Suicide: A Personal Loss

Yesterday morning I was sitting at the breakfast table, sipping chai tea when I received a text message from my mother saying, “Let me know when you’re up and around.” A pang of fear punched me in the stomach for a moment. I thought, “Grandma must have passed away.” She’s been sick for a long time, my grandmother, and we’ve all expected her to pass at any moment. I sat with the thought for a moment, and decided that it was OK if she was gone–it was time.

I texted my mother back saying, “I’m up and having breakfast.” A moment or two later my phone rang. I picked up.

“Good morning, Mom,” I said.

My mother’s voice was grave, “I have some bad news,” she said.

“OK,” I replied.

“It’s really bad,” she said.

That pang in my stomach was back. Maybe it wasn’t about my grandmother. “What is it?” I asked.

“Ian killed himself,” she said.

My lungs forgot how to take in air for a moment. Ian was my cousin. I’d grown up with him. My eyes welled up with tears and I sobbed in a breath. Tears ran down my cheeks. A moment later I recovered myself enough to ask for details, but everything I learned made me feel worse.

I thought of my aunt, Ian’s mother, and of Ian’s brother. Their hearts must be broken. I cried for them. I thought about how much pain my cousin must have been in that he felt that death was the only escape, and I cried for his pain. I thought of the rift in our family caused by suicides–this is not the first one–and I cried for that great gaping hole of loss. I thought about what it must feel like to lose a sibling, and felt a surge of love for my brother and my sister, and sent them a message telling them how important they are to me. I don’t say it enough.

I called my friend, Jessica, and she listened to me while I cried, and then suggested we meet at the mall. So, I took my feelings shopping. I’m not ashamed. Later on, I met up with another friend for wine and conversation. I am so grateful for my support system. I love you so much.

I have experienced suicide from all angles, and possess a knowledge of it’s intricacies that few people do.

As a therapist, every day I ask the question, “Are you having thoughts of killing yourself?” It is a question that most people fear to speak out loud, but it has lost its power over me. I say it without even thinking–like most people ask about the weather. Much of the time people say no when I ask this question. But they say yes more often than you might think. An unexpectedly large portion of the population walk around thinking that they would prefer to be dead. I believe this is a symptom of just how sick our society truly is. We need to be kinder to each other. We need to show each other more compassion. We need to learn to love ourselves more. I do my best to guide people towards love.

What I don’t tell these people is that I truly understand their pain and their hopelessness, because I have been there myself. During the worst part of my illness, a neurologist told me that there was nothing more to be done for me, and that I would, “just get better with time.” I was so ill that I was completely unable to function. I couldn’t eat, keep food down, sleep, think straight. Over the course of a few months I had gone from a vibrant and self-reliant woman who loved to dance to the kind of person that the nurses recognized as a frequent flyer in the emergency room. I didn’t have time. I was dying and it was taking too long, and hearing that there was nothing more to be done nearly put me over the edge.

I had a plan. I would go to the beach, take a handful of the random pills doctors had prescribed to me and swim out into the ocean, never to return to land. I even drove to the beach and parked there a few times, but I didn’t get out of the car. I kept thinking about what it would do to my mother. I thought, “Let’s give it a month and see if I feel better.”

Miraculously, I did feel better. Only a little bit, but enough to give me hope. And then the next month I felt still better, and so on. I am healthy again, and living a full life.

While I wish I never had to go through that hopelessness, I’m glad that I gained that insight into suicidal thoughts. It makes me a better therapist. I can truly empathize with the feeling that death is the only way out.

Usually, however, it’s not true. Usually, there is another way.

When people are in the depths of severe depression, their minds tell them things that aren’t true. These thoughts are symptoms of severe depression in just the same way that fever and chills are symptoms of the flu. These thoughts do not reflect reality or truth, but they feel like they do, and people are so uninformed about the symptoms of depression that they often mistake these thoughts as truth when they are really just symptoms.

One of the things that Depression says is, “Death is the only way out of this pain.” Unless you are terminally ill, this thought is a lie. If you wait, the pain passes. This thought is a symptom of depression and nothing more. Don’t believe it. Get help.

Another thing that Depression says is, “The people in your life will be better off without you. You are a burden to them.” This is also a lie. The people in your life love you and want you to be in the world. They would rather help and support you through a depression than lose you to suicide. I promise you that.

Lastly, Depression likes to say, “The people in your life will be OK with your suicide. They might be sad for a bit, but they’ll get over it and go on with their lives as before.” I have had intimate therapeutic conversations with the family members of people who have suicided, and I know that they mourn the loss for the rest of their lives.

Depression lies. Do not believe it.

If you have been having suicidal thoughts, please get help. Go to your nearest emergency room, call 911, make an appointment with a therapist, or call a suicide hotline. There are many, but the National Suicide Prevention Lifeline is 24 hours per day, and the number is 800-273-8255.

If you are the family member of a suicidal person, please take their suicidal thoughts seriously. You would be shocked by how many suicidal clients have shared that they told a family member about their suicidal thoughts in an effort to get help, only to have their family member tell them “to just do it already,” or that they are “just trying to get attention.” I promise this is not true. It may make you feel safer to believe that it’s just an attention-seeking behavior, but it’s not.

If someone you love tells you that they are having suicidal thoughts, take them seriously. Help them to get to the emergency room, call 911 for a welfare check, help them make a therapy appointment, or call the National Suicide Prevention Hotline number above. It is better to be safe than very, very sorry.

My heart is heavy with loss, but I’m sending love and healing out into the world. If you need it, I hope that you feel it. Take care of each other.

Gratitude–Taking Neuroscience to the Next Level

As the year draws to a close, I find myself wondering what the heck just happened to us all and how on earth we can move forward into a new year. 2020 was a rather boring wild ride. How does that even work? I have no idea.

All I know is that I am flooded with gratitude when I think about 2020 being over and starting over with a fresh new year. I hope that we will not mess 2021 up as badly as we did 2020. It’s wonderful to have a chance to do better.

The depth of gratitude that I feel for the opportunity for a fresh start has me thinking about gratitude in general, and how we can use it to improve our mental health.

Human brains are created with a built-in negativity bias. We are hard-wired to see things in the worst possible light. There’s a great reason for this. As people evolved, the ones who remembered the scary stuff lived to procreate. As a cave person, it helped you stay alive to remember where the tiger lived. Over time, our brains became more and more prone to remembering our worst experiences.

While this was genetically advantageous to cave people, for modern humans it’s a mental health nightmare. Research shows that it takes five positive experiences to emotionally outweigh a negative one. Just think about the ramifications of that in day to day life. If something negative happens in a relationship, five good things have to happen for things to get back on an even keel. Over time the negative experiences tend to overwhelm the positive ones. No wonder relationships often end badly.

It’s not just relationships that are impacted by the negativity bias. Traumatic and hurtful experiences of any kind can fill people’s minds with negative thinking to the point that they can’t even see the good things that they have in their lives, which leads to mental health conditions like depression and post traumatic stress disorder.

This is where gratitude comes in. Practicing gratitude on a regular basis can help you to intentionally overcome the hard-wired negativity bias, leading to a happier and healthier life.

It’s not difficult, but it does take a little bit of effort. All that is required is that you bring up something positive that happened and allow yourself to absorb the experience and the feelings that go with it. Take your time with the positive emotions and really take them in. The more often that you practice gratitude, the more your brain will create new neuropathways that notice positive experiences–meaning that you will see more things to be grateful for, leading to a happier life.

In order for gratitude to work, it really does need to be a practice–something that you do on a regular basis. I’ve had clients who have a list of things in their lives that they’re grateful for that they read to themselves daily. I’ve also had clients who keep gratitude journals, where they write down two to three positive experiences per day in order to absorb the good emotions. How wonderful it must be to re-read a journal full of beautiful experiences that you’re grateful for!

These good experiences don’t need to be anything newsworthy. Someone smiling at you on the street, a tasty breakfast, a good night’s sleep, or the chance to start a fresh new day could all be examples of things you could write in your gratitude journal.

Here’s where we can take neuroscience to the next level. Every time that you pull up a memory, your current situation changes it. This is why memories feel sadder when you’re depressed, or happier when you’re in love. By pairing a negative memory with a positive experience, you can literally re-write the negative one to feel better, or at least more neutral.

This phenomenon is why therapy works. When you bring up difficult experiences in an environment that feels safe, with a person who is non-judgmental, you change the memory in your brain. Traumatic memories feel a little safer, hurtful memories feel a little kinder, and so forth.

You can do this on your own by intentionally pairing a difficult memory with a positive one, or with gratitude. Be sure that good feelings in the positive experience outweigh the negative ones in the bad experience. Then, bring up the good feelings, experience them, enhance them, and link them with the negative experience. Suddenly you’ll find that the negative experience doesn’t feel quite so difficult anymore.

It takes some practice, but it works.

As you go through the last few days of 2020, I encourage you to do your best to take note of the small, everyday things that happen, and take the time to be grateful for them. I think it will help us to make the end of 2020 as good as it can possibly be.

For more information, I suggest Rick Hanson, PhD and his TED Talk, Hardwiring Happiness, which you can find at https://www.youtube.com/watch?v=jpuDyGgIeh0.

Happy New Year to you and your family.

Families of Choice

To say 2020 has been a rough year feels like a laughable understatement. While I sheltered in place and worked from home, trying to avoid adding to those infected with a deadly disease, it felt like the world around me did its best to make up for my personal inaction. When people ask me how I would describe 2020, I say, “It’s the year when everything and nothing happened.” Ben Folds describes it best in his song, 2020, which I highly recommend. Here’s an excerpt:

"How many years will we try to cram into one?
Who thought we'd be living 1918 again?
But we messed that up so bad, God had to toss 1930 in!
As the sun rose on 1968 this morning . . .
Please let's not add the Civil War!
How many years will we cram into one?"

As the world seems to be trying to do all the terrible things at once, we’re left trying to cope on our own. Not only have we been physically isolated by quarantine, many of us have been estranged from each other by political differences. So many of my patients have stopped speaking with friends and loved ones over politics that I’ve lost count, and it breaks my heart that ideologies could have such a devastating impact on relationships between people who have loved each other for their entire lives. I hope that we can all start to remember that disagreeing is OK and accept each other as the diverse creatures that we are.

The holidays can be a difficult time for people under the best of circumstances, but 2020 is introducing problems that many of us had never considered before. People are trying to decide if going to see family is a good idea–weighting risk of infection versus the pain of being alone. Loneliness during the holidays can contribute to depression by highlighting just how wrong the alone-ness is in a way that doesn’t happen at other times of the year.

If you’re falling into the category of isolation during the holidays–whether due to relationship or COVID problems, I would encourage you not to compare your life to the ideal. That Hollywood movie perfect Christmas is pretty unrealistic no matter what’s going on in the world, and it’s going to be even more out of reach this year. Radically accepting this fact will help.

Another thing that can help is surrounding yourself with your Family of Choice. Also referred to as Chosen Family. This term gained prominence in the LGBTQ+ community due to family rejections after coming out. Shunned by their biological families, LGBTQ+ people began surrounding themselves with people that they felt safe with in order to be accepted for their true selves, resulting in Families of Choice.

Linda Bloom, in her article “Family of Choice: Borrowing Relatives from Other Families,” describes her approach this way, “My biological family wasn’t always able to provide the kind of modeling that I needed to become a more conscious and loving person, so I decided to supplement them with members of my family of choice, a collection of surrogate relatives.”

I think Families of Choice are useful to adopt regardless of gender identity or sexual orientation. An overwhelming number of people feel unsafe with their biological families. Pre-COVID, dealing with family during holiday visits was a frequent topic of therapy conversations. I did a lot of work with people on accepting their loved ones as they are, setting healthy boundaries, and coping with anger.

In addition to these skills, I often suggest that people think about who they do feel safe with, and how they can incorporate those people into their holiday festivities. In doing so, they don’t end up feeling like their holidays were nothing but stress and difficult family members, and they can have periods of feeling the warmth of belonging that we all fundamentally need. During COVID times, I think that gathering your Family of Choice around you may actually be a life saver.

You may be thinking, “but what about quarantine? I can’t have a group of friends together right now,” and you would be right. So, it’s time to get creative. Perhaps you can meet individuals from your Family of Choice outside, and one at a time. Perhaps you can do what my friend suggested to me today, and park in the same parking lot, windows facing each other, and talk on the phone so you can see in-person faces. Masked outside gift exchanges could be a thing. Do whatever you need to do to fill that need for community, but also stay safe. Yes, it’s a lot of effort, but it’s worth it. Community and belonging is a basic human need.

If you are alone this holiday season, please know that you still matter. The world is a better place because you are in it. If you find yourself feeling depressed and unsafe in your loneliness, please know that there is always help and support available. You can call the National Suicide Prevention Lifeline 24 hours per day any day of the year at 800-273-8255, or you can simply call 911. There are also multiple online support groups available so that you can start creating a Family of Choice that understands what you’re going through. I highly recommend the Depression and Bipolar Support Alliance (DBSA) at http://www.dbsalliance.org. They offer peer led support groups nationwide as well as education and tools on coping with depression and bipolar.

Above all, please take care of each other.

Blessed are the Assholes

Hi everyone! Thank you for being patient with me over the past two weeks while I went through a major re-write on my book and my book proposal. I attended the Writer’s Digest Annual Conference and had the opportunity to pitch my book to literary agents. Four of them asked me to send them my book proposal and sample chapters, and I was so excited and nervous at the same time that I put in a week of work on re-writing and editing everything to try to look as polished and professional as possible. I sent everything off on Sunday and now I’m trying not to obsessively check my e-mail for responses.

Hopped up on adrenaline, I spent every waking moment for a week trying to get my work to a standard that I felt good about, and somewhere in the middle of all of that work I had an epiphany–none of this would have happened if it weren’t for two of the worst experiences of my life.

The first of those two terrible experiences was my own illness. I focus on healthcare and mental health in my blog and podcast because my book is the true story of my own terrible illness, which was brought on by a whiplash injury. I was in the middle of dancing with a partner, when he forcibly dipped me and seriously injured my neck. For reasons that are only now becoming clear, this injury led to a year and a half of severe migraine symptoms.

That was bad enough, but as I sought help from the medical system, doctors kept telling me that my problem was just anxiety. As a licensed and practicing psychotherapist, I knew that wasn’t true and found a way to heal myself through alternative means. Now I want to share this story in order to provide a road map for others who are struggling through illnesses and can’t get the help that they need.

The second of those two terrible experiences was a breakup that I went through two years ago. I thought I’d finally met the man that I was going to spend the rest of my life with, but after 10 months of the easiest relationship I’d ever had, he suddenly broke up with me. He said that he’d never loved me and wanted to go back to his ex-wife. I was devastated, and I’ve been struggling to move on ever since. But as I struggled through that intensive re-write last week, the thought popped into my mind, “I wouldn’t be on the verge of publishing a book if he hadn’t broken up with me. I would never have gotten this close to my life-long dream of becoming a published author if he hadn’t broken my heart. I’d gotten too comfortable to keep seeking.”

As I shared this thought with my own therapist in our most recent appointment, she nodded and said, “You know, I used to have a framed print of the words ‘Blessed are the Assholes’ over my desk. When people treat you badly, it often leads to the best parts of life.'”

Blessed are the assholes.

Hearing this line brought up so many memories. All of the times that life went sideways and I couldn’t figure out why. All of the times when doors kept slamming in my face and I felt that all of my choices had dried up. The former supervisor who ran me out of the company. The ex-husband who cheated. The friendships that suddenly ended over nothing. So much pain.

And yet, those parts of my life needed to die in order for new parts of my life to be born. I was clinging to things that felt incredibly important to hold on to at the time, but now I’m nothing but happy that they’re gone because better things came to take their places. I didn’t understand at the time that room was being prepared for what was to come next.

Please don’t misunderstand me. This isn’t an “everything happens for a reason” blog post. I hate that platitude so much. Nothing makes me feel more invalidated than, “Well, remember that everything happens for a reason,” when my heart is broken.

When life is messy and cruel, don’t invalidate the pain by anticipating that something wonderful will come out of it. It might. It might not. What’s important at the time is to acknowledge how much it hurts and allow yourself to grieve. It’s only when you come through to the other side of the healing process that you will start to see what came into your life as a result of the loss. Only then will you be able to bless the assholes for wrecking what you thought you wanted in order to show you that you could have more.

If I ran into my former boss who ran me out of the company, I would thank her for being such a jerk to me. If she hadn’t, I would probably still be working as an insurance agent. The idea makes me shudder.

If I ran into my former husband, I might thank him for leaving me, because if he hadn’t I would probably still be married to him (what a horrible thought!), and I would never have become a therapist.

And now I’m realizing that if I ran into my ex-boyfriend, who I thought I was going to marry, I might just thank him for breaking my heart. If he hadn’t I wouldn’t be here on the verge of becoming a published author.

Often it is through pain that we become our best selves. Blessed are the assholes.

Aligning with the Cycles of Life

Yesterday was Halloween, and even here in Southern California, I can feel a shift in the earth. While the days are still warm, the evenings are cooler. I’ve even needed a sweater a few times. The produce at the grocery store has shifted from summer to fall fruits and vegetables and instead of the happy heads of daisies, I see the yellows and oranges of marigolds and chrysanthemums. Earth is letting go of the fecundity of summer, and getting ready for the cold, quiet rest of winter.

Multiple traditions recognize this time of year as special for honoring and remembering the ancestors–people we have let go of from our lives. Yesterday, in honor of this tradition, I sat for a time and remembered family members who have passed, and I said their names out loud to honor them. It made me feel close to deceased loved ones even though they are gone.

Western society has an uncomfortable relationship with death and letting go. We tend to value youth, beauty, fertility, productivity and accomplishment. We tend to devalue and even ignore age, wisdom, infirmity, rest, and death. I would argue that this emphasis on burgeoning productivity is unhealthy. It makes us value silly things that don’t matter like the size of our waistbands and the amount of hair on our heads instead of valuing the experience of a long life or the need to unplug and let our minds have a break.

A shocking amount of people don’t allow themselves to rest. They feel that if they aren’t producing something at any given time, then they are being lazy. They push themselves to accomplish, to multitask, to show results at all times. Then, if they didn’t get everything on the list completed, they mentally beat themselves up about it. In order to maximize productivity, they start cutting things out of their lives that give them rest and pleasure because they feel those things are a waste of time. As a result their lives feel empty and not worth living. Their bodies are over-taxed and not well cared for. And their relationships die from lack of nurturing.

This is an extremely stressful and unhealthy way to live.

We need to start managing stress in more healthy ways. Instead of admiring people that spend all of their time producing, foregoing rest, and never taking vacations, we need to recognize that people like that are setting themselves up for a heart attack. Literally. Stress changes the way that our bodies distribute and store fat, clogging our arteries and creating heavy bellies. Stress also leads to depression. Our nervous systems aren’t set up for a constant state of go. Eventually they will shut down in order to make us rest–a state we call depression.

We need to get more in sync with the cycles of life in all areas. Instead of pushing Earth to produce even out of season, we need to allow her to rest, just as we need to allow ourselves that same grace. We need to value all of the stages of life, not just youth and beauty, but also the onset of middle and older age, a time when our experiences begin to converge into a wonderful state of wisdom and balance.

We also need to get more comfortable with death and letting go. As painful as it is, we can’t keep all of the people in our lives forever. In a discussion of letting go, I was once asked to imagine if everyone I had ever known or been close to was living in my house. I imagined my exes all living with me–all of my former friends and colleagues, and my stomach churned with the stress of having all of those people around me all of the time. I understood that in order to move forward in my life, I’d had to let those people go, just as they had let me go in order to move forward with their lives.

Just as the Earth has to shed the leaves and fruits of summer in order to rest and regroup for the next season’s rebirth, we have to shed our old selves, our old relationships and our old beliefs in order to move forward. We need times of rest and reflection in order to feel into what needs to change in our lives for our own rebirth. We need times of pleasure, just for the sake of pleasure, in order to feel alive and like all of the hard times are worth it.

I encourage you to ask yourself, what can I let go of today in order to get more aligned with the cycles of life, death and rebirth? Maybe there are material objects that you need to get rid of. Maybe there are people that are holding you back. Maybe there is a way of viewing yourself or the people around you that is out of date. Maybe you need to let go of your belief that productivity is the most important thing in life, and that rest equals laziness.

Change is an important part of being alive. Instead of holding on to the way that things have always been or the way you have always thought, I encourage you allow a time of rest, reflection and letting go in order to move into a brighter and fresher you, just as Earth rests in the winter in order to store up the energy she needs to burst into flower in the spring.

The Healing Power of Yoga

It is my fervent belief that yoga saved me from a life of chronic illness, but when my neurologist at the time, Dr. Purcell, suggested it, I didn’t have any idea of the healing powers that yoga offered.  I was just so desperate to be well that I would have done anything that might actually help.  It was only later that I came to understand why yoga healed me the way that it did.  

It shocked me at the time that my nausea went away almost instantly after starting yoga classes.  I couldn’t account for it, but I was grateful for it beyond words.  The constant year-long nausea and vomiting had been the worst part of my illness, by far.  After that, I quickly re-gained the strength, stamina and motivation that had abandoned me, and I began to live again.

It took years to obtain the diagnosis that eventually led to a coherent treatment plan.  It wasn’t until well after I recovered that the label “spasmodic torticollis” came into my life.  I had to google it to understand exactly what it described, having never heard of it before.  It’s such an unusual and odd sounding term that when people ask for my diagnosis and I give it to them, they usually give me a blank look and say, “What was that again?”

In his book, Healing Yoga: Proven Postures to Treat Twenty Common Ailments—from Backache to Bone Loss, Shoulder Pain to Bunions, and More, Loren Fishman, MD has a fortuitous little blurb about my condition.  He writes, “A third condition that occurs in the neck isn’t as common, but if you’ve had it or even if you’ve seen it on someone else, you won’t forget it.  It’s called spastic torticollis—literally spasmodic turning of the neck.  It happens when one group of muscles gets really tight and turns the neck.  Sometimes the head turns in jerking motions, and sometimes it turns and stays in an unnatural place.” (Fishman 122-123).  

For some time after recovering from the worst of my illness, I had the jerking motions Dr. Fishman describes above.  My head would involuntarily turn to the right over and over.  It was embarrassing.  During the day, when I was in public, I would fight the head turning with everything that I had, and completely exhaust myself.  At home, when I was alone, I would relax and let my head do what it would, leading to half watched TV shows and great difficulty in keeping my place when reading.  Fishman writes, “This is a condition so painful and so intransigent that you may need a yoga therapist or a doctor who can give an injection that will alleviate it at least temporarily” (Fishman 122-123).  

Dr. Fishman’s assertion that spasmodic torticollis is extremely painful is, I think, the reason that my diagnosis and treatment took so incredibly long to obtain.  I don’t have much pain at all.  I have the odd headache, and my neck and shoulders tend to be a little bit sore, but I really don’t have significant pain.  In the very beginning of my illness, my ears and my scalp on the left side of my head hurt, making it difficult to sleep or wear a headset, but that pain went away fairly quickly.  

Doctors kept asking me about pain, and when I said I didn’t have much, they immediately dismissed me as a “hysterical woman” trying to get attention for something that wasn’t really very bad.  I would like to point out that pain is not the only thing that makes an illness terrible.  In fact, I probably would have preferred pain to the ongoing nausea and vomiting that I endured for a year and a half.  At least people that are in pain can eat, and they don’t starve to death.  

However, Dr. Fishman is right about the injections.  Every three months I go in to see my current neurologist, Dr. Matich, who is wonderful and warm and helpful, and she uses a machine to measure my involuntary muscle contractions.  She does this by inserting a probe into each affected muscle and listening to the sounds they create through a special machine.  Sometimes my muscles whoosh and growl like storms.  Dr. Matich then injects botox into the extra loud muscles to help them relax, and I can hear the muscle-storms grow calm.  Over time, this has been a helpful addition to my care, but I honestly don’t think it’s nearly as helpful as yoga.

In Healing Yoga, Dr. Fishman describes how “Laboratory and clinical studies have confirmed that pain from upper cervical joints and muscles can be referred to the head” (Fishman, 121).  I think this was exactly the complicating factor in my own illness.  I believe that what happened to me goes something like this: the whiplash injury that I endured caused the upper cervical muscles in my neck to go into spasm, which irritated muscles and nerves in my head, leading to migraine symptoms, but no pain.  I had the visual disturbance, nausea, vomiting and cognition problems that go with severe migraine, but the pain never showed up, which confused everyone—including me.

If he had known about me and my illness, I believe that Dr. Fishman would have backed up my neurologist’s suggestion that I treat my symptoms with yoga.  Dr. Fishman writes, “Appropriate yoga is good for almost anything that ails the neck and for pain referred from the neck to the head. . .  It improves suppleness of the neck muscles and increases the versatility of the joints so they can move more easily in many different ways.  It refines the coordination of the various muscle groups, so muscles aren’t pulling against each other with such ferocity” (Fishman, 123).  I believe that these benefits are part of the reason that I began to feel much better quickly after beginning my yoga practice.  With my neck muscles in spasm, I needed something to interrupt the process of pulling muscles irritating the tissues in my head, and yoga miraculously did that for me.

However, I think there was another contributing factor.  I think that the muscles, nerves, and other tissues in my neck and my head were terribly inflamed by the whiplash injury, at least partially causing the migraine symptoms.  Multiple studies have shown that inflammation is a leading factor in many of the chronic illnesses that people suffer from, such as fibromyalgia and chronic back pain.  Treatments for pain often focus on decreasing inflammation using NSAIDs (non-steroidal anti-inflammatories), such as over the counter ibuprofen, or stronger prescription versions, like Naprosyn.  Many people, including myself, take a daily turmeric pill, which is a spice used in some forms of cooking, because it’s been shown to have anti-inflammatory qualities. 

I didn’t know it at the time that I started my yoga practice, but yoga decreases inflammation too.  Dr. Fishman writes, “We physicians can’t do much apart from medication for swelling of joints; your body can do more by itself, using a molecule called PGC-1alpha. This is a potent endogenous anti-inflammatory that reduces swelling anywhere it occurs in the human body.  Gentle activities such as yoga and tai chi, and especially yoga done for long periods of time, encourage the body to release this miraculous substance from your muscles” (Fishman, 122).  The joints in my neck were certainly inflamed after the traumatic whiplash injury that I suffered, and I believe that getting involved in yoga significantly helped to reduce that swelling through the release of PGC-1alpha.  How miraculous!  

Because of its anti-inflammatory effect, I believe that yoga should be a frontline treatment for any physical ailment that is caused by inflammation.  Can you imagine the wellness that would result if doctors would prescribe yoga for arthritis, fibromyalgia, back pain, and any of the other ailments that they usually prescribe pain medication for?  I truly believe that the world would be a much healthier and happier place.

Speaking of happiness, I’d like to say a little about how chronic illness affects mood.  Dr. Fishman writes, “. . .chronic pain does more than cause people to lose days of work.  It’s depressing.  It produces anxiety.  It makes life so hard that sometimes it doesn’t feel worth living.  I think it’s extremely important to address pain that could be or is becoming chronic and end it as soon as possible” (Fishman, 86).  While Dr. Fishman talks about chronic pain being depressing, I would like to add that chronic illness is depressing whether pain is involved or not.  Before my injury and subsequent illness in 2011, I was the happiest I’d ever been.  I had found a group of people where I seemed to fit in completely for the first time in my life.  I was active and social and enjoying every minute of it.  Then, the whiplash injury happened, and my happy life became very small and extremely unpleasant.  

As I sought help, doctors kept telling me that my symptoms were the result of anxiety, and they kept pointing out how anxious I was in the appointments, and how sad and alone I was.  I argued that I was anxious because I kept seeking help from professionals who dismissed my symptoms, and I was depressed because I was terribly ill and unable to do the things that made my previous life so wonderful.  But the doctors continued to insist that my symptoms were the result of anxiety and depression, not the other way around.  I found this incredibly frustrating and demeaning, and it’s refreshing to have Dr. Fishman acknowledge that chronic illness leads to a life that doesn’t feel worth living, because it absolutely does.

However, it appears that the psychological effects of chronic pain and illness are even worse than I previously thought.  Dr. Fishman writes, “. . . there is a less-recognized reason: chronic pain that lasts more than a year seems to have negative effects that last much longer.  A study done at Northwestern University shows that a year of chronic back pain actually shrinks the gray matter in the brain by as much as 11 percent, the equivalent of ten to twenty years of normal aging, and that loss is directly related to the duration of the pain” (Fishman, 86).  Ten to twenty years of normal aging caused by one year of chronic illness!  Honestly, that blows my mind, but I’ve seen it happen.  

In my own case, after my illness went into remission, and I got treatment that made sense, it took a couple more years for me to be able to focus on reading a book, or to be able to write the way that I had prior to getting sick.  I’m sure that recovering from brain atrophy was one of the reasons that it took me almost 10 years to get my book project together.

My grandmother became ill within the past few years.  Within a year of getting sick, she went from a vibrant older woman who managed a home of her own and loved to sew quilts, to a woman who needed 24-hour care and couldn’t recognize her own grandchildren.  Now she’s living in a nursing home that specializes in dementia care, and I’m certain that her illness was a major contributing factor to her mental decline.

Truly, we must take chronic illness and chronic pain seriously.  It not only decreases life satisfaction, causes anxiety and depression, it actually causes brain damage.  The good news is that in addition to other wonderful effects we’ve already discussed, yoga can help with the terrible mood and brain problems brought on by illness.  Fishman writes, “Clinical trials confirm that yoga helps reduce distress and depression and promotes a sense of calm well-being” (Fishman, 191).  He also explains that yoga is being used to treat PTSD. “The Naval Medical Center in San Diego and other military VA hospitals are offering yoga to help Marines, soldiers, sailors and others wounded in Iraq and Afghanistan who are suffering from post-traumatic stress disorder.  Preliminary military studies have found that the calming effect of yoga can assist PTSD patients in dealing with hypervigilance, flashbacks, depression and anxiety” (Fishman, 201).  Honestly, I think yoga is the cure-all that people are looking for, but it is under-prescribed and under-utilized.

Please spread the word about the healing effects of yoga.  Even though it’s more work than taking a pill, I think it’s more than worth the effort.  It saved my life.  It could save yours too.  Dr. Fishman lists multiple ailments that he has personally and effectively treated with yoga, including: back pain (both neurological and musculoskeletal), rotator cuff syndrome, headache, weight control, bone health (osteoporosis), insomnia, scoliosis, premenstrual syndrome, depression, restless leg syndrome, bunion, and plantar fasciitis.  While this is an extensive list, I’m willing to bet that there are many more conditions that would respond positively to treatment through yoga, and I encourage you to give it a try.

The Importance of Belonging Instead of Just Fitting In

Depressed people often tell me that they spend most of their time pretending to be happy. They feel that they must–that it’s expected of them. They say that they are exhausted by keeping up the pretense of cheerfulness, and that it feels like a mask that they wear to fool the people around them into thinking that they’re “normal.”

Every time someone tells me that they wear a mask of cheerful pretense, the Beatles song, Eleanor Rigby pops into my head:

“Eleanor Rigby
Picks up the rice in the church where a wedding has been
Lives in a dream
Waits at the window
Wearing the face that she keeps in a jar by the door
Who is it for?

All the lonely people
Where do they all come from?
All the lonely people
Where do they all belong?”

Clearly this sense of wearing a mask to fool the world is not new or isolated. In fact, I would bet that we all have done it from time to time. Some of us are better at it than others. Personally, I’m terrible at it. When I try to pretend, I come off as cold and stiff, and everyone knows that I’m not acting normally.

Susan David, in her TED Talk, “The Gift and Power of Emotional Courage,” says that “being positive has become a new form of moral correctness.” She calls this “a tyranny of positivity.” I agree with her. Somehow pretending to be happy is seen as better than living an authentically felt life, and people are shamed for being “negative,” or displaying emotions seen as “bad.” As a result, people walk around wearing happy faces, but feeling dead inside.

You may wonder, what’s bad about pretending to be happy? Isn’t that the point of “fake it ’till you make it?” The answer is that pretending to be happy cuts us off from authentically connecting with other people, and authentic connection is one of the greatest and most basic needs of human beings.

Below is a picture of Maslow’s Hierarchy of Needs, which came up regularly in my college psychology courses. Starting from the bottom of the chart, you’ll see the most basic human needs for food, shelter, water, and clothing. Once those are satisfied, the next level is for safety. Directly after basic survival and safety comes love and belonging, including a sense of connection. Connection is not a luxury–something that might be nice to have one day. Connection is number 3 on the hierarchy of human needs. It’s that important.

Maslow’s hierarchy of needs, a scalable vector illustration on white background

However, there is a big difference between belonging and fitting in. Fitting in happens when people conform in order to be accepted into a group. Fitting in is that lonely feeling of wearing a face that you keep in a jar by the door. It’s the exhaustion that you feel after pretending to be happy all day when you want to cry on the inside. Fitting in does not fill that basic need for connection. Instead, it makes us feel even more lonely than being alone.

Belonging, on the other hand, is the feeling of ease that you have with a trusted friend. Belonging is the knowledge that it’s OK to show your authentic feelings, because the person that you’re with will understand and will continue to support and love you. It’s only in belonging that the basic need for a sense of connection is fulfilled.

In order to have true belonging, it’s necessary to be vulnerable, and while the idea of vulnerability may be so uncomfortable that it immediately makes you want to stop paying any attention to what I’m saying, please stay with me. This is important.

In her TED Talk, “The Power of Vulnerability,” Brene Brown explains that “in order for connection to happen, we have to allow ourselves to be seen. Really seen.” In order to feel that authentic connection that is one of our basic human needs, we have to be able to take off the mask, stop pretending to be happy when we aren’t, and show our true faces. The longer that you’ve been pretending, the more vulnerable this will make you feel.

When I work with clients on their need to belong, they often tell me that the idea of not pretending is preposterous, and that there is no way that they would allow themselves to be so vulnerable. I tell them that the fact that they had such a strong reaction tells me that vulnerability and the ability to be authentic is where the true work is for them. If you’ve had a strong reaction to the idea of being more authentically vulnerable with people, the same goes for you.

Now, I’m not suggesting that you go around telling your deepest darkest secrets to everyone you meet. Being vulnerable with people is a process. It doesn’t happen all at once. If there is someone that you think you might like to get closer with, reveal something small to them and see if they can handle it, and if they share something small with you in return. If so, try sharing something a little bit more personal, and so on. Creating true connection takes time, and you should only share your most personal stories with people who have earned the right, and have shown you that they are worthy. This is the way to build authentic connection with people who are safe.

Will there be times that you will pick the wrong person and get hurt? Of course there will be. However, building belonging in your life is worth the risk.

Belonging heals. In tribal cultures, when a member of the group is sick, the entire community takes part in the healing. The whole group comes out and dances around the fire, sings, or talks with the sick person. While these treatments aren’t necessarily scientific, people often do get well simply because the entire group showed up for them. Can you imagine how it would feel if your entire community showed up for you when you needed them?

Because so many people in Western culture confuse fitting in with belonging, and refuse to take the scary step towards vulnerability, the power of authentic belonging has eroded. When people are depressed or sick, they tend to end up more isolated than they were before their illnesses, and their isolation makes them sicker.

I would like to challenge you to examine your relationships. How many of them are based on fitting in and how many are based on true belonging and authentic connection? If you don’t have many authentic relationships, take the leap into vulnerability with the people that you feel have earned the right to it, and start building true belonging into your life. You’ll be glad that you did.

Shame: How it Affects us, and How to Overcome it

Over the weekend I went out of town to attend my 2-year-old niece’s birthday party. She was adorable, and I enjoyed spending time with my family, but the drive through LA can be brutal. On my way home, a man on a motorcycle whizzed by me and then flipped me off. I have no idea what I could have done to make him angry. I had been driving in the same lane at the same speed for miles.

Despite the knowledge that I hadn’t done anything wrong, I felt hot shame flush through my body, and I recognized the sensation as one that I’ve experienced frequently lately. It seems like every time I turn around these days, someone is suggesting that there is something wrong with me.

Whenever I make a comment online, dozens of perfect strangers attempt to shame me by calling me stupid in myriad ways. Partly, I think that people shame others in order to dispel some of their own frustration, but I also think that they do it believing that the shame will teach the other person a lesson.

I’ve seen parents shame their children for the same reason. Children who get bad grades or fail to do their chores properly are often shamed by their parents, who believe that the shame will get their children to behave better in the future.

Unfortunately, these parents’ efforts are misguided. Shame can’t teach anyone anything. Scans of human brains show that the learning centers shut down on shame. No information is getting in until the shamed person’s brain calms down. If the goal is teaching, it is much better and more effective to speak kindly to people, and help them to understand and practice. A relaxed brain is a learning brain.

Brene Brown, the renowned shame and vulnerability researcher, defines shame as the “intensely painful feeling or experience of believing that we are flawed, and therefore unworthy of love and belonging.” This sense of unworthiness is profoundly damaging to the human psyche. The more that people receive the message that they are unworthy of love, the more that they believe it. Much of my work as a therapist is helping people to undo the programming of shame.

While shame usually begins as damaging messages of unworthiness from the people around us, over time we tend to internalize the shame and begin shaming ourselves. We believe that we need the shame to motivate ourselves–to keep ourselves from becoming lazy couch potatoes.

However, the research shows that shame doesn’t actually motivate people. The more that we shame ourselves, the more depressed we become, which leads to lower levels of motivation, not higher. Giving ourselves kindness and compassion is a much better way to gain motivation.

If you’re thinking that you don’t have shame, think again. Shame is universal. The only people that don’t feel it are psychopaths. The more that we act like shame doesn’t exist, the more it grows. Speaking honestly with each other about the experience of shame is the only way to overcome it.

Brene Brown talks about shame being like a Gremlin. In the 1980s movie, Gremlins, the little green monsters that wreak havoc are only killed in the end by the sun. Shame is the same. It is only by exposing it to the light that it can be defeated.

I’m not suggesting that you start telling everyone you meet about your shame experiences. Doing that would likely just create more experiences to be ashamed of. Instead, share your shame with people who have earned the right to hear your stories, and have the emotional strength to bear the weight of your pain.

These are people who have stuck with you through good times and bad times, and have shown that they can be trusted with your secrets and your pain. If you can’t think of anyone like that in your life, I would suggest that you find a therapist who is trained to hear your shame stories and can help you shed necessary light on your pain.

There’s an important difference between shame and guilt that I’d like to discuss. While shame is the terrible feeling of being unworthy of love and belonging, which is harmful and leads to painful experiences of disconnection, guilt is the knowing that you have done something wrong that you need to make right somehow.

Shame is the sense of “I am bad,” and guilt is the sense of “I did something bad.” Unlike shame, guilt can help people to rebuild connections. When people realize that they have hurt others, they can apologize and seek forgiveness.

If you regularly speak to yourself in the language of shame, I would encourage you to begin practicing self-compassion. If you’re constantly shaming yourself, your nervous system is constantly in fight or flight mode, which is extremely damaging to your body and your nervous system. In this self-protective state, you will have difficulty learning new things, and your body will likely become depressed in order to deal with all of the stress.

Self-compassion is a wonderful way to begin the process of coming out of a self-shaming mind state. There are three components to self compassion: 1) mindfulness, 2) self-kindness, and 3) common humanity.

The mindfulness part is about paying attention to your experience and noticing your self-critical and shaming thoughts. The self-kindness part is really about telling yourself that both you and your feelings are OK. And the common humanity part is reminding yourself that the experience of pain and shame are what make us the same as others, not different.

A self-compassion statement might look something like this: “Wow, I’m feeling a lot of shame right now. It’s OK to feel that way. Many people would feel shame in this situation.” You can create a self-compassion statement that works for you as long as it has all three components. It doesn’t take a lot of time to use the statement, and it can dramatically shift the experience of shame, and reduce your stress.

Despite the messages that you may have received over the course of your lifetime, you are worthy of love and belonging. You don’t have to do anything to become worthy. You are already worthy simply because you are a human being. Babies know that they are worthy of love, and so do the people around them. It seems strange to me that people think that at some unknown point in human development this inherent worthiness goes away. It doesn’t. All people are worthy of love and belonging, including you.

For more information on shame, please look into the work of Brene Brown. She’s one of my sheroes, and I highly recommend her book Daring Greatly. She also has two great TED Talks: “The Power of Vulnerability,” and “Listening to Shame.”

For more information on self-compassion, I recommend the work of Kristin Neff, who has a wonderful TED Talk called “The Space Between Self-Esteem and Self-Compassion.”

It’s Not “Just” Depression

Something that I hear a lot, and often from people that should know better, is “well, it’s just depression.” I hear this in many different contexts, for example, a woman who has been having GI issues goes to see her doctor, who tells her that there really isn’t anything wrong with her digestive track, “it’s just depression.”

According to http://www.dictionary.com, the word “just” has several meanings, but in the above context it means, “only or merely.” That doctor could have easily substituted the word “merely” for “just,” as in “there isn’t anything wrong with your digestive track, it’s merely depression.” Then, said doctor refers the woman to see a therapist, and thinks that the problem is resolved.

Only, it’s probably not resolved. In these cases, people often continue to have health problems. If they do seek help from a therapist, they get suggestions about handling stressors, but therapists can’t treat physical symptoms directly. It’s possible that with time and work the symptoms will resolve, but it’s also quite likely that the patient will continue to struggle with health problems.

Unfortunately, after having their symptoms dismissed as “just” depression, people are unlikely to seek medical attention again because it’s too embarrassing to be dismissed like that. If they do seek medical treatment, they’ll likely see a different doctor, and the first one never learns that the referral to a therapist was unhelpful in resolving the symptoms.

It’s true that emotional symptoms can manifest as physical health symptoms, but the unfortunate fact is that doctors jump to this conclusion much too rapidly, without testing, and make a diagnosis based on opinion instead of on evidence.

If the physical symptoms are truly caused by mental health issues, there are often things that doctors can do to alleviate symptoms while the patient works on underlying mental health issues. However, due to their own inherent bias that it’s “just” mental health problems, they choose not to treat. In my own case, it truly was a physical problem, but since the doctors couldn’t easily fit my symptoms into a tidy box, they told me that the symptoms weren’t medical, and were “just” anxiety, and told me to see a therapist. It took me months and multiple doctor’s appointments with different doctors to get the anti-emetics that I needed so that I could keep food down. That’s months of illness that could have been avoided if doctors had simply taken me seriously enough to even treat my symptoms.

While all of this is bad enough, the medical system’s dismissal of mental health symptoms as not being worth treating bleeds out into the public attitude that mental health symptoms are made up and imaginary, leading to advice from well-meaning loved ones such as, “Well, you just need to get over it,” or “just focus on the positive more. You’ll be fine.”

That’s not how it works. People with mental health symptoms aren’t stupid. They’ve tried taking walks, thinking positive, remembering that the weather is nice, and all of the other too-easy fixes that people suggest to them.

Depression is complex. It takes work and time to overcome, and acting like it’s not serious or is easily conquered makes people with mental health problems feel even more alone than the depression tells them that they are already.

The truth is that depression is a serious disease with a death count. People die of depression in alarming numbers. According to the World Health Organization, more that 264 million people worldwide suffer from depression, and “close to 800,000 people die due to suicide every year. Suicide is the second leading cause of death in 15 to 29-year-olds.”

This idea that it’s “just depression” is a serious barrier to sick people getting the care that they need. An alarming number of patients with depression refuse medication saying that they “don’t want to be dependent on a drug to feel happy.” They wouldn’t refuse other life-saving medications for physical health problems, but they refuse medication for depression because of the idea that depression is something that they “should be able to overcome on their own,” and isn’t really serious.

It is extremely serious.

When people suicide, the big question that as themselves is, “but why would they do that?” People point to the fact that they had everything to live for, and seemed happy.

The answer to this question is that people suicide because they are depressed. It really is that simple. Depressed people can fake happiness quite well in order to get by in the world, but that doesn’t mean that they aren’t depressed.

Conventional wisdom says that depression means that the person is “just sad.” People think, “well, I’ve had the blues before too, and it went away.” Depression doesn’t work that way. Often people that are depressed don’t feel sad at all. Depression often presents with anxiety or irritability, but there is one underlying truth with depression–it tells you that you’re terrible and people don’t care about you. In severe cases, depression says that the people in your life would be better off without you, and might even be relieved that you’re gone.

It doesn’t matter how much external proof there is that these thoughts aren’t true. When someone is depressed, these thoughts feel like truth, and anything that contradicts them feels like lies. This is why people die of suicide. It’s not that they’re selfish or weak. It’s that they truly believe that the people in their lives will be better off when they’re gone because depression says they are terrible people, and it feels like truth.

Another ironic truth about depression is that one of the main symptoms is a lack of motivation. A person suffering from depression might not feel sad, but will likely have a difficult time getting motivated to do things. If they are able to accomplish things, depressed people get very little enjoyment out of what they do.

This makes treating depression complicated. It may be that the sick person has seen a therapist and gained knowledge of skills and behaviors that would help, but can’t seem to get enough motivation to perform those behaviors. They are not being lazy. Lack of motivation is one of the most common symptoms of depression.

When motivation is an issue, the best approach is often to start the patient taking antidepressants in order to get the small amount of motivation needed to start applying the skills they are learning in therapy. Antidepressants are important in the treatment of depression in order to increase motivation to do the work to get well, which is why it’s so important to remove the stigma associated with taking them. Antidepressants truly do save lives, and a combination of medication and therapy is often the most effective approach.

If there is a depressed person in your life, the best thing that you can do is reserve judgment and refrain from advice giving. Simply sit with the person if that is all that they are able to muster the motivation for. If the depressed person speaks, just listen. Don’t tell them that they aren’t thinking correctly, and please don’t tell them to get over it or just get outside or be more social. A little-known truth about depression is that hearing unhelpful advice makes the depressed person more depressed. It confirms their depressed thoughts that they are alone, nobody understands them, and people would be better off without them.

So what can you say? Express your willingness to be with them even thought they aren’t happy right now. Tell them that they are loved and important. Encourage them to seek professional help, but stop there with advice giving.

Here is a list of great things to say to depressed people:

  • What you’re going through right now is really hard.
  • I’m here for you.
  • I love you.
  • What can I do to help?
  • What do you need right now?

If they don’t know what they need, that’s OK. The fact that you asked is what’s important. It shows them that you care about them and that you’re willing to listen. Being present with a depressed person is probably the best help that you can give.

Remember, it’s impossible to talk someone out of being depressed, and trying to do so makes the depressed person feel alone and misunderstood, so don’t try.

If you are a depressed person, I urge you to seek professional help. I know that it feels like you shouldn’t have to, but that’s the depression speaking. When your therapist gives you skills to learn and homework to work on, give it your best shot. It may feel silly or like a lot of work, but there is a good reason for it. Your therapist is helping you to create new pathways in your brain that are healthy and move you away from the pathways of depression that are so well worn and easy to walk down. Remember that small movements forward are progress, and give yourself credit for every baby step.

If you are feeling suicidal, know that what depression is telling you about yourself and the people around you is a lie. The people in your life do love you and care about you and will be devastated if you are gone. You are worthy of love and belonging simply because you’re human. You don’t have to do anything to deserve it. Immediately take yourself to your nearest emergency room, or call a suicide helpline. If you can’t muster the motivation, call 911 and professionals will come to you.

The National Suicide Prevention Lifeline phone number is 1-800-273-8255, and it is available 24 hours a day. Call.

Let’s all start treating depression as the serious and life-threatening illness that it is. It’s not “just” feeling sad. It’s not fake, selfish or weak, and changing the public attitude towards mental health problems will save lives.

Here are some resources for more information:

Doing Harm Website

Compassionomics TED Talk

TED Talks on Depression

World Health Organization’s Depression Page