Sunday, July 25, 2010

Past, Present and Future

The human brain is a marvelous piece of work. It weighs a bit more than 3 pounds, is kind of like holding a jelly fish in your hand (ycch), and enables us to experience our past, present and future. Not only that, we can shift from one to the other very rapidly. Needless to say, good mental health is being able to know which tense we are truly in--that is, if what we are experiencing as a brain state matches objective reality. This is very abstract. Perhaps an example will help.

Suppose you are a corporal in the Alabama National Guard stationed in Afghanistan. There are car bombs going off all the time, explosive devices along road sides, and being stuck in slow vehicular traffic is dangerous because of the fact Americans are targeted for attacks. Every trip in a vehicle is hot and dangerous and triggers maximum alertness, tension and vigilance. You find yourself always keyed up to respond to an attack.  Suppose that two months later you are back in Alabama working your usual job as a police officer in one of our coastal communities. You find yourself stuck in heavy traffic, its very hot and there is a lot of noise from honking cars. You suddenly find yourself profusely sweating, very tense, hand on your pistol and expecting to be attacked at any minute.  You start scanning the traffic for Taliban troops with weapons. For about 30 seconds you are in Afghanistan. This is a dissociative state that we sometimes see in folks with post traumatic stress disorder (PTSD). Thankfully it is not that common, but can cause folks a lot of grief and anxiety.  Certain trigger mechanism cause us to be hyper-vigilant. You can probably easily identify them from this short scenario:  heat, snarled traffic, loud honking. The braiin state of hyper-arousal is triggered by these stimuli in our environment. Key insight: we react to a present event as though we are in the past. Gettling locked into these patterns can rob us of enjoying our present.

Intense experiences tend to make a stronger connection among the synapses that make our memory. Hurricane Katrina in 2005, financial crisis, job losses, and now the Oil Spill. These bad events get linked in our brains and create powerful negative mood states. Not only can these memories overwhelm us in the present, if we dwell on them we can lose the ability to look at the future. One feature of PTSD is having a foreshortened future. Big words for a simple process--we lose the ability to imagine outselves in the future and enjoying love, life, and happiness. We lose the ability to put ourselves into a future happy place. It is so easy to lose the joy from the past, the ability to hope for it in the future and to enjoy it in the present moment. That can lead to such despair that we take our lives.

Do not get to that point. We on the Gulf Coast have to learn to do what military folks have learned. Be a Battle Buddy to our family, loved ones and friends. Reach out an connect to those around you. Listen to what is going on in their lives. Ask what they remember that makes them laugh. Go to a comedy. Laugh and enjoy the present moment and talk about the fun you expect in the future. Remember the second letter of SAFE Therapy is Attunement.  Tune into your fellows and celebrate the fact that the oil has stopped flowing into our Gulf. Focus on that good news, share it, and next week we will think about re-building.

Tuesday, July 6, 2010

SAFE Therapy for What Ails Us

I recently read an article on the effectiveness of various types of counseling and therapy techniques. It is amazing what "psycho-babble" supposedly educated and intelligent people believe in. The list of discredited and downright harmful approaches to helping folks with emotional pain is staggering. Ever heard of Angel Therapy? Orgone Box Therapy? Rolfing or re-birthing therapy? Imagine two shrinks wrapping someone up in a blanket and suffocating them as a therapeutic technique! Yes, dear reader, it did happen and the perpetrators got sued. For years in my practice I have practiced what I call SAFE therapy. It's not really anything radical, just common sense approaches to helping people that have been validated by years of careful, peer-reviewed research. What works for people and is safe.

The acronym SAFE stands for 4 basic tenets that are really good rules for life. The "S" is for the first rule: "Seek a balance in all things in your life." Aristotle talked about the Golden Mean. "A" is for "Attunement to other people." Pay attention to what people say and mean at the explicit and emotional level. Listen deeply to what is going on with them. "F" is for "Forgive yourself and others." That's not always easy. And the "E" is for "Express your feelings; engage them and do not suppress them." As I have aged and worked with thousands of troubled people I have found that we need to add an "R" to our acronym: "Regular spiritual experience." People of all cultures and eras have been at some level aware of this innate need. The variety of human spiritual experience and practice is endless: singing hymns in church, listening to the preacher, meditating in a Buddhist temple, or time spent in an Indian sweat lodge all come to mind.

At a practical level we on the Gulf Coast are being assaulted on all fronts. The environmental, economic and emotional stresses seem to be increasing to a crescendo. People are losing faith in their leaders, their institutions and themselves.  I have some practical tips and encourage everyone--don't give in to the pain!

We have to take time to turn inward for strength in ourselves, outward for connection to others, and to the spiritual dimension for strength that is beyond the human dimension. Simple rules. Turn that TV off!!!!! The constant blare of negativity will make you sick. Read the paper to keep informed. Or watch the evening news for a hour. Then get up and do something useful. Take time to be alone or with a few who are close to you. Converse about good things, successes, happy times. Listen to music, Burn a candle. Remind yourself that when you have self-defeating negative thoughts that they are a signal to you that it's time to go to a Good, happy place physically, emotionally  or spiritually.

It is easy to access and retrieve bad experiences. I can close my eyes and travel in time back to a foxhole in Vietnam. Hear the "ssssptt" sound of bullets flying, smell gunpowder, hear screams and see jet fighter planes dropping flaming napalm on the enemy. Scrunch down in the hole and think that the world is coming to an end. On that day 40 years ago I went to a more happy place and could hear my grandmother tell me "This too, shall pass".  I can choose to go back to the bad time and make myself sick or I can choose to tap into the good, warm, nurturing feelings that come from connection to my inner strength, my loved ones and God.  It is easier to lay down and sink into the hole, but much better to move toward the light. Some day the oil will go and the waters of the Gulf will teem with life. This too shall pass.

Monday, July 5, 2010

Gulf Oil Spill: Savor the Beauty

My bride and I live on the Gulf of Mexico in Orange Beach, Alabama. We are about a mile from the Florida panhandle border with the Gulf of Mexico to our South and Perdido Bay and Ole River behind us. For us, the BP Oil Spill is a daily event, a constant presence, and a grim reality. I won't detail all the bad things associated with this event, but you can go to the Traumatized Psychologist for links to photos of the oil's arrivals on our shores. My preference is to talk about the other side of the coin and ways to cope and thrive in the presence of the bad news.

Numismatists (i.e., coin collectors) call the main or front side of a coin the Obverse and usually display the most important portions of new designs or a famous historical figure on it. The Reverse side usually has a formalized seal or representative design of the government that minted the coin. Think of our moods as different sides of a coin. The Obverse mental state is the pleasant, health enhancing side and the Reverse is the negative, stress inducing side. Not to take the metaphor too far, but the way our brain is wired does somewhat reflect this scenario.

Deep brain structures with names like amygdala and so forth are involved in strong emotions. In fact, from an evolutionary perspective the "default" system of our brain is set to a negative bias. This is part of our built-in survival mechanisms. We tend to see the bad, dangerous, threatening side of things. The good part of this brain wiring is that it keeps us alert and alive! The downside is that it can lead to a constant state of physical arousal that leads to stressful states. Think chronic high blood pressure, gastrointestinal problems, and insomnia.

The negative emotions tend to be stronger and stay longer than the positive ones like happiness and pleasure. Cognitive science tells us that what we need to do is train our brain to focus more on the positive feelings. The (no kidding!) happy thoughts trigger brain chemicals and hormones that enhance our health and well being. Here is the key point. We have to consciously, intentionally focus on the positive to reprogram our brains and moods to a positive state. Coming full circle to the oil spill we see that our task is not to awfulize about the oil we cannot see on the bottom of the Gulf. Rather, we need to see the blue sky, the blue green water, green grass, graceful seaguls and herrons swirling high in the sky. Don't bemoan the lack of motor boats and jet skis. Enjoy the quiet, the sound of gentle breezes and the waves on the beach. Think happy thoughts and this, too, shall pass.