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In my practice, laughter takes place in probably 80% of the treatment sessions. Yes, there may be crying, anger, anxiety, and so forth also, but laughter serves an important role in physical and mental health. I explain to my patients that when they can laugh about something they have seen as “horrible” it gives them some distance from the issue and fosters more of a sense of control. It’s really just a great way to discharge feelings in a more pleasant way and causes the body and mind to relax.
When I worked with combat veterans in the past, I was astonished at how many of them had not laughed in decades. Many of them were still able to laugh and used this as a way of coping. Others, just couldn’t loosen up enough to do it. They all found some benefit when they were able to remember how to laugh.
Milton Erickson, M.D., who was the world’s greatest expert on the use of hypnosis for treating psychological difficulties once noted, “It’s not what patients don’t know that’s the problem. It’s what they know that they don’t know they know.” In other words, people have all the resources needed in order to make a recovery, and a shrink’s role is to often help them remember what they already know.
PsychCentral has a partial list of the benefits of laughter for physical and mental health here. It is worth reading, and in your daily life, remember to take a step back from time to time and laugh at every (appropriate) opportunity you get. It’s also an incredibly useful skill to be able to laugh at yourself. Try it sometime. Make a joke at your own expense and laugh. Hearty bellie laughs are the best. 
Women who deliver vaginally may be more responsive to their newborns in the early postpartum period than those who deliver via cesarean section, new research suggests.1
This has been speculated about for a long time, but new research shows that it is the case. I think it only makes sense. As humans, I think we are automatically more connected with others with whom we have suffered together. But, I think the other point is that this method is more natural (as God intended perhaps). I realize that there are many situations where this is not an option, but I also know that over the years, the decision of vaginal versus cesarean birth has been a matter of convenience. I don’t necessarily mean the woman either. I’ve heard stories about a doctor having to come in on a holiday to deliver a baby, and in order to get it over as soon as possible, opted for cesarean. Or worse, induced the birth and utilized forceps for the most rapid delivery possible. Doctors like their holiday times as much as anyone.
The research also found:
“We found a significant difference in activity in certain cortical and subcortical areas of the brain in this group of mothers who delivered vaginally compared with those who delivered by cesarean section. Broadly speaking, the cortical brain regions are believed to be important for regulating emotions and empathy,” principal investigator James Swain, MD, PhD, FRCPS, told Medscape Psychiatry.
This research is part of a longer term study examining the relationship between bonding at delivery method. The researchers reported that cesarean deliveries have increased from 4.5% in 1965 to 29.1% in 2006. Based on my observations, people who were born via cesarean section are more reactive to sudden changes, scared of surprises, and have more difficulty with life transitions.
I remember one fellow I saw. He was a bartender. Over the years, he joked to all of his friends, “I’ve been a bartender since I was six.” He started out by getting his father a new beer whenever requested (which was often). He didn’t know any different. This was normal family life to him. Then his father was killed in a truck driving accident when he was 8-years-old. His mother became extremely depressed and couldn’t function (couldn’t cook, couldn’t comfort, couldn’t provide parental correction, and so forth). So, he became the perfect boy (independent, high achieving, extremely helpful, protective of those with emotional needs, and so forth).
Unfortunately, he missed out on his childhood. When he became an adult, he dropped out of college, started using drugs, hooked up with women who were bad news, and generally disappointed his mother. She didn’t give him any attention or concern after the death of his father (she couldn’t). He missed his dad horribly. He became a bartender to repeat the early pattern (serving beer and liquor to folks). He also repeated a number of other patterns from his relationship with his father.
These things represent an unconscious wish “for a better outcome.” The person wishes greatly that things had not turned out the way that they had. They keep repeating, in ineffective ways, the early traumatic experience. Unconsciously, they are trying to resolve the early problem–to make things turn out differently. On another level, their symptoms are communicating the problem from their past. When they end up finding a shrink who can understand these things, they are finally able to communicate, verbally, what bothered them so horribly. Unfortunately, with today’s training, there are not many shrinks who can understand this unconscious communication. It’s rare that I don’t see this communication. I see it every single day in my practice. The symptom communicates the problem.
Just as when you have an intense pain in your shoulder communicates that there might be a physical problem with your shoulder. This prompts you to seek medical attention. Life patterns and problems also prompt people to seek psychological help. Too often, this is not recognized in my opinion.
The first thing to consider when you have apparent physiological problems, is that you have a physical problem (a problem with your body). You want to have this checked out by a doctor. Even in cases where many doctors think that the problem is psychological, a significant percentage of case are actually a physiological problem.
Now, there are also a number of cases that have a psychological component. That doesn’t mean that the pain or the symptom is not “real.” Because it certainly is—all symptoms are experienced in the mind. If your finger is cut, it feels like it is in your finger where the pain is, but it is actually ‘felt’ in your mind. Pain signals are sent from the site of the injury to the brain.
It’s been estimated that up to 90% of doctor’s visits are for difficulties that have a psychological component.1 Perhaps that’s a bit misleading, because of the strong link between the mind and the body.
When I first started graduate school, I noticed that every break I had, I got sick! There are different theories as to why this happens. But I found the most important component was my thinking. Now that’s odd isn’t it? Now, during the time of year when people have more of the flu, colds, etc.. (winter), we all notice when others are sniffling, coughing, and blowing their noses. We think, “I hope I don’t get that.” But, we end up getting it anyway, a lot of the time. Oddly, as long as I thought, “I don’t have time to get sick,” and as long as it was actually true, I did not get sick. At times, an illness can perform a function. Such as a severe cold may force you to rest more than you would otherwise. You may have a personality type where you don’t rest enough, but if you are forced to rest, you will.
Now, another notion is that aspects of immune system activity may increase under stress, but then crashes after the stress is gone (I’ve simplified this greatly). This increases our susceptibility to infections of various types. One study found that Olympic athletes are more likely to become ill in the period after the competition is over. Studies have shown that the immune response tends to crash for these individuals after the competition is over. So there is a mind component, but there is also a body component to this. They are intimately linked.
There is a branch of psychology called, Psychoneuroimmunology.2 This is a branch that investigates the relationship between psychological variables, neurological variables, and immunological variables. It’s a fascinating field of study, and there is much to learn about the relationship between the mind and the body. We are only beginning to scratch the surface with our understanding.
1 http://stress.about.com/od/stresshealth/f/psychosomatic.htm
2 http://en.wikipedia.org/wiki/Psychoneuroimmunology
The mind and the body are intimately interconnected. If we’re honest, we don’t understand how this works. Suffice it to say, we only understand some of the results.
One woman I saw was having marital problems. She developed severe hives. She and her husband had an intense argument and she felt the relationship was on the verge of ending. She could not put her feelings about this into words, so I asked her to put it into an image. She rubbed her hand against the bare wall behind her. She said, “This is it. It’s nothing! That’s what I saw for my life. Or stepping off of the edge of the Grand Canyon at night. You can’t see anything. You don’t know how far your falling. It’s just terror.” She showed me her hives when she first came in. I asked her to show me again at the end of the session (they were greatly reduced and she found this remarkable!). This is but a simple example of how emotions can be expressed in the body.
The interesting thing is, with hypnosis, a certain area of the body can be focused on. And while general immune system features may not change (such as circulation of killer T-cells), the immune response changes for the very specific area that is focused on. For example, let’s say a person has a wart on their finger. If in hypnosis, you have them visualize that wart shrinking and healing, there will be a very specific immune system response in that area only! So, how in the world can this happen? Warts are caused by a virus. But the immune system can be unconsciously directed to the very specific area in question by the mind!
I will continue this series in the future.
I’ve written before on how to receive feedback (Part I and Part II). In this series, I will talk about giving feedback to others.
Many of my professors in graduate school were well-known for their inability to give positive feedback. For several of the professors, if you weren’t receiving negative criticism, then you were probably doing fine. My classmates and I thought this was ironic. In our day-to-day relationships, it is very important to compliment people at times. When you are in a relationship and your significant other does something that you like, it is very important to tell them that. Most people find positive feedback motivating. When we are complimented for doing something, it makes us want to do what we were doing at the time even more.
For many people, positive feedback is much more motivating than negative feedback. When giving positive feedback, we want to think about the message that we are sending.
Parent: “You’re such a smart kid. No wonder you get good grades.”
Now, the above example is good for boosting general self-esteem, and you may want to do that sometimes. But, other times, it may not be the message that you want to send. It credits the child’s abilities and not their effort. You don’t want a child to only tie notions of success to innate ability. That builds a fragile self-esteem. You want them to tie effort more to success than to ability. I don’t want to go into that too much, because the topic of self-esteem is worthy of a separate post.
Parent: “You’ve been doing very well at school. You must be working very hard at things. You’re a hard worker aren’t you?”
The second compliment is motivating in a more specific way, and it also teaches something that can be useful in life. It ties the notion of effort to performance.
Spouse: “Thank you for all the hard work you do. I just wanted you to know that I appreciate you.”
People will sometimes give you clues to when you would do well to provide some positive feedback.
Spouse: “I’ve been doing laundry and cleaning the house all day. I didn’t really feel like doing it. Sometimes I hate doing it.”
Response: “I really appreciate that you do all of those things. I know you do them sometimes even when you don’t feel like it.”
So, sometimes a clue may sound a bit like complaining to some people. So, the next time your significant other starts to talk like this, try giving them a compliment for what they are doing. It may not always be that it is this type of clue, it could be a different type, but you’ll find out by how they respond to your compliment. I’ll continue the above example in two different directions to elucidate the matter further.
Spouse: “I really don’t want appreciation right now. I would like some help!”
Oops. But at least you found out what was behind what appeared to be complaining.
Spouse: “It’s okay. I know you appreciate me. I appreciate everything you do too.”
That was on track, and the response confirmed that you successfully understood the clue.
In the second part of this series, I will address how to give negative feedback.
I work with a lot of folks who have a great deal more ability than they ever utilize. I often find myself scratching my head….”This person is extremely capable, but they’ve gone for years only making minimum wage.” They never ask for a raise. They put up with mistreatment in their dead-end job. They are not assertive in their personal relationships (they make no demands on their friends or spouses or boyfriends or girlfriends).
Sometimes, they had a learning disability, and came to believe that they were incompetent. Sometimes they had a speech problem (problems learning how to talk). Sometimes they had problems in developing motor skills (problems learning how to walk, had medical conditions requiring braces on their legs, had an early high fever resulting in poor motor skills, experienced a lack of oxygen at birth resulting in poor motor skills, and so forth). Sometimes, they were viewed by a parent as being completely incompetent, and told that they would be a failure. The reasons are numerous and very personal to the individual.
But the upshot, is that a person’s self-perception becomes their reality. Be willing to fail. You’ll gain more wisdom from failure than you ever will from success. God didn’t give you the skills and abilities that you have for no reason.
Believe it or not, we all have self-defeating expectations at times. What do I mean by this?
“I wish I could meet someone to date…”
“What have you done to try to meet somebody?”
“Well nothing. Nobody would want to date me anyway.”
“Hmmm…”
A self-defeating expectation is different from outright self-sabotage. With self-sabotage, a person approaches a goal only to shoot themselves in the foot by something they do. For example, a person might drop out of college with only a class or two left to complete before achieving a degree. Secretly, they may fear that they will fail in their chosen career path, so it’s short-circuited before it even has a chance to start.
Most often with both patterns, there is an element of anxiety that is often subtly concealed. There can sometimes be a deep-seated belief, “Whatever I do, I am doomed to fail.” This often becomes a self-fulfilling prophecy. A person brings about that which they fear.
Now, believe it or not, sometimes a self-defeating pattern brings about things that are more positive in a person’s life. I remember one lady whose grandmother wanted her to become a nurse. She had a very close relationship with her grandmother. One day, her grandmother was complaining about a pain in her leg. Her grandmother remarked, “Oh, I probably just pulled a muscle.” And she responded, “Yeah, probably so.” Two days later, the grandmother was dead because a blood clot in her leg dislodged and ended up in her heart. This woman felt tremendously guilty—that she had caused her grandmother’s death by not suggesting that she see a doctor. She felt she had to fulfill her grandmother’s dreams for her in becoming a nurse. But she struggled in college. She became more depressed. She kept flunking certain classes. It was not because she lacked intelligence—I tested her IQ level and she should have been able to get all A’s or at least A’s and B’s in every class she took. What we discovered was that she didn’t really want to be a nurse. Once she was able to resolve her feelings of guilt about her grandmother’s death, she was able to see that her grandmother would have wanted her to choose a profession that she wanted to choose. She switched majors and started getting the A’s and B’s that I knew she was capable of.
Sometimes the patterns of self-defeat run a little deeper and keep repeating over and over. Most often, this has to do with a pattern of experiences in childhood that leads the person to have deep doubts about the competence or effectiveness. These patterns take longer to resolve, because the self-defeating beliefs are very strong and resist change. Sometimes, these patterns take several years to resolve. There may be numerous subtle anxieties that keep a person in a repeating pattern of self-defeat. But, if you are truly motivated to overcome these patterns and have a shrink that you connect with, you can overcome these patterns with a lot of hard work. Unfortunately, there is no medication that will help you do this, and there is no quick fix. It is difficult to resolve these patterns outside of a psychotherapeutic relationship, because everyone has their blinders.
Race horses are fitted with blinders. The blinders restrict their field of vision to basically straight ahead of them. This is so they do not become frightened by other things that are going on around them. People have “mental blinders,” defenses that keep them from recognizing those things that frighten them. Psychotherapy can help people remove these blinders and confront their fears and anxieties.
I find that the idea of “Locus of Control” often comes up in treatment. (1)
A person with an Internal locus of control is said to believe that they have control over their own decisions and things that happen in their lives. A person with an external locus of control, believes that their personal decisions and things that happens in life, are determined by external factors (the situation that they find themselves in).
So, very often, in treatment, it is important to establish what things a person has control over, and what things a person does not have control over. I’d say in probably 70 to 80% of the people I see, there are distortions in their notions of control. Sometimes, they feel like they should be able to control everything. Even those situations which we have no control over. Other times, they don’t feel like they have control over anything, including any aspect of themselves.
An exaggerated notion of external locus of control is often associated with depression. An exaggerated notion of internal locus of control is often associated with anxiety and anger. The point is, that there are some things you can control in your life and within yourself, and there are other things that you cannot. As with many things in life, the point is finding the most realistic balance between the two. This is not something that is easily done, and will be a continual balancing act for almost everyone.
I quoted this old proverb previously in On Feeling Defective:
“For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.”
This quote has often been used by my mentor. I used this to describe my approach to treatment. But, as I’ve been thinking about this more, it also applies to all of our lives. Sometimes, we get caught up in intellectual arguments. Sometimes, we get caught up in our desires. Sometimes, we get caught up in the everyday details of everyday life.
But, I think what you want to do in a lot of situations, is to find that nail. It may be extremely difficult. And there are times when there is no nail. But, most often the nail is there if you are open, and dig enough. Most often for believers, you might find that nail to be God. Not, that all your problems will be solved. I don’t mean to say that like many televangelists do, but I do think that nail that God provides can often help to win that war in your life. Regardless, I think it is important to focus on “What is the most important thing?” Whether this be your outlook on life, or a difficult situation that you face.
I’ve noted before that the role of psychiatrists is largely focused only the medication that a patient takes. To be fair, there are a few psychiatrists out there who do actual psychotherapy. Recent research shows this to be declining very steadily. (1)
I think the recent research on the decline of psychotherapy in psychiatry underestimates the ‘true’ shift in the field of psychiatry. The research is based on billing codes, and I know a little about that. I do computer consulting with a mental health center on their electronic medical record system. If the session goes over 15 minutes, it is billed as medication review + MD psychotherapy. So, in other words, if the session lasts more than 15 minutes, it is considered psychotherapy. This is whether it is true psychotherapy, or just an extended discussion of medication. There are no psychiatrists within a 50 mile radius of my practice that I would consider that provide true “psychotherapy.” So, the research results from 2004-2005 showing that 29% of psychiatrists provide ‘psychotherapy,’ is quite distorted. It frankly just means that sometimes they run over 15 minutes in the discussion of medication. I’m not saying that there are not any psychiatrists who provide psychotherapy, I’m just saying that it is very rare. That’s why you ought to be very skeptical about psychologists who have prescription privileges, because it is likely that they will go the way of psychiatrists.
(1). http://www.medscape.com/viewarticle/578684?src=mpnews&spon=12&uac=107497SN
“Pain in life is not optional, suffering is.” –Author Unknown
Without a single doubt. You will experience pain in life, both physical and emotional. All people will recognize this as true. Now, suffering is a state of emotion and thought. Suffering is a state that amplifies physical and emotional pain. To suffer, is to allow the pain (physical or emotional), to have an overriding and defining influence on your life.
Let’s see a little bit about how suffering works in thought.
I’m miserable and I always will be.
Pain rules my world. The only thing I do is hurt.
I can’t deal with anything. My life is hopeless.
Let’s see what kind of difference a minor shift in perspective might make.
I’m anxious a lot, but sometimes I’m not. I really enjoy myself when I’m not.
I have a lot of pain, but I get a lot of enjoyment out of writing and sewing.
Some things are hard for me to cope with, but other things I cope with quite well!
These thoughts may seem like a minor shift in perspective, but they are really a major shift in the manner of living life. Whatever situation you find yourself in, you want to do everything you can to add positives to your life–to give your life that extra meaning. That shift in perspective can help you, if nothing else, to divert your attention from your pain (whether it be physical or emotional). Now, I never advocate lying to yourself. For example, I wouldn’t tell you to tell yourself, “Hey!! My life is great!!!” if it is not. BUT, I will tell you to not focus on only the negatives and to make your life more than the negatives. By adding positives, you will shrink the negatives. Often, you have the knowledge of what will help you to feel better….what helped you to feel better in the past? Start doing those things that you can do again, and put less emphasis on what you can’t do.
Now, these approaches do not eliminate pain, but may help prevent suffering. And the goal really can’t be to eliminate pain, but we can shrink its significance.
Viktor Frankl, author of Man’s Search for Meaning, observed that a person who has a strong enough “why” can cope with any “how.” What he meant by this was that if your reason for enduring something is powerful enough (the why), you can endure whatever you need to for achieving your goal (the how). His observations were based on his experiences in a Nazi concentration camp. He observed that when others in the camp gave up their reasons for being, they died within a few days. So, your meaning in life can actually have a link to and affect your physical health. For some, their driving sense of meaning was their faith, and for others–seeing their families again. The most important thing was that they had this sense of meaning.
Now towards the end of the book, he describes a survey that he conducted. He found that one of the most meaningful experiences a person can have is overcoming great difficulty and then helping others to do the same. I understand this on a very personal level as a Shrink, and it is very true. I recommend the book if you haven’t read it. It can give you a different perspective on life and suffering.
What do I mean by that? The ‘Nonverbal Level.’ What I mean is traumatic experiences that occur before the development of language, or around the time when language is just developing. People who experience these early traumas, often times medical experiences, tend to develop a wide range of difficulties. Most notably, difficulty with self-expression.
I’ve talked a little about early traumatic experiences before. In some ways a person’s emotional development becomes “fixed” or “fixated” at the age at which the trauma occurred. In may other ways they may fully develop (intellectually, physically, etc…).
I met a fellow professional at a conference a few years ago who shared that she had developed an intense aversion to all kinds of fruits and vegetables after an extrended hospital stay at the age of 2. There was no conscious memory of this experience. But her mother told her that she loved fruit and vegetables before going into the hospital, and after being in the hospital would never touch them again. Now, when I met her, she was 40 years old! She had never eaten any fruit or vegetables since that time. And could not do so. She would immediately gag.
She told me a little about her early medical experiences that she learned from her parents. I made a slightly unprofessional comment, “I bet you are extremely ‘gaggy.’” In other words, she has a hypersensitive gag reflex. She said, “Yes, I always have been. I can’t eat any fruit or vegetables without gagging. It’s the texture.” Now, this was related to the fact of being in the hospital for many months, and having tubes down her throat at this very early age.
Now, many people who have very early traumas (traumatic births, early medical traumas in the first couple years of life, etc…) have extreme difficulty in expressing themselves. It may be just talking at all that’s a problem. It may be specific to emotional expression. Regardless, there is almost always a problem in this area.
So, if you have a child who has to be in the hospital at a very young age, the best I can tell you is be there for them as much as you possibly can. Provide a great deal of reassurance and physical comfort (hugs, kisses, touch, etc…). Talk to them. Be soothing. You cannot completely erase the traumatic nature of the experience, but you will reduce it draumatically.
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