Monday, September 3, 2018

I’ve Been There


            “I just can’t go on,” the female voice on the other end of the line said. 
            “Okay.  I got it.  You feel like crap.  Are you willing to talk?”
            “Yes.”
            I then began the coaching call I have done for other clients to help them get through this darkest time.  She could only see and feel the endless pain of her depression and felt hopeless to get through another night feeling there was a no possibility of things ever changing.
            Because many of my clients live with severe depression, we have shared a look at that place that feels so interminable.  In going through this experience, they have gained some willingness to take steps to keep themselves alive long enough to call and have that conversation in which we make choices about staying alive through this night. 
            Among the issues we discuss are the chemistry of the brain that makes this pain so excruciating while seeming to be endless.  I explain that the blinding intensity of the urge to kill herself lasts approximately 20 minutes.  During that time the impulse is strong, and it is important that together we find something she (he) can do to prevent acting on the impulse for self-harm.  I suggest an abrupt change of temperature, intense exercise, or even paced breathing.  Those simple acts can take about 20 minutes, long enough to allow clients a deep breath and think about not hurting themselves.
            Why do my clients think of suicide when they feel living is an impossible burden?  What makes any individual feel that staying alive is more painful than killing him or herself?  Often the urge to take her or his life has been a recurrent thought.  When sadness or hopelessness get very strong the depressed individual often finds the thought of suicide reassuring because it is an option which takes her out of that pain.
            My work is to both recognize and accept that my client is suffering and to offer short- and long-term solutions.  Together we explore the steps needed at the moment of the call and with her or his ideas and editing, we find action she (he) can take in order to stay alive through the intensity after we end our call.  Our work is to keep her (him) alive by finding action they can take that is tolerable and works in that moment.  We also prepare for the next day in which the emotions that were driving her (him) to consider these steps may now include feelings of shame for having considered such intense self-harm.
            When I look at my clients who are or have experienced thoughts of killing themselves I recognize the enormity of their pain.  The question I consider as I aim to support them is:  what can I do to give them the skills needed to tolerate this pain?  Why do individuals who seem to “have it all” think about or even attempt to kill themselves?  Today, on the one hand, we have better tools to support individuals in pain.  We  have medication and therapy both individual and group treatment and we have support groups in many different settings.  There are spiritual counselors from various religious denominations and we are applying mindfulness tools in almost every area of a daily lives. 
            And we are still experiencing increasing numbers of people whose feelings of hopelessness and helplessness lead them to attempt suicide.  One of the answers to why is existential.  We are living in a world of constant change which, for many people is also a world of uncertainty and fear.  These new ideas and new policies as well as the seeming limited ability for each of us to find safety are the starting point for many individual’s pain.  How do we reach out for those personal connections that were so easy to make before our communication was impersonal electronic media?
            Why are the highest number of people who complete a suicidal action in the age group of individuals who are supposedly at the peak of their professional growth and family satisfaction?  Do we, as a culture, put more pressure on women and men when they reach a certain age or a specific level of professional growth, or do we expect people to never feel vulnerable? 
            What is missing in our culture that we are unable to connect to our friends, our neighbors, and even those people we see every day walking our dogs?  What made the fear that prevents us from making these contacts grow?  More importantly, what do we need to know in order to diminish this fear and take the risk of expressing empathy (a very important and healthy quality)?   
            Understanding that we are living in a universe of change that impacts all aspects of our daily living is an essential and fundamental tool if we are to become a healthier culture.  Empathy is both a rich and a key skill for surviving in these stressful times and it is an action we are afraid to demonstrate.  Demonstrating this quality requires both courage and a willingness to remove the mask behind which most of us hide. 
            Offering the homeless person in front of the drugstore a smile or a greeting is the first step in recognizing that we are all - all of us - experiencing some level of fear and loneliness.  This willingness to take a chance and offer contact to another person is the beginning.  How do we attack this epidemic of depression and of suicidal feelings?  By recognizing that we are all human, and we can all start our healing, with the willingness to take responsibility for our own good health.  This healing also includes recognizing that we are part of a bigger world. 
            Those phrases we hear so often, “we are all one,” “we are all connected,” are true and much too easy to forget.  As we work to lower our own pain, we can also remain aware that we do have an impact on the people around us.  It is so important to keep in mind that everyone has issues with which he or she is struggling.  Why is the number of suicides among individuals ages forty-five to sixty so high?  What happens to us as we reach those years?  Mid-life is supposed to be the most fulfilling and is the age of the largest numbers of suicides.
            Some of the answer is seen in the question:  these are the years that are identified as “the richest,” or “the most satisfying.”  We are now living the rich relationship that we have created through the years of being together, without the stress of children.   The pressure to demonstrate the achievements of our 40 or so years often feels empty.  These are the years just prior to retirement when, so the media tells us, we have reached our goals and are celebrating our lives.  And, yet, this idea is another urban myth. 
            The economic and social changes over the past fifty years have left many individuals struggling to maintain an image of success.  Many individuals have ended relationships and cut ties with family and are thus isolated in a world that does not provide the social connections enjoyed at an earlier age.  Women go through hormonal changes at this time that may exacerbate a pain of isolation created by changes in relationship status.  Men are experiencing changes that impact their professional identity.  These physiological changes can produce a vulnerability to emotional pain for which he or she is not prepared.
            Culturally, we have not prepared individuals to grow into a rich and satisfying older age.  As we stand on the brink of becoming an elder statesperson, a status that many cultures celebrate, we find that we no longer have the purpose of parenting, of career growth, and have not created another area in which to find joy or satisfaction. 
            We are finally talking about the impact of this isolation that becomes more profound in these shifting times.  We are facing changes in the community and the economy that impact our capacity to process those predictable daily slings and arrows.  Additionally, there is the demand for tolerance of the unknown for which we are not prepared.  Willingness to accept our limited capacity to understand living with these changes is an important step in caring for ourselves. 
            We cannot know how to live with every new concept occurring in our environment and we certainly don’t know how to resolve the challenges presented.  What we can do is let go of the need to control those changes. For many, dread of the unfamiliar leads to thoughts of suicide.  The intensity of the emotions rising out of our loss of skillfulness leads to the urge to take some stand.  We must act in a way helps us regain the authority we feel we have lost. 
            Understanding the limitations of our power to adapt to change in our lives is fundamental to accepting.  With acceptance comes the capacity to tolerate, and even adapt, to the constant change within our world.  Change is inevitable.  Growth is optional.
            Bethany decided to take a walk.  The sun was beginning to set and, if she went down to the Palisades, just above the beach at Santa Monica, she could watch the gold and red and magenta colors slipping into the ocean.  “Will you be okay walking on that path?” I asked.
              Bethany was quiet for a  moment.  “Yes.  I’m going to be okay.” 
            “You must call me in the morning to tell me how you’re doing,” I instructed her.  “Okay.” 
            “And if you don’t call by 10, I’ll call you.” 
            Bethany was silent for a moment and then replied, “I didn’t want to go to the hospital.”
            “You are very brave to ask for help.  Call me in the morning.”
            “Thanks.  I will.”
            “I’m here.  I want you alive.” 

Saturday, October 1, 2016

Shana Tova

So in preparation for the high holidays-- I contemplate the meanings and lessons stemming from resisting Lashon Hara. With the hope that this year we can create classrooms, schools, relationships, and spaces where we hear, see, feel and understand each other better than we did before. Even when we may disagree or see the world in different ways. Listening, talking, reflecting, understanding, being more thoughtful-sensitive-honest and careful with our words-- may help us do better.

Someplace to start, to work on, and to grow from. Shana Tova

Weapons: Lashon Hara
how does one speak to
another
without saying what the
other wants to hear?
how does one hear
another
without the other speaking
and looking away?
how can we see one another
when our minds are cluttered with a vision of ourselves
and there is no other?
how can they say those things
when they know the words are
heard and they see your face?
how can they listen to words
sharpened into swords?
thinking only of themselves
yet unable to see
themselves or others?
throwing out sharp words
that deafen our ears

Tuesday, August 9, 2016

Monday, August 8, 2016

Sunday, August 7, 2016

We're growing

In September two more of our therapists will complete DBT training.  We will be ready to expand including additional Skills Group sessions.

Such an exciting development to be available to create a healthy community!

Contact us (310/440-2021) to ask questions.

Treat yourself gently and breathe.

Sunday, June 12, 2016

Soundtrack of my Life

The Hollywood Bowl, a lovely summer evening and a concert by Paul Simon.

And so I spent an evening totally immersed in the music that provided the background to heartbreak all those years ago.  What fun.  The music still brings tears to my eyes and the sounds still sound fresh.

The whole musical experience is a reminder that sometimes the very best experiences bring even richer experiences as it is repeated.  Listening to those songs, the classic "Fifty Ways to Leave Your Lover," and "Mrs. Robinson" had an even deeper resonance today when heard in the context of all those sad and fun events in which I first listened.  They remind me of all I have survived in moving from the youthful exuberance of the adolescent to the experience of today's adult.

Thank you, Paul Simon for reminding me of how much I have seen to reach the understanding I now have. . . . slip out the back, Jack.  Making new plans, Stan.

Saturday, April 23, 2016

Take care of You

Resources for you when you're feeling overwhelmed:

What to Do If You Need Help

We have been getting an overwhelming response to this article and wanted to add a few things. The National Institute of Mental Health recommends this site. It also warns that reporting on suicide can lead to so-called suicide contagion, in which exposure to the mention of suicide within a person’s family, peer group or in the media can lead to an increase in suicides.
There are many groups that help people having suicidal thoughts. One, Crisis Text Line, inspired by teenagers’ attachment to texting but open to people of all ages, provides free assistance to anyone who texts “help” to 741-741.
If you prefer to talk on the phone, N.I.H. recommends the National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

Sunday, February 7, 2016

Happy Year of the Monkey

Monkeys are creatures of humor and surprise.  Perhaps those are the traits that will dominate this year.  I can already sense that all the uncertainty of coming events are presaging fun and surprise.  I will have a lovely and surprising visitor from Ireland in April.  A chapter I wrote for a book on working with individuals with Borderline Personality Disorder is being published and there is more travel on the horizon.

All of these changes demand the discipline of getting enough sleep (when???), eating healthy meals and keeping up with my yoga practice.  I have the preparation for classes that takes several hours for each class, then I have the preparation for seeing my clients and I have those basic tasks of paying bills, walking the dog and (argh) cleaning house.

My goal for the next months is to get sufficiently organized  to manage all of those tasks and still have the fun that is required for the year of the Monkey.

Monday, December 7, 2015

Lights in this Challenging time.

Dear Friends,  tonight is the first night of Chanukah. In Hebrew it's called the festival of lights.  With all that's happening in the world, we can use some light now.  There is an old Chanukah song that describes how we as a collective for good can triumph over dark times. Banu Choshech Le Garesh.  Literally, we have arrived together  to chase away the darkness. Here are the words in Hebrew: 

בָּאנוּ חוֹשֶׁךְ לְגָרֵשׁ
בְּיָדֵינוּ אוֹר וָאֵשׁ
כָּל אֶחָד הוּא אוֹר קָטָן
וְכֻלָנוּ אוֹר אֵיתָן
סוּרָה חוֹשֶׁךְ הָלְאָה שְחוֹר
סוּרָה מִפְּנֵי הָאוֹר

Here is my translation adapted for our days:

We have arrived together to chase away the darkness that surrounds us
each of us in our hands has a light from our internal flame
each of us alone and by ourselves are a small but bright light
but when we join together with purpose we are a powerful and towering light
that illuminates a path through the opaqueness and uncertainty ahead
so the darkness will flee from the faces of our radiant lights

May your latkes, jelly donuts, and singing fill the world.  May our lights shine a bright path ahead.

Happy Chanukah

Sunday, November 22, 2015

Peace in the Time of Terror (part 4)

“We want to respect you. Because of a lack of understanding on our part, we have not been skillful at showing our respect, our care I or you, and we have been caught in our own situation of suffering. Please tell us what is in your hearts. We want to understand your suffering. We want to know what mistakes we have made for you to hate us so much.

“We ourselves do not want to live in fear or to suffer and we do not want you to live in fear or to suffer either. We want you to live in peace, in safety, and in dignity because we know that none of us will have peace until all of us have peace. Let us create together an occasion for mutual listening and understanding, which can be the foundation for real reconciliation and peace.”