A person I’ve been close to for many years is going through the dying process. It has been slow and painful; at times evoking one of the most beautiful and poignant musical pieces I’ve ever encountered. It is “Agnus Dei” by Samuel Barber, a choral version of his beloved and well-known “Adagio for Strings.” The text is from the Latin mass and includes the phrase, “Have mercy on us.”

Now, mercifully, there is an end in sight for my loved one, but for those she leaves behind, the grief is palpable—at times dull and weighty, at others raw and biting, and frequently overwhelming.

Those who have gone or are going through the grieving process know how often all of our psychic resources are consumed with just getting through another day. It can feel like there is no room for creativity—only emptiness. But grieving presents an opportunity for both creativity and renewal; just as we have been changed by the relationship with our loved one, we will also be changed by the process of navigating through grief.

The weight of grief often feels like being imprisoned. One might wonder whether the pain will ever cease, and sometimes the restoration to function fully and enjoy life can seem far away. I imagine that it’s much like the feeling of a condemned prisoner.

I am reminded of the struggle of Viktor Frankl, an Austrian psychiatrist who founded the discipline of logotherapy (a therapy based on existentialism—not the nihilist variety of much existentialist literature, but one founded in hope and understanding of the power of the individual to find meaning in suffering).

[fat_widget_grief_right]Frankl was imprisoned in four German concentration camps during World War II. He was initially accorded an elevated status because he was a doctor, but eventually he was consigned to the life of an ordinary inmate, not knowing what the outcome of each day would bring. Frankl refused to accept that he might not survive the camps. Realizing the power of thought and creative visualization, he resolved to envision a positive outcome to his ordeal. It was out of this experience that logotherapy was born.

Later, Frankl wrote a small, but powerful, book, titled Man’s Search for Meaning, in which he outlined his struggle and how—through the power of visualization—he triumphed over despair. Part one is devoted to sharing his personal story with the reader, and the second part discusses the essential questions that form the basis of logotherapy: “What is the meaning of this experience for me?” and “How can I have hope for the future?”

Frankl believed that the process of finding answers to these questions would provide a foundation for coping with adversity and a path toward living a more full and fruitful life. This allows for a person to be changed by the experience of their journey. A person can reinvent an understanding of both the journey’s significance and of personal capacity and strength.

Herein lies the connection between grief and creativity. Working through the meaning of the loss creates not only a new self-concept, but also a new worldview.

I often utilize logotherapy in my sessions with people who are dealing with painful issues related to death and dying, grief and loss, adjustment to illness and disability, and caregiver stress. Utilizing the core questions involved in the re-creation of one’s understanding of suffering and the meaning of life has often been equally helpful to those who believe in an afterlife or a higher purpose and those whose envision our mortal life as finite with no overarching meaning. Although I believe this work is difficult to do without the help of a trained professional, merely asking the questions—such as “What does this mean to me?”, “How am I changed by this experience?”, and “How can I go on?”—sets the framework for conceptualizing a beginning, middle, and ultimate ending to the grief process.

If you are finding it difficult to cope with your own losses, perhaps seeking help from an experienced grief counselor who will be present for you, listen, ask the right questions, and guide you through the grief process would be useful. By all means, reach out to others in your support system. Remember that humans have great capacity for resilience, and the process of developing, recognizing, utilizing, and celebrating that resilience is a highly creative one.

It’s OK to be fully present with our sense of loss, but we should try not to lose sight of the promise of change or the expectation of renewal. You can see your way through this loss, and you may be re-created in a way that is most unexpected.

Reference:

1. Frankl, V. (2006). Man’s search for meaning. Boston: Beacon Press.

Hoarding is a form of obsessive-compulsive behavior. An individual who exhibits hoarding tendencies has a difficult time letting go of physical items and becomes inundated with possessions, often to the point of causing physical and financial harm. Previous research has identified a link between people who hoard and obesity. Now, a new study led by Kiara R. Timpano of the Department of Psychology at the University of Miami, aims to determine if the brain derived neurotrophic factor (BDNF) is responsible for that link. “Studies with gene-targeted murine models have demonstrated that Bdnf variation is linked with memory impairment, greater avoidance, greater anxiety, aggression, and obesity,” said Timpano. The variation, called the Val66Met SNP, was of particular interest to her and her team. “Considering specific psychiatric conditions, the Val66Met BDNF SNP has been associated with multiple neuropsychiatric disorders, including eating disorders,” she said.

Timpano and her team examined the BDNF gene in 301 participants who were classified with obsessive-compulsive behaviors. They used the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition (SCID-P) to identify OCD and the Yale-Brown Obsessive Compulsive Scale (YBOCS) to assess hoarding behaviors. The researchers also measured the body mass index (BMI) of each participant to determine obesity.

They found that more than half of the participants were above average weight, with 25.2% being classified as “overweight” and 27.2% as “obese.” They also discovered that the individuals with the highest BMI were also the most likely to exhibit hoarding behaviors. “Results revealed that individuals in the hoarding group were over two times more likely to be classified as obese compared with non-hoarders,” said Timpano. The team hopes this study helps advance research on this issue. They said, “This finding, in conjunction with our results, brain imaging evidence, and symptomatic and gender differences in hoarding compared with other forms of OCD, provide further credence to the growing notion of hoarding as a separable and distinct phenomenon.”

Reference:
Timpano, Kiara R., Norman B. Schmidt, Michael G. Wheaton, Jens R. Wendland, and Dennis L. Murphy. “Consideration of the BDNF Gene in Relation to Two Phenotypes: Hoarding and Obesity.” Journal of Abnormal Psychology 120.3 (2011): 700-07. Print.

No one can prepare us for the experience of providing care for a seriously ill family member or friend. When sickness strikes someone close to us, there may be a sense of chaos, urgency, and confusion. Details must be agreed upon, phone calls made, and appointments kept.  You’d like to sit and catch your breath, but chances are there is a list of tasks and you’re already running behind.

Illness has a way of sweeping the rug right out from under us.  Some illnesses are chronic, part of our loved one’s day-to-day existence – and ours as well. Others may first appear in the form of a suspicious lump, a questionable lab result, or an accident.  Whether chronic or acute, you’ve got a lot on your mind, heart, and plate. This article is written for you – a few ideas to help you so that you can better help your loved one.

Get centered – Stop, for just a moment, and look at your daily routine. Are you getting enough nutritious food? Enough sleep? Are you able to go for a walk, even around the grounds of the hospital? You can’t drive a car on an empty gas tank. Take a minute to make sure you include some element of self-care.  If this feels overwhelming, keep reading.

Get connected – Meet the doctors and caregivers involved in your loved one’s treatment. Explore resources for support in your community.  Hospitals usually have a Social Services office, oftentimes with social workers and others who can talk with you, offer ideas and resources, and help you navigate this experience.

Get answers – Got a question about your loved one’s treatment? Ask.  Noticing a new symptom or a side effect of medication? Tell someone. Clinicians are often bound by confidentiality, which may or may not apply depending on your circumstances. It doesn’t hurt to ask or to speak up. Knowledge is power. While we are on the topic of answers, is this the time to become aware of your loved one’s treatment wishes, legal matters, preferences about his or her personal paperwork? These can be some of the most difficult decisions we ever have to make, but they are important to consider in the case of serious illness.

Get support – It can be easy to isolate and lose touch with your friends and family, however, having concerned others who can be there for you is vital. Allow others in. If you can, remain involved in school, work, and activities you enjoy. Some days you may need to share how you are feeling with a friend. Other days you may not be able to give one more status report and just want someone to go to a movie with you. Friends and family can be a vital part of your wellness team.

Get control – “Control?? You’ve got to be kidding!”  It may feel right now like nothing is within your control. Serious illness or injury can sweep through your life like a force of nature. But hear me out. What can you control right now? Making decisions about mundane tasks like what to wear or what to have for dinner can add a tiny spot of normalcy. You can prioritize your day in any way available to you: “I will spend an hour at the hospital this morning, then when Mom goes down for x-rays, I will go down to the coffee shop and call a friend.” Getting control may also mean knowing your limitations and saying “No” when you need to.

Finally, get hope. When someone is diagnosed with serious illness, it may be hard to know what the future holds. There is a fine line between facing a significant medical diagnosis realistically, and holding onto hope for recovery. You may find yourself wavering between hoping for the best and yet fearing the worst. You are not alone in this state of confusion. Finding peace and balance can come as you work through the barrage of feelings, thoughts, and fears that are an inherent part of serious medical crises. Reach out to your support system, and allow others to help. If you have a spiritual path, this is a good time to spend some time connecting with your faith. Most of all, take the best care of yourself that you can during this stressful time.

Life holds no guarantees, but knowing this doesn’t make it any easier when we face a medical crisis. You are not alone. Allow others to help, find quiet moments for reflection alone as well as connection with your loved one who is ill, and if you begin to feel your level of distress is overwhelming, reach out and talk to someone you trust.

Imagine a life where you are continually tormented by an inner dialogue that screams of your worthlessness, your hideous appearance, and your pitiful, meaningless existence. Imagine a life where you mange your day solely around food, either by avoiding it, getting rid of it, or consuming as much of it as you can. Imagine spending your birthday in a psychiatric ward, perhaps too sick and too weak to even stand up on your own. And now imagine that there is a very strong part of you that wants to be worse. This is the horrible trap of an eating disorder.

One of the most difficult aspects of eating disorder treatment is the mind-boggling fact that those suffering would often do almost anything to cling to their disease. As much as part of them wants to be happy and healthy and free from the constant torture, there is another part, often referred to as “the eating disorder self”, that convinces the sufferer that they will be nothing without it. When your eating disorder becomes your identity, medicals markers used to gauge its severity, such as amenorrhea (absence of menses in women), or the body mass index scale, are looked upon as levels of achievement. When you’re trapped in this mindset, worse really does seem better.

Throughout the years that I struggled with anorexia, I used the presence of my period as a way to prove to myself that I was still safe, that I still had weight to lose. Some individuals will stop menstruating fairly quickly after substantial weight loss, others, myself included, can maintain dangerously low weights yet continue to menstruate. I remember my therapist and my doctor both diagnosing me with anorexia nervosa, but I had seen and memorized what the Diagnostic and Statistical Manual of Mental Disorders said about anorexia. I had to lose my period to be “officially” classified. The diagnosis went in my charts nonetheless. Yet, I had this strange longing to fit the bill, to really be able to call myself anorexic, because it meant that at least I was doing something right. If I failed at everything else in life, at least I would master my eating disorder. I would be the best anorexic I could be.

I  wanted to be the thinnest in the room, the sickest, and many times over I did hold that title. It became my prize, my sense of accomplishment. I became quite accustomed to the label “skinny, blonde girl.” Anorexia became my identity and when recovery (and the inevitable weight gain) threatened that, I would panic and slip right back into the disordered behaviors. Who would I be without it? I needed this disease to survive, or so my eating disorder constantly told me.

It is a very sick way of thinking, I know, but I also know that I was not alone in thinking. I have spent a great deal of time among other eating disordered individuals, and there is a definite cognitive pattern when it comes to symptoms and diagnostic labels. In short, it seems the worse you are, the better you feel. I can’t count how many times I’ve heard people with bulimia wish they had the “control” of their treatment peers with anorexia, and those who compulsively overeat long for the ability to easily purge like those with bulimia. There is an unfortunate perceived hierarchy among patients, with the “purity” and “cleanliness” of anorexia appearing to outrank the “hedonistic” behaviors of bulimia or compulsive eating.  But in reality, they are all equally serious, and all deadly. Whether you’re starving or stuffing or purging, your eating disorder is a distraction, a desperate attempt to control the un-controllable.

Eating disorders, in general, are very control-focused. Whether it’s an attempt to control anxiety, or anger, or relationships, they trigger and feed off of the  competitive and perfectionist personality traits that many sufferers share. I thought that if more control equaled more medical complications, so be it. But the crux of the matter is that sufferers inevitably reach a point, often quite quickly, where the lotus of control shifts completely out of their hands, and into the hands of the eating disorder.

It’s too hard to battle an eating disorder alone. Reaching out is the first step in successful recovery. Share your secret with a trusted friend or family member. Even that act of sharing a secret can often relieve some of the pain. Seek professional help. There are people who have been in your shoes and are willing to guide you out of the darkness. Hope is real. Recovery is real.

Many people curb their nervousness with a nice glass of wine or other alcohol beverage. Whether you’re gathering the courage to socialize with people you barely know, fly on an airplane, or even if you’re just feeling worried about the future, alcohol can help loosen inhibitions and dampen self doubt and fears.  While you may feel more relaxed temporarily, using alcohol to tame your anxiety can backfire in the long run.

Immediate Effects

Even though you may be feeling calmer after the first one or two drinks, your body is processing the alcohol and the physiological effects can actually trigger feelings of anxiety. Alcohol can negatively impact blood sugar levels each time that it is consumed. Research has shown that the body responds to alcohol by increasing insulin secretion, causing low blood sugar and also impairs the body’s hormonal response that would normally be able to normalize blood sugar levels. Drinking as little as two ounces of alcohol on an empty stomach can lead to very low blood sugar levels. Low blood sugar levels can cause dizziness, confusion, weakness, nervousness, shaking and numbness, all of which can mimic the symptoms of anxiety, or even trigger an episode of anxiety.

Alcohol consumption can also cause dehydration. Alcohol is a fairly strong diuretic, meaning that the body loses water by producing an increased amount of urine. Symptoms of dehydration include dizziness, muscle weakness, lightheadedness and nausea, again, all of which can mimic symptoms of anxiety, or induce anxious reactions related to the fear of being ill.

Alcohol consumption has a sedative effect on the body. It is a drug that depresses the central nervous system. Immediate effects are a sense of euphoria, decreased inhibitions, and lessened anxiety. However, over time the chronic use of alcohol could result in tolerance, dependency, and damage to many organs of the body including the brain, liver, and heart.

Longer Term Effects

People with anxiety are up to three times more likely to have an alcohol problem or other substance abuse than those without anxiety. It takes increasingly larger amounts of alcohol to achieve the same effects, leading to alcohol dependence. Long-term alcohol use can have multiple negative effects on the body and aggravate existing anxiety.

Recent studies have shown that heavy drinking or long term drinking stresses the body and causes it to have higher levels of the stress hormone, cortisol. Cortisol is necessary in short term stress situations because it helps focus alertness and attention, but cortisol also suppresses bodily functions such as wound repair, bone growth, digestion, and reproduction. Chronically high cortisol levels therefore interfere with these important processes in the body. Alcohol use also depletes the body of vitamin B6 and folic acid, which the body needs to help cope with stress. Long-term exposure to alcohol reduces the levels of the GABA-benzodiazepine receptor in the central nervous system and reduces the brain’s ability to calm the mind and the body and cope with anxiety in the long run.

Serotonin is a chemical in the body which is needed for memory, learning, and especially for feelings of ‘wellbeing”. Drinking alcohol can temporarily boost serotonin levels, therefore making you feel happier, but in the long term, excess alcohol can actually lower serotonin levels, and therefore either causing or exacerbating depression.

In another recent study, researchers found that high anxiety levels in humans are related to a deficiency in an important protein called CREB, which is needed by the amygdala, the area of the brain where emotions are processed. The amygdala is important in calming anxious thoughts. The study results showed that drinking alcohol boosts the CREB levels in the brain and therefore lessens anxiety, which helps to explain why so many anxious people us alcohol to self-medicate. The good news is that there are other, healthier ways to naturally raise CREB levels, such as getting regular exercise and listening to music. Some antidepressants can also help raise CREB levels also.

So, even though using alcohol is an easy, short term fix for anxious feelings, you’re not doing your body or your mind any favors by self-medicating with alcohol. Learning to manage anxiety (and naturally boost your CREB levels) in healthy ways such as through exercise, music, and expressing creativity is possible.  Psychotherapy can also be very helpful. In fact, research shows that psychotherapy is usually the most effective long-term treatment for anxiety disorders. Therapy treats more than just the symptoms of anxiety. It helps you discover the underlying causes of your worries and fears.  In therapy, you’ll learn to relax, perceive and interpret situations in new, less frightening ways, and learn better coping and problem-solving skills. Through therapy, you learn the tools to overcome anxiety and how to use them effectively.

1 out of 2 people in the U.S. has a chronic illness and in 96% of these cases, the chronic illness is invisible. This means the illness is not readily apparent to others because the person doesn’t use an assistive device like a cane or a wheelchair. Most people with an invisible illness can tell you story after story of family members, friends, co-workers, bosses, etc. who don’t actually believe they’re ill. They’ve been given snide looks when exiting their car after parking in a handicapped spot. They’ve been told by their friends that they look too good to be sick. They’ve been questioned by bosses as to why they miss so many days of work when even a doctor can’t determine an appropriate diagnosis.

These scenarios are all too common and happen to millions of people every day. Most of us are able to shrug it off and move on in spite of anger, frustration and hurt. But what happens when the person who promised to love you in sickness and in health doesn’t believe you’re actually sick? (more…)

Scents, Memories, and Emotions

The use of pleasant aromas to enhance well-being dates back thousands of years. Fragrant oils were ceremonially used in the Far East, as well as in ancient Egypt and Greece. Essential oils were extracted from herbs and flowers to create medicines and perfumes, to scent one’s home, and to anoint the ill and deceased.

Smell is considered to be the most poorly understood of our senses, yet most have experienced the powerful ability of familiar scents to trigger emotions and memories of times past, such as people in our lives, places we miss, or particular events, such as the holidays.

Who among us has not passed a restaurant or bakery and been immediately transported to another time when a similar dish or baked good was enjoyed, with all of its emotional accompaniments? Have we not all smelled a particular laundry detergent or perfume and thought of a loved family member or former flame? For some, even less-than-pleasant odors can call to mind a cherished memory. I have heard people say that walking into a faintly damp or musty house reminded them of the fun and friendships of summer camp, even 30 or more years later.

Today, the term aromatherapy refers to the deliberate use of plant-derived oils to enhance physical and emotional health. Although aromatherapy is still considered to lie outside the realm of medically accepted therapies and mainstream psychotherapy, interest in this area has grown substantially over the past few decades. Most of those who use aromas for healing tend to do so as part of a whole-person approach to healthcare, rather than as a stand-alone treatment. When applied thoughtfully, aromas may be incorporated into more “mainstream” healthcare practices with good results.

The Impact of Scents on Stress and Performance: What’s the Evidence?

Research related to the impact of scents, particularly essential oils, on mood has increased since the 1970s. Specifically, there have been several studies on the use of essential oils, such as lavender and rose, as well as other pleasant aromas to reduce stress. Lavender in particular has been shown to reduce self-reports of stress. In some preliminary research,  lavender was also linked to increased peripheral blood flow (an effect associated with relaxation) and a decrease in blood pressure, as well as positive changes in heart rate variability. In another trial, peppermint and lavender essential oils were associated with increased accuracy while proofreading.

The calming benefits of pleasant aromas many not be limited to essential oils, however. In at least two studies, the scent of coconut has been associated with decreased startle response, whereas an unpleasant scent (Limburger cheese) was associated with an increased startle response. A more recent study suggested that exposure to pleasant scent (also coconut) may blunt the body’s response to performing a stressful task and also enhance recovery after the stressor has stopped. It is important to note that most of these studies have had methodological challenges, including small numbers of people participating in the trials. Nonetheless, the results are thought-provoking and may make intuitive sense to those who have experienced subjective benefits from aromatherapy.

Aroma in Psychotherapy

How might this be relevant to the practice of psychotherapy? Pleasant aromas can be paired with relaxation training, such as diaphragmatic breathing, mindfulness practice, hypnotherapy, and biofeedback. Doing so may link the experience of relaxation with the scent sufficiently so that in the future, exposure to the scent alone may be enough to elicit the relaxation response.

In cognitive behavioral therapy, this pairing is referred to as “associative learning” or “higher-order conditioning,” and the goal is for the conditioned stimulus (the scent) to trigger the same response as the biofeedback, breathing, or meditation does.

I have frequently used scent as a therapeutic adjunct during all of the above types of treatments for both children and adults. Many have reported enjoying the use of this tool in session and on their own, eventually noticing that they can more quickly and effectively access a state of calm. Even something like at-home mindfulness practice involves “taking in” and being present with the scent of what one is consuming or doing. This includes experiencing fully the aromas associated with eating, drinking, or walking in nature. Thus, being mindfully present can be “aromatherapeutic” or at least “aroma-aware”—even without deliberately introducing a specific scent.

The at-home use of pleasant aroma can be as simple as adding a few drops of an essential oil to a hand or body lotion or hair conditioner, buying natural laundry or cleaning products that feature relaxing or invigorating essential oils, chewing a stick of peppermint gum while proofreading a term paper, or mindfully sipping a cup of fragrant tea.

Common Sense with Scents

When using scent in psychotherapy, it is important to take into account people’s individual preferences for and aversions to various aromas and be aware of the fact that some dislike using any scent at all. Similarly, it is important to inquire about emotional associations to scents that may be popular but could elicit unpleasant memories (“Ugh! My old boss always wore rose oil!”).

Finally, it goes without saying that one should:

1. Ask about allergies to any scents
2. Place undiluted oils on tissue or another object, rather than directly on the person, as many are harmful when applied to the skin at full strength
3. Educate oneself about the properties associated with different oils before introducing them into the work.

Additional Aromatherapy Resources

• For general information about aromatherapy, you can visit: www.aromaweb.com
• For information about training in clinical aromatherapy and the use of aromatherapy by health professionals, you can visit Dr. Jane Buckle’s website: http://www.rjbuckle.com/home.html or read her text, Clinical Aromatherapy: Essential Oils in Practice
• For a recent scientific article describing some of the studies mentioned here, see the text (available to journal subscribers and at many medical or nursing school libraries): Mezzacappa, E.S., Arumugam, U., Yue, S.I., Stein, T.R., Buckle, J., & Oz, M.C. (2010). Coconut fragrance and cardiovascular response to laboratory stress: Results of pilot testing. Holistic Nursing Practice, 24(5).

For those who feel cognitively sluggish or emotionally lethargic, it’s certainly admirable to turn to natural remedies before prescription drugs. But many of the foods and dietary supplements presented as “brain boosting” haven’t been thoroughly studied. New research on diet’s impact on mental energy finds that there is some truth to some of the hype: “The strongest evidence suggests” that omega-3 fatty acids may truly reduce the risk of cognitive decline, and that Gingko biloba does positively impact mood and attention. This research also highlights the need for further researchers before stronger claims are made. If your mood is low and you’re having problems focusing, it doesn’t hurt to incorporate a variety of vitamins and nutrients. If exercise, adequate sleep, and a varied, balanced diet still leave you feeling off, there might be something else going on: talk to your doctor or therapist. But if you’re pinning all of your hope on a single supplement, you may want to reassess.

Starting the day with fibromyalgia pain made Vera angry

Fibromyalgia made it hard for 46 year old Vera to get her legs out of bed in the morning. As she moved toward the bathroom and began her toilette, the pangs of pain moved to her hands, head and neck. It brought tears to her eyes. It made her angry to think that Kurt hadn’t even thought of organizing things around the house to make life a little easier for her. Vera remembered the arguments about accompanying her on doctor appointments and got even angrier. But she never said anything to him. She turned her mind to the support group she would attend later that day, although it wasn’t successful in easing her physical discomfort.

Vera found it easier to focus on the fibromyalgia pain than her scary emotions

As she ate breakfast, flashbacks of her early family file flooded Vera’s vision. She relived the tension she used to feel coming home from school wondering if her parents would fight out loud or give each other the cold shoulder. Her mother would take out her frustration on Vera the oldest and quietest of her kids. Her muscles tightened up as she recalled the fear of uncertainty and not knowing how to speak about her worries. It was the same thing now. She didn’t know how to talk about the anxiety of not being able to take care of herself. Vera had no words for the anger at her father for not making her mother happy, and at Kurt for being equally insensitive and uncaring. What she did have was body pain that ranged from dull aches to excruciating pain for which no specific organic cause had been found. Fibromyalgia was the diagnosis. It came with fatigue, slowing down of actions and restricting her life. It was making Vera dependent on pain medication and on a husband who let her down, repeating the cycle of her childhood. (more…)