You Tell Me Control

I've been thinking a lot about control over the past week or so. Mostly because several things have happened in various areas of my life, and I've had almost no control over any of it.

In my work with clients, I spend a lot of time talking with parents about their children's "high need for control." They wonder why a child would do something so obviously self-sabotaging as laughing at a parent's reprimand or intentionally hurting someone. They're shocked that the child seems to be so excited and delighted at causing them distress and frustration.

Sometimes the word "manipulative" gets used.

I always shy away from that particular term. Words are powerful, and if you use a word like that, I think it attaches a lot of adultish meaning and intention to the behavior of a child.

So instead of "manipulation", we talk about control. And how some kids, some people, seem to need it more than others. It comes out in so many different ways, too. Some good, some bad. The need for control is a basic human feature, after all. One central to many of the rights and values we hold dear. It's important. But some of us are better than others at letting it go, or at facing the reality that we don't really have that much to begin with. And some of us struggle with it.

That's what I've been thinking about. Now I'll give you an example from my own life, from just last week, which, I confess, was a rough one. Because she is lovely and sensitive, Kathleen, my agent, asked me if there was anything she could do in light of the various things I'm dealing with (nothing life-threatening or devastating, so no worries!). She reassured me I could take longer to get certain things done, et cetera. And I said to her--send me the revision notes for my WIP as soon as possible, please. I need to dive into them. I need to bury myself in something. I need to feel like I have control over something.

She came through for me; she sent me a five page editorial letter. And for the last few days, I've been happily tinkering with the world I've built within this WIP, writing new chapters, clarifying character motivation, slicing out inconsistency, wrestling with how to shoehorn the economic concept of the gold standard into a futuristic monetary system based on electronic credits (it's an action-packed urban fantasy/romance, I swear).

Let me tell you, this revising felt good. Cleansing and thrilling. This was something that was all me, all about what I could do in response to critique, how far I could stretch my creativity, whether I could meet the challenge. If these revisions suck, that's because I screwed them up. If they're good, that's me, too. I'm so grateful to have had this task--because I needed something to control.

While I sort out my control issues, tell me. Do you have a high need for control? How does it come out in your life? How about your writing? When does it help, and does it ever hurt you or get in the way?

Remember to check out Lydia's Medical Monday post and Laura's Mental Health Monday post today!

Do You Trust God

“Do you trust God?” the visiting speaker asked, “raise your hand if you do.”

We lifted hands enthusiastically.

“Of all those who just rose your hands, raise your hand again if you have house insurance,” he said.

Many members of the congregation lifted their hand again.

He looked at us meaningfully. “You have all just confessed that you trust God, so why then, I ask you, do you have house insurance? If you truly trust God, then show that trust by your actions…”

I am going to draw the curtain over that particular sermon at this point and shout “STOP!”

This speaker had twisted trusting in God to mean, “Trusting in God means trusting Him to keep you safe from suffering, to keep you away from the storms of life.”

That is not what trusting in God means. We must maintain realistic goals, bearing in mind that everyone goes through trials and experiences times of discouragement and disappointment. To trust in God means to trust Him in all circumstances, in the hard times and the good times, as David shares in Psalm 23:4:

Even though I walk
through the valley of the shadow of death,
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.

Being a Christian is not a game of Monopoly, God does not give us a “get out of suffering” free card. But He does take us by the hand and lead us through the hard times, comforting, protecting, and strengthening us.

When I was afflicted by severe depression, the suffering was beyond my comprehension, but I never let go of Jesus, I never stopped trusting in Him, and He lead me through and eventually out of that storm.

Let us consider for a moment a person who believes that trusting in God equates to never having to undergo suffering of any kind. What will happen when that person encounters a major trial or life-storm:
1. They will mostly likely blame God, saying, "God, I trusted You - how could you let this happen?"
2. Or the alternative is to turn upon themselves, saying, “There is something wrong with my faith!”

Having house insurance does not equate to a lack of faith. We do not know what our future holds. We do not know what natural or man-made disasters or accidents lie in our future. Insurance is simply common sense, not to mention mandatory for all Australian drivers.

A couple of years ago two pipes burst in my bathroom ceiling, causing half of it to collapse. This did not happen because I lacked faith. This happened because of physics – the builders who had renovated the house decades ago had deliberately bent the copper pipes to make room for the new plastic ones… For the next few months, while we waited for the insurance company to arrange for it to be repaired, we had to use a bathroom with a hideous, gaping hole above our heads, with dirty insulation, spiders, and even a lizard coming into the bathroom through it.

My initial desperate reaction was for it to be fixed immediately because I could not relax or find peace in such uncomfortable circumstances, for our skin crawled every time we used the bathroom. But the Lord soon began a work in my heart, showing me that peace did not come from having a clean, secure bathroom, but from Him. So I placed my faith and trust in Him and my heart was no longer troubled.

Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.’ James 1:2-4

Jesus also said that we will share in His sufferings, and that it is an honour if we are persecuted because of Him. This is not something that we see so much in the Western nations, but in many countries, to become a Christian means being ostracized from one’s family or worse. In the book of Acts, Christians were frequently driven from their homes, but God used this for good for they took the gospel with them when they fled to new countries.

“Blessed are you when people insult you, persecute you and falsely say all kinds of evil against you because of me. Rejoice and be glad, because great is your reward in heaven, for in the same way they persecuted the prophets who were before you.” Matthew 5:11

When I was in junior high school, I was bullied and persecuted unmercifully because I was a Christian and different from the other children. Those years were very difficult for me, but I clung to Christ and relied upon Him to get me through them and my faith grew and matured. I was even able to be a witness for Christ because of it.

'Now if we are children, then we are heirs—heirs of God and co-heirs with Christ, if indeed we share in his sufferings in order that we may also share in his glory. I consider that our present sufferings are not worth comparing with the glory that will be revealed in us.' Romans 8:17-18

My answer to the question, “Do I trust God?” is: Yes, I do. I trust God to take me by the right hand and lead me along paths of righteousness for His name's sake, to lead me to green pastures and still waters, and also to lead me through darkened valleys beset with storms, and even be with me when surrounded by enemies.

Psalm 23
The LORD is my shepherd, I shall not be in want.
He makes me lie down in green pastures,
he leads me beside quiet waters,
he restores my soul.
He guides me in paths of righteousness
for his name's sake.
Even though I walk
through the valley of the shadow of death,
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.
You prepare a table before me
in the presence of my enemies.
You anoint my head with oil;
my cup overflows.
Surely goodness and love will follow me
all the days of my life,
and I will dwell in the house of the LORD
forever.

Heres to You Anita Howard

A few months ago, I was feeling rather low. I was consorting with worms, and sticking my head into the compost bin to drown out the harsh and awful daylight.

The words "pull yourself together" could not be more apt for a person like me who struggles with panic and anxiety on a frequent basis. At its worst, fierce panic makes one feel like one is literally "falling apart." These clichés were born of truth.

I had days that were not good. Sometimes I had maniacal thoughts: that my kneecaps would just plain fall off my legs, or that my teeth would fall out into my soup. It's called "personality disintegration" or "depersonalization."

I tried many things, including fancy lights, tinctures, pills, breathing through only one nostril.

I also had what's called "derealization"--that funny sensation that the world is not real. I swam out into the world wearing fogged and hopeless goggles. I forgot how to get home, sometimes.

(The story of all this is being told in a book I'm writing called PURSUED BY BEARS.  I hope it will one day have a spine, rather than a blinking cursor on a screen.)

Then one day a fellow writer named Anita Howard visited my blog from Query Tracker, and left me one of the nicest comments I have ever received. I had been keeping this blog for a long while, but hadn't even bothered to tell my neighbors about it. (It is a pity that I've told them now, because now I can't write about them as freely. Oh neighbors, I wouldn't say a thing about you, and you know that!)

Some friends had read my blog, sure, and they said awfully nice things as well. But Anita was a stranger. And she talked to me like she was an old friend. I knew right off that she was a good egg.

You probably know her. As another blogger recently said, "she knows all the cool kids." If you don't, go and visit her. I'll bet she'll say something nice to you, too. And she'll mean it. No fakies.

I wanted to say thanks, Anita. Because one never knows when that kind gesture, that thoughtful word of hope, that effort to take time out to reach out to someone will matter. It's true online and in our everyday lives. Smile at a dour person you pass on the street and say hello, and see how his or her face changes. It's magic, ain't it? (Unless they are touched in the head, in which case they may bite you with razor-sharp fangs. Best to be warned. It's not my fault if this happens.)

Here's another fat cliché: Ray of sunshine. And another: Ray of hope.

So yesterday Anita gave me this blog award--one of many that she has given to some other wonderful writers on this Bloggy Wonderland post. It sort of says that I am mad as a hatter. In fact, that's exactly what it says.

If I'm mad enough to startle when a butterfly flaps its wings in Tibet, or despair at my own lurching heart, or count and multiply the ceiling tiles in an effort to avoid staggering into a ditch of my own making, then I am also mad enough to dream, to write, to run for the far borders of my imagination.

Thanks for the reminder, Anita. Oh, and you get the Bacon Award AND the Hot Buttered! I don't suppose you want the sebaceous cyst award? Didn't think so. Damn it.

Change your thoughts and you change your world

Today's title is a quote attributed to Norman Vincent Peale.

"Change your thoughts and you change your world".

I have seen this truth in action so many times over in my own life and in the lives of others.

I am sure you as well can think of people who seem trapped in their own bad thoughts about themselves.

I have a friend Jonathon who is miserable and afraid almost all the time. He is so down on himself and his abilities. He hates his job and dreads going to work each morning. All day at work he is in misery and is consumed with thoughts of how terrible his work is and how it is so ill suited to him.

But he is afraid to look for another job. He is terrified that no one else will have him. He is sure his skills are out of date and that there is nothing he could contribute to a new employer. He is fearful to leave and miserable to stay.

He has been like this for 10 years.

What a waste!

Trapped in a job he hates and too frightened to even think about leaving - too down on himself to try anything new.

Of course as outsiders we can all see that his depressed thoughts and miserable attitute cannot be helpful in impressing any new employers or even his current one. How well do you think he would do in an employment interview feeling so down on himself?

I often wish -- if only he would change his thoughts! If only he would pause his thoughts of misery, fear, anxiety and despair and look at what is good in his life. Find something positive to think about, get out of his rut and get self confident and go do something!

Just imagine what could happen in Jonathon's life if he were to change his thoughts - wow how his world could change! And it seems so obvious and easy for me looking in at his life from the outside!

So .......

I also think this about myself. Change those negative, anxious, bad outcome, fearful, worried, panic thoughts to....

Thoughts of confidence, letting go, peace, relaxation, assertiveness, and bravery. Thoughts that things will be okay, I can do this, it will be fine!

I don't need thoughts that make me feel worried, afraid, anxious or fearful.


I need thoughts that make me feel confident, bold, and brave. I need thoughts that make me feel like I belong here. Like I own the world. Not like I am some unwanted scavenger.


I need to focus not on being less afraid or less anxious.

I need to focus on being more bold, more confident, more enthusiastic, more adventurous.

How might my life change if I did this? My world would certainly be a different place!

All the Beautiful Ways to Say I Love You

Dearest one: This anthropomorphic, whorish piece of candy, seated on a bed of what appear to be torn-out organs (possibly spleens?) is wearing go-go boots, which I have mentioned are of particular interest to me in the bedroom. And she is beckoning me (me!) to come to her, and receive possible delightful pleasures at her hands (which shall not be soiled with chocolate, no, never). Note the look in her eye. I beg you to consider the many entreaties I have made to you—some mentioning marriage—and think about sharing a life with me. And my bed. Oh, my bed!

To my fat, porcine devil-baby. Words fail me. They fail me because you are beating me about the head and private parts with that trident you always carry in your trotter. Hand! I said hand!

Dear Valentine: My eye has falled off!

Dear Heart: You should not have left me at this untimely juncture. Do you not see how I will now kill you?

To My Valentine: The last 50 years with you has crushed my manhood like an old peanut shell.

Valentine: Your continued molestation has caused my nethers to shrink inward unto myself.

Sweetie: I bought you this "singing animated friend" because you have no "real friends" and therefore an "animated friend" is about the best you gonna get. At least it sings a damned song! Let it be a companion to you when you feeling all dark and dank and scratching your nads and eating Cap'n Crunch and shit (like you tend to do).

Baby: When I saw this robe I thought of you, staggering through the fog with a bellyful of gin and shattered fingers, and that old shotgun slung over your shoulder. Our lovemaking that night was sumptuous, as the bombs fell and you whispered: "Jimmy! If I only had a robe with a smattering of blue flowers, and a red pillow that bespoke 'love' on which to lay my head." So I bought it for you, dear heart. Sweet thing, why do you stare at me with such strange eyes?

Financial crash got you anxious Youre not alone

A recent NYT article discusses anxiety in the face of financial peril. Anecdotally:

Anne Hubbard has not lost her job, house or savings, and she and her husband have always been conservative with money.

But a few months ago, Ms. Hubbard, a graphic designer in Cambridge, Mass., began having panic attacks over the economy, struggling to breathe and seeing vivid visions of "losing everything," she said.

She "could not stop reading every single economic report," was so "sick to my stomach I lost 12 pounds" and "was unable to function," said Ms. Hubbard, 52, who began, for the first time, taking psychiatric medication and getting therapy.

In Miami, Victoria Villalba, 44, routinely slept eight hours a night until stories of desperate clients flooding the employment service she runs began jolting her awake at 2 a.m. No longer sleepy, she first began to respond to e-mail, but that caused sleeping colleagues' BlackBerrys to wake them, so now she studies business books and meticulously organizes her closets...

...Elizabeth Dewey-Vogt, 25, a paralegal whose bills and shrinking overtime made her move in with her parents in Alexandria, Va., said she began "constantly worrying about finances," and having panic attacks, "rapid heart beat, choking sensation, chills or sweating, numbness and tingling in my fingers," and feeling "almost removed from my body."

Ms. Dewey-Vogt said that she now took anxiety medication, and that a therapist advised her to pull over or "concentrate on the license plate ahead" if she began panicking while driving and to grip on the handles of her chair when panicking at work.

And statistically:

In an American Psychological Association poll in September, 80 percent reported the economy's causing significant stress, up from 66 percent last April. The National Sleep Foundation said 27 percent of people surveyed last fall had sleeplessness because of economic anxiety.

National Suicide Prevention Lifeline calls jumped to 50,158 in January 2009 from 39,465 a month in January 2008, and economic stress more frequently "played a central role," said Richard McKeon, the group's federal project officer...

And while a New York Times/CBS News poll found fewer people saying the economy had worsened, most did not think it was improving. People overwhelmingly thought the recession would last another year or more, and 70 percent were concerned that a household member would be jobless.

Of course, shame is an essential part of what the newly anxious are experiencing:

"I'm embarrassed," [Villalba] said. "Normal people aren't doing this."

...Ms. Hubbard, knowing "financially we were fine," said she believed "I shouldn't feel like this, I'm lucky." She cried visiting her primary doctor, who recommended therapy and medication, hard to accept, she said, because her Depression-era parents believed "you pull yourself up."

"I felt like a neurotic middle-class, middle-aged woman too weak to deal with life on my own," she said. "I should be stronger, it was simply money, and why do I have to take pills to not worry about money."

Guess what, lady? Maybe you are neurotic and unable to deal with life on your own. If so, so what? It's a big club you're joining.

How Do You Know if You Should Try Treating Your Depression With Medication

I have frequently blogged in this venue about the efficacy of antidepressants in “depression.”  I have pointed out that “depression” has a wide variety of different meanings, and that there are also several different syndromes of depressive disorders in the diagnostic manual, the DSM.  While there is considerable overlap in the symptoms of the various syndromes, some are far more likely to respond, and respond dramatically, to antidepressant medication than others.

I have also ranted against physicians who use “symptom checklists” or other self-report “tests” to make a diagnosis of depression, rather than use an extensive clinical interview.  The tests often say very little about whether a symptom a patient complains of is clinically significant for a certain diagnostic syndrome or not.  Aside from not looking at the psychosocial context in which the symptom occurs, the tests usually say very little about three important qualities of clinically significant symptoms – their pervasiveness, persistence, and whether or not they are pathological.  They also do not clearly show whether the symptoms all cluster together at the same times.

As I have pointed out several times, in order to make sure the patient is giving the doc an accurate and complete picture of their mood state, a good doctor must often ask one or even several follow up questions whenever a patient says “yes” or “no” in answer to a question about the presence of a symptom.

But how about a potential patient?  How does a non-professional know whether or not to even consult a physician about their mood state?  Why not just ignore it and see if it goes away?  Alternately, why not just go to a psychotherapist and handle it with psychotherapy alone?

That’s a very important question.  A similar question has recently been widely featured in the media in response to a proposed change in the DSM.  How does a patient or a doctor know when normal grief after the death of a loved one morphs into a clinical depression that would respond to medication?  The argument has mostly been about how long a doctor should wait after such a death before making a diagnosis of clinical depression, (major depressive disorder). 

While it is good that a doctor should not be overly hasty about making a diagnosis in this situation, in some genetically-prone individual, a stress of that severity can indeed trigger a major depressive disorder in a relatively short period of time.  Should that patient have to wait to be relieved of his or her suffering?  Certainly, any proposed “waiting period” specified in the DSM would have to be somewhat arbitrary.

To help patients figure out who to consult and when to consult a physician, a new self-report instrument is available that is significantly superior to the usual ones.  It is called the Post-Bereavement Phenomenology Inventory. It is meant to distinguish normal grief from major depression, but potentially it could also be used to distinguish major depression (likely to respond to meds) from another depressive syndrome, dysthymia (much less likely to respond to meds).

It was meant for physicians and not for patients to review for themselves, but even though it is better than most self-report instruments, IMO it should still not be used in place of a complete and wide-ranging clinical interview.  Context, prior history of major depressive disorders, family history of depression, and a whole host of factors need to also be considered.

But as a screening tool for patients, I think it might be helpful.  It uses a strategy called prototype matching.  This strategy focuses on the difference between depressive syndromes rather than the similarities.  The questions contain different descriptions of how each depressive symptom would present itself in classic cases of the two syndromes, and asks the patient, “[Which of the two descriptions] better describes how you have been feeling, thinking, or behaving for the past one to two months?”

Here it is.  I hope this will help potential patients decide whom to consult.  The first descriptions in each question are of the symptom presentation seen in major depression, while the second are of depressive symptoms that are less likely to respond to medication.  Of course, this is hardly foolproof, but generally the more you answer the questions one way or the other, the more likely you are to be experiencing one syndrome or the other. 


If someone's depression seems to conform mostly to the first prototype rather than the second, there are certain things that people often say to them that are both inappropriate and counterproductive.  An excellent list of such things can be found at http://www.medicalbillingandcoding.org/blog/11-things-you-should-never-say-to-someone-with-depression/

1.       I am filled with despair nearly all the time, and I almost always feel hopeless about the future.

versus

      I feel sadness a lot of the time, but I believe that eventually, things will get better.

2.      My sadness or depressed mood is near­ly constant, and it isn't improved by any positive events, activities, or people.

versus

       My sadness or depressed mood usually comes in "waves" or "pangs;' and there are events, activities, or people who help me feel better.

3.      When I am reminded of my loss (of a loved one, friend, job, etc), I feel nothing but pain, bitterness, or bad memories.

versus

    

       When I am reminded of my loss (of a loved one, friend, job, etc), I often feel intense grief or have painful memories, but sometimes I have good thoughts and pleasant memories. 

4.      I will probably never get back to feeling like my "old self" again.

versus

       Things are really tough now, but I'm hopeful that with time I will feel more like my "old self.”

5.      I feel like a worthless person who has done mostly bad things in life, and has let my friends, family, and loved ones down.

versus

       I feel like I'm basically a good person and that, in general, I have done my best for my friends, family, and loved ones.

6.      All I can think about lately is me and how miserable I feel; I hardly think about friends, family, or loved ones, ex­cept to blame myself for some failing.

  versus

       Even though I'm less social and out­going since my loss, I still think a lot about friends, family, and loved ones, often with good feelings about them.

7.      When friends or family call or visit and try to cheer me up, I don't feel anything or I may feel even worse.

   versus

       When friends or family call or visit and try to cheer me up, I usually "perk up" for a while and enjoy the social contact.

8.     I often have persistent thoughts or im­pulses about ending my life, and I often think I'd be better off dead.

     versus

     I sometimes feel like a part of me has been lost and I wish I could be reunited with the person or part of my life I am missing, but I still think life is worth living.

9.      Almost nothing that I used to like do­ing (reading, listening to music, sports, hobbies, etc) is of any comfort or con­solation to me anymore.

     versus

   The things that I have always liked do­ing (reading, listening to music, sports, hobbies,etc)  give me some comfort and consolation, at least temporarily.

10.  I feel "slowed down" inside, like my body and mind are stuck or frozen, and like time itself is standing still.

   versus

       My concentration isn't as good as usu­al, but my body and mind aren't slowed down, and time passes in the usual way.

   

     

Does Your Mind Trick You Have a Look At Optical illusions

An optical illusion (also called a visual illusion) is characterized by visually perceived images that differ from objective reality. The information gathered by the eye is processed in the brain to give a perception that does not tally with a physical measurement of the stimulus source. There are three main types: literal optical illusions that create images that are different from the objects that make them, physiological ones that are the effects on the eyes and brain of excessive stimulation of a specific type (brightness, colour, size, position, tilt, movement), and cognitive illusions, the result of unconscious inferences.