Today is World Mental Health Day!

Today is World Mental Health Day!

It is easy to dismiss treatment for mental health problems as a luxury. Even in my typically American middle-class community in Western New York, people have to make hard decisions about what gets attention. Will it be renovations to an aging house, tuition for college or psychotherapy?

There is a tendency to put our mental health struggles on the back burner with the hope that things will get better by themselves. When they don’t, even educated, so-called sophisticated people take it as a personal failure. That causes us even more pain, more isolation, deeper mental illness.

Take that scenario and make it global, across cultures, across socio-economic strata, across all levels of industrial development. The same issues that prevent my neighbor (or me for that matter) from getting mental health treatment may be what keeps a young man in Sri Lanka from seeking help.

Mental illness is not just a first world problem. The Secretary General of the United Nations wrote:

“Poverty, unemployment, conflict and war all adversely affect mental health. In addition, the chronic, disabling nature of mental disorders often places a debilitating financial burden on individuals and households. Furthermore, individuals with mental health problems – and their families – endure stigma, discrimination and victimization, depriving them of their political and civil rights and constraining their ability to participate in the public life of their societies.”

What can we do to change things? By being part of the solution:

1. Let’s look at our own lives. Prioritize your and your family’s mental health by educating yourself and seeking the advice of a good mental health professional.

2. Let’s pay attention to how we may carelessly support stigmatizing, discrimination and bullying of those with mental health struggles.

3. Let law makers know you advocate adoption and promotion of mental health policies, laws and services that support comprehensive education, employment, housing and social services for people with mental disorders.

“If someone has a broken arm, you feel sorry for them. But when (the problem) is psychiatric, people don’t know how to react because they can’t see anything.

But just because you can’t see someone’s pain, it doesn’t mean they don’t need your care and support.”

~Samoan woman with bipolar disorder, 29 years old, Auckland, New Zealand

Video: When a Good Ego Defense is Like a Helmet

One of the best books I was assigned in graduate school was Anna Freud’s, The Ego and the Mechanisms of Defense. Here is a quick review:

When The Ego and the Mechanisms of Defense was first published in German in 1936 it was at once recognized as a major contribution to psychoanalytic psychology, and its translation into English quickly followed. More than half a century later it enjoys the status of a classic. Written by a pioneer of child analysis, and illustrated by fascinating clinical pictures drawn from childhood and adolescence, it discusses those adaptive measures by which painful and unwanted feeling-states are kept at bay or made more bearable.

Anna Freud’s arguments have a clarity and cogency reminiscent of her father’s and the work is remarkably undated. Nothing stands still, but The Ego and the Mechanisms of Defense has unmistakably passed the test of time.

The take away message from this book that stuck with me is that ego defenses such as denial, repression, identification and rationalization work to protect ourselves from painful anxiety. The defenses themselves are a gift from nature, just as anxiety is when we need it to warn us there is something in our environment that could harm us. It’s just that both anxiety and the accompanying defenses can get stuck in overdrive, causing us to over-react, over-compensate and generally over-mess up our lives.

So how can we tell when our defenses are good and when are they getting in the way? That’s a tough one. My first answer is the fall back, “I don’t know how to define it but I know it when I see it.” That’s lame and not helpful. Sorry.

What I can say with confidence is that most of the people I work with, people with thin skins, (and most people with depression or anxiety have thin skins) need to boost their ego defenses, not lower them. They need permission to put up that force field so that the nasty people or the difficult situations can’t hit them so hard.

By the way, I mention half chaps  in the video and forget to show you what they are. You can click here to see a photo. Half chaps are these cool gator-like leg coverings that slip over your paddock boots. They protect your lower legs which work hard applying aides to your horse. The times I rode hard, like during a lesson, without half chaps or full riding boots, my inner legs felt bruised and tender. Ouch!

This video was shot in the Spring of 2011. (I have no idea why it took so long for me to publish it.) I compare the gear I put on to protect myself when I ride Annie to allowing myself to have good protection for my self-esteem. Please let me know what you think in the comments! Your input is very much appreciated.


Overwhelmed? Stop & Take Your Mood Temperature

When we get overwhelmed we tend to see things in black and white. Depressed, sad, angry, anxious, take your pick of mood, when the going gets tough, it can feel like a heavy wet blanket of yuck. We feel helpless to do anything about it, it is too consuming, a blinding fog, and feeling hopeless isn’t too far behind.

Instead of giving into the dark feeling, stop and take a closer look. Take your mood temperature.

Using a 0-10 scale, assign the extremes first because they are easiest. Think of an old-fashioned thermometer: 0 is totally relaxed, happy, content, free of strife, however you want to describe bliss, that’s 0. The temperature rises as the stress level and the negative mood rises so 10 is the extreme version of whatever your particular bugaboo is: panic, out of control rage or depression so oppressive you are thinking self-destructive thoughts.

Five might be having moderate stress to deal with but feeling like you have it in control, in balance. Now describe the numbers in between 0-5 and 5-10. Under 5 you may experience increasing stress but still maintain a sense of control. On my scale for anxiety, even up to 6, I feel like I still have enough of a grip that I can easily apply coping techniques to get the temp down.

Seven and above is when the negative mood may be getting out of control and intervention is called for, like taking a mental time-out, conscientiously addressing negative thoughts with more reasonable thoughts, calling a friend for support, or your therapist, if your temperature is rapidly heading for higher numbers.

The idea behind the mood thermometer, developed originally by child psychologists to help children learn how to describe what they were feeling, is to become more sensitive to the nuances of mood. In other words, we can be more effective in dealing with our mood if we can see the different degrees of color in between the black and white. If I only see 10, I am overwhelmed. Also, it is easier to do things to keep from boiling over if you catch the bad mood before it gets too hot. If I stop and note that my mood is more like an eight, or a 7, I can do something about that. Improving my mood suddenly seems attainable.

Confessions of An Easy Crier

Have you ever had anyone tell you to stop crying? That just drives me nuts. Too often when people see tears they assume you are out of control. Not true. Actually when people say ‘Don’t cry’ (especially men, let’s face it) it’s because they are uncomfortable with your tears, not necessarily to comfort you.

This used to happen to me a lot until I learned that there was no good reason for me to feel bad about crying. I’m an easy crier, and proud of it! It took a long time for me to be comfortable with my low tearfulness threshold but once I did it was liberating. Finally instead of worrying about bursting into tears I could just concentrate on what was going on to cause the swell of emotion.

Anything could bring on the lump in the throat and stinging eyes, from a sappy movie trailer to a heartbreaking story about children violently orphaned to a genuine hurt from someone I cared about. Happiness, anger, remorse… basically I’m an open book kind of person.

I read somewhere that there are people who are born with ‘porous auras’. They feel things easily. Not to be confused with ESP, it’s just a heightened sense of empathy. I think this sensitivity is in part what makes me a good therapist but not a good companion at slasher movies.

If you’d like to read more about the self-discovery and science of crying, go to my post on PsychCentral, “…I’ll Cry If I Want To”, and let me know what you think.

Illustration courtesy of The|G|TM via Flickr

Post-Traumatic Stress Disorder, Heart Attacks & Other Medical Traumas

Ever since the relapse of my kidney disease I’ve struggled with depression, with the close to twenty pounds I’ve gained because of the medication I have to take and fatigue. This relapse brings back the memory of all recurrences of the disease from the past and that’s a bummer. But I don’t have to worry about sudden death.

Not so for thousands of people who live with the memory of surviving a heart attack. A study reported by Tara Parker-Pope in today’s New York Times sheds light on what many of us in the behavioral health field have known anecdotally for a while. A significant number of people who have experienced a sudden cardiac event develop symptoms of post-traumatic stress disorder (PTSD).

It makes perfect sense. My first job as a newly minted psychologist was at Mt Sinai Medical Center in Manhattan where we studied and treated post-stroke depression. A stroke is another kind of “attack.” The survivors fought hard to recover from the physical effects but often overlooked how the experience was effecting them emotionally.

Both the study I was a part of many years ago and this more recent one out of Columbia University Medical Center, suggest that the presence of PTSD symptoms can contribute to poor disease management, like  not taking medication because taking it every day provokes strong negative feelings like anger, sadness, and underneath it all, fear: “I hate that I have to take this pill because it just reminds me of how fragile I am.”

Hypervigilance, can also be a problem. Those of us who live with chronic conditions that go in and out of remission fight with the ghost of hypochondria. Every little twinge, every little pain is like a sudden loud sound for a combat veteran. “Is it happening again?”  is a life and death question for heart attack, cancer and stoke survivors.

All this stress, sleep problems, anxiety, without proper diagnosis and treatment, may lead to the very thing cardiac patients wish to avoid, another heart attack. PTSD and depression probably also contributes to slower recovery as we found in our post-stroke depression study.

The good news is that PTSD is treatable with good psychotherapy and if needed, anti-depressant medication. If you or someone you know is having a hard time coping with life after a heart attack, or any life threatening sudden event please reach out to a good therapist. You can always call or email me.

Read more at Carolyn Thomas’s Heart Sisters: Not just for soldiers anymore: Post-Traumatic Stress Disorder after a heart attack.

Photo courtesy Sofia Francesca Photography

Depression: What is it? What does it feel like? How is it treated?

The statistics on depression are depressing. About 5% of the world’s population suffers from depression at some time. In the US depression is the leading disability for people between 15 and 45 years of age. Chances are good that you or someone close to you has experienced depression first hand. There are so many myths and misconceptions around depression it is refreshing to watch this program, Charlie Rose Brain Series: Depression, where intelligent people explain what depression in all it’s forms looks like, can feel like and how it can be treated.

What I appreciate about this program is that these experts, the people who study depression as well as those who have experienced the worst kind of major depression first hand, all state that psychotherapy alone, or with medication, is a powerful treatment for depression. Too many physicians out there are very quick to treat their depressed patients with Zoloft, Wellbutrin or whatever, and do not bother to make a referral to a good therapist. Offering drugs alone may be depriving their patients of the most effective way to not just get them out of depression but to help them stay out. Depression, like anxiety, can relapse. Good psychotherapy provides people with psychological, emotional and behavioral tools that can be used as needed.

Medication is good. Psychotherapy is good. In combination, for some of the worse, most stubborn depression, they can be the needed one two punch.

Click here to view the program’s video. It is an hour long show well worth your time.

Mike Wallace & Depression

Mike Wallace always seemed really old. His face was craggy, his voice rough and deep. He was on 60 Minutes, a news magazine show that seemed to be an old person magnet. Sadly in our culture it’s easy to dismiss old people as not relevant. It wasn’t hard for me to forget what a pioneer Wallace was, and not just in journalism.

Upon his death at 93 years old, I read a few articles about Mr. Wallace.

At his lowest and most desperate, a bottle of pills and a suicide note seemed like the only answer for the legendary journalist Mike Wallace.

Whoa! That got my attention. Mike Wallace was not known for being warm and cuddly, weak-willed or a pushover. His reputation was made for yanking people in power under a glaring light; holding them to accountability. He asked the uncomfortable questions most of us were thinking but were too intimidated to ask. I did not know he ever experienced the dark desperation of major depression.


Celebrate National School Counseling Week!

National School Counseling Week 2012 will be celebrated from February 6-10 to focus public attention on the unique contribution of professional school counselors within U.S. school systems. National School Counseling Week, sponsored by the American School Counselor Association, highlights the tremendous impact school counselors can have in helping students achieve school success and plan for a career.


The school counselors of my kids’ school district are awesome. My husband and I have gone to them several times for help and they have always stepped up.

The first time was when my son was in second grade. At the time my mother and father had moved into our home while she received palliative care for pancreatic cancer. My house was Grand Central Station as my brothers and sisters rotated through from their homes in other parts of the country. We thought my son was doing great handling all the chaos at home. Little did we know his frustration was just going underground. When his teacher expressed concern, I made a bee line to his school counselor. Right away I knew my son was in good hands. Together with the school psychologist, she was able to give him the opportunity to process his anger through play therapy.


Investing in Therapy

“I have [a] good friend who borrowed against his house to pay for a therapist. Unless you were walking in his shoes you might think that was stupid, but it saved his life and changed his career. It ended up being one of the best investments he ever made.”

~Carl Richards, Author of “The Behavior Gap:

Simple Ways to Stop Doing Dumb Things With Money,”

Looking for a Good Therapist? Call Dylan Broggio, LCSW


Do you have a child you are worried about but don’t know how to help her? Are you a young adult overwhelmed with the sudden pressure of grown up responsibilities? Maybe you’re in a relationship that doesn’t feel right but you wonder if you should give up and settle?

It is hard to find good therapist. You don’t have a lot of time to ‘shop around.’ And when it comes to your vulnerable self-esteem, or the well-being of your child and family, the importance of finding just the right person to work with is especially important.

If you haven’t met her yet I am very proud to introduce you to Dylan Broggio, LCSW! Dylan came to Explore What’s Next with over ten years of experience helping kids, teens, adults and families cope with stressful events in their lives that provoke anxiety and depression.

Dylan is approachable and smart. She brings an enthusiastic energy to her practice. Her clients appreciate her great sense of humor, genuine understanding and empathy.

For your convenience, Dylan has open hours in the evenings, after five, and on Saturdays. This will be especially helpful for students during the school year or individuals and families in need of greater scheduling flexibility. Dylan is adept at using Skype for long distance consultation as well.

Among the many things I admire about Dylan is her genuine love of this work while keeping high professional standards. Dylan truly lives up to the requisites of an Explore What’s Next therapist: Qualified, kind and easy to talk to.

Dylan is taking new clients now and offers a free initial 30 minute consultation!

Contact Dylan directly at 734.474.6987 or email her at

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