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self harm

Caution: Possible triggers for self harm. No disturbing images.

on self harm:

It won’t surprise anyone who knows me that self-harm is often on my mind. No, by conventional definitions I do not self harm. I do occasionally indulge in emotional overeating, but that’s pretty much the extent of it. I do, however, have both clinical training and life experience with the effects of self harm and a deep sympathy for those who feel the need.

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crazy people and guns

Gun Wall (Photo credit: Mike Saechang)

Whoa, Nelly.

I’m no foe to moderate, reasonable limits on gun ownership… but I swear if I read one more comment about how if ‘crazy people’ couldn’t get guns, we wouldn’t need any other measures.. I will, uh, write a blog post about how many ways that statement is wrong.

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dandilionI work in a high burnout field. I work in a VERY high burnout field. About every two years or so I hit a wall, and I hit it hard. And yet, I love doing therapy. Even more, I love doing case management and working with people to help them get their basic needs met and improve their lives.

I love blogging, and doing internet activism, and coming up with ways to help people improve their lives and publishing them, and seeing comments when I’ve touched someone’s life in a positive way.

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murder and mental health

This is some seriously important shit. Go read this now. And then come back and we’ll have that discussion we’ve been needing to have in this country for far too long on murder and mental health.

I’m not Adam Lanza’s mother. I don’t think.

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Ten personal commandments

Once upon a time I came across a meme on LiveJournal asking people to identify their ten personal commandments.  I like memes. When people participate in them, interesting thought experiments spread across the world.

I took the assignment seriously and took perhaps a full week to think about what ten principles I would like to live by. I wanted them to be universal, to apply in addition to rather than instead of a religious belief, and to address both harm to self and harm to others.

Here is what I came up with:

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Deadly Sin Wrath

Aw, hell. I was in the middle of this post about wrath when Sandy Hook Elementary school in Newtown,  Connecticut became the victim of  a mass killing of (among others) kindergarten students. I have completed my original thoughts, but have added, in the context of today’s events, a comment about what happened. It’s at the end of this post.

I started this series with wrath because it is perhaps the most deadly of the deadly sins — and not just because people who live in anger have a greater tendency to commit murders.  Anger creates a condition of continual stress in your body, which, over time, causes heart disease, high blood pressure, and other physical ailments.

Anger vs. Wrath

When people come to a therapist, they usually have one of three emotions that they are trying to ‘get rid of’: anger, fear, or sadness. Leaving aside for a second that “getting rid of”

deadly sin wrath

Pieter Bruegel the Elder: The Seven Deadly Sins or the Seven Vices – Anger (Photo credit: Wikipedia)

an emotion is not the answer, the key here is that anger is one of the top three most miserable emotions to live with… and it’s even more complicated than that.

Anger is almost always tied up very tightly with anxiety. Sometimes the anger attempts to hide the fear, and sometimes the fear is desperately covering up deep rage, but they appear to be paired in many, many people.

On top of its marriage to anxiety, anger also sometimes serves an important function, by giving energy to people who are paralyzed by fear or depression, to function at a more or less ‘normal level’.

Anger is a useful emotion.

That bears repeating: Anger is a useful emotion. Which is why I tell people I will not help them get rid of it, only to use it better.

It can help you identify wrongs in your life. Is someone consistently treating you with disrespect? Anger will let you know, if you let it. Are you being asked to do more than your fair share at home or work? Anger will give you a heads up. Are someone’s lies hurting you? Anger will tell you (if you let it).

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Ion having depression; dandelion seeds blowing in the wind Have Depression

I am not owned by my depression but I am affected by it.

I battle it into submission, and sometimes it battles me into retreat

Having depression means I have to take enormous care to eat right, get the sleep I need, and balance my life. and that I am sometimes completely incapable of eating right, sleeping right, or balancing my life.

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(A mindfulness meditation exercise. Get comfortable, and begin).

Shh! Close your eyes again, and now wake up slowly. Imagine.

It is the hour before the dawn. There are a few birds chirping.

You hear a car drive by, but only one, and its very quiet, as if it is trying not to wake you.

Someone has brewed coffee. You smile, knowing it will still be hot when you get up.

But not yet. 

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.. (Photo credit: LUZ-2011)

Happiness Results from Full Participation in Life

How many of us have groaned or sighed when some happiness guru or another has said ‘just think positive’? How many of us have growled at the speaker or the book and thrown the remote or the book across the room in anger?

Do you know why you get so angry? That kind of deep anger covering up an even deeper injury? It’s because you’re being asked to take half (more or less) of reality and pretend its not real. It doesn’t work, because ‘think positive’ is only a bit of the answer, and the wrong bit, at that.

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Visualizing mindfulness (366/194 July 12, 2012)

Visualizing mindfulness (366/194 July 12, 2012) (Photo credit: ConnectIrmeli)

What is ‘everyday mindfulness’ and why do it?

Mindfulness is the state of simply being, in the present, with all of your attention in the present.  It is compatible with any spiritual or religious belief, or lack thereof. It’s both simple and difficult, and it has been found by numerous studies to be useful in a variety of situations, including easing chronic pain, depression and anxiety. It doesn’t (necessarily) involve any special equipment, can be done (nearly) anywhere. 

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Disarm Anger

Angry Sphynx (Photo credit: Wikipedia)

Why disarm anger and not just walk away or react angrily yourself? Because most of the time, not only does it help the angry person, it helps you and the people you care about as well. You develop a skill that is useful at home, at work, and even in random public places.

You know the scene: The boss screams, the co-worker curses, the customer threatens, the sister, the uncle, the brother in law, the spouse, and the parent blame. You want to grit your teeth and find something better to do or get ready to do battle. And yet, if you take the time to disarm the anger, you’ll have a better outcome, and you know it.

I’m going to let you in on a a little secret. All of those angry people are in pain. Most of them are in the pain of fear or anxiety (which is like fear but on steroids and constant), and quite a few are in actual physical pain. And pain nearly always (though not always immediately) responds to kindness.

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A drop of water frozen by flash
Image via Wikipedia
I used to have a little quote pinned to my cork board at work that said something to the effect that constant activity is the Western idea of laziness. It is impossible for some of us to do nothing. In the interest of not perpetuating a stereotype, I’m making clear that this isn’t true for all Westerners – but for some of us it can be very true.

I literally cannot ‘just’ watch television. I can barely stand to watch movies in the theater, and then only because I consume far too many calories in the process of giving my hands something to do. I can read for hours on end, but only if I completely still my environment – the opposite of how I cope with ‘doing nothing’ in many other situations.

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coping with depressionT-Shirt available here

Depression doesn’t go away just because you don’t have the money or resources to treat it. This series is for those of us who are going through a depression, for whatever reason, and either don’t have insurance, don’t have adequate insurance, or don’t have local mental health facilities available to us.

If you have thoughts of harming yourself or others, thoughts that you even half take seriously, this is not an article for you. You need to get help right now from a professional. Call 911. Call a mental health hotline. Get help right now. Even if you can’t afford it.

If you’re still here, here’s what I’ve got to say on how to cope with depression when you don’t have access to mental health resources.

I once knew a man who suffered from severe major depression. It was my job to help him cope with that depression, and so of course I asked him how he managed. He looked at me for a long moment before answering me, then said. “Every single morning, no matter what, I put one foot on the floor.”

I wasn’t a green counselor when I heard these words, but they hit me fresh and new, in a way that a graduate education and a lot of continuing education credits, and discussions with colleagues, and all that other jazz didn’t. It was one simple concept that worked for him, that got him through the darkest days.

I listened for another reason. I have had my own issues with depression. In early adulthood I suffered several severe depressions and I still have bouts that I have to wrangle with on occasion (you can usually tell, because one of my coping mechanisms is to write about depression at those times). Like many others who have a lifelong tendency toward depression, I have found ways to cope so that for all but the worst bouts, I can go about my life, get out on the floor, and keep dancing.

Here’s a start: Put one foot on the floor. (I bet you knew I was going to say that).

(if the Abominable Snowman can do it, anyone can)

Every damned day, put one foot on the floor. Do one thing on your goal list. Despite the case of the ‘fuck-its’ that is overwhelming you and making you not care if you live or die.

To stave off the fuck-its (or eff-its, if you prefer):

Apply for one job. Or one financial support.

Do the dishes. Or the laundry.

Keep all your appointments, even if you don’t want to.

Make more appointments.

Get out of the house, even if you don’t want to.

..but that’s just a start. That’s just keeping moving so you don’t fall down. Treading water.

There are people in your life. Some of them will be helpful and some will be not helpful. Some of them you have responsibilities to, and other have responsibilities to you. If you have children, you have responsibilities to them. If you are unable to meet your responsibilities to them, if you need respite, seek out those who have responsibilities to you and ask for their help. If there is no one, find someone to trade time with, another parent of children who needs respite time.

This is still treading water.

When you’re at the fuck-it stage, the only thing to do is to give in or keep going. And you will give in if you think too big. Do just one thing.

Do just one thing.

When you are able, do another.

When you are able, do yet another.

Focus on those things you absolutely must do to keep functioning. Make compromises that keep the function with as little fuss as possible.

Let the kids play video games for the afternoon, but at bedtime ensure that all electronics are out of the bedrooms and tell them to stay in their rooms until morning. They’ll sleep. Really they will.

Eat cereal for dinner, or sandwiches, or something out of a can. Or let someone else cook for you, if you have that luxury.

Shower, change your clothes, and brush your teeth daily, even if you don’t want to.

Get out of bed, even if you don’t want to.

If you absolutely can’t cope with the responsibility of caring for another human being, ask a friend or relative to take the kids overnight, or encourage them to get invited to a friend’s house, or pass the duty off to your partner if you have one.

Take that nap you wanted to take. Have a good cry. And then, before that nap turns into another and another, put one foot on the floor, and do just one more thing.

Part two will begin helping you build coping mechanisms to make each depression shorter and less intense.

Can people with depression build happiness in their lives? Absolutely. They can even do so when there are no resources for professional help.

* Reading through this again after publication and criticism, I realize that in many ways this is a restatement of spoon theory.  If you have never encountered spoon theory, you might want to go read about it. It is helpful in nearly every chronic disease situation).


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Hand Off

The Hand Off

In your helping career you will find that many people will ask you for a kind of help you don’t or can’t offer. In these cases, the most important way you can help the person in front of you is to make sure that he or she gets to the right person at the right place and time in the right frame of mind to get the help he or she needs. You don’t want to waste the time of the person you’re trying to help or of the agency or department you are sending him or her to.

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Harm reduction isn’t a new concept, but it is one that is often unfamiliar to people who are not professional substance abuse or mental health counselors. Often, volunteers and front line staff who begin a job working in a program for people with addictions have never heard of it before. For them, two main questions almost immediately arise: 1) What is harm reduction and 2) What does it mean for me in my job? This article will attempt to answer both questions

The first principle of harm reduction, the one that governs all of the rest, is that substance abuse is primarily a public health problem and personal health problem, not primarily a moral issue or a criminal issue.

Keeping that principle in mind, it’s much easier to understand and accept the idea that the goal of harm reduction isn’t necessarily complete abstinence but reduction of substance (including alcohol) use and reduction of harmful side effects of use (such as infections from shared needles, DUIs, domestic violence, arrests, etc.)

At this point, a lot of people start protesting. ‘But substance abuse is harmful to society,’ they say. ‘We need to put an end to it.’ That would be nice, yes. But it’s not realistic. Substance abuse has been a part of human society ever since the first fermented fruit accidentally got someone drunk, or someone at a mushroom or chewed a leaf that made him or her feel funny.

Think of it like other diseases that have a lifestyle component. While a doctor might encourage someone with heart disease or diabetes to exercise more, eat better foods, or lose weight, that does not mean he doesn’t treat the symptoms of the disease. With harm reduction substance abuse policies, we adopt a similar idea.

There a lot of implications of using a harm reduction way of thinking for the way you will interact with people you are helping, and a lot more theory and background than a short blog post allows for. There are links for further research at the end of the article. In the meantime, here are some tips for working within a harm reduction state of mind:

  • When someone comes to you and admits a substance abuse problem, refrain from offering advice immediately. Instead, ask ‘what do you want to do about it?’ Many of the best solutions start with the person who has the problem, because he knows what will work best for him.
  • Acknowledge, praise and/or reward even small changes in behavior. Someone who used to drink a pint of whiskey every night and now is only drinking half a pint has improved. Make sure you notice and ‘catch’ her getting better.
  • Encourage the person you’re helping to set his own harm reduction goals. While it might be a less ambitious goal than the one you would set, the fact that it’s his own goal and not yours makes it more likely that it will be a successful goal.
  • Be realistic about relapse. Most people who are trying to change a behavior relapse periodically. When someone you help relapses, help her understand that relapse does not mean failure and does not mean she can’t succeed. Help her find a way to ‘get back on the wagon’.
  • Keep a list of harm reduction resources in your area for the people you’re helping. Free condoms, needle-replacing programs, and recovery groups that emphasize harm reduction are excellent resources for the person you’re helping.
  • Help the person you’re helping brainstorm ways to change behaviors in small ways that will improve their lives. For instance, encourage him to always take a friend to the bar and hand that friend the keys to his car, or smoke marijuana only in the evenings after work, or smoke crack instead of shoot it.
  • For your own well being, it’s important to take both a very short term point of view, noticing every improvement and pointing it out to the person you’re helping, and a very long term point of view, looking at the overall curve of behavior rather than at today’s relapse or setback. You will soon learn to be able to take setbacks in stride and continue being supportive.
  • If issues come up again and again as a ‘trigger’ to relapse, suggest to the person you’re helping that she might want to explore problem issues with a therapist or other supportive helper. Often, past trauma and mental illness play a role in substance abuse.
  • Never minimize or ignore substance abuse behavior. Acknowledge it, but move past it. ‘I think that your marijuana use is preventing you from getting the job you want’ or ‘Your drinking worries me. At your age, it’s very likely that you are developing serious liver damage’ are both complete legitimate things to say to the person you’re helping.
  • Emphasize the quality of life of the person you’re helping. Ask questions like ‘how is your substance abuse getting in the way of what you like?’ and ‘what would be better in your life if you reduced use or quit using (your drug of choice)’

Two articles I found useful for basic theory and background of harm reduction philosophy are:

Principles of Harm Reduction

What is Harm Reduction and How Do I Practice It?

Throughout the article I have linked to several books on that explore harm reduction more thoroughly. If you feel that you need further grounding in the ideas of harm reduction, I strongly suggest that you buy or borrow a copy of these books and do further research.

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compassion fatigue

 Compassion Fatigue:

Dear JHP:  I’ve been working as a receptionist at my agency now for two years, and I’m tired of it all.  My clients are whiny, my boss is never happy, and I wake up every morning dreading going to work.  I’m sick of it all, but in this job market, I’m afraid to just quit, and I haven’t found anything else out there.  On top of it all, even though I’m sick and tired of them, I still worry about the people I help.  What should I do?

Sick and Tired of Being Sick and Tired.

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