Here’s what happened in my life over the past week:
My sleep has been messed up, and I’ve felt really unfocused and vaguely physically unwell. The heat has probably been messing with my lithium levels, and I don’t think it’s helped that there’s been horrendous air quality from forest fire smoke.
I went to yoga once, and also had a massage. I’m still not thrilled with my new massage therapist, and I have a feeling things aren’t really going to improve much. I feel kind of guilty thinking about bailing on her, but my vacation in October could be a good excuse to disappear a bit more subtly.
I had found out a few weeks ago that one of my jobs was going to be ceasing to exist in the fall, as the program was shutting down. After an initial freak-out, I went into hardcore avoidance mode. Anyway, this week I found out that I will be getting work with the company that’s pretty much taking over the work that my current employer has been doing. It wasn’t a competitive application process; it seems like they’re taking any nurses that want to switch over. Strangely enough, I don’t feel particularly happy or relieved, maybe because I’ve switching from not thinking about it due to avoidance, to now not having to think about it because it’s just not an issue any more.
I did a night shift Wednesday at my other job to cover for someone who’d called in sick. I didn’t get called until around 7pm, and I was so tired already at that point that should have just said no, but I agreed to take the shift. I can’t nap without meds, but 7pm was just too late to take any meds before an 11pm shift. So I was a total mess. I ended up sleeping almost all day and night Thursday. I realized when I woke up still feeling gross on Friday morning that I had managed to miss 3 days in a row of morning meds, and I was probably going into venlafaxine withdrawal.
Near where I live there are some flowers that attract a ton of fat, fuzzy bumblebees. It’s mesmerizing – it makesthe perfect mindfulness moment.
My guinea pig boy has been hiding out in his house more lately. He’s getting very old for a guinea pig, and I wonder if he’s not feeling very well. My girls, on the other hand, have been extra adorable this week with their begging for food behaviour. They’re not hungry by any stretch, they’re just sticking their furry little faces out the cage door hoping that by looking cute I’ll decide to give them extra treats.
In this series, I dig a little deeper into the meaning of psychological terms.
This week’s term: conversion therapy
I’ve forgotten the details, but recently I heard/read something that mentioned conversion therapy, so I decided to look a little closer at this pseudo-therapy that aims to force people’s sexuality to fit with heteronormative expectations. It is sometimes referred to as trying to “pray the gay away”. I expected to be rather disgusted by what I would find, and I wasn’t disappointed.
Early strategies used in conversation therapy were outlandish and often cruel. According to Wikipedia, one endocrinologist transplanted testicles from straight men into gay men. Electric shocks were sometimes applied to people’s genitals, and other strategies included ice-pick lobotomies (by a neurologist with no surgical training), chemical castration, masturbatory reconditioning, and administering nausea-induced drugs at the same time as showing homosexual images. From 1968 to 19977, researchers Masters and Johnson conducted trials of sex therapy, with subjects engaging in sex acts in a lab in order to basically fuck the gay away.
Wikipedia describes a more recent approach called “reparative therapy”, developed by in the 1990’s by psychologists Elizabeth Moberly and Joseph Nicolosi, which views homosexuality as “a person’s rational and unconscious attempt to ‘self-repair’ feelings of inferiority”. So-called “ex-gay ministries” have also arisen promoting the effectiveness of conversion therapy.
Wikipedia states that between 1939 and 1969, “conversion therapy received approval from most of the psychiatric establishment in the United States”. It became increasingly challenged after the Stonewall Bar riot to protest a police raid in 1969. Homosexuality was removed in 1973 from the Diagnostic and Statistical Manual (DSM), where it had been classified as a mental disorder since 1952.
In 1992, the National Association for Research and Therapy of Homosexuality (NARTH) was formed, and began publishing material claiming that conversion therapy was effective. One of the cofounders was Joseph Nicolosi, who developed reparative therapy. This group was not supported by any mainstream mental health or medical organizations, but some fundamentalist Christian and other religious groups have partnered with them. A group of Christian right organizations funded a $600,000 advertising campaign in 1998 promoting conversion therapy.
Wikipedia provides the legal status of conversation therapy in various nations. I was surprised to learn that it’s only banned in one Australian state, two Canadian provinces, and 14 American States; the UK government announced just last month that it would begin putting together a bill to ban it; it is officially endorsed by the Malaysian government; and in 2016 and 2017 Israel voted down a proposed ban on conversion therapy for minors.
It disturbs me the outlandish practices that have been a part of mainstream treatment over the last century when it comes to the treatment of any group that is considered aberrant, whether that’s mentally ill, LGBTQ, racial minorities, etc. As much as I might be inclined to shuffle something like conversion therapy into the same crazy bin as L. Ron Hubbard’s made up religion/psychotherapy Scientology, it’s something that was once accepted by major psychological and medical organizations. There are countries that still allow it, or even, in the case of Malaysia, embrace it.
What is wrong with humanity that people are so blind, so willfully judgmental?
The Adverse Childhood Experiences (ACEs) study was a landmark research trial conducted by Kaiser Permanente and the U.S. Center for Disease Control. The study examined the correlation between adverse experiences in childhood and health outcomes in adult, and clearly showed just how profound that connection is.
The study participants were asked to report whether they had experienced physical/sexual/emotional abuse, physical/emotion neglect, exposure to domestic violence, household substance abuse, household mental illness, parental separation/divorce, and incarcerated household members. Two-thirds of participants reported at least one ACE, and more than 1 in 5 reported ≥3 ACEs.
The results showed a dose-response curve between number of ACEs and risk of adult health problems (i.e. a higher number of ACEs was associated with a higher number of health complications). ACEs were associated with the following negative outcomes and high-risk activities associated with negative health outcomes:
Alcoholism and alcohol abuse
Chronic obstructive pulmonary disease
Health-related quality of life
Illicit drug use
Ischemic heart disease
Poor work performance
Risk for intimate partner violence
Multiple sexual partners
Sexually transmitted diseases
Early initiation of smoking
Early initiation of sexual activity
Risk for sexual violence
Poor academic achievement
Not only are there a large number of negative effects, the size of these effects is extremely disturbing. An ACEs score above six was associated with a 3000% increase in suicide and a life expectancy 20 years less than the population average. I think that one of the particularly important findings of the study was that the negative outcomes were not a simple cause-and-effect relationship with high-risk behaviours. The wide-ranging negative outcomes still occur with or without high-risk behaviours.
ACEs are thought to effect structural development of neural networks in the brain as well as biochemistry, including chemical messengers like cortisol and adrenaline. The related stress can also cause epigenetic changes that alter how genes are expressed, and these changes can also be passed to fetuses.
I first heard about this study way back when I was in nursing school, and I remember wondering at the time why I hadn’t heard of something that important before then. I still think it’s something that more people need to be aware of, because it sheds so much light on the experiences of those who have lived through childhood trauma.
In Untangled: A Story of Resilience, Courage, and Triumph, Alexis Rose offers raw, forthright descriptions of the repeated abuse she experienced in childhood and into adulthood. I would caution anyone who has experienced abuse themselves to carefully evaluate whether they are far enough along in their own healing to feel safe while reading this kind of account; I would suggest a better place to start might be Alexis’s other book, If I Could Tell You How It Feels, which focuses more on the healing process. Aside from this caveat, this is a powerful, eye-opening book. It is truly remarkable that Alexis has been brave enough to share her story, and is able to tell it so clearly, in a manner that is calm yet still captures the emotional devastation at the time. She very effectively describes the hell of not only living through traumatic events, but struggling with the lasting trauma reactions afterwards. She also touches on many questions that those unfamiliar with trauma might wonder about, including trauma bonding with an abuser, continuing to follow instructions drilled in by the abusers, and maintaining silence.
The sexual, physical, psychological, and ritualistic abuse began at an early age at the hands of her parents and others. As she was being abused, she would imagine seeing the house next door on fire through her window; she eloquently described how this helped her to find a “golden thread of survival. That thread kept the pieces of my shattered soul together, and gave me the strength I needed to wake up and face another day.” Messages to remain silent were frequently drilled into her, and as she grew older, various techniques were used to keep her under tight psychological control.
Alexis describes a horrific pair of trips to the Middle East, where her mother moved after her father died. She explained the bizarre trauma bond she developed with a man she was forced to live with who exerted complete control over her and frequently spoke down to her as if she were garbage. She was informed that she was to serve as “a killer and a whore,” or else she herself would be killed. She observes that by that point, “any shred of my psychological health had been obliterated.” She ended up being tortured and beaten, and she describes the ways in which she dissociated as her mind tried to protect itself.
When she was finally allowed to return home, she began the processing of repressing the memories of what had happened to her. Without other skills available, she relied on this strategy of repression continued for as long as she could manage. Her abusers continued to make themselves known periodically, through phone calls, mail, and in person, and she was subjected to ongoing psychological abuse from her mother.
She began to have flashbacks, although she lacked the knowledge to understand that’s what they were. She writes that she had “no idea that the level of abuse I survived as a child was worth talking about or bothering with.” At one point she stopped therapy because she was unable to move past the brainwashed messages that she must remain silent. She adopted a pattern of trying to “push feelings aside and keep moving”, as this was the only way she knew to keep going. She made the interesting distinction that “it wasn’t that I was living in the moment; I was just continually on the move.”
Things came crashing down after her daughter was hit by a car while crossing the street. Alexis writes about the extremely intense flashback triggered by the call she received from the police, and finally realized that “my mental health was hanging by a very thin thread that was about to break”. At that point she started seeing the psychologist who became “my healer, my teacher, and the one I would call my Sherpa, who truly started me on my journey. Walking into his office that day I began six years of a difficult and treacherous trek up the highest of mountain peaks, but that was also the day I began to claim my life and start to live, not just survive.” She finally got to a point where she could begin “forgetting how to forget”.
Despite the horrific things that have happened to her, she has been able to leave behind those who have abused her and move forward with healing. She has been able to draw on resilience and an ability to thrive, and has reached a place where she can be optimistic and thrive. Alexis writes: “I’ve untangled myself. My courage has set me free, and now nothing can keep me tied to the past. I can truly live today with blinders off and eyes wide open.” This is a truly inspiring book that tells an amazing story of survival through adversity.
Some studies have shown that the quality of the therapeutic relationship between client and therapist is a stronger predictor of therapeutic outcomes than the type of therapy used. However, it seems logical that the type of therapy should at least to some extent match up with how you tend to conceptualize the problems you’re experiencing. Here is a brief run-down of some different psychotherapy approaches. This is by no means an exhaustive list, and it doesn’t include things like humanistic approaches or those therapies that do a deep dive into past issues and attachment. GoodTherapy.org has a much more extensive list.
ACT: Acceptance and Commitment Therapy: ACT takes the perspective that resistance to thoughts and feelings is the main cause of distress. It addresses areas such as present moment awareness, acceptance, separating the self from thoughts, and taking committed action consistent with identified values.
CBT: Cognitive Behavioural Therapy: CBT is perhaps one of the best known counselling approaches. It considers the relationships between thoughts, feelings, and behaviours, and how each of those elements can be changed. Evidence for and against thoughts is examined with the goal of identifying cognitive distortions that cause distress and replacing them with more realistic thoughts. As well, new behaviours are practiced to reduce distress and promote more realistic thinking.
CPT: Cognitive Processing Therapy: This is a form of CBT for PTSD, and aims to change cognitions about the trauma that are keeping the person stuck and preventing them from fully processing the trauma.
PE: Prolonged Exposure: This is a form of CBT that aims to decrease fear and trauma responses by exposing the person in a controlled way. This can be either in vivo (in person) or imaginal (the client is asked to vividly imagine a particular situation), or a combination of both. It progresses based on an identified hierarchy of feared stimuli.
TF-CBT: Trauma-Focused CBT: Like CPT, this is a form of CBT for trauma, but it is geared toward children and adolescents.
CFT: Compassion-Focused Therapy: CFT is influenced by CBT, and focuses on compassion towards both others and the self. It can be useful for people struggling with emotions like shame and self-criticism.
DBT: Dialectical Behaviour Therapy: DBT was developed by Dr. Marsha Linehan to address some of the shortcomings of CBT for treating borderline personality disorder. The dialectic refers to the idea that the way the individual is doing things now is valid and they are doing the best they can, but they would still benefit from change. DBT is very skill-based, with modules covering areas of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.
EFT: Emotionally Focused Therapy: This type of therapy consider emotions to be reflective of underlying needs, and classifies emotions as adaptive, maladaptive, reactive, and instrumental. Therapeutic tasks are identified based on the client’s particular emotional experiences.
EFT: Emotional Freedom Technique: Not to be confused with the other EFT, this is an approach that utilizes tapping on meridian points while focusing on an issue and then an affirmation. It draws on concepts from acupuncture and neurolinguistic programming (NLP). There is not a robust research evidence base to support its effectiveness, although that doesn’t speak to how a particular individual might or might not respond.
EMDR: Eye Movement Desensitization and Reprocessing: EMDR is a type of trauma counselling. The client uses horizontal eye movements to track the therapists’ fingers, and while this is being done the client focuses on an identified distressing image and the bodily sensations associated with that distress. A Subjective Units of Distress (SUDS) scale is used to track progress, and as the SUDS score drops the therapist and client work on installing a new positive cognition.
IPT: InterPersonal Therapy: IPT is a short-term, structured approach that focuses on addressing interpersonal problems that contribute to problems with mental health, and building interpersonal communication skills. Research has supported its effectiveness for the treatment of depression.
MBCT: Mindfulness-Based Cognitive Therapy: This type of therapy is focused on the use of mindfulness to address cognitive distress. It covers things like acting on autopilot, being mindful of the breath, allowing and letting be, engaging in self-care, and recognizing that thoughts aren’t facts.
SFBT: Solution-Focused Brief Therapy: SFBT works on identifying and developing the skills to create changes and achieve goals. The therapist asks particular types of questions to guide the client toward envisioning their future and identifying strengths and coping skills.
What types of therapy have you tried? What was your experience like?
I like to answer reasonable questions about mental health on the question-and-answer forum Quora, but often reasonable questions are hard to find. Here are some of the dumb ones I’ve come across.
Question: Do you think it’s cowardice to think that people with borderline personality disorders are all evil?
Answer (the most frightening one out of several): Do you understand that the Personality Disordered person is the coward? These people refuse to take responsibility for their own actions and constantly manipulate others to exploit them for their resources, precisely because they are COWARDS. The PD’ed person uses all sorts of tools, techniques to avoid the effort it takes to exhibit and exercise conscience towards others and themselves in the home and in society.
Question: Would long term exposure to nature be a more effective treatment for depression compared to pharmaceutical medications?
Question: How is a bipolar manipulative behavior treated?
Question: Can meditation cause schizophrenia?
Question: Depression, anxiety, “personality disorders”, etc. can be healed naturally, so why do we tolerate a mental health system that is drug-based, and is failing people?
My favourite answer: They can be healed naturally? You are out of touch with reality.
Question: Does depression lead to materialism?
Answer: Depression … n .. materialism … no way …. It is another disease callled bipolar .. where materialism comes .. go to google for details
Question: Is depression just sad narcissism?
Question: Do bipolar people have coexisting autistic and psychotic traits?
Question: It seems like lot of untreated people with severe schizophrenia eat out of the garbage, are unclean, and lacking sleep, but do not get sick like well people probably would. Do people with schizophrenia have stronger immune systems than most people?
Question: People with no real problems to tackle usually get depressed. Is depression a disease whose first symptom is laziness?
Are there any particularly stupid or bizarre questions you’ve seen/heard people ask about mental illness?
Here’s what happened in my life over the past week:
I spent the earlier part of the week visiting my Grandma. It was a good visit, but quite tiring. Especially hard was that she would have moments of confusion when she would get really irrational, like thinking my uncle was trying to steal her money. Her short-term memory is really impaired, so I was having to try to explain the same things over and over, which got frustrating even though I knew it wasn’t her fault. My parents, who live not far from Grandma, knew I was in town but I didn’t hear from them. I’m not sure what that’s about, but it doesn’t feel very good.
I’ve been more irritable this week, although it’s hard to tell if that’s internal or just annoying stuff happening that pissed me off. I full on spazzed at a guy in my building who was being a vehicular menace in the underground parking (e.g. he almost backed into me, I leaned on the horn, he paused for a second, then resumed trying to back into me). I usually try to keep my irritability on the inside, but on this occasion I just let er rip.
I’d been waiting for my iPhone 5S to start giving me problems before getting a new phone, and this week that time had come. I got a new iPhone 8 and switched to a different carrier that gave me a better plan for less money, so that’s a good thing.
I had some short periods of really negative thoughts. Just when I start thinking that I’ve convinced myself I know these thoughts aren’t true, they pop up to say hello and remind me they’re still floating around in there, ready and waiting to do a little crazy dance.
I’ve been feeling a bit overwhelmed by things I want/need to do, even though there really isn’t much to be overwhelmed by, and I worked very little this week. I guess it’s just taken a few days to get settled in and comfortable after being out of town at Grandma’s.
After an experience 6 months ago of crying and then getting up and walking out, I have concluded that dental appointments always need to be pre-treated with drugs. With the assistance of Ativan and Seroquel, I made it through an appointment yesterday without a meltdown, although I still felt pretty panicky. I think it’s partly the pain/discomfort, partly the feeling of having no control, partly that it’s intrusive, and partly I feel like I’m drowning when they use the ultrasonic water scaler thingamabob.
In this series, I dig a little deeper into the meaning of psychological terms.
This week’s term: Type A personality
The first question that popped into my mind when I thought of delving into this topic was are there other letters? Because you only ever seem to hear about type A. So let’s get to it.
Type A and its opposite type B were first proposed by two cardiologists, Drs. Friedman and Rosenman, in the 1950’s to predict the risk of developing heart disease. They determined that type A personalities had a higher risk for cardiovascular disease. However, this finding was based on a sample of middle-aged men, and it was later learned that there was influence from the tobacco industry to support any findings that distracted from the clearly emerging effect of tobacco on health. Damn they were slimy buggers.
According to Wikipedia, type A describes people who are competitive, highly organized, outgoing, impatient, anxious, and highly concerned with time management. These people are often workaholics and experience high levels of work-related stress. They tend to be impatient, impulsive, and quick to anger.
Type B personalities are defined less by what they are and more by what they aren’t; they’re the opposite of type A. They tend to have lower stress level and are less competitive and more tolerant. They enjoy exploring ideas and may be more likely to work in creative fields.
Another lettered personality type was later identified in the field of medical psychology, the type D (distressed). According to Wikipedia, this includes a combination of negative affectivity (e.g. worry, irritability) and social inhibition. Type D’s tend to keep their negative thoughts to themselves due to fear they may be rejected by others. Some studies have found a correlation between type D and worse cardiac outcomes, although these findings have been inconsistent.
Type A/B personalities can be measured using the Jenkins Activity Survey. A modified online version is available here. Scores range from 35 (highly type A) to 380 (highly type B). I scored a 204, with my tendency to be organized and always on time pushing me toward the type A side, even though I feel like overall I’m a very different person than the picture painted with the type A personality .
Type D personalities can be measured using the DS14 Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality. I couldn’t find an easy online version that would spit a score out for you, but I did find a version here that involves doing some addition. I scored sufficiently high on both negative affectivity and social inhibition to be considered a type D personality, but then again the answers to a lot of the questions would have been quite different if I was answering them while not under the influence of depression.
To me it seems a bit ridiculous to think that we can classify everyone into 2 (or perhaps 3) personality types. And while type A may capture a certain type of individual reasonably well, it doesn’t seem nuanced enough to separate out those who exhibit only a few type A characteristics but exhibit them quite strongly. This was the first time I’d ever really done any looking into type A personalities, and I had no idea that they were first proposed by cardiologists and that their development was promoted by the tobacco industry. Given what I’ve learned, I’m not particularly inclined to buy into this typology.
Do you think you fall into one of these personality types?