Bipolar Disorder - An Interplay of Forces

Those diagnosed with Bipolar Disorder experience an array of various symptoms and can often feel confused about what contributes to the waxing and waning of the disease. Most professionals thinks of the cycling of bipolar disorder as reflecting a complex interplay among genetic vulnerability, biological agents, psychological agents, and stress factors (Miklowitz, 2011). By genetic vulnerability, experts mean to imply that there is an inherited aspect to this disease. If you have family members diagnosed with Bipolar, you’ll likely have the propensity yourself. By biological agents, experts mean that there is actual abnormal functioning of brain circuits involving neurotransmitters, such as dopamine. And then there are psychological agents, meaning the internal psychological underpinnings of your self, how you perceive yourself and the world, and your internal beliefs. Finally, the stress agents that the literature points to involve the environmental factors occurring in one’s surroundings that may add stress.  Therefore, we do not need to think of bipolar disorders as either a brain disease or only as a psychological problem. It’s more complicated than that and usually entails various contributory causes.

Pain is our friend

The physician who spent much of his life working with lepers in India was a gentleman by the name of Dr. Brand. He discovered that leprosy destroys the nerve endings in the body, leaving lepers unable to to feel. While this fact might seem like a blessing, it is ultimately a curse, resulting in the loss of limbs and even death. Without pain, lepers are unaware they have been injured. Dr. Brand is quoted as saying, "I thank God for pain, I cannot think of a greater gift I could give my leprosy patients." Symbolically speaking, the avoidance of pain can make us emotional lepers - we become incapable of experiencing the aches, pains, and fears of our existence, as well as the joys, the beauties, and freedoms of our lives. Although no one enjoys feeling pain or fear, these emotions play an important role in our existence. They help us stay alive!

What really counts when it comes to effective therapy

I frequently find myself thoughful about what's effective in psychotherapy. Is it particular things I say in response to my patients? Are there specific modalities that are more effective than others? Being the psychodynamic psychotherapist that I am, I possess a natural inclination toward understanding the deeper layers of the human psyche. Somehow, change and understanding the human being takes so much more than just a manualized approach to specific symptoms. For me, it's more about understanding the heart and soul of each person that walks in my door and treating each with as much dignity as I can muster. Each patient is more than just a list of symptoms. Each patient is more than just their pain. When I read the following article on research done in Sweden, I found myself feeling justified in how I've been trained: http://scottdmiller.com/icce/revolution-in-swedish-mental-health-practice-the-cognitive-behavioral-therapy-monopoly-gives-way/

Is psychotherapy effective?

As a practicing psychologist in Pasadena, I'm occasionally challenged by my patients to discuss the effectiveness of psychotherapy. "Will I get better? they often query. It's an honest and legitimate question - one I find myself pondering frequently. To my patients, they want to know whether the benefits of embarking on the strange journey toward self disclosure, vulnerability, and potential pain will be worth it. And will I be able to help them? Will paying for my services, my training, and my expertise be enough of a catalyst for healing? The answer is complex and multi-faceted. There's the issue of goodness-of-fit. Research shows that upwards of 80% of the effectiveness of psychotherapy has to do with the fit between patient and psychotherapist but how does one measure that? Other variables that influence the outcome of psychotherapy include such things as the level of participation of the patient, the level of motivation, and how accurately the empathy in the psychotherapist. With all this in mind, however, and the longer I'm privileged to do this work, the more I find that individuals who walk into my office really are seeking a deeper experience of authenticity and empathy and many are NOT looking for the quick fix. For a fascinating read on the effectiveness of longer term psychotherapy vs short term, see the following link: http://horan.asu.edu/cpy702readings/seligman/seligman.html

Psychotherapy - Effective or Not?

Before embarking on psychotherapy, most people want to know what to expect and how to go about achieving the best kind of help. A lot of people seek help, and may even go so far as to call a psychologist, but once you starting meeting with someone on a regular basis, what then? Is psychotherapy generally a good idea? The basic answer is a resounding “yes!” On average, approximately 80% of folks who enter treatment will walk away feeling as they have achieved some real change. In this day and age, that percentage is actually pretty good! However, in order to achieve that high percentage, it’s important to keep a couple of things in mind. First, finding a psychologist with whom you feel safe and connected is paramount. In fact, research seems to show that this is one of the MOST important variables for good treatment outcomes. Secondly, be aware of the “15 session blues,” a term I affectionately tell my patients to expect at around the 12th to 15th session. Again, research seems to show that a lot of folks are tempted to stop treatment at this point, and it is usually because difficult emotional things are beginning to surface. But…think about it. Most of the things that prompted you to begin therapy took many years to form. Doesn’t it make sense that it’s going to take some time for all that to unravel?

Bipolar Disorder, a Variant of Depression

One of the trickiest mental illnesses to treat is Bipolar Disorder, specifically because of its biological basis and because those who suffer may initially deny they have it. If you, or someone you love, have recently been diagnosed with Bipolar Disorder, I highly recommend The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know by David Jay Miklowitz (Dec 15, 2010). This book offers practical knowledge on the symptoms and treatment of Bipolar Disorder and is a must-read for both the general public and clinicians alike.

De-stigmatizing Depression and its Treatment

Did you know that no one is exempt from the experience of depression? Would it be surprising to know that some well known individuals have suffered from depression? Take, for instance, Bruce Springsteen. Even with his career taking off, in 1982, Springsteen remained haunted by his past, which included growing up with a depressive and self-isolating father. Bruce’s own symptoms of depression surfaced just as he was completing the acoustic album “Nebraska,” recounts the musician’s friend and biographer Dave Marsh. But what was shocking was how severe Springsteen’s depression became, reaching the point of spiraling out of control during a cross-country trip. He was even feeling suicidal. But here’s what’s interesting, he began seeing a psychotherapist. He credits receiving treatment with finally healing his past wounds. At a concert years later, when Springsteen introduced his song “My Father’s House” he recalled what the therapist had told him about those nighttime trips: “He said, ‘What you’re doing is that something bad happened, and you’re going back, thinking that you can make it right again. Something went wrong, and you keep going back to see if you can fix it or somehow make it right.’ And I sat there and I said, ‘That is what I’m doing.’ And he said, ‘Well, you can’t.’ ”

Reverse Culture Shock

Reverse Culture Shock, or "re-entry", is a term associated with the phenomenon of returning to one's own country and culture. Very similar to culture shock, a person entering into their home environment will have to make adjustments to reacquaint themselves with their surroundings. Unlike culture shock, most do not anticipate feeling like a foreigner in their own home. However, it should be expected. If you have made any cultural adjustments while abroad, you will have to readjust once back home.

Experiencing reverse culture shock is extremely common and may include any to all of the following emotions:

  • Restlessness, rootlessness
  • Reverse homesickness-missing people and places from abroad
  • Boredom, insecurity, uncertainty, confusion, frustration
  • Need for excessive sleep
  • Change in goals or priorities
  • Feelings of alienation or withdrawal
  • Negativity towards American behavior
  • Feelings of resistance toward family and friends

(Taken from the following website: www.globalinksabroad.org)

Normal Grief

Normal or common grief begins soon after a loss and symptoms go away over time. During normal grief, the bereaved person moves toward accepting the loss and is able to continue normal day-to-day life even though it is hard to do. Common grief reactions include things like emotional numbness, shock, disbelief, or denial. When this occurs, the individual may feel like they’re not thinking clearly or feel like they’re in a dream-like state. Another reaction usually includes anxiety over being separated from the loved one. The bereaved may wish to bring the person back and become lost in thoughts of the deceased. Additionally, images of death may occur often in the person’s everyday thoughts and it’s not uncommon to feel extremely occupied by the loss. One of the most difficult aspects of loss is the distress that leads to crying; sighing; having dreams, illusions, and hallucinations of the deceased; and looking for places or things that were shared with the deceased. Individuals in grief sometimes feel like they see the person they lost out in public…or may feel like there are constant reminders of the loss no matter where they go. Anger is also a common reaction to loss. Depending on the type of loss, the individual in bereavement may feel their anger is irrational – but it’s not. The person may feel angry at themselves, at the deceased, or at various aspects of the loss. This is common! And finally, there will be periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt, and loss of interest in life. Day-to-day living may be affected. In normal grief, symptoms will occur less often and will feel less severe as time passes. Recovery does not happen in a set period of time. For most bereaved people having normal grief, symptoms lessen between 6 months and 2 years after the loss.

Some Things to Expect with Grief

Many bereaved people will have grief bursts or pangs. Grief bursts or pangs are short periods (20-30 minutes) of very intense distress. Sometimes these bursts are caused by reminders of the deceased person. At other times they seem to happen for no reason. It’s important to remember that these bursts of grief are UNPREDICTABLE, which is one of the most difficult aspects for most individuals. Most of us tend to enjoy the fact that we feel in control of our emotions and lives so when things happen that are unpredictable, it can feel very disturbing and difficult to tolerate. However, allowing yourself to endure these distressed episodes, will eventually get us through them.

Treatment for Post-traumatic Stress Disorder

One of the many biological systems that have been identified as being affected by traumatic experiences is the part of the limbic system that is centrally involved in interpreting the emotional significance of experience: the amygdala. The amygdala detects whether incoming sensory information is a threat and forms emotional memories in response to particular sensations such as sounds and images that have become associated with physical threats. These emotional interpretations are thought to be extraordinarily hard to extinguish. Therefore the challenge of psychotherapy is to de-condition the amygdala from interpreting innocuous reminders as a return of the trauma. In other words, certain smells, objects, or relational dynamics have become, for the individual, associated with the actual experience of the trauma, even if the object, smell, or whatever is actually itself benign. Part of what psychotherapy offers as a means of de-conditioning the amygdala is various forms of what psychotherapists call “Exposure Therapy.” Most psychologists can explain what forms “Exposure Therapy” can take.

Treatment for Depression

As common as depression is, it is important to know how to address this mental health issue in the healthiest way possible. Treating depression is usually not a quick fix but if you’re willing to keep at it, you’d be surprised at the results. Treating depression usually includes a combination of elements, and no one element by itself works as well as all of them combined! There are many effective ways to deal with depression, including exercise, talk therapy, medication, natural supplements, and lifestyle changes. Learning about the treatment options will help you decide what measures are most likely to work best for your particular situation and needs. And another fact to keep in mind, research studies indicate that it is usually a combination of both talk therapy AND medication that brings the most effective results. And if you’re like most, the idea of talk therapy can feel intimidating and scary.  As understandable as that might be, don’t let it keep you from taking one of the most powerful steps toward change and healing.

Prevalence of PTSD

Just how frequently is PTSD diagnosed? The National Comorbidity Survey Replication (NCS-R), conducted between February 2001 and April 2003, comprised interviews of a nationally representative sample of 9,282 Americans aged 18 years and older. The NCS-R estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%. The lifetime prevalence of PTSD among men was 3.6% and among women was 9.7%. Thus, the diagnosis is by no means uncommon. 

Depression in Los Angeles

The Los Angeles County Department of Public Health has issued a new report citing that nearly 14 percent of adults across the country report that in their lifetime they have been diagnosed with a depressive disorder. This figure is an increase of almost 50 percent from the nine percent who reported having a depressive disorder in 1999. Depression is a serious clinical illness that interferes with a person’s ability to function, and it can last for weeks, months or even years. Depression in Los Angeles, like in other areas of the country, places a serious burden on the health and well being of society. One reason for the disturbing rise in incidence may likely reflect a greater awareness about the disorder, rather than any actually increase in the number of individuals who suffer from this mental health illness.

 

Benefits of Therapy

The research on the effects of therapy continually demonstrates that the relationship between patient and therapist is much more important than the "brand" of therapy, that the personal qualities of the therapist are far more relevant to the success of the treatment than his or her theoretical orientation. There also appears to be temperamental differences among patients that suit them more toward one kind of treatment than another. Analytic, depth therapies tend to be a good fit with people who are curious, who like to figure things out for themselves, who have some tolerance for ambiguity, who are comfortable with emotion, and who have some intuitive sense that there are unconscious processes within the human psyche.

Grief and Our Bodies

One of the things about grief that often surprises people is their physical response. Physical sensations or some type of bodily distress is actually very common. Depending on the severity of one’s grief, or the suddenness of the news, common somatic responses can include hollowness in the stomach, tightness in the chest, tightness in the throat, oversensitivity to noise, or even breathlessness. Some individuals may even vomit, burst into tears, or see stars. These responses should not alarm you per se – they are not uncommon and reflect our physiological connection to painful feelings.

Growing Up Overseas

Have you ever known anybody who grew up overseas or lived in a country that was not their parent’s home culture? That individual may be a “Third Culture Kid.” First used in the 1960’s, the term “Third Culture Kid” was coined by Ruth Hill Useem, a social scientist contracted by the University of Michigan to travel to India to study the expatriates living there. In the course of her research, she began to notice specific enduring personality traits among the children of these families that were not shared by the parents despite the commonality of living overseas.

So what did she mean by “Third Culture Kid?”  A TCK (Third Culture Kid) is an individual who, having spent a significant part of the developmental years in a culture other than the parents’ culture, develops a sense of relationship to all of the cultures while not having full ownership in any. Elements from each culture are incorporated into the life experience and personal identity of that individual.  The following example may make this clearer. An American family with two children moves to the Middle East for the father to be employed as a helicopter pilot for an oil company. The American culture is the “first” culture represented in this family and the Middle East country they reside in is the “second” culture. The amalgamation of both of these cultures, embedded within the children’s sense of self, view of the world, and personal identity is the “third culture.” The cross cultural experience must occur between birth and 18 years of age - the period of time when that child’s sense of identity, relationship with others, and view of the world are being formed in the most basic ways. TCK’s have incorporated different cultures on the deepest level, as they have several cultures embedded into their thought processes and their way of being.  Common populations where one might find TCK’s are families whose parents have had careers in international business, the diplomatic corps, the military, or religious missions. Others have parents who have studied abroad.

The two circumstances that are key to becoming a Third Culture Kid is growing up in a truly cross-cultural world, and high mobility. Instead of observing cultures, TCKs actually live in different cultural worlds. By mobility, it means mobility of both the TCK and others in their surrounding. The interplay between the two is what gives rise to common personal characteristics, benefits, and challenges. TCKs are distinguished from immigrants by the fact that TCKs do not expect to settle down permanently in the places where they live and are also different from individuals who may live in another country as an adult. While the latter may experience some degree of cross cultural adjustment and difficulty, their personality and sense of self is, for the most part, already solidified and stable.

TCKs also tend to have certain personal characteristics in common. TCK’s are often tolerant cultural chameleons and highly adaptable. As a result, TCKs develop a sense of belonging everywhere and nowhere, leaving them with a deep sense of not knowing where they belong and sometimes appearing wishy-washy. Asking a TCK, “where are you from?” can spark deep confusion albeit underneath the surface. Additionally, while TCKs usually grow up to be independent and cosmopolitan, they also often struggle with the losses they have suffered in each move, leaving them struggling with feelings of unresolved grief. Having to say goodbye to one’s African nanny at the age of nine never to be seen again, can leave a tremendous emotional impact, especially if one’s parents do not assist in negotiating those sad feelings.  Moreover, TCK’s frequently experience confused loyalties. Because they deeply understand the complexities of their cultural influences, questions related to poverty, politics, and world issues are not always clearly defined. A TCK raised in Africa and living in Kansas, for instance, may experience some opposing feelings related to issues between the Western industrial powers and those of Third World Countries.

The above mentioned characteristics of TCK’s are in no way exhaustive but can provide the reader an accurate initial impression. Underlying issues of unresolved grief, the impact of broken attachments with early caregivers , and how concepts of identity and worldview have been impacted by cultural and mobility issues is worth considering.