old story of how cute you were when you were five and sang the Oscar Meyer jingle in the middle of Mass? Let it go and make gagging gestures where he can't see you.

Granted it becomes a lot tougher if the stories are truly heinous or hurtful. In that case, why are you anywhere near Uncle Milton? Spare yourself and make other plans if you possibly can (Suggestion #3).

In most other situations, a bit of creativity is always welcome. I especially liked this idea from the article, Food, Kin and Tension at Thanksgiving. It's genius!


Surviving the Suicide of Someone You Love

My brother’s childhood best friend committed suicide. I was 16 years old at the time, Mark (not his real name) was 21. Mark’s parents were close friends of my parents; we played together as little kids, he was my first crush. We drifted apart as we grew up. Mark was a Kennedy-esque figure to me, handsome and smart. Everyone expected great things when he went off to an Ivy League law school. Then he was dead.

I have a vivid memory of walking around the neighborhood with Mark’s brother at night. The adults were sitting shiva and he had to get away. Suddenly he grabbed a fallen branch and wailed it on the trunk of a tree. Raw anger.

This family did heal. Before support groups or national days of recognition they talked about the conflicting emotions pain, anger, guilt. The same tape kept playing in everyone’s head:
If only… If only… They used therapy, the love of family, friends and good works, to find their way through. They found a way to forgive. 


Project Happily Ever After

Great name, right? Project Happily Ever After, a website/blog run by Alisa Bowman, a professional writer, was brought to my attention by a reader of this blog. Alisa's readers love her blog about her marriage and life with her family because it's fresh and very real. Alisa has ghost written and read a ton of self-help books. She is smart, genuine and has learned a lot along the way. Alisa shares how her marriage was once in dire jeopardy, how she and her husband learned to reconnect and fall in love all over again.  Her sense of humor is self-deprecating and funny!

In this post she describes how she tackles those pesky negative thoughts that can bring her down. It's all very consistent with Cognitive Behavioral Therapy. I thought you might enjoy a down to earth use of a basic CBT technique. Alison's take:

"Researchers know that depressive people like me tend to see the
world through a negative lens. For instance, on an unusually hot day in
the summer, a well-adjusted person might think, “This is a perfect pool
day!” A depressive person like me will think, “Definitely global
warming. The world is going to end soon.”

Years ago, a therapist taught me that I needed to counter my
unrealistic negativity by constantly feeding myself more positive,
realistic thoughts. At first, I didn’t think it would work, but she
told me that was just my Negative Voice talking. Don’t you hate when
your therapist has an answer for every excuse like that?

Anyway, I tried this positive affirmation business, and it worked amazingly well."

Some examples of Alison's positive self-talk are….

When Life Feels Too Hard

“Everything always works out eventually. This will, too. And if it
doesn’t work out, that means I’m dead, so it won’t matter anyway.”

“Anything is possible, even this.”

“Just put one foot in front of the other.”

When I’m Too Scared to Take a Risk

“It’s better to try and fail than to not try at all.”

“I need to do this. Otherwise I’ll always wonder, ‘What if I’d had the courage?’”

When I’m Wallowing in Self Pity

“Build a bridge and get over it.”

“There are much worse things than this.”

“This, too, shall pass.”

When I Feel Overwhelmed

“I’ll get it all done. I just might not get it all done today.”

“Am I really going to care about this when I am on my deathbed?”

When I Feel Like a Good-for-Nothing Loser that My Own Dog Doesn’t Love

“I’m definitely going to get my period tomorrow.”


Six Things I love About Cognitive Behavioral Therapy

411013618_62900d9571 The graduate school I went to, the Derner Institute at Adelphi University, is a professional school that teaches psychoanalytic, psychodynamic
psychotherapy. It wasn’t until my first post-doctoral job that I
learned about cognitive behavioral therapy (CBT) and whole new approach to helping people opened up to me.

I was very fortunate to get my CBT training from Dr. Arthur Freeman, who studied under Drs. Albert Ellis and Aaron Beck, the grand-daddy and daddy of CBT. Having in-depth education in both these modalities is like having a nice, deep bench for your basketball team. I can adapt easily to whatever my patient needs even if those needs change in the process of therapy.

My father was a Neo-Freudian psychoanalyst so the psychodynamic approach was super familiar to me. Discovering CBT was like discovering a whole new color in the spectrum. Awesome!

Basically and very simply put, CBT focuses on what is happening here and now to shape our thoughts which in turn influences our mood.  Psychodynamic therapy uses the exploration of past experiences and relationships, internal and external, past and present to provide insight and change in the patient.

Both approaches have a place in treating depression, anxiety and other mood and personality disorders. Here I share a few things I love about CBT in particular:


Doing the Unthinkable – Going Offline

"The biggest source of stress in
my life is the screen, the blogging." 

~Jessica Valenti, founder and editor of

What? I
mean, let's get real here. It must be really, really nice not to have a
greater crisis eating up your attention and time than blogging. On the
other hand, I understand exactly what Valenti means.

Anything can cause us to lose focus on what is fundamentally important, even seemingly innocuous things. For some parents it could be getting sucked into over-scheduling extracurricular activities
for the kids, for a college student it might be taking on too many
credit hours, for a young professional it might be the pressure of
passing their certification exams the first time around. I've known people to have serious debilitating anxiety over these things.

Why stress over such stuff when there are so many much more serious troubles in the world? Unemployment, illness, war. Take your pick.

Because it's our direct experience that's important to us, that's why. I tell my patients all the time, please, don't compare your stress to someone else's. It's like comparing pain of any kind. It can't be done. We can and I hope do, have compassion for each other but who am I to minimize the stress of a new mother just because her baby is healthy? Or of a young man, trying his hand at being an entrepreneur? These are good things, right?

Sure they are. But still it takes courage to do them and doing them can be stressful.

And what about blogging?  I know I needed a break this weekend. Not going online for a few days was hard the first day. Easier the second. Genuinely cleansing the third.

We all need a break whatever is causing us stress; a respite, a moratorium. If you can, I recommend closing the door on whatever is causing stress for you and getting back to some fundamentals like uninterrupted sleep, play time with the kids, cooking a favorite meal, eating it. 

You will get back to your unique not-to-be-compared life, refreshed and stronger.

The Medication I Hate But Can’t Live Without: Prednisone

Steroids, corticosteroids, prednisone.*

Do these words strike terror in your heart? Or are you grateful beyond measure for their existence? Both? Then chances are you, or someone you love, has a chronic illness that is reversed or relieved by steroids.

I have been on and off steroids, prednisone, all my adult life. Ever since my mid-twenties I’ve had a tumultuous relationship with that medication.

Steroids are miracle drugs. A synthetic compound that mimics the hormone excreted by the adrenal glands, they rev up the nervous system, reduce inflammation and suppress the immune system. Short term use, for five days to a week, is not usually a problem. The problem is with longer term use, when they are as toxic as they are beneficial. In her article Steroids’ Miracle Comes With a Caveat, Jane E. Brody, wrote:

“…as with any powerful remedy, corticosteroids come with a downside: side effects that can sometimes be as serious as the ailments they are intended to treat.”

No joke.

The doctor who first put me on prednisone neglected to tell me about the down side of the drug. My father, also a physician, didn’t warn me either. I’m still mad at both of them for this lapse in judgment (which is inconvenient because they are both dead). All they had to do was tell me:

You need this drug to keep your kidneys functioning well. You are on a high dose but we intend to taper you off after a few months, slowly, to reduce risk of a relapse and complications. In the meantime look out for:

  • insomnia
  • agitation
  • hyper, even manic mood
  • depression
  • irritability
  • increased appetite
  • weight gain

In other words, expect to be a coo-coo-bird nut-case.

Totally oblivious, I went back to college where I lived alone in a little studio apartment (which sounds a lot cuter than it really was). On my first night I had a serious case of the heebee geebees. I felt like someone had injected a double espresso laced with Red Bull right into my bloodstream. By morning a million bugs were trying to worm their way into every pore of my skin. I seriously thought I was losing my mind. Frantic, I called my doctor who nonchalantly (God, I’m so mad) said, “Oh, that’s the prednisone. Relax, it will get better. Don’t change the dose, whatever you do.”

That was my first experience with prednisone and I’ve hated it and loved it ever since.

Without prednisone, many of us would be crippled, in agony, suffocating or dead. I’ve been able to live a functional life because of steroids but I’ve suffered from them, too.

Twice my body became dependent on the steroid which meant every time my doctor (a new one whom I adore with all my heart) tried to get me off my kidneys would relapse. That meant I was on prednisone for years. Brody wrote:

“Steroids taken orally for more than three months can have more profound and sometimes irreversible effects. Serious side effects are more likely when steroids are taken in high doses for a year or longer.” And what are those serious side effects?

more weight gain
high blood pressure
deteriorating bone mass
thinning skin
muscle weakness
Fat deposits on the face (moon face), stomach, chest and upper back
easy bruising
increased sweating
heart disease
delayed wound healing
increased risk of infection

And all this is in addition to the first list (see above)!!!


A Veteran’s Day Salute to Women in Uniform

When I heard that the police officer who took down Hasan at Fort Hood was a woman, my heart swelled with pride for my gender. Not only a woman; Kimberly Denise Munley is a five foot, four inch tall firearms specialist and SWAT team member, nick-named 'Mighty Mouse' by fellow officers after she saved her partner from an assault while on duty.

Then I remembered a compelling photograph (#2 in the series) I saw recently on the front page of the New York Times. Attributed to David Furst of Agence France-Presse, the caption read: "United States Marines settled into a makeshift patrol base at the start of Operation Germinate in the restive Bhuji Bhast Pass in Farah Province, in southern Afghanistan." 

All four Marines in the photograph are women.

My heart goes out to all veterans of all wars. I could never do what they do everyday, have done and will do. I am especially proud of the women. I can't help it. When I was a kid playing 'Kill the Nazis' with my brothers and the neighbor kids, I was often relegated to being the nurse, "Because that's what girls do." It burned me.

They made it sound degrading.

If only I knew of the battlefield medical corps during the Civil War, WWI and II, Korea MASH officers, Vietnam; the WASPS flying troop carriers and supply planes behind the lines; the WACS and USO workers putting themselves in harms way doing everything and anything that needed doing.

The United States Department of Veterans Affairs estimates the total number of women veterans to be 1,824,198 as of September 2009. I'm assuming this number represents women vets alive today. The real number must be far greater. There was nothing degrading about their sacrifice, discipline and bravery.

Today women participate in every war-time job alongside men. This puts a new and special burden on our society to care for them, the men, the women and their families. We are still adjusting this new paradigm. I hope we get it right soon, for all our sakes.

Image: The Vietnam Women Veterans Memorial. Photo courtesy jcolman via Flickr

Thoughts on Rules to Live and Eat By

Two months ago I wrote Eight Mental & Physical Fitness Principles I Can Live With. I just re-read them because I needed a reminder. For whatever reason I am forever slipping and picking myself up again. Maybe the lesson here is that that's not so bad. Maybe slipping is OK as long as there's that golden mean we keep striving for. Perfection is a mean taskmaster, reasonableness is kind and nurturing.

Following that thought and guided by the sweet support from many friends on this blog and elsewhere, I am not going to get down on myself for being a bit up on weight. Like many people I went through a tough seasonal transition where the hibernation instinct pulls us to eat great big mounds of pasta and mashed potatoes. Deciding I'm beautiful no matter what the scale says (Principle #8), I didn't chain myself to the calorie counter for a month. Instead I listened to an inner voice of reason that allowed some indulgence (big bowls of popcorn traditionally popped in veggie oil) but drew the line when it came to cookies and brownies. I eat less cheese, upped my fruit intake and gave up coffee, not because of weight but because my insides feel better for the change. 

Now I'm ready to go back to food journaling and exercise only in a kinder, gentler manner. This suits me, for now, until I slip again. Or maybe it's not a slip. Maybe it's a tactical realignment. Hm…something to think about.

As a non-caloric treat today I want to share this article by Michael Pollan: Rules to Eat By. It appeared in the New York Times Magazine last month. Pollan has been featured on this blog before (An Omnivore's Deduction). His writing on food and Americans' relationship to it, is simple, direct and plain spoken. He's like the Mark Twain of food journalism. His article shared twenty "rules to eat by" from the thousands that he's collected for his new book, Food Rules: An Eater's Manual (out in January '09). Here are five of my favorites:

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