Archive for the ‘Health’ Category

You Wear the Suit: 8 Tips on Trading Places with Your Spouse

June 25th, 2009 admin No comments

womens-work.jpgI’ve noticed many more men at pick-up from school and camp, soccer practice and birthday parties. The women? They’ve gone back to work because there are more jobs available in their fields.

In a recent article, Peter Coy writes:

They eat from the same dishes and sleep in the same beds, but they seem to be operating in two different economies. From last November through this April, American women aged 20 and up gained nearly 300,000 jobs, according to the household survey of the Bureau of Labor Statistics. At the same time, American men lost nearly 700,000 jobs. You might even say American men are in recession, and American women are not.

What’s going on? Simply put, men have the misfortune of being concentrated in the two sectors that are doing the worst — manufacturing and construction. Women are concentrated in sectors that are still growing, such as education and health care.

Yep. That’s what’s going on in my home. No one needs architects right now because the housing market got flushed down the toilet with the rest of the construction business. My job as a mental health professional? As my former boss liked to say, “When times are good, business is good. When times are bad, business is better!” So I’m working more, and Eric is working less. We essentially traded places.

Like all major adjustments, the transition has included its share of awkwardness. That’s why I’m going to share a few tips that have worked for us.

1. Say thank you. Often.

Honestly, what has helped us most during these months are our brief emails to each other. I will often write him a note like this: “I appreciate your picking the kids up from school today and for folding the laundry. You are a wonderful father, and I’m glad the kids get this time with you.” He often sends me an email like this: “Thanks for working so hard and for being so productive. I’m glad your career is going somewhere.”

2. Respect each other.

I remember the bridal shower I attended where each person in the room had to share one piece of marriage advice. A woman who had been married for 40 years said this: “Be nice to each other.”

It was so simple, and yet so profound.

My writing mentor Mike always reminds me to “err on the side of compassion.” So right when I’m about to storm into the kitchen… or the location of the mayhem … and tell Eric to stop shouting at the kids, and tell the kids to stop driving their dad insane, I will take a few deep breaths, say to myself that they are fine, that this stuff happened all the time when I was with them … it’s just that Eric couldn’t hear it from his office down the road. Moreover, I can’t go stomping into his turf, because I need to respect him and the job he’s doing.

3. Communicate clearly.

This is probably the hardest step. First, I think it’s important to know when NOT to say anything: when you are hungry, angry, lonely, or tired (HALT, I learned in 12 step meetings). So, in the three minutes you have after lunch, there’s your window of opportunity!

John Grohol outlines some great tips for better communication in his post, “9 Steps to Better Communication Today”:

  • Stop and listen. When we’re knee deep within a serious discussion or argument with our significant other, it’s hard to put aside our point for the moment and just listen.
  • Be open and honest with your partner. Being open means talking about things you may have never talked about with another human being before in your life. It means being vulnerable and honest with your partner, completely and unabashedly.
  • Pay attention to nonverbal signals. Most of our communication with one another in any friendship or relationship isn’t what we say, but how we say it.
  • Communicating is more than just talking. To communicate better and more effectively in your relationship, you don’t only have to talk. Some couples also find that using email or another method is easier to discuss emotional issues rather than trying to do so face-to-face.

4. Stay flexible. And give.

Eric and I have an advantage here. Both of our jobs are very flexible. To a certain extent, we make up our schedule. But we didn’t land these jobs in a stroke of good luck. We made conscious decisions all along, to go with the more flexible job over the higher-paying one. I know that Eric could easily work for a prestigious Washington, D.C.-based architecture firm, commuting to the city on top of long hours. He opted instead for a flexible position around the corner because he knew that working was important to me, too, and that if he took a D.C. job I wouldn’t be able to keep a finger in my career.

In that vein, I like to think of this time … when he doesn’t have much work and I do … as giving back to him … as a way of thanking him for the choices he has made in the past for me and for our family. Staying flexible, for us, means thinking as a family, not necessarily as an individual.

5. Revisit priorities and commitments.

Eric and I never call a “commitments” or “priorities” meeting.” We’re far too disorganized for that. However, we do analyze our priorities quite often… usually after running into some of our friends that seemed much less stressed out than we are.

We revisit our commitments.

  • We don’t want to hire a full-time nanny or au pair.
  • We don’t want to use full-time daycare.
  • We would both like to continue working.

Since we don’t have a lot of outside help from our families, that makes our goals very difficult to attain. Something, ultimately, has to give: our marriage, our jobs, time with kids, or all the housekeeping and domestic tasks in which June Cleaver excelled.

We chose D: the plants, the laundry, the stains on the walls.

As long as we keep on remembering that we chose this route–we chose this set of priorities, and we chose them together as a couple–then the stress over us becomes less debilitating.

6. Think outside the box.

It’s important to know that you have options today, especially given all the technology available. If you’ve been laid off and can’t get another job like the one you just had, that doesn’t mean you can’t use your talents, skills, and services in a slightly different capacity … part-time or full time.

I’ve seen folks pursue a part-time job at the bookstore, dally in graphic design, wait tables … anything that gets them out of the house and generates a few bucks. Think for a moment: Is there any way you can use your skills as a consultant? Can you ask some of the contacts you’ve made over the years if there is a service you can provide? Be creative. Broaden your view. Open your mind to a new way of working.

7. Make some rules. Get a system.

Eric and I did have to adopt some appropriate procedures for processing the reams of paper sent home in the kids’ school bags, not to mention all the emails about soccer practice, Cub Scout meetings, and community news. For about three months, whenever I’d get an email from the school, I presumed he was handling it. He thought I had it. Thus, we missed out on the summer homework we were supposed to order, soccer signups for next fall, and oh, those damn letters of the alphabet we were supposed to cut out every week.

“Okay, we need a system,” I said, after I got reprimanded from Katherine’s teacher on not cutting out letters D through X. “From here on out, you put all the papers about school stuff on my desk. And I will presume you are handling all the emails unless you forward something to me. Does that work?”

It did work. Not full proof, you know, but good enough.

8. Don’t forget to laugh.

As I discussed in my post “9 Ways Humor Heals,” a sense of humor is absolutely crucial here because humor combats fear. And when you don’t know how you are going to pay your next bill … or find another job, fear can take over your life. Laughter forces a few steps–some much-needed distance– between a situation and our reaction. We all would do well to follow the advice of Leo Buscaglia: “When you get to the end of your rope, tie a knot and hang on. And swing!”

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Tips To Find A Good-Enough Doctor

June 25th, 2009 admin No comments

stethoscopeWhen you have a chronic illness your relationship with your doctor is second only to your spouse or your parents. Being honest (and you must be honest!) with that person means being able to trust them to hear you.

In my CI career I fired three highly recommended specialists because they were rude poopy heads. Thankfully I’ve also had wonderful physicians who literally saved my life and my mind. Not uncommonly for people with chronic illness, the path to find a good-enough doctor is an odyssey.

Laura Hillenbrand, author of the fabulous book Seabiscuit: An American Legend, was diagnosed with Chronic Fatigue Syndrome but not before she was put through all kinds of humiliation by physicians who out of ignorance did not listen to her.

“The doctor I found waved me into a chair and began asking questions and making notes, pausing to rake his fingers through a hedge of dark hair that drifted onto his brow. He ran some tests and found nothing amiss. He told me to take antacids. A few weeks later, when I returned and told him that I was getting worse, he sat me down. My problem, he said gravely, was not in my body but in my mind; the test results proved it. He told me to see a psychiatrist.”

Ms. Hillenbrand was 20 years old. At 5′ 5″ her weight had dropped to 100 pounds. She suffered from chills, fevers, exhaustion, swollen lymph nodes and dizziness. Being young and alone, she followed doctor’s orders and went to the recommended psychiatrist. After a thorough assessment:

“He wrote my internist a letter stating that he would stake his reputation on his conclusion that I was mentally healthy but suffering from a serious physical illness.”

Her doctor’s reaction?

“‘Find another psychiatrist,’ my internist said over the phone, a smile in his voice.”

Ms. Hillenbrand went through two more doctors before she found her good-enough one at Johns Hopkins. He listened to her, read all her documentation and correctly diagnosed her condition.

Recently a client of mine asked how to tell if she had a good doctor. If I were you, I said, I would look for these three basic qualities:

  • Expertise, knowledge, intellectual curiosity and all the right credentials.
  • Warm, receptive, a good listener and communicator. The bedside manner thing.
  • A well-run office, with smart, efficient support & medical staff.

You know you’ve hit the jackpot when your doctor rates high on all three. I’ve had two doctors like that in my life, both gifts from heaven. Several were really awful. Picture this….

Scene 1: Doctor’s examining room, midtown Manhattan. Thirty-something, I sit on the examining table, my legs dangle over the side. I wear a paper shmata. My husband is standing next to me. The tall physician in his crisp lab coat faces us.

Doctor: I believe you have lupus.

Me: [I don't say anything. I'm too busy crying.]

Doctor: [With a wise-guy sneer] Why are you crying? It could be worse.

My husband and I get up and leave, never to return.

Scene 2: (A couple of years later in Buffalo, NY) Doctor’s examining room. I sit on the examining table, my legs dangle over the side, wearing that same stupid paper thing they have the nerve to call a gown.

Doctor: Clearly the disease has progressed. There’s not much we can do except hope the medication turns it around.

Me: [I don't say anything. I'm crying.]

Doctor: [Nervously] You seem anxious. There’s no reason to be anxious. Maybe you should see a psychiatrist.

Me: [Angry] You’re telling me the disease is unchecked and you wonder why I’m anxious?

The first doctor I fired. The second I kept. It was a close call but I kept him. Let me explain.

In the scenarios above, the first doctor, a rheumatologist, flunked because he not only sucked at communication, he lacked intellectual curiosity. Underneath my distress I didn’t think I had lupus, I didn’t know what I had but it wasn’t lupus. He didn’t care. He wasn’t going to discuss it with me. He was already thinking about his next case. Deal breaker.

Doctor number two, also a rheumatologist, had all the right credentials, a super-sharp mind and the curiosity of Sherlock Holmes. He was more scientist than clinician. Doc 2 probably communicated great with lab rats; it was people he couldn’t handle. His nursing and office staff were tops, always accommodating and respectful of my time. He would listen to me as long as I reported ‘just the facts’ like Mr. Spock; I was a ‘fascinating case’ (how many times have you heard that old line?) and thus worthy of his attention.

Keep him or let him go?

My options weren’t as great in Buffalo as they were in New York City. There were maybe two other rheumatologists in the area capable of dealing with my condition and they were both trained by Doc 2.

A few more things to keep in mind:

  • If you are in doubt, interview several doctors as if they were applying for a job and you are the employer. If you don’t feel comfortable with your doctor or what s/he is telling you, get a second opinion. Don’t even worry about hurting anyone’s feelings. They are professionals and can handle it. If they can’t and give you a hard time, run, do not walk, to the nearest exit.

  • Only the actual physical examination needs to be done in the examining room with you in a hospital gown. Any good-enough doctor would allow you to change into street clothes and sit comfortably in a chair for the important post-exam conversation.
  • If you want the best, search for your doctor among the medical faculty of a teaching hospital. Medical centers tied to a medical school, teaching hospitals are where the medical students and residents do their training. The faculty who teach and supervise there know the latest diagnostic procedures, tests and treatments because they have to teach it. Putting up with the gaggle of med students (who make Doogie Howser look like a geezer) is worth it as long as your doctor hears you.
  • A good-enough doctor will admit when he/she doesn’t have the answer but will work with you to figure out a plan, maybe even try something experimental if you’re willing.
  • Trust your gut. Filter out what others say, focus on what your physician is saying and make your own judgment. Don’t micromanage your doctor, but don’t just be a Yes person either.
  • A good listening doctor can show compassion without getting all touchy-feely. If you need someone to pet you and say “Poor baby,” (and we all do) go to your mother, a friend or your spouse. Don’t expect it from your doctor.
  • Remember that doctors, just like the rest of us, are not perfect. If you found one who is good-enough, celebrate and get to work.

So I kept Doc 2, even though he had the social IQ of a kumquat. He was a leading expert on my disease and as long as our conversations focused on that we were good. We decided on an experimental treatment that (knock on wood) worked. He’s a big reason I’ve been in remission this long. Go figure.

An addendum: Since first publishing this article I realize I’m so close to this subject I may think I’m communicating the subtleties of developing a working relationship with our doctors and I missed a few points. First, Doc 2 was not a warm fuzzy guy, but he wasn’t nearly as bad as Doc 1, e.g. he was not condescending and he did hear me. His lack of warmth was not a deal breaker for me while it could have been for someone else. There is no right or wrong here. We did have a ‘talk’ to air out the relationship so we could understand each other and move forward. Secondly, I failed to mention that having a good therapist during the entire diagnostic process and after was important to me. It wasn’t the referral to a psychiatrist that was amiss for either Laura Hillenbrand or me. It was the idea that our not-so-good doctors were implying that we were mentally/emotionally out of control and they couldn’t handle that. This subject is a post all by itself. And thirdly, this post was inspired by the comments from Five Rules For Living With Chronic Illness. Thank you for your comments, questions and stories.

Photo courtesy of wenzday01 via Flickr

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6 Steps to Manage Your Time Better: An Interview with Russell Bishop

June 25th, 2009 admin No comments

An Interview with Russell BishopToday I have the pleasure of interviewing Russell Bishop, currently Senior Editor-at-Large for the Huffington Post and founder of Bishop & Bishop, a consulting and coaching company. Russell is the author of numerous articles on the power of choice and awareness, and has two books in development. An expert in personal and organization transformation, Russell has coached leadership teams, entrepreneurs, and CEO’s in 34 countries around the world. He has lectured for executive MBA programs at UCLA, University of Texas and Washington University. Russell received a Master’s degree in Educational Psychology from the University of California and currently resides in Santa Barbara, California.

I’m glad that my husband Eric didn’t overhear our conversation, because Eric has been after me for months to sort through my e-mails and delete the ones I don’t need. At one point Russell asked me how many messages I have in my e-mail inbox. I couldn’t find the number. Finally, I just started adding up all the e-mails from my five accounts, and I told him the figure was around 70,000.

He laughed out loud.

“What?” I said, “Is that a lot?”

At any rate, I am in dire need of some time-management and organizational coaching, and I have always enjoyed Russell’s posts on The Huffington Post. So here is to share some of his organizational tips with you!

Therese: In your post “Is Multitasking Good For You?” you explain the difference between multitasking and multi-goaling. The former leads to half-tasking, which is not recommended. How do we avoid half-tasking?

Russell: I think the first thing we need to do is to focus on the purpose and value of what we are doing. Most people are distracted by what’s right in front of them. They get an e-mail, so they read it. Then they reach for something and find a note that they forgot to follow up on, and so forth. They see the thing that’s right in front of them. And they do it, without a lot of thought.

Therese: So you are saying we need to employ the four-quadrant system of time management that Stephen Covey presents in his book, “The Seven Habits of Highly Successful People,” about distinguishing urgent from important?

Russell: Precisely. That’s a classic formula – urgent versus important – that helps a person give the appropriate attention to something–to assess its value–so that the non-urgent matters don’t become urgent. Because the main gripe I hear from my clients is that they are constantly fighting fires. I tell them, “Don’t be a corporate arsonist.”

Therese: Sounds good, but how do you do that?

Russell: By operating a little more like fire department. Can those guys afford to have a flat tire or mechanical problem with the truck? No. Lives depend on their showing up without a hitch. So they take all the necessary precautions for them to be prepared. They get the truck maintained. They run through the appropriate training.

Therese: I’m with you, but how does that translate into managing time better?

Russell: I think in order not to be extinguishing fires in your personal and professional life you need to 1. Get a plan, 2. Engage, and 3. Get it done. You assign value to each task, and you decide how to execute, so that what’s left undone doesn’t combust and cause a huge problem.

Therese: Okay, so when you get an e-mail or someone asks you to do something, how do you implement this fire-department plan?

Russell: I have a series of six questions I ask myself in order to process information.

1. What is this? Is this a piece of information? Is there something I have to do?
2. What action is required? How long will this take? If it’s less than two minutes, can I just do it now?
3. (If it requires more time than two minutes) What value shows up if I do this? What is the impact?
4. Is it worth doing? What are the consequences if I do this, or if I don’t do it?
5. Is this my responsibility, or is this for someone else? Who is responsible for managing this?
6. Does it have a time deadline? Does it need to be done on a certain date? And if it’s not my responsibility, do I need to follow up?

Therese: What would you say is the biggest mistake we make in managing our time?

Russell: I think we always need to make sure that what we are doing is tied to a meaningful goal, and in that way we assign personal integrity to every task.

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You Have the Right to Your Health Data

June 25th, 2009 admin No comments

I sometimes feel like we take one step forward and two steps back as we embrace technology. Because with the advances in providing people with access to their own health care data (including mental health data), there seems to be inevitable stumbling blocks along the way.

Insert your data into Company A’s personal health record or electronic medical record and you’ll find no easy or accessible way to get it back out. Explore the health data kept by your hospital about you and you may find important pieces missing, or just plain wrong, with no accountability or record of who put that in there.

Want to get Doctor XYZ to see your health data? Be prepared to sign a release and then play the waiting game.

Better yet, want to get a copy of all of the health data kept in your records for yourself? Good luck trying.

You’d think people would already own the data about themselves. You’d especially think that would be true when it comes to data about your health — data that really only you would be interested in.

Introducing the Declaration of Health Data Rights, a simple statement of fundamental patient rights:

In an era when technology is allowing personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

  • Have the right to our own health data
  • Have the right to know the source of each health data element
  • Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form
  • Have the right to share our health data with others as we see fit

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

I believe in the Declaration and wholeheartedly endorse these rights. I believe that every health (and mental health) care provider, organization, hospital, medical records company, and any one else having anything to do with our health care system should do the same. We have the fundamental right to our own health data, and nothing should stand in the way of that right.

Visit the site now:

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Positive Thoughts Make Things Worse for Poor Self-Esteem

June 25th, 2009 admin No comments

You think positive self-talk would always result in feeling more positive about yourself.

New research suggests that may not always be the case.

If a person has poor self-esteem to begin with, and then tells themselves something like, “I am a lovable person,” they actually end up feeling worse about themselves than those with good self-esteem. Why does this occur? Because the positive statement contradicts their own self-image, reminding them of the fact they do not see themselves as a “lovable person.”

So positive self-talk is positive only when the person who’s doing it really believes it. If one’s pre-existing beliefs contradict the positive self-talk, it appears the pre-existing beliefs will usually supersede (and overrule) the self-talk.

The new study was published earlier this month in the journal Psychological Science and was led by Joanne Wood:

Dr Wood suggests that positive self-statements cause negative moods in people with low self-esteem because they conflict with those people’s views of themselves. When positive self-statements strongly conflict with self-perception, she argues, there is not mere resistance but a reinforcing of self-perception. People who view themselves as unlovable find saying that they are so unbelievable that it strengthens their own negative view rather than reversing it. Given that many readers of self-help books that encourage positive self-statements are likely to suffer from low self-esteem, they may be worse than useless.

I’m not sure about that last statement, since self-help books are usually filled with exercises and techniques for helping a person try different strategies for dealing with a specific psychological component in their life (such as relationships). A strategy to encourage positive self-statements is rarely done in a vacuum, but as a part of something bigger.

And low self-esteem itself, while perhaps sometimes overrated, is still an issue that is a legitimate focus that folks may want to change. Combating negative self-talk is one way to do that. But this new research suggests that perhaps positive self-statements may not be the best way to do it.

Read the full article: Positive thinking’s negative results: Words of wisdom

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Thankful for My Dad

June 25th, 2009 admin No comments

Thankful for My DadAs we get older, we gain perspective, if we open ourselves up to understanding and knowledge. It doesn’t always come readily or naturally.

Of course, one of the primary things you gain perspective about as you age is, well, aging. You grow older and people you know start dying. Friends. Family. Colleagues. Death is the ultimate giver of perspective.

You begin to appreciate the richness of the lives that have been voluntarily shared with you, and stop taking them for granted. And you start to understand that despite all of the things our parents might have done wrong by us, they got a lot of things right too.

I can’t complain about my childhood, as I grew up in a decidedly middle-class suburb in a university town, living a decidedly middle-class life. While I may have not gotten everything I wanted (for some reason, some of those memories never seem to leave us), I most certainly got everything I needed. Even if it was often a pair of hand-me down clothes from one of my older brothers. At least I had something different to wear.

As a child, I spent a lot of time outside, playing in the backyard, or over a friend’s house (often in their backyard). We were fearless, my friends and I, and roamed the seemingly-endless suburban neighborhood we called “home” at will. Our technology of choice at that time was GI Joes and bicycles. GI Joes were made for playing in the dirt, and bicycles were the primary form of transportation for kids like us (and still are, in the non-virtual world).

Who made such things possible — a home in the suburbs, GI Joes and bicycles? And more importantly, the freedom to explore and be a kid that such things bring (or at least encourage)?

My dad.

While my mom eventually went back to work in a different career, it was my dad who did the 9 to 5 gig as an accountant in an office that you could’ve taken right out of the 1960s. It was the biggest treat in the world to visit my dad at his office, and one I only was able to enjoy a handful of times. It was very quiet in the office, as everyone was busy doing whatever it was they did there. My dad had his own office, and I thought that was the coolest thing in the world. Something about having your own office still, to this day, connotes status that a cubicle just can’t pull off.

My dad always seemed so very proud when one or more of his kids came to visit him in the office. He’d take us around and introduce us to his co-workers and boss, and he always seemed to lighten up and be very proud of us. My dad is inherently a kind, gentle soul who has a very social and engaging personality. But when growing up, we kids often didn’t see this side of him.

Of course, there wasn’t much for a kid to do in an office, so after letting me play with his cool electronic calculator (which had a paper roll!), we’d all usually go out to lunch, and I’d say goodbye to him when we returned to his office as we made the 45 minute journey back home.

It felt like my dad worked hard at his job, because I don’t remember a lot of interactions with him after work. He seemed tired a lot, and after dinner he would often take a short nap in his chair while reading the newspaper or what-not. I blamed the job for that, not him, and vowed never to work in a boring office job, sitting at a desk all day. (Yes, I get the irony.)

On the weekends, things were different. My dad came out of his work routine and played with us kids, and we as an entire family often did things together such as going to the local farmer’s market, going to a nearby park to play and have a picnic, or visit our grandparents who lived an eternity away by car — over 3 hours (which is an eternity for any kid, sorry).

But as a child, we simply take our parents for granted. We don’t know much about them or their personal lives, and understand only a small part of their personality and background. As we grow up, we start learning more and more about them. As I aged and my dad got involved in supporting the high school band, I saw more and more of him interact outside of the home. I really began to see and enjoy his socially-engaging personality (something I didn’t see much at home at all). Many of my friends would remark to me, “Wow, your dad is the coolest,” and I always thought to myself, “Really? My dad??! You must be mistaken.”

I later understood more of the reason my dad was the way he was at home — the marriage eventually fell apart when all of the kids were out of the house. Him and my mom battled over many things which took their inevitable toll on the relationship.

My dad has since remarried and retired, and lives within 5 miles of where I spent my childhood. His battle is no longer with any one person, but with Parkinson’s disease, something he’s been dealing with now for nearly a decade. I’ve spent far more time with my dad making new memories now than I think I did as a kid, and for that time and those memories, I am eternally grateful.

I’m thankful for my dad, for providing for us early on, allowing us to have all of the things a family needs in order to feel safe, secure and cared for. He provided us not only with the physical means of family, but also with a never-ending supply of love and pride of a dad for his sons and their achievements over the years. I am also thankful for the opportunity of getting to know him as a person over these past 20 years, and try to appreciate every moment I spend with him now, as such moments dwindle.

So thanks, Dad. I love you.

Happy Father’s Day!

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6 Ways to Stay Out of the Psych Ward

June 25th, 2009 admin No comments

It’s been three years since I’ve dined in the community room of a psych ward with some fellow depressives… Trying to slice a piece of rubber turkey with a plastic knife while wondering what I had to do to get out of there. I would like very much not to return. I came up with these steps to help me. But they are good sanity tools even if you’ve never made it to the community room.

1. Keep a consistent rhythm.

I’m not talking about rap, or your tempo on the drums. I’m referring to your circadian rhythm, the internal biological clock which governs fluctuation in body temperature and the secretion of several hormones, including the evil one, cortisol.

Here is how you establish good rhythm that assists you with the whole sanity thing: you live a boring life.

Sort of.

You have to go to bed at the same time every night, and wake up at the same time. Preferably with the same person. You can’t befriend Australians, or if you do, you can’t visit them. Because travel, in general, and especially travel to different time zones, will throw off your circadian rhythm. During the fall and winter months, I stare into my HappyLite for an hour a day because, fragile creature that I am, my brain mourns the sunlight that it gets in the spring and summer.

Folks with seasonal affective disorder and bipolar disorder have to be especially careful to prevent disturbances in the circadian rhythm in order to keep their friends and their jobs. And long-term disruption can actually do mega damage, like messing with the peripheral organs outside the brain, and contributing or aggravating cardiovascular disease. Chronic disruption of the circadian rhythm can suppress melatonin production, too, which has been shown to increase the risk of cancer.

2. Don’t be a cooking frog.

Psychologist Elvira Aletta recently reminded me of the lesson of the cooking frog: You put a frog in a pot of boiling water, it jumps out to preserve its life. You put the same frog in cold water, turning up the heat gradually, and he stays in there … acclimating to the temperature. Until, that is, he boils to death.

I can feel the temperature rising in my pot lately, so I’ve just ordered a bunch of ice-cubes–a vacation, vitamin D supplements, extra therapy–to cool things down.

3. Team up.

Think of the buddy system from Boy Scouts. Teaming up with someone means that you have to be accountable. You have to report to someone. Which lowers your percentage of cheating by 60 percent, or something like that. Especially if you’re a people-pleaser like me. You want to be good, and get a badge or checkmark or whatever the hell they’re passing out, so make sure someone is passing out such reviews.

Also, there is power in numbers, which is why the pairing system is used in many different capacities today: in the workplace, to insure quality control and promote better morale; in twelve-step groups to foster support and mentorship; in exercise programs to get your butt outside on a dark, wintry morning when you’d rather enjoy coffee and sweet rolls with your walking partner.

4. Squeeze in some downtime.

There is another kind of rest that is almost as crucial to your mental health as sleep: downtime.

What is that? I don’t have a clue but my sane friends tell me it’s great.

Downtime lives in quadrant II of Stephen Covey’s time-management matrix I talked about in the video I published awhile back. This kind of rest is important but not urgent. So we say “fuhgedaboudit.” But we really shouldn’t “fuhgedaboudit,” because downtime is our cushion against stress. If your body is without a cushion for too long, the pieces tend to fall apart. Like Humpty Dumpty. And, I hate to bear the bad news, but sometimes the doctors can’t put you back together again.

5. Know your triggers.

After twelve years of therapy and 21 years of hanging out in twelve-step groups, I think I have finally located my triggers: Irish bars loaded with inebriated folks, super-sized Wal-marts with over 100 aisles of products manufactured in China, Chuck-E-Cheese restaurants with life-sized rodents singing melodies to screaming children, and conversations with people who think mental illnesses are like mermaids–not real–and that absolutely every health condition can be fixed with the right thoughts plus a little acupuncture.

6. Preserve your willpower.

Managing your emotions is like being on a permanent diet. If you start off eating celery with hummus for lunch every day, your diet will last approximately six days. At least that’s when I threw out the bag of celery and reached for a BLT.

No. You have to pace yourself–throw in a small piece of dark chocolate … or a pound–so that you keep the momentum of eating right.

Science supports my claim here: Humans have a limited amount of will power. It’s like coal. So don’t even try to quit smoking when you’re eating veggies, or abstain from your Pinot Noir if you’re de-cluttering your house.


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Putting Cool Ahead of Science: TweetPsych

June 25th, 2009 admin No comments

A new service launched this week by a web developer named Dan Zarrella called TweetPsych. Zarrella is also a marketing manager for HubSpot, an online marketing firm. Zarrella calls himself a “scientist,” because I guess it sounds sexier than “web developer” or “marketing manager,” but he doesn’t list any academic credentials. (I wouldn’t mention the scientist or credentials part except that Zarrella makes specific scientific claims about his new service.)

The interesting new service is marketed as offering “psychological profiling” based upon what you post to Twitter. But it’s really just a content analysis service, using two psychological dictionaries and your past 1,000 tweets. Zarrella claims this analysis “builds a psychological profile of a person.” Real psychological profiling is a science, and is usually done with a lot more than just one piece of a person’s life (such as what they write on a micro-blogging service). TweetPsych then makes the contradictory claim that it is for “entertainment purposes only.” Which is it?

There are problems with one of the dictionaries Zarrella is using in the analysis as well. One dictionary — the LIWC — is a valid psychological linguistics database. But the other, the English Regressive Imagery Dictionary (RID), is far less so. The RID is composed of about 3,200 words and roots assigned to 43 categories of thought and mood. The primary problem with the RID is that is has basically no research backing (despite Zarrella’s quoting of a website making it seem as if it does). It was developed by a single professional, who then went on to write a bunch of books about it and other psychoanalytic processes. A book isn’t the same as a peer-reviewed research journal article (as researchers know), and the RID is completely lacking any empirical backing. This suggests that half the analysis is invalid before we even begin.

The second dictionary, the Linguistic Inquiry and Word Count (LIWC), is based primarily on the written word — people’s writings — or the spoken word — like a therapy session or conversation between two people. It was not developed to analyze artificially short 140-character entries, such as those found on Twitter. People abbreviate words when tweeting, because of the character limit, and it’s not clear that simple stemming is going to accurately analyze all of the words written with on-the-fly nonstandard abbreviations. What about re-tweets as well? A person who retweets something isn’t necessarily “speaking,” but instead acting as a mouthpiece for someone else’s words. Does the service differentiate? Without knowing the extent of the problem, you would have no idea whether your analysis is artificially biased in some manner (unless you specifically studied these kinds of issues first). These issues are addressable, but haven’t been addressed in this service.

Zarrella’s ability to quickly analyze 1,000 tweets and compare all the text contained therein to these two dictionaries in a few seconds is an admirable feat of linguistic programming. The challenge then faced is, “How do I present the results of the analysis in a thoughtful, intuitive and actionable manner?” This is the part where TweetPsych simply fails to deliver.

Putting Cool Ahead of Science: TweetPsych

Since Zarrella apparently has little psychology background, the psychology results are pretty unsatisfying. You receive a list of “features” (of your personality? your tweeting?) that include things like “Occupation and Work.” Next to it is the helpful description, “You talk a lot about jobs and your work” and a score.

Gee, thanks for the great insight.

You have no idea what the score means, because there’s no context for it. Is a 47.87 for work good or bad? What’s the average? Other features include “Present Tense,” “Upward Motion,” “Positive Emotions,” “Negative Emotions,” and three dozen other categories.

This part of the analysis, based upon the LIWC, is also only as good as the LIWC’s basic dictionary. While categories such as work, achievement and leisure are all “current concerns” that the LIWC can identify, it has no category for something like “relationship concerns.” But you wouldn’t know that unless you knew the LIWC. It might be something you’d mention to people who take the analysis. Other popular topical content tweeted about regularly — like politics, technology and celebrity — are also not a part of the LIWC. So again, they’ll never show up in the analysis, even if that’s all you talk about. So the information the LIWC — and by extension, TweetPsych — can provide is limited. (The use of a customized dictionary solves some of these issues, but it’s not a dictionary TweetPsych offers.)

The “Primordial, Conceptual and Emotional Content” from the RID comes with absolutely no descriptions, and again, nothing to put your scores into any type of context or understanding. But since it’s not a scientific dictionary to begin with, you can pretty much ignore the scores anyway. They could’ve been developed randomly and provide just as much helpful information.

The last part of the current analysis is “Others like you,” a common component of any social networking service. Curiously, this component was missing from the first version of this tool. Based solely upon what you tweet, it claims “Some people that think like you” and then provides you a list of other people who’ve gone to TweetPsych and entered in their username to analyze.

Of course it’s not people that think like you — it’s people that tweet like you. This is an important distinction. A service that analyzes a tiny portion of what you write every day, and based upon an analysis that may be flawed by its users’ widespread use of abbreviations, surely cannot claim to analyze what you think.

How reliable is TweetPsych? Well, today as I was writing this article, I noticed that all of Dan Zarrella’s own scores changed because of a single tweet (he’s only tweeted once today). His “occupation and work” score dropped 20%, and his “present tense” score went up 16%. His abstract thought score went down 16%. How could all of this happen from just one tweet? One tweet — compared to his 999 other tweets — shouldn’t be able to affect one’s score so much. Unless something else is going on. (Compare the screenshot below, taken at 2:55 pm ET, to the one above, taken at 9:00 am ET today.)

My own results in analyzing Zarrella’s past 1,000 tweets in the LIWC2007 program shows something very different. I don’t know Zarrella’s methodology (since he didn’t share it), but I took the text of his past 1,000 tweets and processed them in two forms through the LIWC — stemmed and “as is.” Neither produced scores anything close to what appears on TweetPsych. This could be due to his using an older version of the dictionary, or some sort of transformation variable he’s adding to TweetPsych that he didn’t disclose. You can view the results of this LIWC2007 analysis here. (I’ve highlighted in yellow things TweetPsych has highlighted, and in green other areas no longer highlighted by TweetPsych; note the significant difference in scoring.) It makes you wonder, though, exactly what is going on with the service. If its psychometric reliability and validity are questionable, how useful is it?

TweetPsych is getting plenty of positive press, with only a dash of skepticism thrown in. CNet’s Josh Lowensohn wrote about the service and only noted in passing, “This makes it less about psychology and more about your personal lexicon, but the results are still quite fun.” Yay, fun! Ben Patterson over at Yahoo! Tech said, “Unfortunately, the psychological profiles that TweetPsych dispenses aren’t the coherent, narrative variety you might hear from the resident psychiatrist on “Law & Order: Criminal Intent.”” And yet, isn’t a coherent narrative far more useful than some nondescript categories? None of the reporters, nor the original article on Mashable (where, surprise!, Zarrella is a contributor), note the lack of psychology background Zarrella brings to the table. None connected the dots as to why the results are so unsatisfying in their interpretations. Apparently tech journalists are great at redistributing their own positive press releases, but not so great at being actual journalists who dig into the claimed science of such a service.

Of course, Zarrella himself admits he didn’t put much thought into the service, as he told the NY Post, “”People just love to compare themselves against other people and to try to ‘get inside’ other people’s heads,” says Zarrella. “It’s like being a fly on the wall at a therapy session.”” A therapy session? Is it really that insightful to find someone is talking about “upward motion?” In the rush to put the service online, Zarrella apparently never asked the question, “Is any of this information actually useful?” The service, as it exists today, is an unfinished thought that few will revisit.

TweetPsych, despite its limitations, has opened the door to future services that actually provide usable, useful and actionable information that would likely have greater validity. Imagine taking not only a person’s tweets, but information contained within their Facebook profile, blog, etc., and have it placed all into one huge analysis engine… Such an engine might have then have the capability of providing true psychological insight into an individual based upon what they say online.

Until that time, we have freshmen efforts like TweetPsych, which really should be called “TweetFun!” Because while it is indeed fun to play with, it provides little psychological insight — except of the most shallow kind — into anyone.

(You can read additional concerns of TweetPsych by Tyler Hayes here.)

10 Ways to Manage Your Weight on Psych Meds

June 25th, 2009 admin No comments

10 Ways to Manage Your Weight on Psych MedsAwhile back, a Beyond Blue reader asked me to address the problem of weight gain and medication. “How do you deal with this yourself?” she asked me.

I’ll be perfectly honest. It’s a battle. As someone with a history of an eating disorder, I’ve had to work very hard on getting to place where I eat when I’m hungry. For that reason, I won’t go near drugs like Zyprexa, because the 20 pounds that I gained in one month made me feel ALMOST bad as my depression.

I totally understand that body image is important to your self-esteem. I wish I wasn’t so shallow, but look at the ads around us. What’s the message that they’re screaming?

“Thin people are beautiful. Overweight people aren’t.” I hate that.

So, since this is Friday’s question that is usually answered by an expert, I read through my Johns Hopkins’s literature and found some helpful modification guidelines by Karen Swartz, M.D., Director of the Clinical Programs and one of the physicians who evaluated me in March of 2006 (and then sent me directly into the inpatient unit!). I hope her guidelines help. In the “Fall 2008 Depression and Anxiety Bulletin,” she writes:

In 2006 a study funded by the National Institute of Mental Health and published in the Archives of General Psychiatry reported that nearly one in four cases of obesity is associated with a mood or anxiety disorder. Among newly diagnosed patients with a mood disorder or anxiety complaint, weight gain is often a serious concern. Many fear that they’ll become fat–or get fatter–if they start medical treatment. A rapidly expanding waistline is also one of the major reasons why patients prematurely discontinue an otherwise effective treatment, fall back into depression and experience a poor outcome. Building a strong doctor-patient relationship and proactively discussing concerns such as weight gain are essential to a positive outcome.

In addition to discussing your weight with your physician, I hope you’ll find the following behavior modification guidelines helpful.

1. Set realistic goals.

Instead of attempting to lose a specific number of pounds, make it your goal to adopt healthier eating and exercise habits. If you feel compelled to set a weight goal, losing 10 to 15 percent of your current body weight is a realistic objective. The good news is that weight loss of as little as 5 to 10 percent of body weight can significantly improve heart disease risk factors such as blood pressure, blood glucose, and triglyceride and cholesterol levels. The safest rate of weight loss is 0.5 to 2 pounds a week. And added bonus: If you lose weight at this rate, you are more likely to keep it off.

2. Seek support from family and friends.

People who receive social support are more successful in changing their behaviors. Request help from family and friends, whether this means asking them to keep high-fat foods out of the house, relieving you of some chore so that you have time to exercise, or even exercising with you to keep you motivated. It will be easier to stick to your new eating plan if everyone in your home eats the same types of foods. You might also want to consider joining an online or local weight support group to talk with others about dieting and exercise challenges.

3. Make changes gradually.

Trying to make many changes too quickly can leave you feeling overwhelmed and frustrated. Instead, ease into exercise; do not overdo it. If you can only walk on the treadmill for 10 minutes, that’s fine. However, in a week or two try to increase the time to 15 minutes. In addition, adopt a healthy diet in stages. For example, if you typically drink whole milk, switch to reduced-fat (2 percent) milk, then to low-fat (1 percent), and then to fat-free.

4. Eat slowly.

Many people consume more calories than needed to satisfy their hunger because they eat too quickly. It takes about 20 minutes for the brain to recognize that the stomach is full, so slowing down helps you feel satisfied on less food. In addition, eating slowly allows you to better appreciate the flavors and textures of your food.

5. Eat three meals a day, plus snacks.

Skipping meals or severely reducing your food intake is counterproductive, since such strict changes are impossible to maintain over the long terms and are ultimately unhealthy. In addition, eating the bulk of your calories at one sitting may slow down your metabolism. You will be more successful in the long run if you allow yourself to eat when you are hungry, eat enough nutritious low-fat food to satisfy that hunger, and spread your calorie intake over the course of the day.

6. Plan for exercise.

Choose activities that are convenient and enjoyable for you to do on a regular basis, and then treat exercise like any other appointment: Set a time and jot it down in your date book. Many people find it easier to exercise first thing in the morning, before the demands of the day interfere.

7. Record your progress.

Start a food diary and exercise log to keep track of your accomplishments. This may seem cumbersome, but it can help you stay motivated, and reviewing your entries can help reveal problem areas. The information can also help your nutritionist or doctor treat your eight problem more effectively.

8. Evaluate your relationship with food.

Behavioral and emotional cues all to often trigger an inappropriate desire to eat. The most common cues are stress, boredom, sadness, anxiety, loneliness, and the use of food as a source of comfort or as a reward. Eating may appear to soothe uncomfortable feelings, but its effect is temporary at best and ultimately does not solve any problems. In fact, eating may distract you from focusing on the real issues.

9. Recall your accomplishments.

Over your lifetime, you have probably been successful in tackling many challenges, including coping with your mood or anxiety disorder. Reminding yourself of your own strength can help you feel more confident about making the changes that will lead to weight loss.

10. Don’t try to be perfect.

While losing weight requires significant changes in eating and exercise habits, not every high-calorie food must be banished forever, and you do not need to exercise vigorously every day. On some days, you will go off your weight-loss plan. This is normal, so don’t let these “bad” days deter you from returning to your healthier eating and exercise habits as soon as you can.

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Plant a Tree in the Name of Mental Health

June 25th, 2009 admin No comments

Midweek Mental Greening

June 18, 2009 (tomorrow!) is the deadline to do just that, if you’re one of the more than 1,000 Croydon residents who receive services from the South London and Maudsley National Health Service (NHS) Foundation Trust (SLAM) who received a patient satisfaction survey to complete.

As part of an effort to encourage patients to complete anonymous patient satisfaction surveys regarding the care they receive from SLAM, the NHS has promised to plant a tree for each completed and returned survey.

SLAM Medical Director Dr. Martin Baggaley says this extra incentive is two-fold: It will encourage patients to share what they like and dislike about SLAM services and help end the shortage of trees in London:

“Taking part in the survey is good both for the local environment and mental health services. We want to hear about what we do well, and what we could do better. We also know people care about the environment they live in, and there’s a shortage of trees in London.

“We plan to plant a tree for every person who completes the survey. That’s potentially up to 1,000 more trees in London.

“We will be working with councils to plant trees in public places, such as parks, as well as at our hospital and community sites.”

Good thinking, SLAM!

I’m wondering if there’s any place here in America that does, or has done, something similar. I know my local community mental health care center has a patient-operated greenhouse, but it’s more for the benefit of the patients and the customers who purchase the flowers and other plants.

Do any of you know if your area mental health care centers have offered such earth-friendly incentives?

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