Saturday, September 8, 2018

Dear Ellen, "There are times when I'm touchy, feeling empty and unfeeling."

And another entry on the anonymous form. THANK YOU!
Thank you, Comfreak!
Hey Ellen, your content is so helpful so thank you for the time to offer such valuable advice to all of us. My question is: I get bouts of what feels like depression periodically, possibly due to hormones (I'm self diagnosing here). There are times when I'm touchy, feeling empty and unfeeling. I won't feel like doing anything, not even things I liked. This can last for a few days and can affect my relationship with others. Do you have any tips or advice on how to survive the grey cloud that feels like it could never go away? Thank you!

And thank you, too. I’m so glad you’re finding this useful.

It sucks when your body is messing up your mind - and your relationships!- but you have two great things going for you. Not only do you recognise you have an issue but you think you know what is going on. It means you’re not wandering in the dark and that’s awesome.

Now, you say it lasts just a few days, so I’m guessing it’s a menstrual cycle issue?

My advice would be to gather data. Basically, you need to track the days and times when your body is interfering with your mood.

Note that this may be retroactive because on Monday you might hit the ceiling over nothing and it’s only on Wednesday that you realise why.

I suggest you use your phone calendar and use a simple hash tag, like #Mood if you’re feeling gentle with yourself or #EvilWitch if you’re feeling sarcastic.

Track yourself and hopefully, you will see a pattern emerging.

Once you know what’s going on, you plan for managing these difficult times. It’s a two step process: anticipate when it may happen, and have a plan for changing your behaviour.

For example, suppose your bad spots fall on the first Monday and Tuesday of every month, and you notice your temper rises in the afternoons and you get the blahs at night.

First mark your calendar with pink to hint which days might be ‘temperamental’.

Second, on those days, you go into the world with the knowledge that you are not your usual self. So, on those days you do several things:
1.      If possible, restrict yourself from potentially difficult situations on those days. Avoid meeting with toxic people, taking big decisions and so on.
2.      You know you are touchy so when you feel your temper rise, you pinch yourself and say out loud that it may or may not be warranted. Make a conscious effort to step away.
3.      You know you will feel blah at night, so you can either give yourself permission to hang out and do nothing OR you can schedule specific things that you know will give you a boost. There’s no right or wrong: do what works best for you.

Apart from understanding your own body and mind, if you’re worried about how those #Mood #EvilWitch moments affect your relationships, you can have a conversation with the people most likely to be affected.  “I know I blew up at you last Tuesday over nothing. I’m sorry, it’s pesky hormones. I’m trying to manage it better.” And you can choose how much to share from that point on.

I’m not saying you’re going to get a free ticket on your bad days, that would be a bit much, but understanding and the effort to manage should get you some Brownie points.

Finally, if you find your hormones are really causing you issues, it is worth seeing someone. If it’s mildly annoying and you just need some hand holding while you figure stuff out, try a therapist.

If it’s more serious, then maybe your family doctor can help but I would be heading to my gynaecologist, preferably one who is very good with things like post natal depression because it means she is used to dealing with hormonal and mood issues.

I do hope that helps!  And feel free to use the anonymous form again.

Friday, September 7, 2018

Dear Ellen "My sister is sick and won't help herself"

We have another question via the anonymous form:

Dear Ellen, I'm writing to seek some advice regarding my sister, who is in her early 30s. She is currently staying with my parents and we're worried about her health.

She is overweight and a body checkup revealed that she has fatty liver. She has an inactive lifestyle and all she does is go to work, then spend the rest of her time either on the computer or on sleeping.

We've advised her to move around more and have a healthier diet but she does not heed our advice.

Could you please provide some suggestions on how to motivate her to change her lifestyle? Thank you!

Oh lord, what a frightening situation for you all.

Okay, first things first. I am sure you’ve read the superb overview by the doctors on WebMD on Nonalcoholic fatty liver disease

It’s one of those things that can hit anyone, and the nasty thing about it is that one of the effects includes fatigue.

It is entirely possible that your sister is going to bed rather than the gym because of the disease. 

It is also possible that she’s had a shock from being diagnosed and that she’s down or possibly depressed.

As the doctors advise a change of diet and exercise, you are right in that she must make some changes. But advising her has to be done with great care and compassion.
I suggest this:

You cannot force an adult to do things they don’t want to, therefore, you have to recognise that your current communication strategy is failing. Junk it and start afresh.

Prepare yourself for the discussion by throwing away all of your past impressions, thoughts and experiences. You are going in fresh and this is the first step of a negotiation.

Pick a time when your sister is most likely to have some energy. She needs to be in a calm spot where she’s open to talking.

Make sure it’s just the two of you, nobody else. The fewer people, the easier it is to talk.

Start by telling her you won’t be advising her. This is important because she may be fed up with people telling her what to do.

Tell her you love her.

Ask her, what is she feeling about this new situation?

Then listen.

Ask only questions, don’t give opinions. The trick is to aim away from advising and towards understanding. Ask until you are certain you see it from her point of view.

When you get how she feels, you can say, “Okay, sis, I want to help but I need you to tell me exactly how.” You say this because this is her issue and she's the one in control.

If she doesn’t have any concrete ideas, here are some of mine:

Schedule some happiness into her week, every week, in order to keep up her spirits. There’s a blog post here on how to do that.

Everyone is worried and that can lead to endless “How are you?” health conversations that would drive anyone bonkers.  Negotiate how you talk about her health. It may be that she limits you to asking about it only on Fridays, or that you have to respectful and back off when she says, “I’m not talking about it today.”Whatever she wants, do it.

Changing over to a new eating style can be bothersome, so make at least part of it fun. Discover some delicious healthy food dishes together. Either swap recipes or cook for each other. Set up family Healthy Lunch or Healthy Dinner outings.

About exercise. Usually, people suggest that you buddy up for walks and swims. In my experience, that’s usually a disaster because people very quickly find reasons not to go.

My best advice is that your sister hires a personal trainer once a week. With a personal trainer, you get proper routines and as it’s a business, you turn up on time and there’s no nonsense. Tell that person what the doctor said, and figure out a custom action plan.

Also, get her signed up for one class, in dancing, swimming, yoga, pole dancing - whatever. You can go with her if you want, but it has to be a regular group and it has to be awesome fun. Any kind of movement will do.

Most importantly, she will need an advocate, someone who can help her stand up to family, friends and complete strangers who will be drowning her in unsolicited advice. Worse, there will also be people hoping to cash in by selling her miracle drugs from overseas.

Be totally on her side, and work out between you how you deal with kindly but meddlesome types, rude imposing types and scummy swindling sales types.

Important: this is about how your sister wants to manage her life, and so she makes the decisions and you are her enforcer. Don’t let anyone bully you.  Be a tiger!

And finally, talk to her about the possibility that she may also be suffering from depression. If she is, and the symptoms last for a fortnight, being assessed might be a good idea.

Making lifestyle changes is not easy, so expect setbacks and obstacles, but do know that it can be done. 

Your sister has you and your parents, so start with that and gradually build up her support network. Again, there’s a blog post on how to do that here.

I hope this helps. If you need more, do use the anonymous form again. I’ll be thinking of you.

Thursday, September 6, 2018

Dear Ellen "I have it all but I'm still depressed"

Someone filled out the anonymous form and so we have a question of the day:

What is your advice for finding true happiness inside and out? I’m sure I’m an undiagnosed depressed soul. I’m educated, employed, mother of 2 with a great husband of 22 years. I never feel happy and I’m sure I’m negative to my friends and family. I want to break the cycle. I’ve tried medication in the past but it was ineffective.

I’m sorry to hear you’re having a bad time and glad you’re reaching out.

You have a lot of blessings but as you note, depression can hit you regardless of what your circumstances are. That’s what makes it so difficult. 

Somehow or another, we have talked ourselves into thinking that's it's only okay to be depressed if you have a solid reason. But the fact is that depression can hit anyone at any time.

Don't worry about whether you've 'the right' to be depressed. It's just an issue you have to deal with, like having spots or sore feet.  

Also, you’re not alone!

The 2017 National Health and Morbidity Survey found that 29% of Malaysians suffer from depression and anxiety disorder - that’s more than double the 12% who reported having these issues back in 2011.

So, giving it's a really common problem, let’s start with the how you should approach tackling depression.

Ideally, you:
1.      See your family doctor to rule out physical issues like thyroid problems. More on that, here.
2.      Talk to a therapist to see what stresses are in your life and to get an accurate picture of exactly what is going on.
Only at that point do you see if you want to explore medicine or therapy or both. Some more thoughts about that here.

I don’t know what you did or how long ago it was but if it’s been a while, please adopt that approach.  

Everyone is different so be fully informed first and only then take decisions that suit you and your needs.

Also, a thought about the medication. NOTE: I am not a doctor and only medical doctors can discuss this properly. However, may I ask how long you took meds? Because a lot of antidepressants take several weeks before they start working. Doctors sometimes forget to explain that, and so people pop a pill for three days, expecting instant results, and then quit.

If you did that, then factor that into your decision making.

What would I suggest you do right away? Rule out physical stuff and then talk to a therapist, starting with your workload.

I say that because, from your short description, it sounds like you have a lot of roles and responsibility. Are you perhaps overworked? Is everyone around you pitching in or are you somehow bearing the whole load?

Also, what about your self care? Do you do things that are fun for you?  A little happiness scheduling may be of benefit.I wrote a blog post on how that works, here.

Then, work on your communication. You recognise you’re a bit negative, and that is a habit you can change. Get some help with that, and learn to tweak your responses a little. A good strategy for that is cognitive behavioural therapy. And yes, there's a blog post on that too, here.

I hope this helps you start your journey to happiness. Do write again if you like and we continue the conversation. The form is here.

Wednesday, September 5, 2018

Ask a counselling psychologist. Free, anonymous Q&A.

While we're getting much better about talking about mental health, but there's still a lot of stigma to overcome. So, if you've ever wanted to ask a question but been too shy to ask, here's an anonymous form. Ask anything you like and I will do my best to answer.

Monday, August 27, 2018

Can you eat your way to happiness?

 Serotonin is associated with mood and it’s present in certain foods, so can you eat your way out of depression and into happiness?
Will this dish clear your depression?
 If Google it up, you’ll find lots of articles pushing the idea that depression can be fixed by adjusting your diet. One of the common suggestions is that you should be looking out for serotonin. Is it true, a Facebook rumour or a marketing scam?

Here’s what you need to think about before you decide.

Serotonin and depression, what’s the link?
In the 1950s, scientists discovered that a treatment for tuberculosis had an amazing side effect: it relieved depression and anxiety, too. The key to the magic seemed to be a chemical called serotonin.

Today, serotonin is associated with mood but also physical good health.

What exactly is serotonin?
Serotonin is a chemical whose job involves passing messages around the nervous system.  It is a neurotransmitter.

Where do you find serotonin?
It’s in your brain as well as your digestive system, in your blood and your central nervous system. In short: pretty much all over the place.

What does serotonin do?
Here are some of the things serotonin is involved with:
o       Mood, especially happiness, depression and anxiety,
o       Bowel movements,
o       Bone health,
o       Blood clotting,
o       Sex drive,
o       Sleep.

Okay, sounds good. So, I want loads of it, right?
The really annoying thing about the human body, is that you can’t simply whack up your serotonin levels and think it’s all good.

For example, if you boost serotonin in the brain you can help fight depression, but the higher levels can have a bad impact on your sex drive.

Think of your body as a complex machine like a car: oil is an important ingredient that keeps it all going, but immersing your ride in it wouldn’t be too wonderful.

So, how about I eat lots of serotonin food and let my body figure it out?
Exactly what the scientists have been thinking. In all the research, some are asking, “If we boost serotonin in the gut, can we boost happiness in the brain? Can we eat our way to happiness?”

Of course, being scientists, they argue over the best way to test that theory, too.

Some researchers said, “Look, we’re going to get volunteers, feed them a load of food that’s high in serotonin: plantain, pineapple, banana, kiwi fruit, plums, and tomatoes and see what happens.”

They did this, several times, and results were mixed. Some thought it was a good thing, others said it did nothing for depression.

Other researchers said, “Okay, instead of serotonin let’s focus on food high in tryptophan, an essential amino acid that is involved in creating serotonin, a kind of a precursor.”

They fed their volunteers food high in tryptophan, like: meat, shellfish, fish, whole oats, wheat germ and also chia seeds, cashew nuts, soybeans, cheese, and eggs.

Again, results were mixed. Some thought it made a difference and others said it didn’t.

So, what’s the thing I need to take away from this?
Although serotonin does seem to be play an important role in mood, science doesn’t have a solid answer on whether eating specific foods will help relieve depression or not.

However, if you’re down or depressed, I suggest that you incorporate this pineapple, banana and kiwi fruit salad into your diet.

Think of it this way:

It can’t do you any harm - unless you’re allergic.
People who are depressed often don’t eat properly.
Eating delicious food is a cheerful activity all by itself.
Also, eating fruit = a huge whammy of vitamins.
Finally, talking about bowel movements: having excellent digestion is a happy thing.
Fruit will help with that, too.

Why are there strawberries in your salad?
Because I like them and my local fruit shop buys them from a small organic farm in the Cameron Highlands. Whenever I eat them, I love the flavour and I feel as if I’m helping a small business.

And you are...?
I’m a counselling psychologist. I have a degree in psychology and a masters in counselling. I use talk therapy to help my clients.

I am not a genius researcher or neuroscientist, so if you want to dive into the subject, you need to talk to a specialist.

I wrote this because I worry about unscrupulous marketing people who will tell you all kinds of crap just to make $$$ out of you.

My aim is to present information so that you can make up your own mind. I do it as best I can but it’s simply what I think. Like everything else you read on the Internet, don’t take it as gospel. Read critically and double-check everything.

I need to read these studies for myself
Awesome! A good start is
How To Increase Serotonin In The Human Brain Without Drugs  It’s not the latest paper but it has a really good literature review and it’s easy to access. If you want to read more, go to Google Scholar and look for serotonin depression diet and see the latest papers.

Thursday, May 31, 2018

Be Your Own Therapist: Support System Mapping 101

There are some common techniques and practices in the mental health professional toolbox that anyone can (and should!) use. Here’s one of my faves: the support system map.

We are very social beings, and when we don’t feel supported, we feel lonely and this fuels depression and stress.

As a first step to happiness, it makes sense to know how you stand in terms of support. This is why it is one of the very first things I tend to suggest in sessions.

Now, the support system map is dead simple to set up. You sit down with a sheet of paper and ask yourself, “Who makes me happy? Who can I call, visit, or see when I need support, advice or just a giggle?”

Some clients resist this exercise, saying, “I know who I can go to, and don’t need to write it down” but when they start, they inevitably discover it is incredibly useful because it highlights support strengths you may have overlooked and identifies areas you need to beef up.

This is one of the fundamental principles of therapy: just applying structure to the chaos can be enlightening.

Blog posts work best with examples, so I’m going to share my support system map.

Do note I work very hard on my connectivity because I work from home, and I live very far away from my family in a culture that I wasn’t born into. That’s a triple whammy (my choice!) and I love my life but I’m aware I need to be super careful.

So, here’s what I have

People I can say anything to at any time, and call in the middle of the night in an emergency
Tom, my husband
Ian, my brother
My mum
Plus four friends I’ve had for over twenty years, and two close friends I’ve had ten years

Friends I have a ‘mutual moan’ pact with whom I can Skype or Message anytime without an appointment

Author friends I have a ‘mutual moan’ pact with whom I can Skype or Message

Therapy friends I have a ‘mutual moan’ pact with whom I can Skype or Message
Problem area: up until six months ago I had two but they left Malaysia. Needs beefing up.

People I’d trust 100% to give me solid advice and counsel on either love or career
Seven friends

Friends in the neighbourhood I can go for a quick morning coffee with
Two friends

Lunch friends who always inspire me
Too many to mention

Friends to go to the pub with in the evening
Problem area: five years ago that was over a dozen people, but most have moved away and one passed away. Needs beefing up.

So, if you’re stressed and you’re not at the point where you need someone like me to talk to, create your own support system map and beef up all the bits you feel are lacking. Honestly, it’s a great help. Also, if you are unhappy at work, here’s a post onhow to use this together with self determination theory.

I’m off to see my mum for my annual holiday. I will be seeing my present clients but I won’t be taking on new clients until July 1st. 

Tuesday, May 22, 2018

On being a personal cheerleader, because we all need to hear it, “You can do it. You are also a hero.”

I realised last week that when I was little, I read fantasy books that were rich with strong, interesting and capable heroes and where female characters were one dimensional caricatures.

As I said in my sweet romance blog post, it didn’t bother me at the time. Ever since I wrote that, I’ve wondering why. I think I’ve come up with the answer and curiously, it has a lot to do with my therapy work.

I grew up in Amsterdam in the late 1960s and early 1970s (yes, I’m THAT old!). The Netherlands has been an egalitarian society for a very long time, and all the adults around me were solidly supportive.

When I didn’t do great on my schoolwork, my teachers didn’t scold. I was told, “If you’re trying, that’s good enough. It will come.”

My ambitions to be a pilot, or maybe a vet, elicited an, “Awesome!”

No matter what, it was dinned into me, “You can do it.”

When we moved to Scotland in the late 1970s, that support was spotty. My parents were rocks as were some of their friends and some of our teachers, but there were a lot of others who, frankly, were absolutely toxic.

For the first year, the bullying was stellar. In the school I attended, the teachers encouraged the kids to throw stones at me because I didn’t speak the language or share their religious beliefs.  

After I switched schools, the bullying disappeared. However, sexism was rife. One moment that really crystallized that attitude for me was the deputy headmaster who advised me that I should be a shop girl “because careers are for boys.”

So, what does this to do with my enjoying fantasy novels that have great male characters and few or no females? Just this: because of my early experience, I never associated strong and capable with being male.

From my earliest days I was taught that anyone could be a hero.

So, when I read Lord of the Rings, I was Frodo, Gandalf and Aragorn as easily as I was Galadriel. Reading the Rift War saga, I was Pug and Arutha as happily as I was Anita (although TBH I preferred the Valheru over all of them!)

And this leads me to my therapy work. I’m aware that my early training gave me the confidence and resilience I needed to reach for my happiness. It’s not always easy but that foundation has been a tremendous help.

Not everyone is as lucky. There are those who aren’t treated well by their parents, their families, their bosses, or their communities.

When they have a personal crisis, they feel they can’t open up because they would be judged.

“I’m supposed to be stronger than this.”
“If they knew, I’d lose respect.”
“I just need to talk through this, without being lectured.”
“It’s embarrassing, I don’t want anyone to know, but I need a second opinion.”

Back when I first signed up to do my Masters, I thought practice would be all about helping clients work through and manage issues. But over time I’m beginning to learn that for some people, it’s about needing temporary support, a personal cheerleader, if you like. Someone whose professional code means she will never tell.

I’m okay with that. I think we all need to hear it, “You can do it. You are also a hero.”