Sunday, February 18, 2018

Depression and Grief, Similarities and Differences

If you have suffered from a serious depressive episode you may have felt sad and inconsolable. If you have suffered from a serious loss in your life, this might be a relationship that ended, a major transition where you were separated from people that you cared about, or perhaps you had to deal with the death of a friend or a family member, you may have felt depressed. Does a serious loss, like death or divorce, naturally lead to depression? Are people that are suffering from grief depressed or at risk for depression?

These are hard questions, but they require some sort of answer. While Recovery meetings normally deal with trivialities, as these provide a good focus for practicing Cognitive and Behavioral Therapy methods, we do need to acknowledge and do our best to understand the difficult situations that members may face.


The DSM is published by the American Psychiatric Association. It offers a common language and standard criteria for the classification of mental disorders and is used by doctors and clinicians to diagnose conditions. The DSM-IV was published in 1994, and in its definition of depression it included an exclusion for bereavement. Briefly, if a patient had suffered a major loss and presented the symptoms of depression shortly thereafter, they would not be classified as mentally ill. While on the surface this sounds very reasonable, it has some unusual implications for treating those who may be suffering. The DSM-5 was published in 2013, and one of the most controversial changes was the removal of the bereavement clause from the definition of depression.

An article appeared in Innovations in Clinical Neuroscience titled: "The Bereavement Exclusion and DSM-5: An Update and Commentary" which addresses the questions around this change. The concern presented by critics of the DSM-5 is whether by changing the definition of depression to not account for a patient's recent loss amounts to medicalizing grief.

One way to think about this question is to consider whether depression and grief are separate but similar experiences, linked causally, or completely different. The argument for removing the bereavement clause in the DSM-5 rests partly on the idea that suffering from the grief induced by loss should not disqualify a person from receiving treatment for depression. While a person is not necessarily suffering from a mood disorder if they are suffering from grief, we should not reject the idea that a person might suffer from both at the same time and reasonably seek treatment for their depression while grieving. Attempting to treat depression while suffering from grief is complex, since the symptoms appear similar, and we need to be clear that fixing one issue may not address all issues.


Given that grief and depression have many of the same symptoms, how do we separate them?

In Recovery meetings we focus on the notion of temper. You can think of the colloquial expression where we say one "loses their temper", as the prototypical example. Distinct from temper Abraham Low presents the notion of a genuine feeling in MHTWT from the chapter titled "Tantrums Have Much Force but Little Feeling" where he writes:

If a mother loses her child her sadness may have an irresistible quality.

... 

In the language of Recovery, temper is distinct from genuine feeling. The sadness of the bereaved mother is a genuine feeling. That feeling is original, primary and pure. In contrast, temper is derived, secondary and adulterated. I shall try to explain these terms. Every feeling has thoughts attached to it. A sad person is bound to think that the world is flat and stale. In this instance, the feeling of sadness produces the thought of staleness. It is not so that the bereaved mother forms first the thought that the world is stale and, consequently, falls prey to sadness. The reverse is true: she is first sad and then thinks the world stale. The feeling of sadness is original, the thought of staleness is derived from the feeling of sadness. You can express the same relation between feeling and thought if you substitute "primary" for "original," and "secondary" for "derived." You will then understand that, in the instance of the mother, the feeling of sadness is primary, and the thought of staleness secondary. The terms "purity" and "adulteration" are easily explained. The mother feels sad, pure and simple. She is not angry, fearful, jealous or envious. She has no desire to dominate others, to be consoled by them. She is just sad, and her feeling is not contaminated by an admixture of other feelings. It is original, primary and pure, i.e., genuine. Contrast now this genuine feeling of sadness with Ada's temper tantrum. In Ada's own words, after the sister left, "before long I had myself worked up into a panic." The feeling did not descend on her; she "worked" on it, produced it and fanned it into a lusty fire by means of inflammatory thoughts. What precisely was the nature of her thoughts? Ada says it was the idea of being left alone, the idea of helplessness, the idea of perhaps needing help and not getting it. If that was true she could easily remedy the situation; visiting a friend or merely going for a walk, or to a show would have cured the loneliness. Instead, she "worked herself up." We know what that means. It means that Ada now gave herself up to all kind of sinister thoughts.

In Low's presentation, the genuine feeling of sadness and the anxiety that results from temper may feel very similar but they have distinct sources. The genuine feeling of sadness is "original" or "pure" in Low's terms, whereas the temperamental response is derived and has unrealistic thoughts attached to it.

The root idea of Cognitive Behavioural Therapies is that many of our difficult feelings arise because of faulty thoughts about ourselves, the world, and the future. In Recovery we focus on the experience of "working-ourselves-up" which is an acknowledgement that we fan the flame of our symptoms and make them seem worse than they actually are.

We should not make the mistake of dealing with genuine grief in the same fashion. While there may be scenarios with some cross over between genuine grief and temper, that doesn't mean the same techniques will work for both.


What is Grief?

Many people have heard of the notion that grief goes in stages; denial, anger, bargaining, depression, and acceptance. (see: https://en.wikipedia.org/wiki/Grief) This notion of stages was first introduced by Kubler-Ross and was based on a study of those who were dying from cancer. While this early work is considered to be classic by many, these five stages are far from universal experiences (see: https://www.psychologytoday.com/blog/transcending-the-past/201702/abiding-grief-five-things-i-learned).

The symptoms of grief are similar in many respects to the symptoms of depression.

Physical symptoms including: tightness in the throat or heaviness in the chest. An empty feeling in the stomach, and a loss of appetite.

Reduced concentration. A preoccupation with the emotions of loss and an inability to concentrate.

A Sense of Numbness. Grievers often report that the first reaction they experience after notification of a loss is a sense of numbness. This numbness can be physical, emotional or both. 

Disrupted sleep patterns. Not being able to sleep or sleeping too much. Dreams of their lost loved one (or scenario), sometimes acknowledging the loss within the dream, sometimes the dreamer is reunited with a loved one and only realizes the loss (again) on waking.

Changed eating habits. Grievers talk about having no appetite or that they eat nonstop- or both.

Roller coaster of emotional energy. Grievers may experience a number of emotional highs and lows often leaving them feeling emotionally drained. May include feeling guilty or angry over things that happened or didn't happen in the relationship with the deceased (lost situation, etc). 

The "Grief Recovery Method" is described in detail in a handbook published by the Grief Recovery Institute written by John James. This book presents a collection of steps to work through or complete a grieving process- much of the method focuses on talking through the details of a lost relationship with a partner. The Grief Recovery Institute offers group counseling and one-on-one counseling, and is one example of many similar organizations.

The Grief Recovery Handbook discusses many interesting ideas, among them it includes a broad definition for what experiences might result in grief. Grief is defined as:

Grief is the normal and natural reaction to significant emotional loss of any kind. Grief is the conflicting feelings caused by the end of, or change in, a familiar pattern of behavior. Grief is the feeling of reaching out for someone who has always been there, only to find when you need them again, they are no longer there.

This definition is rather expansive, which I think is good. Some individuals don't appreciate this broad definition. A woman wrote a review of this book where she complaining that she had suffered through both the divorce of her first husband and death of her second husband and remarked that there was no comparison between these experiences. She stated that she could still see, argue, laugh and share anecdotes from the past with the first husband, but that none of these basic things were possible with the deceased husband. She found the equivocation of divorce and death as similar grieving experiences offensive.

Suffering is by no means universal in intensity or detail and each loss experienced by any person will be unique and is not comparable. I think John James does acknowledge this and is making an effort to describe some of the common experiences and tools that can work and those that usually don't work, although I think its also understandable to be put off by any solution that is overly formulaic, or claims to be universal.


Flawed Methods for Dealing with Grief

In The Grief Recovery Handbook John James discusses common strategies that don't work, and I think reviewing this list is helpful. It is more difficult to define how we should deal with grief than how we should *not* address grief, since there are so many ineffective strategies. From the summary workbook:

Time heals. Time does not heal, action within time does. We know people who have waited 10, 20, 30 or even 40 years to feel better.

Grieve alone. Often this advice is subtly implied, “Give your mom her space” or “He just needs a few minutes alone in the other room.” As children, we learn that this means that sad feelings should be hidden or experienced alone.

Be strong. Usually the Griever is asked to be strong for others. “You have to be strong for your [wife]” or “Be strong for your children.”

Don’t feel bad. This is usually followed by an intellectually true statement but is not helpful at all to the Griever, “Don’t feel bad, his suffering is over.” or “Don’t feel bad, at least you knew her as long as you did.”

Replace the loss. This is common with pet loss or the end of a romantic relationship. “On Tuesday we’ll get you a new dog” or “There are plenty of fish in the sea. You just have to get out there and date again.” Most likely there has been no action taken to grieve over the loss of the pet or relationship, just an attempt at not feeling the emotions attached to the loss.

Keep busy. “If I just keep busy then I won’t have time to think about the loss.” This one is sad because some people spend their whole lives with this mentality and never get a chance to grieve and complete what was unfinished with the particular loss.

When struggling with difficult feelings it is also common for people to use strategies to control their feelings, although this is generally not considered to be a healthy response. A control strategy is anything you do that is designed to distract you from your suffering, or change how you feel. In moderation these activities can be fine, they become problematic only when they take over, and the trouble is that often they do.

The most obvious example of a control strategy is having a few drinks in the evening to calm down before going to bed. For some, drinking to hide from their feelings can have serious consequences if it turns into a daily habit. Eating is another common control strategy. For example; having a chocolate bar to distract yourself can be fine, however, overeating foods high in calories or sugar can lead to overweight or put one at risk for diabetes. Control strategies can turn into addictions and these can take many forms. In addition to consuming substances, shopping or collecting items are other examples. These behaviours can lead to vicious cycles where they cause as much pain has they cover up, especially if they result in debt, isolation, health problems, and interfere with normal life activities. In these situations their value as a distraction is lost, and they become problems in and of themselves.


What Can We Do About Grief?

There are many different answers to the question of what can we do about grief, and I can't provide any kind of general strategy in a single blog post, but systematically avoiding grief and refusing to express genuine feelings is not part of a functional solution. Learning to be at ease with the loss is. Of course if we were at ease with the loss, we wouldn't be in pain, and grief wouldn't be an issue for us, so how do we become at ease with the pain that results from grief? Maybe we don't? Maybe the best we can do is reduce the intensity and work through the experience so we can remember our past without being overwhelmed or crushed by the feelings connected to our loss.

The strategy presented by John James involves exploring loss and the associated feelings of grief through a collection of exercises which focus on the idea that processing grief involves acknowledging incomplete communication and expressing your feelings of loss to another person. In the case of death and also in the case of other losses where our future plans with the individual were cut short there are often things that we wish we said that we never could. Forgiveness is a concept that is often presented as part of dealing with the death of a person that we may have been in conflict with. John James says some very insightful things about forgiveness he writes:

Forgiveness is giving up the hope of a different or better yesterday.

Most people seem to convert the word forgive into the word condone. The definition in Merriam-Webster's Tenth Collegiate Dictionary illustrate the problem:

FORGIVE: "to cease to feel resentment against (an offender)."

CONDONE: "to treat as if trivial, harmless, or of no importance."

If we believe the two words to be synonymous, it would be impossible to forgive. The implication that we might trivialize a horrible event is clearly unacceptable. However, if we use Webster's definition of forgive, we are on the right track.

...

The insensitive, unconscious, and sometimes evil actions of other people have hurt us. Our continued resentment and inability to forgive hurts us, not them. Can your continued resentment harm him or her? Clearly not! Can it harm you? Unfortunately, yes. As with all recovery components, the objective of our actions is to set us free. We forgive in order to reacquire our own sense of well-being.

The notion here that forgiveness is about no longer resenting the actions of someone from our past, rather than condoning them is a helpful part of working through the grief associated with a lost relationship that may have been fraught or difficult. Exploring forgiveness may not apply if the lost relationship was relatively trouble free. Grieving is a process which must include many actions. While forgiveness is a component of The Grief Recovery Handbook presented by John James, it is just one part of a fairly complex process grounded in discussing your feelings with other people and exploring the history of your loss.


Grief Counselling

Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that have overwhelmed a person's coping ability. The Grief Counseling Resource Guide from the New York State Office of Mental Health provides a description of the grief counsellor's role:

The Companioning Model of Bereavement caregiving developed by Dr. Alan D. Wolfelt is one in which we as bereavement caregivers help people to integrate life’s losses by being present to them and observing them—companioning. He tells us that observance comes to us from ritual. It means not only “to watch out for,” but “to keep and honor, to bear witness.” 

...

Utilizing this model of bereavement caregiving, the helper: 
  • Listens in a supportive manner to individuals’ concerns.
  • Helps disaster survivors recognize that, in most cases, their emotional reactions are natural, normal, and to be expected. 
  • Assists survivors to reduce additional stress by organizing and prioritizing day-today and recovery-related tasks. 
  • Helps individuals to understand and recognize the wide range of reactions to trauma, such as numbness, frustration, confusion, anger, anxiety, sadness, and feelings of helplessness. 
  • Assists individuals to draw on their own strengths and develop healthy coping mechanisms that permit them to gradually resume their pre-disaster level of functioning. 
  • Sensitively and caringly helps individuals to grieve their losses in their own unique ways. 
  • Systematically draws upon an array of recovery resources for appropriate referrals.
The heart of grief counseling, according to Dr. Ken Doka, writer and lecturer in grief and loss, is validation. Grieving individuals need reassurance that what they are experiencing is normal. Counselors can help people understand and identify the ways they are reacting. Some people grieve through their expression of feelings. Others grieve through problem-solving, thinking, and activities. Doka, in a recent presentation (2002), maintains that there are many different ways in which individuals experience, express and adapt to loss.

There are common problematic approaches that people stumble into as part of dealing with grief, and while some of these may be obvious, it is remarkable how easy it is to pick up a bad habit while struggling with loss. The more complex challenge is to find a method of grieving that is healthy, and gives us a strategy to search for peace, or at least be less traumatized by our loss. While grief is generally not a focus of our discussions at Recovery meetings, as we don't view loss as a mental health problem to be fixed, but rather a natural genuine response to difficult situations, we make every effort to be aware of the genuine suffering of our members.

Recovery meetings provide helpful tools, and these tools are applicable to the struggles that many people must deal with, however the path to becoming a complete person may be long and involve many detours along the way. Personally I've found that when in genuinely difficult situations where I struggled with loss Recovery tools helped me to remain realistic in my approach. We can always take a difficult situation, like the death of a parent, and make it far worse than it needs to be by inserting squabbles about who is right and who is wrong when dealing with the details of a will, or managing our parents home after their death. Recovery tools and other Cognitive Behavioural Techniques cannot make bad feelings associated with grief go away, but they can help us to remain realistic when confronted with the most challenging situations, stay focused on dealing with life's most difficult losses and remain genuine in how we handle them.


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Monday, February 12, 2018

Everyday Frustrations

One of the basic ideas that meetings are designed around is that we focus on everyday frustrations. These are small incidents where members talk through trivialities and explain how they became upset or worked up about a simple situation and what they did to manage their responses. When we discuss chapters from Abraham Low's books, the participants in his original meetings also followed this pattern. The sort of conflicts described involve two people arguing over who should mail a letter, whether a plate is a candy dish or an ashtray and about losing your place in a line up.

For some people new to the group, looking in, this may not seem like the right approach. A common reaction is to say: "I have real problems, these 'trivialities' aren't an issue for me..." or "The things that these guys complain about are unreal? Who cares about these little problems?" 


Why Trivialities? Why Everyday Frustration?

Appreciating this choice of format for the meetings is important for understanding how you can change your thinking. Abraham Low's ideas regarding the focus on everyday situations are more accepted now than they were when he first wrote his books. If you've seen movies that feature a classical psychoanalyst talking to patients lying on a couch Low's ideas may seem unusual or overly simplistic. If you know anything about Sigmund Freud, who described the id, ego, and superego, the subconscious, and neuroses like the Oedipus and Electra complexes, you may think that "talk" therapies necessarily involve a complex exploration of your past and subconscious. Carl Jung and many of Freud's students and associates focused on examining ideas expressed through dreams that identify subconscious conflicts that a patient may not be aware of. While this is where psychoanalysis and talk therapies started, there are a number of limits to this approach.

Abraham Low was originally trained in the classical school of psychoanalysis, although he became frustrated with the approach early in his practice. He found that not only was it an exceptionally long procedure, but he also questioned its effectiveness. This is partly where his ideas for developing group counselling procedures came from and why he does not make any references to Freudian ideas, except that he generally disagrees with the effectiveness of the approach.

Low argues for the importance of examining simple scenarios, which he refers to as trivialities, because if average people are going to get well, they need a method that is easy to remember and understand. This doesn't necessarily mean that Low's books pander to simplistic ideas, or unsophisticated readers. Instead he emphasizes techniques that do not require degrees in literature, a grounding in the abstract operations of metaphor, archetypes, collective unconscious, transference theory, or the many other complex notions that Freud or Jung might have used as part of explaining a person's neurosis. There may be a place for these ideas, but they are too complex to discuss at a self-help meeting run by volunteers. Abraham Low argued that if these psychoanalytic ideas are too hard for a layperson to easily understand, or require extensive explanations, then they can't be of much use in dealing with practical problems in the lives of average people.


Step 1. Report a single situation or event that occurred- an everyday event when you began to work yourself up.

At meetings experienced members present examples of how they used self help tools in their everyday lives. The first step of presenting an example focuses on several details. We begin with a "report" of a single situation. Part of managing the anxiety or frustration that occurs in a situation involves maintaining a certain amount of objectivity, so we report the situation the way a security guard, scientist, lawyer, or police officer might. We try to be objective in our description of the scenario. The situation being described is small, and self contained, like a disagreement about who should deliver a letter. When reporting a situation we also acknowledge that "...you began to work yourself up." This detail is important, the person arguing with me about the letter didn't "make" me angry, and I didn't "get worked up", rather, as the disagreement happened, "I worked myself up." Taking ownership of our responses gives us the power to change our response.

The language used in this first step encourages you to be neutral in the description of the event, to keep the event self contained, and to acknowledge that you are the source of your feelings about the event. Our feelings may be heavily influenced by the details of what happened. It is of course quite natural to be receptive, reactive, and responsive to others, but the specific form of the actions we take in response to the scenarios we find ourselves in are up to us.


Learning is Easiest When We Remain Objective

Because our goal is to learn a method, its important to focus on simple events. When we are talking about the small and potentially manageable frustrations that we experienced when arguing about an inconsequential decision, like who should mail a letter, we can begin to recognize objectively that the negative feelings that we experience come from us. The other person does not control our mind, or inject thoughts, or create frustration within us. It might seem that the other person is the root of the problem, but by changing the way we describe the scenario we can begin to see that our response comes from within. In Low's terminology, the other person is the outer environment, our thoughts and responses are experienced as part of our inner environment.

It may be the case that the other person's behaviour towards us is unreasonable, abusive, or unfair. That is a reality of this world, sometimes people make absurd demands. When we practice with a simple situation like a disagreement about who should mail a letter, our investment in the situation is hopefully low, and we can reflect on how our feelings arose, and what we decided to do about them. This reflection on our initial response to the situation, and what we chose to do to address it, is where we can look for patterns in our own behaviour. We note our temperament, dispositions, and tendencies to situations and people. This helps to inform us of what sort of scenarios create issues for us. Family, and social situations represent common difficult scenarios, for example. Understanding our dispositions helps us to be prepared for our own reactions and not to be surprised when we feel our temper rise.

If we tried to practice with a very difficult situation, like a boyfriend who we catch having dinner with his ex-girlfriend on a night that he told us he had to work, its very difficult to observe the details of our response. In difficult situations, when we don't have access to self-help tools, we are easily overwhelmed. These situations are also infrequent, and while it might seem that the boyfriend who lied, or the friend who passed away, or the job that we were fired from is the root of our misery, it can be very difficult to use this kind of situation as a starting point. These very difficult situations are really the end point, once you learn a number of tools, you can begin to apply them to these hard situations. Just like learning to drive a car, we start with simple situations in a parking lot, not hard scenarios, like taking curves at 170 kph at the race track.


Our Lives are Filled with Trivial Events

When I was very depressed, every single thing I did seemed exceptionally difficult, in some ways this was my depression. Getting up in the morning was hard, so I didn't do it- I stayed in bed until noon or later. Doing my dishes was hard, so I avoided it and let them pile up. Going to school or work was unpleasant, so I stopped. Everything was unpleasant, everything was frustrating, nothing was going well. Of course I wanted all of it to get better, that is how everyone feels- they want all their problems to go away. However, if you have developed a lot of unproductive habits in part as a result of not feeling well, and are stuck in certain negative cycles, you may find the totality of your life exceptionally difficult and want everything fixed but have no clue where to start.

I used to believe that there was probably some fundamental misunderstanding, a puzzle piece which if I could just drop it in place these things would go away. Perhaps the right job, girlfriend, insight into my past, new place to live... I didn't know what was missing, but if I found it, things would go smoothly. Maybe, but guessing the ingredients for a good dinner is probably easier than guessing the ingredients for a good life. I've made a lot of bad meals when I didn't use a recipe, so the idea that I will just stumble upon the missing piece in my life through trial and error isn't a plan I have much faith in.

The self-help-tools described by Low ask us to start with small events, things that we can easily identify, and recognize that our life is filled with them. We focus on scenarios where we worked-ourselves-up. If we aren't handling simple things well, like phone calls, dishes, taking public transit, requests from family, talking to strangers at a shop, keeping our home organized, doing mundane chores, and the many other small things in our lives, our world can become a big mess. If every thing we do seems fraught with danger, and has an emergency quality to it, then our existence can become a horror show.


Big Events are Rare, and May Require the Assistance of a Professional

Coming to meetings and learning self-help-tools ought to be just one of the strategies that you use to understand difficult feelings. We also recognize that many members who are suffering may be experiencing intrusive thoughts related to difficult situations, or alternately may have numbed themselves out so they feel very little of anything at all. There are many professionals who can speak to you privately about intensely difficult situations or extremely upsetting emotions that you may be experiencing. In our self-help meetings we are not able to address certain non-trivial events; things like a death in the family, dealing with an abusive spouse or parent, suicidal feelings, traumatic horrors from your childhood, or the many other real and difficult situations that members struggle with. There is space to talk about these events, and we don't advocate suppressing your feelings, or pretending that things are okay when they are not okay, but there are certain limits to what we can discuss in our group forum.

Many of our members have struggled with serious traumas in their past. These members will attest to their ability to apply the techniques learned in meetings and practiced through everyday scenarios as the same tools that helped them through their most difficult times. Changing how you think takes work, and we approach it through an incremental process focused on everyday average events. Start small, think of the last thing that happened today that was frustrating, that you wanted to avoid, or that left you feeling down. We accept our initial responses to these situations, and apply simple rules of thumb, like being group minded, keeping our expectations reasonable, and when possible not taking ourselves too seriously. While we can't always control our initial response, we can control what we think, say and do, and we start at the beginning with something trivial.

In "Manage your Fears Manage your Anger", Lecture 13, Dr. Low says:

Well, do you understand now that this matter of being average, or this matter of averageness, is not merely a phrase. And if anybody wants to look down his nose on Recovery and say, "Look here, they talk trivialities," then I’ll agree with him. We talk trivialities, and it is these trivialities which touch on averageness, and it is the principle of averageness that makes you human and healthy. And I will advise you, don’t expect that your condition, being as complex as it is— and I don't deny that—requires complex methods to check it and to conquer it. That’s not so. The simple method is always the superior procedure.


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Sunday, February 4, 2018

The Pursuit of Happiness

I went to University in the 1990s and at that time I strongly believed that the pursuit of happiness was an important goal. I was concerned about having useful job skills - both so I could have an income but also meaningful employment some day, and so I took a number of applied courses. I also believed that there was more to life than work and I took arts courses as electives, and participated in a variety of campus activities. I had a lot of cool friends at that time. We spent time talking about deep thoughts, working things out, and we tried to understand life. We described our emotions, our thoughts about the world, the evils of manipulative people and the trouble caused by corporations and politicians. We did lots of fun things, we went to dance clubs, participated in campus groups, threw bohemian parties, fought the establishment, we even went to our classes- the future was a distant reality and of little concern. I miss those days.

Today I think of that time as somewhat idyllic, although I also recall that these were the years when I first encountered serious symptoms of depression. I was sure that money was not a real source of happiness, so I wasn't going to get involved in business, or banking, or anything like that, and I spent a lot of time trying to figure out what would make me happy. What always seemed to me to be a brutal irony was that while I honestly believed that there were many routes to a happy life, and that this should be a more important goal than status based accomplishments, or straight up profiteering, and I tried to align my values appropriately, happiness seemed to me to be elusive, and a thing I couldn't quite get a hold of.

My pursuit of happiness as a goal, although driven by what I thought were positive ideals, was really a failed enterprise. At 29 I was a big mess, I was angry, depressed to the point where I couldn't get out of bed, terrified of the future, and eventually hospitalized. Where was happiness? What had I done wrong?


One of the first Cognitive Behavioural Therapy (CBT) books I read was called The Happiness Trap, by Dr. Russ Harris. I got this book from the Hamilton Public Library, they still carry it and I recommend it. This book describes a variation of CBT called Acceptance and Commitment Therapy (ACT). Dr. Russ Harris has a website where you can read sample chapters from his books and look at videos where he describes ACT:

https://www.actmindfully.com.au/

An important focus for all varieties of Cognitive Behavioural Therapies is identifying unrealistic thoughts. ACT methods are no exception to this but also emphasize mindfulness and explicit techniques to diffuse negative emotions allowing space for them. In The Happiness Trap, Dr. Harris discusses unrealistic thoughts that people have about how to achieve happiness. When I was in my 20s I was using simple rules of thumb like money and status will not bring you happiness, look elsewhere. Dr. Harris agrees with this in principal, but his ideas go beyond this and he asks tough questions: Why do you think pursuing happiness even works? Do you believe that if you are happy you won't have negative feelings? When you have bad feelings (and you will) why can't you just do the things that make you happy to get rid of them? 

In the opening chapter to his book Dr. Harris lists several myths related to happiness.


Myth 1: Happiness Is the Natural Status for All Human Beings

Our culture insists that humans are naturally happy. But the statistics quoted in the introduction clearly disprove this. Remember, one in ten adults will attempt suicide, and one in five will suffer from depression. What's more, the statistical probability that you will suffer from a psychiatric disorder at some stage in your life is almost 30 percent!

And when you add in all the misery caused by problems that are not classified as psychiatric disorders- loneliness, divorces, work stress, midlife crisis, relationship issues, social isolation, prejudice, and lack of meaning or purpose - you start to get some idea of just how rare true happiness really is. Unfortunately, many people walk around with the belief that everyone else is happy except them. And - you guessed it - this belief creates even more unhappiness.


Myth 2: If You're Not Happy, You're Defective

Following logically from Myth 1, Western society assumes that mental suffering is abnormal. It is seen as a weakness or illness, a product of a mind that is somehow faulty or defective. This means that when we do inevitably experience painful thoughts and feelings, we often criticize ourselves for being weak or stupid. 

Acceptance and Commitment Therapy is based on a dramatically different assumption: the normal thinking processes of a healthy human mind will naturally lead to psychological suffering. You're not defective; your mind's just doing what it evolved to do.
...

Myth 3: To Create a Better Life, We Must Get Rid of Negative Feelings

We live in a feel-good society, a culture thoroughly obsessed with finding happiness. And what does that society tell us to do? To eliminate "negative" feelings and accumulate "positive" ones in their place. It's a nice theory, and on the surface it seems to make sense. After all, who wants to have unpleasant feelings? But here's the catch: The things we generally value most in life bring with them a whole range of feelings, both pleasant and unpleasant. For example, in an intimate long-term relationship, although you will experience wonderful feelings such as love and joy, you will also inevitably experience disappointment and frustration. There is no such thing as the perfect partner, and sooner or later conflicts of interest will arise. 

The same holds true for just about every meaningful project we embark on. Although they often bring feelings of excitement and enthusiasm, they also generally bring stress, fear, and anxiety. So if you believe Myth 3, you're in big trouble because it's pretty well impossible to create a better life if you're not prepared to have some uncomfortable feelings. 


Myth 4: You Should Be Able to Control What You Think and Feel

The fact is, we have much less control over our thoughts and feelings than we would like. It's not that we have no control; it's just that we have much less than the "experts" would have us believe. However, we do have a huge amount of control over our actions. And it's through taking action that we create a right, full, and meaningful life.

The overwhelming majority of self-help programs subscribe to Myth 4. The basic claim is: if you challenge your negative thoughts or images and, instead, repeatedly fill your head with positive thoughts and images, you will find happiness. If only life were that simple!

...

The likelihood is, if you're like most other humans on the planet, you've already spent a lot of time and effort trying to have "good" feelings instead of "bad" ones, and you've probably found that as long as you're not too distressed, you can, to some degree, pull it off. But you've probably also discovered that as your level of distress increases, your ability to control your feelings progressively lessens. Sadly, Myth 4 is so widely believed that we tend to feel inadequate when our attempts to control our thoughts and feelings fail.


When I first read this book I found the ideas in it compelling, but also strange. I had the same experience when attending Recovery meetings for the first time, the approach seemed interesting but also not what I expected. For many years I thought that the true focus of understanding my unhappiness had something to do with understanding my past, and dealing with it in some fashion. While I still believe that a person's history has a lot to do with how they got into their current predicaments, your history is something that you can't change. Whether you fully understand it or not may help to some degree, but this is only a small part of the answer.

I now believe that happiness isn't something that you can pursue in a meaningful way. Sometimes it's there, sometimes it isn't, and these days I'm more willing to be surprised by what will make me happy and what won't make me happy. Social engagements, new electronics, cookies and sometimes beer have been reliable at bringing small bursts of happiness over the years, but these things are arguably as base as money or status, they don't provide fulfillment. I've tried eating boxes of cookies, and occasionally spent money I didn't have going to parties, or to buy new gizmos, and these activities all have limits in providing positive feelings. These small pleasures sometimes bring their own negative consequences without providing anything but a brief break from feelings I was trying to hide from.

Dr. Harris gives an answer to these questions that is very much like Dr. Low's answer. This always sounds overly stoic, but I have come to believe it is the truth; that you will have negative feelings, and they will come of their own accord. You can make them more intense by neglecting parts of your life (your bills, work, or important relationships), and while new electronics, good food, and parties may mask these feelings briefly, these activities are only temporary control strategies, and no variation or amount will provide any sort of long term solution.

So what can you do? In Recovery we say "You can't control what you feel, you can control what you think say and do." We also say "Feelings will come and go if you let them" and "Feelings can be distressing, that does not mean they are dangerous." It requires effort to act in spite of your feelings, but this is a large part of the recipe for managing negative emotions like fear and anger. That never means that we ignore our feelings, its important to express them in a reasonable and civilized way, and while we can't dictate what our feelings will be, we shouldn't respond impulsively to drive away negative sensations. Telling yourself to not feel bad about a situation is about as effective as telling yourself to not feel any pain at the dentist. The pain and upset are there and they are real, you cannot wish them away. However, you can face tolerate and endure the discomfort. Many people are frightened of going to the dentist but they go, because the long term consequences of ignoring cavities can be far worse. We encourage the same attitude with other feelings, be aware of them, but don't be controlled by them.


At Recovery meetings we talk about being "Self led, and not symptom led." This means that we rationally chose our long range goals based on positive values and work towards them. We emphasize endorsing for our efforts, and not necessarily the outcome. For example if our goal is to do some housework on the weekend for our family, we make an effort to do it, and minimize behaviors that would distract us - like watching television with a bag of pretzels to avoid feeling guilty about not doing what we said we would do. Some TV is okay, because we acknowledge that we aren't perfect. And, if at the end of the day we didn't do everything we had planned to, that is also okay, achieving the goal is not nearly as important as respecting the effort that we put in. Feeling happy is something that may come eventually if we resist our impulses, it also may not come. We know for sure that if we engage in short term relief strategies - like eating junky snack foods while watching Netflix, we are attempting to make bad feelings go away, and often we end up feeling worse than if we had just done the unpleasant chore.

In the chapter "SABOTAGE METHOD NO. 9: Failure to Practice Muscle Control" from MHTWT Abraham Low describes how sensations come and go, he writes:

Sensations are notorious for their transient and ephemeral existence. They come and go. All you have to do is to observe yourself for a few minutes time and you will have no difficulty spotting numerous mild sensations rising to consciousness and instantly falling back into unawareness. You can then notice in quick succession a warm feeling in the lobe of the ear, some tenseness in the neck, a tickle in the throat, a momentary heartburn in the region of the sternum, a pulling in the shoulder, an itch somewhere and a pressure somewhere else. Some sensations, if mild, are pleasing, like the warmth, the tickle and the itch; others are displeasing, like the heart-burn, the pulling and the pressure. In this manner, stimulation and irritation alternate. The one set of sensations are relaxing; the others are tensing. This continuous ebbing and flowing, appearing and disappearing has been likened to the systolic and diastolic phases of the action of the heart and has been called the "sensation pulse."

How is it, one may ask, that the sensations felt by nervous patients come but do not go? What causes them to lose their transient character and to acquire the quality of sustained duration? To express it differently, why do the sensations experienced by nervous patients tend to lose their pulse? The same consideration may be applied to the obsessions which plague nervous patients. An obsession is a thought, usually a suspicion. The suspicion may be directed at others as in jealousy, or at one's self as in the case of the obsessive thought that one's body is changing or that people stare at you. Of thoughts it is just as axiomatic as of sensations (and feelings) that they are of transient durations flitting through the brain, coming and going, unless they are concentrated on. Just give yourself over to a few moments of revery or day-dreaming and you will realize how your thoughts wander across the field of experience, now reaching out into the future, then roaming through the past with a motley assortment of ideas, opinions, plans and dreams crowding in on one another, the ones just entering your brain, the others leaving. This ceaseless hustle and bustle of an up and down flowing mentation has been called the "stream of thought." The question is again permitted: How is it that with nervous patients the ordinarily fading and floating thought elements harden and crystallize into perennial and unending suspicions and obsessions? Why does their stream of thought cease streaming? Obviously, some factor operating in nervous patients upsets the pulse of their sensations and interrupts the stream of their thoughts. That factor is an abiding sense of insecurity producing, through concentrated preoccupation, sustained tenseness and preventing the nervous system from relaxing. 

Chasing happiness, and never finding it, can create this sense of insecurity, this idea that it no longer matters what we do, that we are doomed to a life of anxiety and depression. These thoughts are however not entirely realistic. As Abraham Low points out, our mind is filled with thoughts and sensations that are ceaseless in their coming and going. While we don't have much choice in which thoughts arise spontaneously, we are almost guaranteed that new thoughts will come. If we punish ourselves with ideas like "...why isn't this party making me happy now!" or "...all my friends have an iPhone-X11, they are happy, why doesn't my iPhone-X11 make me happy?" we are wandering into the zone of insecure thinking where we fixate on unrealistic ideas and become frustrated. Paradoxically, focusing on feelings of not being happy and working to erase them or cover them up usually just creates more unhappiness. Russ Harris talks about making choices based on positive values (creativity, curiosity, courage, persistence, freedom and gratitude) despite having difficult feelings in this short youtube video:



Our minds function in a peculiar fashion, and are not entirely under our control. We can control what we think, say and do, despite not feeling well and despite having contradictory impulses. If we make rational and good choices based on positive values, and try to not respond to all of our insecure thoughts, or get wrapped up in achieving particular goals without endorsing for our efforts, our feelings will have the opportunity to change. Happiness isn't something that we are going to easily find or manufacture, we aren't broken if we aren't happy, and we can still function without happiness.

Many people argue that the pursuit of happiness is an unrealistic goal because true happiness, like all feelings, is so ephemeral. More realistic pursuits involve identifying positive values and working towards related goals without being too concerned about how they make us feel in the short term. We need to remember to focus on the journey, and while choosing a good destination is important, if we don't get there it will be okay so long as we put positive effort in to our trip and celebrate our efforts. This can be difficult, we often pursue that which is pleasurable and avoid that which is painful. With some effort however, we can pursue that which is meaningful despite feeling afraid or uncomfortable. While pursuing worthwhile endeavors almost always includes pain and frustration, with luck we may experience some happiness and fulfillment along the way.


More Information

The Imposter Syndrome, Competency, Self-Esteem and Rejection

Mental Health Myths, Inkblot Tests and Electro-Shock Therapy

Feelings are Not Facts

Friday, February 2, 2018

February is Psychology Month



Psychology Month is celebrated every February to highlight the contributions of Canadian psychology and to teach Canadians how psychology works to help them live healthy and happy lives, help their communities flourish, help their employers create effective workplaces, and help their governments develop good policies.

To read more about the Canada wide program see:

Canadian Psychological Association

Recovery Hamilton runs weekly meetings where we discuss methods to address anxiety and depression. You can always learn more though, and this month the Hamilton Public Library is hosting a collection of events sponsored by area experts. Subjects explored include managing emotions, dealing with anxiety and depression, sleeplessness, mindfulness, and other topics. See:


Events Run by the  Hamilton Public Library

Hamilton Public Library

Tackling Anxiety: Strategies for Managing and Coping with Anxiety


Tue Feb 06, 2018, 7:00 PM
Westdale Branch, 955 King Street West

Anxiety is a common emotion that is often experienced in response to stressful or threatening situations and life events. Join us for a discussion about strategies and techniques to effectively cope with anxiety.


Being Mindful: The Basics of Mindfulness Meditation


Tue Feb 06, 2018, 7:00 PM
Turner Park Branch, 352 Rymal Road East

Being Mindful: The Basics of Mindfulness Meditation

Thu Feb 08, 2018, 6:30 PM
Sherwood Branch, 467 Upper Ottawa Street

Mindfulness meditation has been shown to have numerous benefits. It can prevent depression, reduce anxiety, help people manage stress, and even improve immune system functioning.


Tackling Anxiety: Strategies for Managing and Coping with Anxiety


Sat Feb 10, 2018, 11:30AM
Terryberry Branch, 100 Mohawk Road West

Anxiety is a common emotion that is often experienced in response to stressful or threatening situations and life events. Join us for a discussion about strategies and techniques to effectively cope with anxiety.


Managing Big Emotions


Wed Feb 21, 2018, 6:30 PM
Central Library, 55 York Boulevard

Do you feel like your emotions sometimes control you? Are they overwhelming and difficult to manage? Join us to learn about the function of emotions and practical strategies to help manage how you feel and cope with difficult situations.


Pillow Talk: Strategies for Managing Insomnia


Thu Feb 22, 2018, 7:00 PM
Westdale Branch, 955 King Street West

Sleep difficulties are common during times of stress but can become chronic, leading to insomnia. This talk will explain the difference between normal and problematic sleep and will provide strategies for preventing and managing insomnia. These strategies are based on the principles of cognitive behavioural therapy (CBT), the gold standard treatment for insomnia.


Being Mindful: The Basics of Mindfulness Meditation


Sat Feb 24, 2018, 1:30 PM
Dundas Branch, 55 Cootes Dr.

Mindfulness meditation has been shown to have numerous benefits. It can prevent depression, reduce anxiety, help people manage stress, and even improve immune system functioning.


For a Complete List of Hamilton Public Library Events See:

http://www.hpl.ca/season/all/psychology-month



More Information