Thoughts / hopestreetcards

The Hippo that Acknowledges Frustration

We made another card! It’s a card for anxiety disorders and this is what it looks like:

This card wasn’t born out of any clever psychological theory or any observed societal need. It was born out of the honest truth that when someone is experiencing a mental illness it can be really, really frustrating, sad and scary at times. And I’m not referring to the person who has the illness. I’m talking about everyone around them. This card was written for the card givers. (In the hope they’d still give them away to others).

Finding out that someone close to you has a mental illness can lead to any number of feelings and these feelings can have a serious emotional impact on you. Some loved ones might struggle to find a reason for the illness and wonder if they are in some way responsible, leading to strong feelings of guilt. People might feel angry and frustrated that this is happening, that the illness has become a dominant focus of life and disrupted the normality of the family or friendship group. It can be normal to feel confused as to what the hell is going on and what in the heavens this means. A lot of people report feeling a significant sense of loss and grief. It can be possible to begin grieving the loss of the relationship as it was and the life you had, the opportunities and plans that have now changed and to feel overwhelming sadness as to how much the person that they really, really love has been changed by their illness. Mental illness is still a stigmatised condition and for some people they might feel embarrassed or ashamed about what others might think of themselves and their loved one. And it’s scary. Loved ones are particularly likely to worry about what might happen to a person with a mental illness and if they will ever get better.

This exhaustive list of emotions is shit. But all of these, or a combination of a few, is a pretty common and normal experience for loved ones to go through when someone close to them has been diagnosed with a mental health condition.

As a supporter of someone with a mental illness, it’s really, really, really important that you acknowledge and talk about these feelings. Whether that’s with your own friends and family, a mental health professional or a support group. Acknowledging these feelings is the first step towards resolving them. It is important to understand that neither you nor the person with the mental illness are to blame for any of these events or feelings. They just are.

And with this in mind, I wrote this card. The aim was for the supporter to be able to say “OMG, this is just so shit. I am feeling awful and I know you are probably feeling worse and I just wish by magic it could all go away and we could go back to how it was”. But in a way that wasn’t going to make the person with the mental illness feel more guilty/alone/afraid/insert awful consequence of anxiety here. (Obviously I tried to keep it a bit upbeat/empathic/loving).

Because if you, as the supporter, can acknowledge and move past these common, yet horrendously awful and possibly destructive feelings and develop a more positive attitude, you’ll be able to be such a wonderful support for your friend or family member with a mental illness.

And really, really nice feelings can come from supporting someone too. So many people reflect on how their love for their friend or partner or relative deepens and a closer bond develops as they venture through experiences such as this. The new relationship you form with your loved-one can bring growth, deeper connections and learning for you both.

You can find the card here.

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Power and Recovery

Dr M said a while ago – “People who have gone through recovery are very powerful”. And I would have to totally agree. It got me thinking though, where is it that that power comes from?

I think/hope it’s reasonably well known by now that there is no quick fix or stand alone cure for mental illness. Instead what we aim for - for ourselves and for our loved ones - is ‘recovery’.

This in itself can be a bit confusing. When we are physically unwell we do all we need to do in order to recover. We go to the doctor, we take the medicine, we get the physiotherapy or the surgery or the rest or the whatever it is we need. We can see and feel the results when we are recovering and they are obvious to others as well. From my understanding, in the medical world, recovery generally means cure or no current symptoms.

To add to general life complexities, in the psychiatric world the concept of recovery is not about being restored to your previous health. Indeed, it could be argued that nobody returns unchanged to a prior state after an event. We are changed, if not in the objective sense, certainly in the experiential sense and how we see the world. As such, mental health recovery does not always refer to the process of complete recovery from a psychiatric condition in the way that one might recover from a physical health problem.

For many people, the concept of recovery is about staying in control of their life despite experiencing a mental health problem. Recovery can be described as a process of change through which people improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMSHA, 2011).

Recovery is "a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness" – William Anthony, 1993.

So, just because the illness isn’t there anymore doesn’t mean the battle is over. I remember very clearly when Dr M and I were discussing my current state and experience well over a year ago and he cheerily said “Well, you’re not clinically depressed anymore.” I nearly cried. I was bordering on devastation. There was no celebratory dance for no longer meeting DSM-V criteria for a current psychiatric condition. No, I was upset because whilst I was not technically “unwell”, I knew I still had a really, really long way to go. I was in recovery again. And I knew what I was in for.

This wonderful picture explains recovery from a mental illness perfectly to me:

(Source: Anna Borges, Buzzfeed)

Recovery is messy. Really, really messy. And hard. Really, really hard. And time-consuming. And a bit shit. For me, the process has felt like trying to walk up a really steep hill on really unsteady legs during a cyclone.

And why wouldn’t it? I was in the process of building a meaningful and satisfying life, with the threat of recurring symptoms or mental health problems. The evidence suggests, the key themes of recovery are:

  • Agency: Gaining a sense of control over one’s life and one’s illness. Finding personal meaning, an identity which incorporates illness, but retains a positive sense of self.
  • Opportunity: Building a life beyond illness. Using non-mental health agencies, informal supports and natural social networks to achieve integration and social inclusion.
  • Hope: Believing that one can still pursue one’s own hopes and dreams even with the continuing presence of illness.

So what does recovery look like in action? I think this is what we’ve got so far. Diagnosis is helpful, but just because a person no longer is identified as a ‘patient’, doesn’t mean there’s not still work to be done. The development of resilience might still be required to meet the challenges of life. Also, based on the definition there is more than one road to recovery and treatment is just one route amongst many. Sure there are a lot of well researched pharmacological, psychological and social interventions widely available, but there are a lot of ways forward here. And possibly most importantly, the best judge of recovery is the person directly affected. How could anyone else possibly comment or judge on whether another individual is living the life they want to lead? It’s impossible.

Personally, the thing that I have been most surprised about is that recovery is not all bad. I knew back when I was beginning recovery that I would probably not get my previous life back – because, really no one can go backwards – but I didn’t expect to have such a mixed reaction to it all. I would never, ever in my wildest dreams wish the experience of a mental illness recovery on my worst enemy, yet I also wouldn’t ever want to wish my own experience of mental illness recovery away. My recovery has helped to create a more meaningful life than I have ever had. It feels pretty powerful. And I’d never, ever wish that away.

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Hello Compliments!

Say a big ‘HELLO’ to our brand new product! The ‘Positive Pocket Reinforcers’. These are handy little cards with compliments ready to go. You can keep the compliments for yourself, deliver them to a loved one or hand them to a total stranger.

 

And, why would you want to hand out compliments? There are a few reasons and I’m more than happy to sell them to you.

The first reason is Pavlov and his dogs. In operant conditioning (the psychological theory brought to life by Dr Pavlov and his experiments on dogs) positive reinforcement involves the addition of a reinforcing stimulus following a behaviour that makes it more likely that the behaviour will occur again in the future. Positive reinforcement relies on the belief that when a favourable outcome, event, or reward occurs after an action, that particular response or behaviour will be strengthened.

Parents are often really good at positive reinforcement. When a very young little man mouths the word “poop” and then points to the potty for the first time, prior to relieving himself, the happy dance, kisses and hugs from his Mum are beautiful displays of positive reinforcement. Chances are he will now repeat that behaviour over and over given how exciting his Mum’s reaction was.

Compliments are another example of positive reinforcement. I think compliments are one of the most extraordinary components of social life. A compliment can create so much positive energy around two people that things can then move forward as if by magic. We can also imagine compliments as little gifts of love. They’re not asked for or demanded and tell a person they are worthy of notice. Powerful, powerful gifts.

Compliments are such powerful gifts and positive reinforcers that research has recently found that they can improve performance in a better way than receiving a cash reward can. In a recent study adults were asked to learn and perform a specific task on a keyboard. One group of participants received individual compliments on their performance from an evaluator, another group involved individuals watching another participant being complimented and the third group evaluated their own performance on a graph but were told improved performance would incur a monetary reward. When the participants had to repeat the task the next day, the group of participants who received direct compliments from the evaluator performed significantly better than participants from the other groups. Ha! Scientific evidence that receiving a social reward like a compliment is better for performance than money! Wowsers.

Selling Point #1 – These compliment cards could make your own or someone else’s daily performance better!

Secondly, these cards are closely linked to the emotion of kindness. And luckily for us, mammoth amounts of scientific studies have shown that one of the most significant ways to improve one’s wellbeing and life satisfaction is to engage in acts of kindness and prosocial behaviour. And these effects occur regardless of whether you are the giver, the receiver or even just the observer of the act of kindness – everyone reaps the rewards!

Kindness has been shown to result in an increased production of serotonin in the brain. Serotonin is the naturally occurring neurochemical that has a very calming, soothing and comforting effect on us. It helps regulate our mood and reduces our anxiety and generally makes us ‘feel good’. This is the mechanism of action in which a lot of anti-depressant medications work as they limit the reuptake of serotonin by the brain which helps to alleviate some symptoms of depression. So engage in an act of kindness and say hello to activation of the feel good pleasure centre in the brain! And this increase in serotonin happens to the giver, the receiver and the observer. That’s a win-win-win!

Selling Point #2 – These compliment cards will activate the magic pleasure spot in the brain and make everyone feel good!

Quite naturally we feel good when we give, help or serve others, a phenomenon called the ‘helper’s high’. This ‘high’ has been described as a feeling of exhilaration and burst of energy similar to the endorphin-based euphoria experienced after intense exercise which is then followed by a period of calmness and serenity.

Selling point #3 – Reap the benefits of exercise without actually exercising by giving someone a compliment card!

And there are physical benefits too. Research has shown that those who routinely engage in acts of kindness, such as volunteers, experience alleviation of stress, chronic pain, and even insomnia. Dr Christine Carter notes that:

“People who volunteer tend to experience fewer aches and pains. Giving kindness to others protects overall health twice as much as aspirin protects against heart disease. People 55 and older who volunteer for two or more organisations have an impressive 44% lower likelihood of dying early – and that’s after controlling for other contributing factors like physical health, exercise, gender, lifestyle habits and more”.

Selling point #4 – Buy our cards + Distribute = Live Longer!

So there you are. Some proof that sending some complimentary love either to yourself or someone else could have some really abundant effects – feelings of joyfulness, reducing negative feelings, diminishing the effects of diseases and disorders. Surely that’s plenty of reasons to give them a go!

Oh and did I mention they fit snuggly in your pocket? How handy!

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Hope Street Cards Book Club - January

Welcome to the ‘Last Wednesday Book Club’! It’s our very first meeting and this gathering probably would have started better had I properly invited you along or given you full notice in advance. But we will continue.

Here’s the down low. ‘Last Wednesday Book Club’ is new to Hope Street Cards for 2016 and what it will involve each month is me posting a blog reviewing a book which in some way discusses issues related to mental health or mental illness. It might be a self-help book (not to be scoffed at – some are actually helpful), a memoir or autobiography (we will NOT be reading anything related to Ben Cousins), it might even be a textbook of sorts. Each month I’ll let you know the book we will be reading for the month and if you wish, you can join in. And due to the powers of the Internet you can join in in the most wonderful ways. You can submit your own review by commenting on the blog, you might choose to leave your thoughts on our Facebook page (Hope Street Cards) or you might like to tag really lovely photos of you reading the book to our Instagram account (@hopestreetcards) or with the hashtag #lwbc. Again – how wonderful is the Internet?

So, I will know channel my inner Jennifer Byrne and kick it off. This Month I read Sane New World: Taming the Mind by Ruby Wax.

For those who haven’t come across her, Ruby Wax is/was a British comedian who apparently used to interview a lot of celebrities on the tele. As she discloses in the book, at one point she was involved in a television series where she interviewed people in their homes who were experiencing mental illnesses like OCD, depression and PTSD. Interestingly at this time she was also an inpatient at a (very nice) private psychiatric facility and would return to the hospital post-interview to receive treatment for her own depression. Following this, Wax began studying psychotherapy before going on to Oxford University and completing a Masters in mindfulness-based cognitive therapy in an attempt to understand the neuroscience behind her own experience of mental illness.

The book is split into four parts. The first part is a subjective look at depression and Wax’s formulation for why we are all “mad”. She moves on to make a compelling case for how certain “normal” human thought processes and behaviours were incredibly useful to the average hunter-gatherer – and how they’re not so well suited to the ins and outs of everyday modern life. The third section looks at the ways in which the brain controls and balances our emotional lives. There’s information about the structure and the function of different parts of the brain, and an outline of some of the better known neurochemicals. And in part four of the book she explores mindfulness – the practice of focusing one’s attention and becoming aware of one’s experience – and its use in self-regulating thoughts and emotions as a means of dealing with mental health problems. Replete with exercises that aim to put in practice the art of mindfulness, the book encourages readers to reconsider the way they deal with and think about their emotions and thoughts and ultimately the ways we can retrain our brains to improve our health and happiness.

I don’t really know how to write a book review. I was in a book club once before but it seemed as if our main priority in that club was reviewing the food available. So, I’m going to do this review motivational interviewing style, because that I know how to do.

The good things about this book:
• This book is really quite funny. Despite a lot of banging on about how most of society is really gloomy, Wax makes you laugh out loud. Whether it’s describing her Nazi-escaping parents (“child rearing was not their specialty”) or explaining the complex issues surrounding the evolution of human brains: “Millions of years of natural selection, and this is what we’ve come to. We want to be the most famous, the richest, the thinnest and the busiest. Darwin would shit himself in his pants”, you can't help but chuckle.
• The part of the book where she talks about the brain – the development, the structure, the way it works, the important neurotransmitters – is brilliant. Really well researched and informative. And because she brings in her humour, there’s a chance you’ll actually remember some of it. I really wish I had have been able to use this book to study for my second year undergrad neuroscience subject at Uni. The text I tried to rote learn was dull in comparison. Can’t remember a single thing. The diagrams in this book were also very good.
• In terms of celebrity memoir (of which there is quite a bit) it’s not too over the top or narcissistic or irrelevant here. That seems to happen with celebrity memoirs. A lot.
• Because of her inherent sarcasm and almost cynicism about the world around her, that Wax has faith in mindfulness practice adds further to her argument for neuroplasticity and mindfulness practice. For example, she scorns books that give 200 pages of advice “that boil down to ‘Think happy thoughts and your dreams will come true, just like Tinker Bell promised’”, yet she’s ultimately providing us with a 'self-help' book of sorts. And she puts in a lot of evidence-based research to support her theories.
• For a ‘self-help’ book it’s pretty brutal and honest. When outlining the predicament of the minds of all of western civilisation in part one there’s not much sympathy. In a nutshell, Wax sees us all as pretty stupid. And that was quite refreshing for a book of this genre.
• The overall message is one of hope. And this message is supported by the science. That we can change the way we think and improve our responses to things like depression and panic and feeling crap. Or as Wax puts it, “the brain is like a pliable 3lb piece of Play-doh, you can resculpt it by breaking old mental habits and creating new, more flexible ways of thinking”.

The less good things about this book:
• I can’t really figure out who this book is for. I think she thinks it’s for everyone, however it would be very difficult to read if you were experiencing a mental illness or in early recovery. The first part in particular is very heavy on the doom and gloom. If it’s for people who are functioning, however haunted by the “nag-nag” voices then it might be worthwhile. But then the parts regarding Wax’s own experiences with depression might make it feel less relevant. Still stumped on this one.
• It’s really quite a tiring read. And I don’t think it was the content, with all the brain information , research etc., that made me tired. It was all the quick sentences and punch lines and exclamation marks. It’s written in a very similar way to how she speaks on a comedy tour. And I found it a little relentless and exhausting. It was hard to read before going to bed. The irony of it all is that she’s writing at such a frenetic pace, yet telling us all we should all slow down.
• It might be funny (for some people), but I don’t think there’s anything to be gained by using terms like “mad” and “crazy” and “inmates” to describe oneself or other people. Nothing at all. We have so many other words at our disposal, yet Wax almost incessantly sticks to stigmatising mental illness language. I think it’s unhelpful. I’m not going to bang on about why it’s unhelpful. Now, anyways. (You can find one of my rants about it here though).

So, that’s my review. Overall I think it’s pretty good. And my take home message was if we don’t start paying attention to what’s happening in the present, we’ll miss it all. And that will suck.

If you’ve read it and have opinions get involved and let me know them. If you haven’t read it, but have opinions on my opinions get involved and let me know.

Next month I’ll review The Anti Cool Girl by Rosie Waterland. Last Wednesday of February. Happy mental health reading!

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Sending empathy, love and hope

Feedback from the ground (that’s you guys!) is that, buying a card for someone who is experiencing a mental illness is one thing. That perhaps is the easy bit. But writing and sending a card for someone experiencing a mental illness is a whole other story. This perhaps is the not so easy part.

Totally agree my friends. I still get a bit nervous or worried when someone I really like in my life is unwell. What can I say? Will I say the wrong thing? Will I be unhelpful? All valid points, thank you critical voice in my head. But do you know what’s probably worse? Knowing someone is unwell and not doing anything at all. Just pretending it’s not there and ignoring it all together.

Whilst everyone is unique and ultimately you know your loved one much better than me, here is a list of my general tips to fill in the blank spaces of your cards with compassion, empathy and hope.

  1. Try and use statements that show you recognize that your loved one is unwell. This is called validation. Validating someone’s feelings and their illness rather than shaming, questioning or trying to analyse it can make a difference. Statements such as “That must be very hard for you”, or “You are important to me. You matter to me and so do your feelings”, can be very comforting for the person experiencing a mental illness and has the potential to relieve them from some of the shame they may be experiencing regarding their experience.
  2. Often when people are experiencing a mental illness their brain is being a total bitch. In a nutshell it can really attack the person from the inside, skewing their perception of themselves and the world around them. This is an excellent opportunity to bring them back to reality. Or try anyway. Pay your loved one some compliments. Remind them why you really, really like them. For example, “Please don’t forget that I think you are a kind/ generous/beautiful/insert-nice-adjective-here person to be around.” If you’re loved one is very unwell they might not believe it 100%, but it’s never harmful to hear these things. 
  3. Let your loved one know that you’re not going anywhere. And then don’t go anywhere. Everyone fears abandonment on some level, but often the experience of mental illness can be particularly isolating and lonely. As someone who has had a mental illness, or three, the fear that people are not going to stay around for much longer as a result of being so unwell was a real and significant fear. Who would want to hang around someone who hasn’t been able to wear anything but tracksuits and leave the house in a week? If you can say “I am here for you and I’ll be hanging around too”, this might just bring a massive sense of relief to your loved one.
  4. Ask your loved one what you can do to help. The key word here is ‘ask’. This is important because it shows your loved one that you’re ready to assist them in their way. When they’re ready.
  5. Remind your loved one that what they’re going through is really tough and they are doing an excellent job. Something along the lines of “Be kind and gentle with yourself. You are doing the best you can”, is realistic and factual, but probably the kind of feedback that your loved one is not giving them self right now.
  6. Provide some statements of hope. Unfortunately mental illness often comes with other friends attached. Friends like hopelessness and helplessness. If you can provide some realistic words of encouragement and hope it might slightly lessen the impact these friends are having. Statements like “You can get through this experience. I believe in you”, can let your loved one know that you are hopeful for them, even if they are unable to be right at this minute.
  7. Write about a ridiculously silly and incredibly funny story. Sometimes when people are experiencing psychological pain they need something to laugh about. And just because they have a mental illness does not mean they have lost their sense of humour. When I was in hospital my sister used to send me ridiculous photos, texts, emails and updates about her day. Like how many biscuits she’d eaten. The sheer ridiculous of these frequent daily updates (and the phenomenal number of biscuits she could consume in a work day) eventually bought me to belly laughs.
  8. Tell them you love them. Do this repeatedly. This is probably the simplest, best and most important thing you can do.

These things can all be hard to say – or write – but if you can find something that comes from love, acceptance and empathy I think you’ll be right. Remember, they’re still just that person you really, really like. And if they’re experiencing a mental illness they’d probably really love to hear that from you.

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Chatting and dreamin'

I had the most beautiful conversation today.

It came from the pleasure of lunching with two of my favourite human beings. Whilst this is a reasonably regular occurrence, special shit went down today.

These two friends have been having some difficult times of late. One is experiencing symptoms of a mental illness and undertakes outpatient therapy and has begun taking prescribed psychiatric medication. The other has started seeing a psychologist for support with managing the effects of someone close to her experiencing a mental illness.

Now there’s nothing beautiful about the situations my friends are in. Both of their experiences have been difficult to watch. It’s so incredibly hard to see your loved ones in distress. And unfortunately neither of these situations is uncommon. Nor are these things are easily fixed. It’s a continual adventure of gains and setbacks.

But at lunch today, I took a moment just to observe what was happening. And it was divine.

We were all discussing aspects of our emotional health with vulnerability and honesty and openness. And there didn’t appear to be any shame involved. We didn’t feel the need to lower the volume of our voices, in order to hide our experiences from those around us. We offered each other advice and support with compassion, empathy and love. We felt safe. We discussed our own experiences of therapy and referred to each other’s therapists by first name. We came up with hypothetical conceptualisations and formulations of our own and other people’s behaviour. And my non-mental-health-professional friends used psychological terms fluently, sporadically AND correctly. Terms like “co-rumination” and “validation”. As I mentioned – divine.

There’s so many things that are special about this. Firstly, and most importantly, these two loved ones have acknowledged that they value their mental health and have been brave and courageous in asking for help and professional support. And my hypothesis on this, is that with time, they’ll reap the rewards. Secondly, I didn’t feel one little bit guilty. Guilty about burdening others with my emotional issues. Thirdly, it was so very, very easy to talk about these things. We switched between the achievements of potty training to our mental health to illegal internet browsing at work without any hesitation at all. And I think it was easy because we came from a place of love. We were open and honest and discussing these things in a place of no judgment.

Even though I reasonably regularly have conversations about my mental health with my loved ones, the frequency of these conversations is still rare. I’m so glad I took that moment to observe this experience in all its beauty, because otherwise it might have just passed us by. We’ve probably had other lunches just like this and I've probably had other conversations on par with this, but just not noticed how special it was at all.

So my dream is that all – okay, I’ll go with most – conversations about mental health are like this. Filled with honesty, love and empathy. Devoid of shame, judgment and fear. My dream is that conversations like this don’t just occur between three really close friends. But occur between friends, colleagues, acquaintances even.

Imagine if you could run into a distant relative down the street and when they asked how you were, you could explain that actually you’ve been experiencing some panic attacks and they’ve been quite horrific and you’re really struggling, but you’re seeking some assistance from a professional. And you’re not scared or ashamed to do that. Because the basic human reaction that you’re expecting is compassion and love and support.

Wouldn’t that be divine? I hope it happens in my lifetime. I’m so glad the conversation I had today did.

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A new depression card and another man's dogs

You may not be able to immediately tell, but this brand new card comes from dogs.

Pretty much everyone has heard of Pavlov. And his dogs. But there’s another important psychologist who had dogs too. And he didn’t treat them all that well.

In 1965 Martin Seligman began electrically shocking dogs in an attempt to expand on the research of Pavlov - the genius who could make dogs salivate when they heard a bell ring. For nerds, he was the brains behind ‘classical conditioning’.

Seligman’s study involved fear and learning. To condition the dogs when Seligman rang his bell, instead of providing the animals with food, he zapped them with electricity. And to keep them still, he restrained them in a harness. It was predicted that the dog would learn to associate the bell with the shock and then in the future (when released from the harness) the dog would feel fear when it heard the bell. And that fear would cause the dog to run away or show some other signs of mild panic when the bell toned.

Following the conditioning/bell-electric-zapping-time, the dogs were put back into a box with a small fence dividing it into two halves. It was expected that when the bell rang, the dog would jump over the fence to escape it. It didn’t. The dog just sat there and copped it. When they shocked the conditioned dog without the bell, nothing happened. Again, the dog simply lay down and took it. Interestingly, when the researchers put a normal dog into the same box contraption, when zapped it immediately jumped over the fence to the other side to escape it.

Unfortunately for some people who experience depression they are just like Seligman’s dogs. I know I was.

Like the conditioned dogs, who had learned more than the connection between the bell and the shock, some people with depression may believe that escape from possible shocks is futile. In other words they have somehow learned to be helpless. According to Seligman, people experiencing depression may feel that whatever they do will be futile and that they have no control over their environments. This is called ‘learned helplessness’.

Seligman proposed that individuals who - over the course of their lives - had experienced defeat or abuse or loss of control, learned over time that there was no escape. To the point that if an escape was offered, it wouldn’t be acted upon. Initially this theory didn’t really explain how people who hadn’t experienced negative life events ended up going on to experience depression, so Seligman added in some important cognitive or thinking style components.

Studies of people with depression reveal that when these people fail they often will give up and stop trying. Whilst most people will look for external reasons and factors to explain failures, people experiencing depression will hold much stronger views – “It’s my fault”.” I’m stupid.”

Imagine having to carry these thoughts around with you – constantly - whilst feeling – constantly - shit and sad. It’s not then hard to imagine that an extended period of these feelings and thoughts could lead you to giving in to despair and accepting this as reality. Learned helplessness is very closely linked to a loss of feeling in control.

In 1976 Langer and Rodin found that in nursing homes where conformity and passivity is encouraged and where every patients need is attended too, the health and wellbeing of patients’ declines rapidly. In contrast, the patients in nursing homes who were given choices and responsibilities remained healthy and active. This research was repeated in prisons, finding that if inmates were able to move furniture around and control the television this kept them from developing health problems.

When someone is experiencing depression, there’s a strong possibility that feelings of helplessness might begin to occur and may become totally overwhelming. Making small choices and achieving daily tasks, like getting dressed or having a shower, are the things that can hold someone back from the crushingness of learned helplessness. And for someone with depression these tasks are not just tasks, they are massive fucking achievements. When you can succeed at something small, harder tasks might feel more possible. But if you don’t notice what you’re achieving, everything will seem too bloody difficult and useless.

Remind your loved one that you can unlearn learned helplessness. Don’t let them give in to it yet. Celebrate ALL the achievements.

You can find the card here.

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The joys of therapy

For some weird reason most human beings prioritise their physical health over their psychological health. Take for example our teeth. There are so many things most of us do, to ensure good dental hygiene. We brush our teeth. And not just every single day, twice a day. We eat appropriate foods. We might use mouth wash. My Dad even flosses! And we’ll have regular check-ups at the Dentist and if something feels wrong in our mouth, we’ll make an emergency appointment with the Dentist. We do this, despite going to the dentist being one of the most despised activities on the planet.

Compare this to our psychological health. We all experience emotional injuries or pain ALL the time. Things like failure and rejection and sadness. And often they get worse if we don’t look after them or go off and get them treated. And mostly we don’t go and get them treated. Research shows that only 35% of people who experience significant mental illnesses seek treatment. And this is so very weird, because psychological treatment is not like going to the dentist. Seeing a counsellor/psychiatrist/psychologist or therapist is awesome!

 

There are so many wonderful things about therapy. Here is my first, of hopefully many, lists of why getting some counselling is purely fantastic.

1. You get a solid chunk of time, whether that be half an hour or an hour, to focus completely on yourself. Therapy is like an education course where you are the subject matter. Could anything be more interesting? You can explore yourself, go deeper into your current thoughts and feelings, or just sit and ‘be’ for a while (a pretty vital practice that often gets ignored).
2. You get to enhance your vocabulary. You can learn all these new convoluted and sophisticated terms to describe relatively simple behavioural phenomena. I don’t know where I’d be now, without being able to use the terms ‘dissociation’, ‘transference’ and ‘priming’ throughout the course of my day.
3. Therapy can be a dress rehearsal for life. You get to practice all the things that just seem way too hard in the real world. That’s right friends, I’m talking role plays and experiments, which means when you have to go out into the bright lights of work, social and family settings new patterns and behaviours don’t seem as terrifying.
4. You never, ever get told to stop crying. Or feeling whatever you’re feeling. On the contrary, you might be asked to explore the feeling or try and work with it. For so many people this is quite a different approach. Working through the shit feelings, the ones that usually get avoided and denied. Trust me, it’s really quite nice in the long run.
5. There is stack loads of research and scientific evidence behind talk-based therapies showing that it is effective for making painful experiences more tolerable. It’s a proven method for changing harmful thinking, relational and behavioural patterns. It’s also used to make good lives great. And I haven’t come across many people who don’t want to change anything about their life.
6. Your therapist can make you feel really, really normal. As an objective professional, they are really, really good at normalising base impulses and behaviours. Just the other day, when I was banging on about how difficult it would be for me to keep up a relatively new behavioural pattern forever, Dr M kindly reminded me that all humans have a fundamental issue with the concept of “forever”. Boom. Thanks Dr M. Correct, and weight lifted of my shoulders.
7. The therapeutic relationship is really one sided. And if you’re the patient/client/consumer, that’s in your favour. It’s a fascinating and intriguing experience being involved in such a relationship. A relationship where someone knows so, so, so, so much about you and you know nothing at all about them. To even up the balance, I like to invent things about Dr M. He’s a bird-watching hipster who is really a passionate geek at heart.
8. There’s someone who will hold all of your secrets. Without any judgement. Amazeballs.
9. It’s a really good opportunity for “aha” moments. If this was a cartoon, a light bulb would be in a thought bubble above your head. These moments are pretty awesome. When you come to a realisation of how everything has been fitting together and what might need to happen next. There is the potential here for transformation and enlightenment and just general life gets better stuff.
10. You get to be an explorer of one of the most complex and grandest things – the mind. And more importantly, your own mind.

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The sick brain?

At Hope Street Cards we’ve released a new card. This is what it looks like:


That’s right; this card is all about the neuroscience. That is, the science of the brain.

The world of understanding things doesn’t really seem to know exactly why and how mental illnesses exist and occur. Diagnosing a mental illness isn’t like diagnosing other conditions. There’s no blood test, no x-ray, no CT scan that can yield a diagnosis of anything mental health related. It’s much more difficult and it involves looking at a big conglomerate of complex factors that makes up an individual’s situation – the biology, the environment, the thinking, the culture, the relationships.

When it comes down to the relationship between mental illness and the brain it all gets pretty interesting. And even a little bit controversial.

The brain is AMAZING. It consists of billions of neurons or cells that must communicate with each other. The communication between neurons maintains all of our bodily functions, informs of us of pleasure and pain and lets us know when a bird has pooped on our head. The communication between neurons is controlled by the brain’s type and level of neurotransmitters. Neurotransmitters are the chemical substances that control and create signals in the brain both between and within neurons. Without neurotransmitters, there would be no communication between neurons. The heart wouldn’t get a signal to beat, our mouth wouldn’t know how to speak and our arms wouldn’t be able to react widely in an attempt to shake bird poop from our hair.

For quite some time it has been believed by numerous smart people that having a “chemical imbalance” or an imbalance of certain neurotransmitters within the brain was the main cause of psychiatric conditions.

Dopamine is one such neurotransmitter, which when found in the thinking areas of the brain can be considered the neurotransmitter of focus and attention. It is hypothesised that low levels of dopamine here can impair our ability to focus on our environment, stay on task or activities, or maintain conversations. Low levels of dopamine in these areas of the brain have been found to be prevalent in individuals experiencing Attention-Deficit Hyperactivity Disorder (ADHD). At the other end of the scale, extremely high levels of dopamine in the brain can cause us to lose our contact with reality. We can begin to develop unusual ideas about what is happening to us. We might experience delusions (false beliefs) and we might experience hallucinations of our senses. Not surprisingly then, medications that block the dopamine receptor work wonders in calming the psychotic symptoms of people with schizophrenia.

Serotonin is another neurotransmitter that has been identified in multiple psychiatric disorders. This neurotransmitter is a major regulator of things and is involved in a lot of bodily processes such as sleep, libido and body temperature. Most importantly it is commonly regarded as the chemical responsible for maintaining mood balance. Because of its’ role as a major regulator of things we often rely on serotonin a lot when we are stressed. Living in a high stress situation for a prolonged period of time, we use more serotonin than is normally replaced and prolonged exposure to high stress can gradually lower our serotonin levels. When serotonin levels are low, we experience difficulties with concentration and attention. Routine responsibilities can seem overwhelming. Sleep and appetite disturbances can occur and mood can reduce. Drug treatments, such as Selective Serotonin Reuptake Inhibitors (SSRI’s) a commonly used anti-depressant, have been found to have beneficial effects in people with major depressive disorder. These medications work by blocking serotonin-producing cells from reabsorbing a good portion of the neurotransmitter they secrete – as they normally would – leaving more of the chemical available for communication around the brain.

These drug discoveries resulted almost entirely from serendipitous accident though. And scientists went searching for the neurological roots of the medications workings after the fact. So we know that SSRI’s can work for treating depression in some people, but we still don’t know for sure that a shortage of serotonin is the cause of the depression.

And it appears that the research focus on neurotransmitters as the key cause of mental illness stopped producing any new findings long ago.

Despite not knowing the nature of the imbalance, the term ‘chemical imbalance’ has been argued to have made psychiatric disorders more palatable for patients and less stigmatising. If the cause of mental illness is our brain chemistry or our DNA, then it’s much more difficult for the person to be blamed for their symptoms. Advocates argue that stigma will diminish if we come to see mental health problems as biologically caused diseases, no different from diabetes or cancer.

Critics of the ‘chemical imbalance’ hypothesis claim that this hypothesis continues to be advanced only by pharmaceutical companies, with mammoth amounts of money going into possible pills that could bring their brain chemistry back into balance.

So does someone who has a mental illness actually have a “sick brain”? I don’t think we know for sure yet. We presume there is a ‘chemical imbalance’, but it’s uncertain as to what that imbalance actually is. We don’t know the exact biological nature of what is wrong when someone has a mental illness. And we don’t know for certain the exact mechanism by which medications or other treatments work.

I think we can say that someone’s brain is sick though to describe what we can’t scientifically explain. We know that something is not quite right in someone’s brain when he or she shows symptoms of bipolar disorder or schizophrenia or major depression. We know that certain chemicals might help to alleviate these symptoms. We also know that a mental health condition is probably caused by a range of things outside of the brain as well.

Like other body parts though, it’s entirely possible that the brain can also become a bit sick, or faulty, or imbalanced. Whilst it’s not the only factor contributing to the development of a mental illness, it’s an important one to note. If we acknowledge that there is a part of mental illness that is physically manifested, perhaps we will start to move from a narrative of blaming the person with a mental illness for being crazy or weak, to just being unwell. Because that’s what they are. And like all unwell people, they very much deserve to receive a card of support.

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Keeping your bubble safe

I really debated whether to write on this topic, mostly because by now probably every other person has said their piece. For better or worse. But in the aftermath of the events over the weekend and in the context of the horrors of what happens across the world on a regular basis, perhaps there is a couple of things we need to be mindful of.

From what I’ve read, the term ‘terrorism’ can be a difficult thing to concretely define. In the psychology world though, we often refer to terrorism through the concept of ‘psychological warfare’. The mechanism of action to terrorise the society may be a little different but the purpose remains the same. I’ll attempt to explain it. Terrorism is a form of political violence that is meant to send a message about a particular organisation or idea through violent victimisation or destruction. By design these acts induce terror and psychic fear (which is sometimes indiscriminate), but aids the activity of achieving maximum publicity and amplifying force (Marshall, 2005).

Terrorism and psychological warfare have been around for as long as anyone can remember. Throughout history, pretty much every military conflict has in one way or another involved some form of psychological warfare to disadvantage the opponent. But in today’s world, the rules of engagement in this type of mental battle have changed.

Because of the advances in technology, we have no idea what we might see, hear or learn when we turn on the television, pick up our phone or engage with our friends through social media. Unlike historical military battles, the effects of psychological warfare aren’t limited to the people involved or the countries and communities in which they took place. Nowadays we can all, in one way or another, become involved. Images of terror can trigger a visceral response no matter how close or far away from home the event happened. And the impact has the potential to be even greater too. To instil a sense of fear that is much greater than the actual threat itself.

Sometimes I like to think of each person having a psychological bubble around them. The bubble is made up of all their strengths, their range of coping skills, their beliefs and values and their past lived experiences and history. It’s a protective barrier that can help each person, in its own unique way, navigate through their experience of the world. And when things happen, the bubble reacts and transforms in different ways.


I spoke to a number of people over the weekend, who were feeling distressed about the news of what had happened in a foreign country half way around the world. And I felt it too. I felt sad and shocked and scared. And this is natural. As awful as it is, it’s natural to feel disturbed. And that’s because the majority of us are all beautiful human beings and in our bubbles we have the strength to feel empathy. Professor Haroun from the University of California says: “The human reaction is to put yourself in the situation, because most of us have good mental health and the capacity to empathise. We put ourselves in the shoes of the unfortunate.” So in essence, because we have the capacity for compassion for others, events such as these hurt.

Not only can it trouble the feelings in our bubble, witnessing an act of terror can also disrupt our belief system. There was a time when I was working closely with patients who were seeking asylum in Australia. It was not until then that I realised that how l had been so fiercely protected by the belief systems and values that were inside my bubble. I was fully aware that not everyone had the same values and social niceties as I did and I felt that as a result of my life experiences I had a reasonable grasp on reality, but when I heard the stories of extreme terror from these patients my bubble, my beliefs and values about the world I live in, became significantly challenged and violated. My bubble was significantly disrupted. And the result was an immense fear. Fearful in the sense that I was living in an uncaring and unsafe world because I was no longer ignorant to how low the bar of humanity was. And it took quite some time to learn to cope with that. To get my bubble back in balance.

The research suggests that the key to coping with psychological terror is to find a healthy balance. And most people do. Studies have shown that even in extreme disasters, the majority of people do not become incapable of functioning. While there may be initial shock and distress; people call on their personal strengths and those of their family and community. And for the most part, people recover and return to their normal activities.

We may not be able to prevent all attacks that occur, but there are some things we can do to protect ourselves and those we care about to find a healthy balance, protect our psychological bubble and ensure that we don’t become over-anxious about the possibility of terrorism. Because we are human, our decision-making skills can be impaired in times of extreme stress. So try and stay grounded in reality and seek out the reliable sources of news and information. And where possible don’t rush to make quick judgements on what might be incomplete or inaccurate information.

The Mental Health Association of NSW offers a number of practical suggestions to assist people living with the fear of terrorist attacks or other human-made disasters. These include:
- Find out where to get help in the event of an emergency
- Give and receive emotional support
- Keep in touch with the people you care about
- Offer help to others in the community

Additional suggestions can be found here. It is also possible that people with pre-existing mental health conditions may experience a worsening of symptoms in response to such events. Keep an eye out for any such loved ones and where possible try and provide additional support.

A strategy that has worked well for me in the past in ensuring my bubble remains strong and resilient is to seek out the hope. Hope is often the antithesis of fear. And so I find that by discovering (and sometimes it’s quite a search) the things that come from a devastating event that can add some hope back in to to my bubble helps to get my psychological health back in balance.

“When I was a boy and I would see scary things in the news, my mother would say to me, 'Look for the helpers. You will always find people who are helping." Fred Rogers.

So whilst our news feeds on social media, the opinion pieces on blogs and the background natter of the television continue to remind us of humanity’s atrocities, please look after yourself my friends. Try and keep your psychological bubble balanced, healthy and strong.

If you need to chat to someone:
Lifeline: 13 11 14
Beyond Blue: 1300 22 4636

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