Thoughts / love and mental illness

Understanding love

Happy (belated) Love Day my friends!

Phew! I am exhausted. After a full month of blogging all things relationships, I’m a little drained. And a little confused. And I don’t know if I’m all that much wiser on this thing called love. Are you?

We looked at intimate couple love and fighting and breaking up and being single. And we explored love as requiring components of acceptance and compassion and communication and reality.

But it very much feels like there are some glaringly obvious holes. And I’d like to acknowledge (some of) these. As a single, white, childless, heterosexual woman who has never been married (or divorced), my personal experiences are somewhat limited when it comes to relationships. So my inspiration for the content may have been a little vanilla, or lacking in diversity. Despite this, I believe that everyone deserves to be able to love and be loved. In the respectful relationship of their choosing.

As an example, I never mentioned LGBTIQ relationships. So I’ll quickly mention one thought I have on these relationships now. According to law in Australia marriage is the union of a man and a woman to the exclusion of all others, voluntarily entered into for life. I think this law is ridiculous. This being said, I believe that the choice to marry should be available to all of us regardless of the sex of our partner. I believe all members of the LGBTIQ community should have the same opportunities to celebrate their relationship and be afforded the same respect, love and recognition from their community as that of their heterosexual counterparts. And I look forward to a time that the law reflects these beliefs that we are all a bit more equal in a more socially just society.

I also didn’t discuss the complexity of domestic and family violence. Because it’s so hard and complex and tragic. And it would have taken me months and months.

So, instead we barely scratched the surface of love and relationships over the past month. And it’s all pretty confusing, but I recently came upon this beautiful definition that might just help us a bit more.

“love is understanding”

For the more religious of us out there, this definition comes from a medieval thinker Thomas Aquinas who was trying to define what Jesus was getting at, when rather than be shocked by particular people around him, he continually embraced them (E.g., apparently in Matthew, chapter 8 Jesus is approached by a man with leprosy. He’s in a disgusting state. But Jesus isn’t shocked, reaches out his hand and touches the man. Despite the horrendous appearance, here is someone (in Jesus’s eyes) entirely deserving of closeness and kindness. In a similar vein, at other times, Jesus conspicuously argues that tax collectors, prostitutes, thieves and adulterers are never to be thought of as outside the circle of love).

In this way of talking about love: if we truly understand love, we could possibly love anyone. In other words: love isn’t specific in its target. It is open to everyone. All of humanity, even (and in a way especially) its less appealing examples.

And we do this often. Express our love as understanding. For some of us, we commonly do this with our extended families. If I had a dollar for every person who upon disclosure of me being a psychologist replied “Oh, you should come work with my family”, I would not be renting anymore. And it is the same in my own family. We’re all highly functioning and get along very well. But things are a little bit weird round the edges. But it’s only because we really, really know the intricacies of our families and what’s gone before for decades and decades that help us to understand. But despite all of this, we still love. We understand and we love.

Working in a therapeutic role assists greatly with this level of understanding. As therapists we get to ask heaps of questions and listen. And as you hear the stories of a human developing, whether it be through a story of childhood trauma or an unexpected incident, we can begin to understand why a person might be behaving in a particular way. A person is not a ‘sex offender’ or a ‘drug user’, but another human with needs and imperfections.

We’re all flawed. It’s part of the human condition. But we’re social creatures and I reckon that means that part of our job as humans is to love. Not the romantic head over heels love with one person only. The effortful love. The love that takes work to see beyond the outwardly unappealing surface of another human – in search of the tender, interesting, scared and vulnerable person inside. Our minds tend fiercely to resist such a move. For instance: if someone has hurt us we naturally want to see them as horrible. The thought they might themselves be hurting themselves feels very weird. If unpleasant events happen in someone’s life – if they keep on losing their job or acquire a habit of drinking too much– we’re tempted to hold them responsible for everything that happens to them. It takes a deliberate effort to move the mind to understanding. But the more energy we put into looking at love through understanding, the more we might be able to love more people than we initially thought.

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Being our own BFF

Let's do a very quick experiment. Grab a pen and some paper. Go on, this will be good fun!

Firstly, quick as you can, without too much conscious thought, list all of your most favourite things about your bestest friend.

Easy? Got a massive list of amazing qualities? Excellent!

Now, with that pen and paper, list your most favourite things about yourself. Quickly. Off you go.

How was that? A little bit harder? Was your list a little bit more difficult to cultivate than that of your besties? A bit slower to get off the ground? Maybe your BFF’s qualities look a little longer than your own when written down on paper by you?

It’s interesting isn’t it? In general, we are way nicer to our friends than we are to our self. We humans can be much, much better at being able to love the people around us than we are at loving ourselves. To improve our relationship with our self it might be worthwhile to consider the practice of ‘self-compassion’.

At its core self-compassion is about treating ourselves kindly. Extending towards our self the same kindness and sympathy that we might extend to a good friend.

Over the past decade self-compassion has gained popularity as a related and complementary construct to mindfulness, and research on self-compassion is growing at an exponential rate. Dr Kristen Neff a pioneer in the self-compassion field has explained:

Self-compassion involves acting the same way towards yourself when you are having a difficult time, fail, or notice something you don’t like about yourself. Instead of just ignoring your pain with a “stiff upper lip” mentality, you stop to tell yourself “this is really difficult right now,” how can I comfort and care for myself in this moment?

Instead of mercilessly judging and criticizing yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings – after all, who ever said you were supposed to be perfect?

In essence, compassion for our self is similar to the compassion we feel for our loved ones. When we feel compassion for others, we feel kindness toward them, empathy, and a desire to help reduce their suffering. It’s the same when we are compassionate toward our self. Self-compassion creates a caring space within us that is free of judgment—a place that sees our hurt and failures and softens to allow those experiences with kindness and caring.

To explain it a bit more, it might help to outline what self-compassion isn’t.

Self-Compassion is not self-pity.

When we humans feel self-pity, we can become totally immersed in our own problems and forget that others have similar problems.  We can ignore interconnections with others, and instead feel that we are the only ones in the world who are suffering. Self-pity tends to emphasize egocentric feelings of separation from others and exaggerate the extent of personal suffering. Self-compassion, on the other hand, allows us to see the related experiences of self and other without these feelings of isolation and disconnection.

Self-Compassion is not self-indulgence.

Self-compassion is also very different from self-indulgence. This took me a while to understand and some other (struggling) perfectionists may also have difficulty with this one. I was initially reluctant to be self-compassionate because I was afraid that without my inner self-criticism I would let myself get away with just about anything and everything would fall to shit. This, however, is self-indulgence rather than self-compassion.  Being compassionate to oneself means that we want to be happy and healthy in the long term. In many cases, just giving oneself pleasure may harm well-being (such as taking drugs, over-eating, being a couch potato), while giving yourself health and lasting happiness often involves a certain amount of displeasure (such as quitting smoking, dieting, exercising).  We are often very hard on ourselves when we notice something we want to change because we think we can shame themselves into action – the self-flagellation approach.  However, this approach often backfires if we can’t face difficult truths about our self because we are so afraid of hating our self if we do.  Thus, weaknesses may remain unacknowledged in an unconscious attempt to avoid self-censure. In contrast, the care intrinsic to compassion provides a powerful motivating force for growth and change, while also providing the safety needed to see the self clearly without fear of self-condemnation.

Self-Compassion is not self-esteem.

This is a really important one. Although self-compassion may seem similar to self-esteem, they are different in many ways.  Self-esteem refers to our sense of self-worth, perceived value, or how much we like ourselves. While there is little doubt that low self-esteem is problematic and often leads to depression and lack of motivation, trying to have higher self-esteem can also be problematic.  In modern Western culture, self-esteem is often based on how much we are different from others, how much we stand out or are special. Accordingly, it is not okay to be average, we have to feel above average to feel good about ourselves. Unfortunately this can mean that some attempts to raise self-esteem may result in narcissistic, self-absorbed behavior, or lead us to put others down in order to feel better about ourselves. We might get angry and aggressive towards those who have said or done anything that potentially makes us feel bad about ourselves. The need for high self-esteem may encourage us to ignore, distort or hide personal shortcomings so that we can’t see ourselves clearly and accurately. Finally, our self-esteem is often contingent on our latest success or failure, meaning that our self-esteem fluctuates depending on ever-changing circumstances.

In contrast to self-esteem, self-compassion is not based on self-evaluations. People feel compassion for themselves because all human beings deserve compassion and understanding, not because they possess some particular set of traits (pretty, smart, talented, and so on). This means that with self-compassion, you don’t have to feel better than others to feel good about yourself. Self-compassion also allows for greater self-clarity, because personal failings can be acknowledged with kindness and do not need to be hidden. Moreover, self-compassion isn’t dependent on external circumstances, it’s always available – especially when you fall flat on your face! 

But the two do go together. If you’re self-compassionate, you’ll tend to have higher self-esteem than if you’re endlessly self-critical. And like high self-esteem, self-compassion is associated with significantly less anxiety and depression, as well as more happiness, optimism, and positive emotions. However, self-compassion offers clear advantages over self-esteem when things go wrong, or when our egos are threatened. Research indicates that in comparison to self-esteem, self-compassion is associated with greater emotional resilience, more accurate self-concepts, more caring relationship behavior, as well as less narcissism and reactive anger.

The bottom line is that according to the science, self-compassion does in fact appear to offer the same advantages as high self-esteem, but with less discernible downsides.

So, how do we focus on cultivating a compassionate and kind relationship with our self? Well according to Dr Neff, self-compassion entails three components and in order to be truly self-compassionate we combine each of the three essential elements.

1. Self-kindness

Self-kindness is being gentle and understanding with ourselves rather than harshly critically and judgmental. Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism.  Self-compassionate people recognise that being imperfect, failing, and experiencing life difficulties is inevitable, so they tend to be gentle with themselves when confronted with painful experiences rather than getting angry when life falls short of set ideals. People cannot always be or get exactly what they want. When this reality is denied or fought against suffering increases in the form of stress, frustration and self-criticism.  When this reality is accepted with sympathy and kindness, greater emotional equanimity is experienced.

The best way to think about being kind to yourself is to think about a friend. Go ahead. Do it now. Visualise your best friend. Again. Now imagine they come to you and say they are hurting because they were passed over for that promotion at work that they’ve wanted for so long. Would you say to them, “Well, it’s probably because you didn’t work hard enough. And you’re too weak. You should have spoken up about wanting a promotion a long time ago.” What? You wouldn’t say that to a friend? Would you say it to yourself? It’s more likely that you would hug your friend and say, “Oh no! That’s terrible. I know how long you’ve been hoping to get that promotion. Come on, let’s go get some coffee and talk about it?” You can be kind to yourself in this way, too. Treat yourself as you would treat a friend who is suffering. Just as you would hug your friend, soothe yourself as well. Put your hands over your heart or locate the spot in your body where your hurt is hiding and gently place both hands there. Speak kindly to yourself. Call yourself by an endearing name. “Oh, honey. I’m hurting because I wanted that promotion so badly. This is a really hard place to be in right now.”

2. Common humanity

This is my favourite bit. Self-compassion requires recognition of our common humanity, feeling connected with others in the experience of life rather than feeling isolated and alienated by our suffering.

Frustration at not having things exactly as we want is often accompanied by an irrational but pervasive sense of isolation – as if “I” were the only person suffering or making mistakes.  But we all suffer. All the humans suffer. Turns out the very definition of being “human” means that one is mortal, vulnerable and imperfect. And yes, that’s shit, but with self-compassion we recognise that suffering and personal inadequacy is part of the shared human experience – something that we all go through rather than being something that happens to “me” alone.

Many times when we criticise or judge our self, we can feel very, very isolated. It can seem as if we’re the only person in the entire universe with this problem or flaw. And yet, we are all imperfect. We all suffer. And so we are all connected by our shared humanity.

One of the wonderful outcomes of self-compassion is our enhanced sense of belonging, the feeling that we are all in this together.

The next time you are looking in the mirror and not liking what you see, remember that you are an integral part of a flawed, wonderful, wounded, miraculous human tribe.

3. Be mindful

Third, it requires mindfulness—that we hold our experience in balanced awareness, rather than ignoring our pain or exaggerating it.

Self-compassion also requires taking a balanced approach to our negative emotions so that feelings are neither suppressed nor exaggerated. Mindfulness is a non-judgmental, receptive mind state in which one observes thoughts and feelings as they are, without trying to suppress or deny them. We cannot ignore our pain and feel compassion for it at the same time.  At the same time, mindfulness requires that we not be “over-identified” with thoughts and feelings, so that we are caught up and swept away by negative reactivity.

How will you know that you are suffering if you are repressing your pain, rationalizing it, or busy with problem-solving?

We can allow awareness of our pain to enter in. Being mindful is about noticing what is happening in the moment and having no judgment about it. Notice our hurt and just be with it, compassionately and with kindness. And note that trying to make pain go away with self-compassion is just another way to repress pain and hurt. Self-compassion is about being with your suffering in a kind, loving way, not about making suffering disappear.

Taken together, the research suggests that self-compassion provides an island of calm, a refuge from the stormy seas of endless positive and negative self-judgment, so that we can finally stop asking, “Am I as good as they are? Am I good enough?” By tapping into our inner wellsprings of kindness, acknowledging the shared nature of our imperfect human condition, we can start to feel more secure, accepted, and alive. – Kristen Neff

It does take work to break the self-criticising habits of a lifetime, but at the end of the day self-compassion is just asking us to be friendlier to our self. Asking us to relax, allow things to be and love our self with a little more kindness.  

For more good stuff on self-compassion, check out the website of one of the lovely ladies I completed my psych training with here. Dr Brooke is a self-compassion guru and she's got an awesome #bemyownbestie Insta campaign going to keep your practice on track!

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In sickness and in (mental) health

Over the previous 8 blog posts, it’s been pretty clearly established that relationships are not the easiest of things to manage. They generate a bit of work for us. But overall, having people in our lives is pretty worthwhile. (I cannot believe I’ve just summarised all those words into 3 piddly sentences).

In a very similar vein, when we love someone who is experiencing a mental illness it can be bloody hard work. Bloody hard. But probably worth it in the end.

I’m a bit loathe to write this post because there are plenty of articles floating around titled “how to love someone with a mental illness” or even “why you should love someone with a mental illness.” And it makes me cringe up a bit. For a number of reasons:

  • It perpetuates the “us versus them” mentality. People who experience a mental illness may have specific medical and psychological symptoms they have to deal with, but that doesn’t mean they’re something other than human. Would you love some with diabetes differently? Or need advice on how to love someone with athlete’s foot?
  • Doesn’t’ everyone have their own shit to deal with? Experiencing the symptoms of a mental illness may require certain lifestyle adjustments and more care at specific instances, but so do other things in life. Like when we take on way too much stuff at work. Or when the kids are really sick. Or when we change jobs. Lose our job. Are struggling financially. Lose someone in the family etc etc. Dare I say we all need specific care at certain instances in our lives, mental illness or not.
  • Even if there are unique ways in which people who have mental illnesses need love and care, that’s largely on an individual basis. We all have specific needs at certain times in our lives. These needs have to be communicated with the people around us — our friends, family, significant other, colleagues, etc. Because articles with “tips” about how to care about someone who has a mental illness may not be what every individual person needs nor wants. The person with the mental illness is responsible for knowing what they need to stay well and being able to communicate that.
  • Stigma is usually why these kinds of articles exist. I wouldn’t have to write about this if social stigma didn’t exist because then we would realise that we don’t need to try to love someone who is perceived as different in one way or another. We would simply love people because we are humans and we should care about each other's welfare.

Having noted all of that though, sometimes when we love someone who is experiencing active symptoms of a mental illness there’s particular things that are a real struggle for us. We might be worried we are not saying the “right” thing. We could be constantly concerned for their safety. We can be frustrated that they’re not improving. Or that they’re not seeking treatment. Or that they can’t see that there are any problems with their health at all.

All of these struggles though come from a place of love. If we didn’t feel these things about the person close to us, then we wouldn’t feel so strongly about them. And here’s a really, really, really important thing when someone is experiencing a mental illness, love is really, really, really important.

In the book A General Theory of Love (2001), a trio of psychiatry professors, Lewis, Amini and Lannon, describe love as an interaction of neurotransmitters and hormones in our body:

“Our nervous systems are not separate or self-contained; beginning in earliest childhood, the areas of our brain identified as the limbic system (hippocampus, amygdala, anterior thalamic nuclei, and limbic cortex) is affected by those closest to us (limbic resonance) and synchronizes with them (limbic regulation) in a way that has profound implications for personality and lifelong emotional health.”

Interestingly, we can actually see evidence of these connections when we explore research in this area related to stress management, depression, anxiety.

The ability to adequately cope with stress, is one of the protective factors against mental illness. British psychiatrist John Bowlby, known for his seminal work in the area of developmental science, defined attachment as a “lasting psychological connectedness between human beings.” In Attachment (1969), Bowlby showed us the crucial importance of the secure relationship on the development of adaptiveness and coping capacity. And throughout our lifetime, this remains true.

‘Allostatic load’, a psychological term coined in the 1980s, represents the physiological consequences of chronic exposure to stress. Positive social experiences and higher levels of social integration and support are associated with lower allostatic load in both young and older cohorts. From childhood until old age, being connected to others in secure and loving relationships helps us better deal with stress.

Currently depression and anxiety disorders are the most common psychiatric conditions that are experienced in the Western world. And social isolation is clearly linked to higher rates of depression and anxiety. According to a Health and Human Services report, getting married and staying married reduces depression in both men and women. And research in the areas of physical health has shown that high levels of social support may actually improve prognosis in such conditions as cancer and myocardial infarctions by reducing symptoms of anxiety and depression that can often be associated with these illnesses.

And when people seek treatment for depression it will often focus on interpersonal relationships as a way to improve depression as is the case in attachment therapy in children and interpersonal therapy in adults. In addition, Emotionally Focused Therapy (EFT), which focuses on transforming relationships into ones that feels safe, secure and connected, have also been found to be effective in significantly reducing the symptoms of depression and anxiety. Ultimately, encouraging our people with a mental illness to be involved in loving and stable supportive relationships can potentially help in their recovery.

Though there are times when people need to “take a step back” from someone experiencing active symptoms of their illness, this generalises to any situation where one simply needs to create boundaries with another person in order to maintain one’s wellness.

Mahatma Ghandi once wrote, “Where there is love there is life.” Loving and stable relationships can help to improve a person's ability to manage stress and can help to decrease anxiety and depression. We are all social creatures, whether we experience mental illness or not.

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