Dear Tony,
A while ago I was reading a book about a burn unit. One point the book made was that in first- and second-degree (mild to moderate) burns, the person is often in excruciating pain. As difficult as it is to endure, that pain is actually a good thing: It means the nerves are intact. On severe, third- and fourth-degree burns, often the nerves are destroyed and the person cannot feel pain.
In my experience that analogy often holds true for mental illness. When we are dealing with really severe pain our sensors become dull or shut off and we can’t really feel it. As we gradually become better, we start to feel more. And our reward for becoming more healthy is that we are hit with these feelings to which we had previously been numb. As we become more able to feel and process pain, we feel and process more pain.
I have had some horrible things happen to me. I would imagine that you have, too. Pain is a healthy and natural response. Not feeling pain after a deeply traumatic episode would be unhealthy. I am learning to process through them piece by piece and step by step. But I don’t really want the pain to go away. I just want to learn how to process it better.
Being in pain can be a good sign. Growing better can often mean feeling worse. That is difficult to take at first, but you need to learn to work through these feelings a little at a time. There are ways to process pain, but it takes work.
Sunday, April 28, 2013
Thursday, April 25, 2013
Improving Your Skills
Dear Tony,
Do the best you can. I tell myself that over and over again. Just do the best you can with what you have.
When I was sicker, I was extremely dependent on my moods. When I was in a good mood, I could do a lot and start a lot and make progress moving forward. When I was in a bad mood, I could not compensate. I would try and try and try, but I could not make my mind work the way I wanted it to.
It took a very long time to fix that problem. It took considerable skill-building when I was in a good mood. Slowly and gradually I was able to do more even when I was upset. Frankly, I still have some problems with that. When I am upset I need to rest and compensate. I can still accomplish some things, but not nearly as much as when I am feeling better.
Being in a good mood has some pitfalls, too. When I am feeling well, I want to try to make up for missed time and accomplish everything at once. I may try to start everything at once and then become upset when I can’t follow up with it. I have learned to step back and choose the most important things to accomplish, and then stick with them. I may not finish everything, but generally the more I can do the better off I am.
More often, I start to work and make progress and then become annoyed when I cannot comprehend everything. The world is a complex place, relationships are very complicated, and no one person cannot possibly understand everything. That is difficult for me to swallow. I want to know everything, and I grow upset when I realize how much knowledge I am missing. Just do what you can. I read once a long time ago to just try to be 1% better every time you try. That can help. We all need to learn that again and again. You don't need to make large steps - only to continually keep making small steps. Look closely at the details of a situation and figure out something you can do - anything. It does not have to be big (it probably shouldn’t be big at first). But look at the details and find some way to make your life or your work or your relationships better.
Do the best you can. I tell myself that over and over again. Just do the best you can with what you have.
When I was sicker, I was extremely dependent on my moods. When I was in a good mood, I could do a lot and start a lot and make progress moving forward. When I was in a bad mood, I could not compensate. I would try and try and try, but I could not make my mind work the way I wanted it to.
It took a very long time to fix that problem. It took considerable skill-building when I was in a good mood. Slowly and gradually I was able to do more even when I was upset. Frankly, I still have some problems with that. When I am upset I need to rest and compensate. I can still accomplish some things, but not nearly as much as when I am feeling better.
Being in a good mood has some pitfalls, too. When I am feeling well, I want to try to make up for missed time and accomplish everything at once. I may try to start everything at once and then become upset when I can’t follow up with it. I have learned to step back and choose the most important things to accomplish, and then stick with them. I may not finish everything, but generally the more I can do the better off I am.
More often, I start to work and make progress and then become annoyed when I cannot comprehend everything. The world is a complex place, relationships are very complicated, and no one person cannot possibly understand everything. That is difficult for me to swallow. I want to know everything, and I grow upset when I realize how much knowledge I am missing. Just do what you can. I read once a long time ago to just try to be 1% better every time you try. That can help. We all need to learn that again and again. You don't need to make large steps - only to continually keep making small steps. Look closely at the details of a situation and figure out something you can do - anything. It does not have to be big (it probably shouldn’t be big at first). But look at the details and find some way to make your life or your work or your relationships better.
Monday, April 22, 2013
Nuances of Communication
Dear Tony,
I would like to write more about learning how to communicate.
As I said, I needed to go rigidly one step at a time. The first step was just learning how to communicate ideas and make my thoughts known. The second step was starting to figure out the etiquitte of communication: tone of voice, volume of voice and eye contact. Once I had the basics of communication, the second step was not too difficult.
The third step was challenging, though. I needed to learn to put people at ease and make polite conversation (as opposed to just saying directly what was happening to me and what I wanted to know). I could feel myself starting to pick up some nuances of conversation and cues from the other person. However, I still had difficulty responding to them.
One of the first challenges was figuring out appropriate topics for conversation. Most counselors will be willing to provide lists of safe and unsafe topics of conversation. I personally have found those lists to be less than helpful. They might be a good guide for some people, but often topics are far more nuanced than could be said on a simple list.
For example, take the rule which is probably the most well-known and enforced rule of polite conversation in the United States, where I live. Religion is an unsafe topic for polite conversation. That is a well-acknowledged fact. It would be on almost every such list. But would it be okay to share a silly story about a Nativity play run amok with non-Christians? Would it be okay to mention to devout Christians that historical evidence indicates that Jesus was not born either on year 0 or December 25? Would it be okay to ask devout Jews how many cases of Tay Sachs disease they have personally seen? Would it be okay to discuss with anyone how pigs have very few uses other than meat, yet two major religions presumably working separately (Judaism and Islam) have completely condemned pig meat? I would say it depends more on the context and the person you are talking to. Religion can indeed be a dangerous topic, but so is giving a blanket condemnation of any topic.
Another challenge, at least for me is that safe and unsafe topics vary not only by culture but also from person to person. For me, they were essentially reversed. Topics that most other women like to talk about — diets, clothes, television shows — feel deeply personal and intimate to me. Maybe they were pushed too much by well-meaning previous therapists. I’m not sure. But for a long time it was virtually impossible to have a comfortable conversation about any of those topics.
Explaining that to people can be challenging. I will admit did not do that very well. Looking at my own experience, I would suggest you just tell them politely but firmly and repeatedly that those topics are uncomfortable for you. As long as the information is not critical, you have a right to insist people stick to topics with which you are comfortable, and so do they. Finding common ground can be challenging, but it is essential. I think for a long time I stuck with politics and current events. That topic can be dangerous, too, but as I mentioned before almost anything can.
I would like to write more about learning how to communicate.
As I said, I needed to go rigidly one step at a time. The first step was just learning how to communicate ideas and make my thoughts known. The second step was starting to figure out the etiquitte of communication: tone of voice, volume of voice and eye contact. Once I had the basics of communication, the second step was not too difficult.
The third step was challenging, though. I needed to learn to put people at ease and make polite conversation (as opposed to just saying directly what was happening to me and what I wanted to know). I could feel myself starting to pick up some nuances of conversation and cues from the other person. However, I still had difficulty responding to them.
One of the first challenges was figuring out appropriate topics for conversation. Most counselors will be willing to provide lists of safe and unsafe topics of conversation. I personally have found those lists to be less than helpful. They might be a good guide for some people, but often topics are far more nuanced than could be said on a simple list.
For example, take the rule which is probably the most well-known and enforced rule of polite conversation in the United States, where I live. Religion is an unsafe topic for polite conversation. That is a well-acknowledged fact. It would be on almost every such list. But would it be okay to share a silly story about a Nativity play run amok with non-Christians? Would it be okay to mention to devout Christians that historical evidence indicates that Jesus was not born either on year 0 or December 25? Would it be okay to ask devout Jews how many cases of Tay Sachs disease they have personally seen? Would it be okay to discuss with anyone how pigs have very few uses other than meat, yet two major religions presumably working separately (Judaism and Islam) have completely condemned pig meat? I would say it depends more on the context and the person you are talking to. Religion can indeed be a dangerous topic, but so is giving a blanket condemnation of any topic.
Another challenge, at least for me is that safe and unsafe topics vary not only by culture but also from person to person. For me, they were essentially reversed. Topics that most other women like to talk about — diets, clothes, television shows — feel deeply personal and intimate to me. Maybe they were pushed too much by well-meaning previous therapists. I’m not sure. But for a long time it was virtually impossible to have a comfortable conversation about any of those topics.
Explaining that to people can be challenging. I will admit did not do that very well. Looking at my own experience, I would suggest you just tell them politely but firmly and repeatedly that those topics are uncomfortable for you. As long as the information is not critical, you have a right to insist people stick to topics with which you are comfortable, and so do they. Finding common ground can be challenging, but it is essential. I think for a long time I stuck with politics and current events. That topic can be dangerous, too, but as I mentioned before almost anything can.
Saturday, April 20, 2013
Learning to Comprehend
Dear Tony,
Some interventions I found almost instinctively.
Another stereotypical young-child activity which helped me is to watch the same television show again and again and ask for the same bedtime story again and again. I started doing that without realizing it, and eventually was focusing on it. I can feel the changes in my own brain. It has to do with moving beyond understanding information told to me directly to picking up cues and subtle hints from the broader culture. I have always had difficulty with that. You need some sort of template in place to do that, and I was lacking one.
I worked with the first season of ER, something which I had rarely watched when it was originally aired. I focused on television strictly for practical reasons: It is much faster to watch the same forty-five minute television show again and again than it is to read the same two hundred page novel again and again. I watched one specific episode over and over again, and eventually was able to figure out what was happening and how people’s words and actions led to different outcomes. Some lines were intended for that specific episode's plot, some were intended for character development, some were not important at the time but hugely important in future episodes, and some were intended just for humor. While I fully understood that in theory I had tremendous difficulty putting each individual line in its specific category. After watching several episodes repeatedly I was slowly able to classify each utterance bit by bit.
It helped me learn to sort out what I do and do not need to pay attention to. I gradually learned to identify what was important and how one specific incident led to another. All of these were things I was not able to do before. If asked, I could explain the meaning of one specific scene, but I could not figure out how that scene connected to those before and after it. I gradually grew able to understand how different interactions worked together.
Although I did not know it at the time, ER was a really good choice because it focuses on multiple characters and on-going situations. Once I had the basic template from one episode in place I was able to follow the different story lines to other episodes. I needed to watch each episode at least twice — and some I watched more than ten times — but slowly I was able to build my capacity to follow different characters and story lines and see how they related to specific incidents.
One final note: I am not advertising ER. It benefited me because it was a longer show (a half-hour sitcom was too short to push me) and had multiple on-going story lines. I think another reason ER worked well for me was because I could remember some of the details people discussed when it was aired and some scenes which I could not understand back then. It was a great thrill to be able to put those memories in context at long last. I later tried to do the same thing with the first season of The West Wing, which meets all the above criteria but aired when I was out of the country. I didn't work. I thought I would enjoy the show, but I just could not become interested. At least for me, it seems that connecting my actions with ancient memories is a critical piece to making progress.
Some interventions I found almost instinctively.
Another stereotypical young-child activity which helped me is to watch the same television show again and again and ask for the same bedtime story again and again. I started doing that without realizing it, and eventually was focusing on it. I can feel the changes in my own brain. It has to do with moving beyond understanding information told to me directly to picking up cues and subtle hints from the broader culture. I have always had difficulty with that. You need some sort of template in place to do that, and I was lacking one.
I worked with the first season of ER, something which I had rarely watched when it was originally aired. I focused on television strictly for practical reasons: It is much faster to watch the same forty-five minute television show again and again than it is to read the same two hundred page novel again and again. I watched one specific episode over and over again, and eventually was able to figure out what was happening and how people’s words and actions led to different outcomes. Some lines were intended for that specific episode's plot, some were intended for character development, some were not important at the time but hugely important in future episodes, and some were intended just for humor. While I fully understood that in theory I had tremendous difficulty putting each individual line in its specific category. After watching several episodes repeatedly I was slowly able to classify each utterance bit by bit.
It helped me learn to sort out what I do and do not need to pay attention to. I gradually learned to identify what was important and how one specific incident led to another. All of these were things I was not able to do before. If asked, I could explain the meaning of one specific scene, but I could not figure out how that scene connected to those before and after it. I gradually grew able to understand how different interactions worked together.
Although I did not know it at the time, ER was a really good choice because it focuses on multiple characters and on-going situations. Once I had the basic template from one episode in place I was able to follow the different story lines to other episodes. I needed to watch each episode at least twice — and some I watched more than ten times — but slowly I was able to build my capacity to follow different characters and story lines and see how they related to specific incidents.
One final note: I am not advertising ER. It benefited me because it was a longer show (a half-hour sitcom was too short to push me) and had multiple on-going story lines. I think another reason ER worked well for me was because I could remember some of the details people discussed when it was aired and some scenes which I could not understand back then. It was a great thrill to be able to put those memories in context at long last. I later tried to do the same thing with the first season of The West Wing, which meets all the above criteria but aired when I was out of the country. I didn't work. I thought I would enjoy the show, but I just could not become interested. At least for me, it seems that connecting my actions with ancient memories is a critical piece to making progress.
Wednesday, April 17, 2013
Starting to Communicate
Dear Tony,
In pieces of these blogs, I will tell you directly what has worked for me. Most of my treatment is based on Bruce Perry’s ideas. All I know is what worked for me. They are not intended to be instructions or guidelines for everybody with a mental illness. They are simply suggestions.
Dr. Perry would say that one critical piece in my treatment was that I was about two-and-a-half when these traumas started happening. (There were multiple changes at once — my illness was the largest, but there was a number of other factors.) That meant that my brain and development had the chance to have a good start. If I had become ill when I was six months old I would have likely had very different problems. Most of his book focuses on children who were traumatized at a younger age. Dr. Perry gave me the essential philisophical underpinning, but I was on my own to devise specific strategies.
I don’t have much experience with children. I have a younger sibling and my mother is an elementary school teacher. Much of what I used is based on stereotypes and my own vague memories. While stereotypes are problematic, it was enough to give me a start.
My first strategy was for a problem I have described earlier: my inability to communicate effectively. That was at the time my most critical problem. My difficulties communicating had landed me into extremely uncomfortable and sometimes even dangerous situations. I tried to think of what young children do and what I missed. Young children struggle to communicate. They focus only on learning to communicate. Which was basically what I needed to do - focus solely on communicating my message. Not on eye contact. Not on my tone or volume (much like a young child, I had a tendency to speak very loudly for a while). Not on my specific word choice. Only on communicating my message. Once I was better able to communicate I could gradually incorporate those other elements into my speech.
In pieces of these blogs, I will tell you directly what has worked for me. Most of my treatment is based on Bruce Perry’s ideas. All I know is what worked for me. They are not intended to be instructions or guidelines for everybody with a mental illness. They are simply suggestions.
Dr. Perry would say that one critical piece in my treatment was that I was about two-and-a-half when these traumas started happening. (There were multiple changes at once — my illness was the largest, but there was a number of other factors.) That meant that my brain and development had the chance to have a good start. If I had become ill when I was six months old I would have likely had very different problems. Most of his book focuses on children who were traumatized at a younger age. Dr. Perry gave me the essential philisophical underpinning, but I was on my own to devise specific strategies.
I don’t have much experience with children. I have a younger sibling and my mother is an elementary school teacher. Much of what I used is based on stereotypes and my own vague memories. While stereotypes are problematic, it was enough to give me a start.
My first strategy was for a problem I have described earlier: my inability to communicate effectively. That was at the time my most critical problem. My difficulties communicating had landed me into extremely uncomfortable and sometimes even dangerous situations. I tried to think of what young children do and what I missed. Young children struggle to communicate. They focus only on learning to communicate. Which was basically what I needed to do - focus solely on communicating my message. Not on eye contact. Not on my tone or volume (much like a young child, I had a tendency to speak very loudly for a while). Not on my specific word choice. Only on communicating my message. Once I was better able to communicate I could gradually incorporate those other elements into my speech.
Thursday, April 4, 2013
Variations
Dear Tony,
Do the best that you can.
Don’t strain yourself. Making these changes and trying things that you haven’t done in a long time (or never before) is enormously stressful. If you add to that by demanding that you reach certain limits, routinely do something at a specified time or for a certain length of time, you are going to burn out.
A large part of this is discovering what you can do, what your limits really are. People’s limits change from day to day (sometimes from minute to minute), are sensitive to moods and outside events, and frequently are not known in the beginning. People recovering from mental illness are even more sensitive to such issues. Your best work today may not be your best work tomorrow or the day after. Do the best you can at any certain point. Concentrate your efforts on not pushing too far and not burning out.
Do the best that you can.
Don’t strain yourself. Making these changes and trying things that you haven’t done in a long time (or never before) is enormously stressful. If you add to that by demanding that you reach certain limits, routinely do something at a specified time or for a certain length of time, you are going to burn out.
A large part of this is discovering what you can do, what your limits really are. People’s limits change from day to day (sometimes from minute to minute), are sensitive to moods and outside events, and frequently are not known in the beginning. People recovering from mental illness are even more sensitive to such issues. Your best work today may not be your best work tomorrow or the day after. Do the best you can at any certain point. Concentrate your efforts on not pushing too far and not burning out.
Monday, April 1, 2013
Maintaining Focus
Dear Tony,
One point which is both very difficult and very important is not to think too far ahead.
In her book Nadia Comaneci said that when she was growing up and training for the Olympics her dreams were of obtaining new skills. She never saw the larger picture of fame and fortune.
Admittedly, she grew up in strict conditions in a Communist country. Those conditions can’t and probably shouldn’t be replicated in this area today. But I have found that idea of simply focusing on the next few steps, of imagining and fantasizing of building new skills, to be very helpful.
We can only go one step at a time, and (at least at the beginning) I could only work on one thing at a time. Thinking too far in the future can be discouraging as you realize how far away it is. Certainly don’t give up on your dreams. But put them away for now. Focus on what you can do. Try to direct your thoughts as much as possible on the next few steps.
One point which is both very difficult and very important is not to think too far ahead.
In her book Nadia Comaneci said that when she was growing up and training for the Olympics her dreams were of obtaining new skills. She never saw the larger picture of fame and fortune.
Admittedly, she grew up in strict conditions in a Communist country. Those conditions can’t and probably shouldn’t be replicated in this area today. But I have found that idea of simply focusing on the next few steps, of imagining and fantasizing of building new skills, to be very helpful.
We can only go one step at a time, and (at least at the beginning) I could only work on one thing at a time. Thinking too far in the future can be discouraging as you realize how far away it is. Certainly don’t give up on your dreams. But put them away for now. Focus on what you can do. Try to direct your thoughts as much as possible on the next few steps.
Subscribe to:
Posts (Atom)