6 Things I Know About Grief

A few months ago my friend Bruce Barber asked me to write a response to the question "How do you cope with the loss of a love one?" for his website, Real Life Survival Guide. Here is what I wrote:

My first real life up close experience with grief was when my dearest friend and her brother were killed in a car accident. We were just twenty-three years old and had known each other since kindergarten. Her death, and the death of her brother, had a profound impact on how I came to view life and life's loss. Nine years ago my mother died of pancreatic cancer and two years later, my father quietly died in his sleep. While each death is unique and tells its own story, the process of grief followed the same path.

Here's what I know about grief.

1) Grief is natural, even though it doesn't feel like it.

2) Grief is not depression, even though it puts you in the deepest sadness.

3) Grief cannot be hurried, even if others say it is time to 'move on'.

4) Grief is not linear; sometimes it feels like a quiet, cloudy day, the next a battering hurricane and back again.

5) Grief is sneaky, be prepared to be surprised by it.

6) Grief is necessary; even though it is our instinct to avoid pain, allow it.

In my practice I've seen people who have suffered horrible loss – a child, a spouse. They come because they are having trouble 'getting over it'. There are rare cases when grief does get stuck and morphs into major depression or dysthymia. Years after the death of a loved one, carrying on healthy relationships with the living, work or caring for their family is too great a burden. People who find themselves in this kind of situation do need professional help and I am glad they come to me.

But in many cases, the bereaved just needs time and the assurance that their pain is natural. There is a reason most cultures set aside an entire year for mourning. In a year we experience all those 'firsts'. The first Mother's Day without my mother was brutal. My first birthday. After a year, it still hurt. But each subsequent year hurts less and less until they are dull echos of the first.


A Conversation About Lawyers with Depression

If you are in the Western New York neighborhood tonight, I encourage you to attend A Conversation About Depression hosted by attorney Dan Lukasik. Dan is a fellow traveler.  He has experienced the dark hole of major depression himself, and has made it a personal mission to inform other professionals, especially lawyers and judges, about diagnosis, treatment and living with depression. His website and blog, lawyerswithdepression.com is full of helpful information presented in an attractive, readable format.

Professionals of all stripes, doctors, lawyers and Indian chiefs, often have trouble,

1) admitting they have a problem and

2) reaching out for help.

Professionals are trained to think for ourselves and to take pride in being self-sufficient. Heck, we define ourselves by that old attitude:

"Pull yourself up by the bootstraps!"

"Stiff upper lip,"

"When the going gets tough, the tough do anything but stop and consider therapy!"

It could be that people who enter the professions self-select for stubbornness. It could be what we learn self-sacrifice in our training. It could be that society, which expects a great deal from us in terms of role modeling, puts pressure on its professionals to keep fighting even when they are down for the count.

Dan Lukasik knows about this from the inside out and wants to help other professionals, lawyers in particular, to not wait, to get the help they need to climb out of depression. Here is how his article, One Attorney's Depression Story, which appeared in Trial, a journal for the American Association for Justice, is introduced:

Editors’ note: In a seminal study published in 1990, researchers at Johns Hopkins University found that lawyers were 3.6 times mo re likely to suffer from depression than members of any other of 104 professions studied. Since then, smaller studies and data from bar association lawyer-assistance programs continue to confirm that many attorneys are plagued by this soul-sapping and sometimes life-threatening disease. Other research has shown that suicide is a leading cause of premature death among lawyers. Here, a plaintiff attorney who has confronted his illness shares the story of his ongoing struggle for mental health, and his law partner tells how their firm helps him cope while maintaining a successful litigation practice.

Dan Lukasik's talk tonight, Monday, September 27th, is at 7PM at the Wick Center at Daemen College, 4380 Main Street in Amherst.

If you are a professional who requires the utmost confidentiality and you wish to explore options for treatment of depression or anxiety, please call me at 716.308.6683. You can learn more about me and how I work at explorewhatsnext.com.

Explore What’s Next Blog Among Top 100 Blogs for Depression!

When the Nursing Schools blog informed me that the Explore What's Next Blog was on their top 100 list for blogs on depression, I was thrilled… And then I wanted to know what number? Yes, I am petty like that.

I don't know that it matters, the person who runs the site doesn't say. Are they rated or are the blogs listed randomly? EWN is number 76 which is wonderful! I mean, #76 in the world! Not bad! EWN is in good company, with the likes of Beyond Blue and the Happiness Project. I look forward to checking out many of EWN's fellow listees that I am not yet familiar with.

Nursingschools.net is a website that helps people interested in a nursing career to navigate all the possible career paths in nursing and how to get there. Their mission is to inform future nurses of many health related topics and they do it well. Here's what they say about depression:

"About 9.5% of Americans each year suffer from a mood disorder of some type, and 18.1% must face down some type of clinical anxiety. Depression in its myriad twisted forms is the leading cause of disability between the ages of 15 and 44, sometimes co-existing with bipolar disorder, anxiety disorders, obsessive-compulsive disorder, borderline personality disorder, schizophrenia, eating disorders, substance abuse, self-mutilation, suicidal thoughts or actions and many other serious conditions. Unfortunately, society's entirely unfair stigmatization of the mentally and emotionally unbalanced leads sufferers to feel even more isolated — even leading some to dangerously avoid seeking treatment altogether. However, more and more people are bravely emerging from the wrongfully-imposed shadows to open up to the world about the challenges they must conquer on a daily basis. Nobody suffers alone, no matter how marginalizing the general public forces upon them."

Click here for the entire list!

There’s No Place Like Home, Over the Rainbow

'Over the Rainbow' was on the childhood soundtrack for me, a Kansas girl. It was a favorite of my mother's, who adored Judy Garland. I sang it at many family events, the last time at my father's memorial service. Everyone in attendance sang along.

When I was a kid, once a year, my family gathered around the one television in the house to watch the 'Wizard of Oz.' That was a big event back then before movies on demand or DVDs. By the time Dorothy said, "There's no place like home!" everyone in the place blinked, pretended they weren't sniffing away tears. 

I love this fresh new rendition of a lovely, iconic, old song done by the cast of Glee. Enjoy!




10 Challenges for Parents With Chronic Illness

In the Parents Magazine article, “Mommy Isn’t Feeling Well Today,” Sarah Mahoney interviews many experts: professionals, parents who have chronic illness and sometimes, as in my case, people who are both. The article is impressive in how it covers many of the challenges parents face every day rearing their kids while their health is seriously compromised.

Below I summarize the article’s most salient points and add my comments:

1)  “Handling chronic illness is about learning to live in balance,” said Rosalind Doran, Psy.D.

Many of us learn the hard way that if we don’t pay attention to what and how much we do in all spheres of our lives we can quickly over-do. The result is the same as when the tires on our car are out of balance. We’re in for a very bumpy ride.

2) “You can’t dwell on questions like. ‘Why is this happening to me?’ or ‘What if it gets worse?’ It’s important to focus on feeling well and to maintain a positive outlook.”

Yes, this is more easily said than done but this is an important point and one I’ve made before. If you have a chronic illness, and I do, there is a danger that we will over-identify with being a sick person. We are not our illness and it really does matter that we make the effort to see the cup half full.

3)  The first hurdle is revising expectations of family life. “Of course, you can still be a loving parent, but some adjustments will have to be made. Your family will not look the way you imagined it would. That’s a loss, and it hurts a lot.”

In order to move on, down a new path, we need to let go of what may have happened if we had gone down another. If we hold on to, “What would my life have been like if I wasn’t sick?” we deny ourselves the opportunity to create a real and satisfying present.

4)  A chronic illness may change your plans about having more children.

That may mean imagining a life with fewer kids, considering adoption or even remaining childless. I had to accept the very real possibility that I would not be able to have kids. As anyone who has been through such an agonizing reality, there is a mourning process, a grieving that takes place. For many women there is also a feeling of guilt (could I have done something to avoid this?) that must be let go.


Myth Buster Quiz Answers

1) Psychotherapy means lying down on a couch.  Answer: T & F!  Usually therapists do not require their patients to lie down on a couch. We often have comfy couches in our offices but I think it’s fair to say they are there for us therapists to take naps on in the middle of a long day! :-) On the other hand, there are therapists who offer their patients the option of reclining, to enhance comfort and trust in the process. Still others practice a particular kind of psychoanalytic psychotherapy for which non-face to face communication encourages the sub-conscious to speak up, helpful to the analytic process. But in general, the lying down on the couch thing is more often seen in New Yorker cartoons than in real life.

2) In therapy, all the therapist says is, “How did that make you feel?” Answer: If this is really all your therapist is saying, be direct with them and let them know you need more from him/her, or consider finding a better therapist.

3) Psychotherapy takes years to be effective.  Answer: T & F  In the old days, psychotherapy meant a commitment of five sessions a week for up to twenty years (Woody Allen is famous for talking about the length of his analysis.) We’ve learned a thing or two in the last seventy-five years. Today we have effective solution-focused treatments, cognitive behavioral techniques and empowerment exercises that encourage a shorter term treatment. On the other hand, there are times, for many reasons, we need a longer term supportive treatment and there’s nothing wrong with that as long as both the therapist and the patient are working toward independent resilience and not encouraging dependence on the therapist or the process.

4) All you need is medication to treat depression.  Answer: Study after study demonstrates that the most effective treatment for many types of mental health issues is a combination of a good talking therapy with the right medication prescribed by a psychiatrist. For mild to moderate issues the talking therapy alone is all the is needed.

5) Depression/anxiety means a person is just weak.   Answer: F  Depression or anxiety can strike anyone, at any time — whether you’re “weak” or strong, it knows no bounds. Some of the strongest people I’ve ever met are people who’ve coped with depression or anxiety at some point in their lives.

6) Depression/anxiety only effects old people, losers or women.  Answer: F While more women than men are diagnosed with depression, men suffer from it all the more since many people in society believe that men shouldn’t show signs of weakness (even a man’s own upbringing may reinforce such messages).  Depression is not a normal part of the aging process. In fact, teenagers and young adults grapple with depression just as much as seniors do. Successful people have also had to deal with depression, people such as Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan and Michelangelo. Being a loser is not a prerequisite to being depressed.

7) All mental health issues boil down to low self-esteem.   Answer:  F  Research shows that low self esteem isn’t strongly associated with poor mental health. In a comprehensive review, Roy Baumeister and his colleagues canvassed over 15,000 studies linking self-esteem to just about every conceivable psychological variable. They found that self-esteem is minimally related to interpersonal success, and not consistently related to alcohol or drug abuse. Moreover, they discovered that although self-esteem is positively associated with school performance, better school performance appears to contribute to high self-esteem rather than the other way around. Perhaps most surprising of all, they found that “low self-esteem is neither necessary nor sufficient for depression.” In my experience, low self-esteem is more likely to be the result of mental health, situational and relationship stress than the cause.

8) The best way to manage anger is to express it, don’t hold back.  Answer: F More than 40 years of research reveals that expressing anger directly toward another person or indirectly toward an object actually turns up the heat on aggression. In an early study, people who pounded nails after someone insulted them were more critical of that person. Moreover, playing aggressive sports like football results in increases in aggression, and playing violent videogames like Manhunt, in which participants rate bloody assassinations on a 5-point scale, is associated with heightened aggression. Research suggests that expressing anger is helpful only when it’s accompanied by constructive problem-solving designed to address the source of the anger.

9) All mental health problems are biologically/medically based.  Answer: F  While emotional issues, such as depression, has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure.

10) People tend to go crazy when the moon is full.    Answer:  F  In 1985, two psychologists reviewed all available research evidence on the lunar effect, and found no evidence that the full moon is related to much of anything — crimes, suicides, psychiatric problems, psychiatric hospital admissions, or calls to crisis centers. Later investigators examined whether the full moon is linked to suicides, psychiatric hospital admissions, dog bites, or emergency room visits, and came up empty-handed.

We hope you had fun with the quiz and if you learned something too, that’s a bonus! Good health!

The Williamsville Health Fair & the Myth Buster Quiz!

It's the weekend! Let's have some fun!

If you are in the neighborhood head down to the Williamsville Health Fair. We are celebrating holistic health which of course includes our emotional, spiritual and mental well being. There will be thirty plus vendors at the Fair, giving away stuff like head and neck massages. Pick up a Health Report Card and get a free fitness evaluation on the spot. You do not want to miss this!

The Explore What's Next booth is in the big Common Room upstairs. Come by for some calming tea, browse through our favorite self-help books and enter our gift card raffle!  $100 worth of gift cards for Tim Horton's, Wegmans, iTunes and more!

In the spirit of fun, while simultaneously shattering some mental health misinformation, we developed the Mental Health Myth Buster Quiz. Come by and fill out the quiz, enter the raffle, hang out with us and have some tea and chocolate!

We look forward to seeing you there!

Horses Help Heal Our Wounded Warriors

Thanks to Mac, my friend on Facebook, I learned about this wonderful program that uses Equine Assisted Therapy to help veterans with PTSD.

Maze, a licensed clinical social worker, offers this program for
soldiers stationed at Fort Gordon, Georgia in the Warriors in
Transition Program. 

"I've always wanted to come
back and work with the military…Equine Rescue of Aiken [South
Carolina] is a perfect match. We have horses who need healing and we
have soldiers and people who need healing."

She goes on to describe the special power horses have…

all have their own style of therapy that they like to work with. One
horse likes to work with people who have Attention Deficit Disorder,
another works with those who have mental challenges; [the horses]
migrate toward them. I worked with civilians in Kentucky. We have a
conscious mind, things that we're aware of, and we have [the]
sub-conscious and unconscious. The horses seem to be able to get at
that innate sub-conscious…things the person being treated may not
recognize. It makes people think outside the box to come up with their
own solutions."

Suze Maze
has what it takes to be a qualified equine therapist. On her Facebook
profile page, she says, "After a forced retirement from riding
racehorses for 20+ years, then
pursuit of a professional career as a licensed clinical social worker,
I am now able to combine them both with Equine Assisted Psychotherapy."

Anyone wanting to learn more about this particular program could contact Suze directly at Operation Open Arms. You can get more information about other Equine Assisted Therapy programs at the Equine Assisted Growth and Learning Association website (EAGALA). They have programs around the world.

A Message From My Weight Loss Journey

My goal was to prove that I, a 56 year-old woman, could lose weight and maintain a healthy level of fitness without spending a ton of money on a gimmick, pills, pre-packaged food, extreme diets or (shudder!) surgery.

After years of searching, a few months ago, around mid June 2010, I finally found a healthy lifestyle that works for me. Maybe it would work for you, too.

I love the Mediterranean diet. Not a diet, but more like a way of eating that suits my entire family. The Mediterranean diet is full of juicy, colorful fruits and vegetables. I also use Michael Pollan's Food Rules as an eating guide. In this little book is the wisdom of a thousand grandmothers and the findings of laboratories full of scientists. Also, my husband and I meal plan and grocery shop together which helps a ton! 

For food and calorie journalling I use the Lose It! app on my iPod Touch. It's free. I love, love, LOVE that little app! As my daughter would say, I want to marry it, I love this app so much! Lose It (check it out on Facebook) makes counting calories super easy, so easy there is no excuse to cheat, none, and that makes a world of difference.

For exercise I do what I love, whatever feels good on that particular day. My favorites are yoga, run/walking on my treadmill and horseback riding. For you it might be gardening, bike riding, tennis, golf, walking the dog, it doesn't matter. What matters is movement every day. Choose activities you love. It will keep you young.

Finally, I, a psychologist, am learning that my mind can be devious and I need to keep an eye on its tricks that keep me lazy and overweight. To help me with this process I faithfully follow Our Lady of Weight Loss, Janice Taylor, and others who advocate mindful eating and loving yourself thin. I've always been an advocate of using the carrot rather than the stick to influence behavior. It just took a freaking village to get me to apply this loving, creative, divine philosophy to my own weight loss journey.

It is a journey – never ending, forever challenging. And that's a good thing! Now that I'm on this path the weight is coming off and I am in awe.

See more on My Weight Loss Journey page. Your comments are most welcome! 

Losing Weight & Body Hate

6a00d83527e90e69e2011570b54069970b-800wi Do you ever have 'fat' days? I know, I know… Is the Pope Catholic?

Yesterday I felt fat. My mind was convinced I had gained back every single pound I lost over the last three months. It took effort to talk back to my mind. I said, "Mind, that's impossible. Even if you gained a few pounds since Sunday, it's nothing. You really did lose that weight and you have been eating responsibly. Cut it out!"

This morning I did something I usually resist doing. I weighed myself. I decided it was better to just know what I was dealing with. The scale said 145.0, down half a pound since Sunday. Was I happy? Hell, no! I got off and back on three times, convinced my scale was blatantly lying to me! I was actually looking for a higher number! Who does that?

Clearly that strategy didn't work. I should have known better. Living and dying by the scale, not a good idea. I still feel big. Is it the heat? We don't have air conditioning and there's another heat wave going on. Is it a matter of saying goodbye to the weight lost? Why am I 'holding on" to it? Am I afraid? I thought I was done with that. Hmmm.

There is a degree of self-criticism going on here. I've always been an ectomorph (I think that's the right term.) My body resembles a rectangle, small breasts, flat butt, thick waist. In a better mood I would say it's an athletic body, good for throwing javelins, riding horses. When I'm overweight the rectangle just gets bigger all over, which I'm told is a good way to gain weight. The ectomorph hides extra pounds well.

Now that I've lost weight the opposite seems to be true as well. My body hides the weight loss too. Well, that stinks. I was hoping I'd morph into Audrey Hepburn and instead I still look more like a tree trunk.

OK, that is enough! Somehow I got sucked into hating my body again (probably from reading too many fashion magazines. Damn you, September Vogue! How you tempt me!) and even I know that is so unhealthy! My body has gotten me through thick and thin. (Arg! I didn't just say that…)

What I mean to say is… My body is my friend, my dear, dear friend. It has been through emotional wars with me, fought the battles of illness, death and hardship. It has also given me joy through communicating to me the gifts of the universe through my senses. It made my children, for God's sake! I love my body, no matter what size it is in.

There. That's a much better place to be. Now that that insanity is over, I think I'll go take my body for a much deserved mani-pedi! Care to join me?

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