Making Choices – An Essential Component of Mental Health

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 We are always making choices, big and small ones. We make them all day and throughout our lives. Choices are crucial to our happiness and well being; from choosing our friends, partner and occupation, to choosing what we want and how we will go about getting it in a particular situation. The people I meet with often have made bad choices. They have chosen an unsuitable partner or occupation. They have chosen a way of life that is governed by stress and anxiety. They have chosen ways of being and habits that can lead them to addiction, depression and difficult relationships with others. In most cases they think they are making positive choices, but they are not. These people have lost the ability to make wise choices. How is this ability lost?

When we first come into the world we are quite clear about what we want and don’t want. We are fully connected to our needs and wants and can express these quite easily. In other words we are born with the ability to make choices because there is clarity within us about choosing the people and things around us. However, over time this natural capacity becomes infiltrated by other people’s needs and wants. As Alice Miller, the noted psychiatrist and author, puts it, we become ‘prisoners of love’. As infants we are dependent on our parents for our needs. A basic need is to love and be loved. However, love is rarely unconditional, even at this stage of life. We are given messages by our parents that certain things we do or express are acceptable or not acceptable to them. These messages can be subtle or overt. Over the years researchers have visually recorded interactions between mothers and babies. One thing that is seen is the way mothers can control the emotional expressions of their babies (however this varies according to the emotional health and awareness of the individual mother). For example, if the baby shows anger and the mother disapproves, her face and body language will convey this. Right away the child is being told what to feel and what not to feel. The infant realizes that the price for showing the forbidden emotion or behaviour is withdrawal of love and that is too much to bear. What eventually results is that the new person will cut themselves off from what is inside them that is forbidden. Over time they become fragmented beings who have become separated from essential parts of their selves. Because of this lack of integration, our ability to know what we want or what is good for us becomes compromised. Furthermore, as we develop, the society around us tells us what we should choose and not choose, and so we become further divorced from our own selves’ ability to think and choose for ourselves. It is no wonder then that my clinical practice is filled with people who have made bad choices that have cost them dearly.

As the person and I look over the course of their life we generally see childhood environments where it was impossible for them to gain a proper sense of self that could ensure the ability to choose. For instance, if they are children of alcoholic parents, they find themselves surrounded by people who are very restrictive about feelings and thoughts. They often learn that people are unable to possess their own beings and can become codependent as a result. Furthermore, if people suffered childhood abuse they were dramatically given the message that they were bad. Therefore they learned to distrust themselves and, as a result, cannot make good choices. For these reasons, much of the therapy I practice consists of helping a person understand how he or she became separated from themselves. We look at family history to reconstruct part of the story. We also try to help the person reconnect with their true feelings and thoughts. Because, even though we may lose a sense of these, they are still there somewhere within us. The difficulty and time of the process will depend on how deeply the person has buried themselves. They may be buried under years of self denial in the form of addiction, depression, negative jobs or relationships and often great stress and anxiety.

It can, and often is, hard work to reclaim yourself and reconnect to what you truly want or don’t want in life. Nevertheless, there is no more rewarding work. Because, when choices are informed by true connection to the self they are good choices and life enhancing ones.

We Heal From The Inside Out

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We live in a society that constantly dangles new ‘things’ in front of us: phones, computers, clothes, furniture etc, etc. etc. . We have to have the latest and best. In this type of environment it is very difficult to be satisfied. Of course our economy depends on dissatisfaction. We must constantly be dissatisfied with ourselves, our lives – what we have, what we do, who we’re with, where we live, etc, etc, etc – or else the economy will grind to a halt. In my work as a therapist I am constantly encountering people who are desperately seeking someone or something that will finally make them happy. To my mind this is very much like the alcoholic who needs the next drink to prop them up. Like all addictions it is based on a feeling of emptiness inside.

The truth of the matter is that we are not empty inside when we are seeking an outside release; we are in pain. The outside props are medications. In order to heal, we need to heal from the inside out. When I work with people I try to convey this idea to them. Mostly they resist. I don’t blame them. Who wants to believe that they are filled with pain and who wants to face it? Recently a man who was suffering from depression and addiction said to me, “If I look at the pain inside of me, I will become even more depressed.” I explained to him, as I do to others, that his medicating his pain does not get rid of it. It only makes it worse since the alcohol and depression combine to cause more pain through his hurting himself and those around him.

I realize that facing our pain is difficult since it hurts and it is not a quick fix; but it allows us to have the opportunity to confront it and release it. I go on to explain that it is like the process of grief; those who can grieve have a better chance of letting go of their pain than those who will not grieve. However, going within is not just about feeling pain, it can also be about seeing what is good within you. I see this with people who are dealing with self esteem issues.

I recall a woman, a child of alcoholic parents, who felt that she was worthless. Within her alcoholic family she was taught that she didn’t matter. As a result, her life was filled with self recrimination and stress. When we looked at her life, she indeed felt the pain of her childhood. But she also saw inside her a person of value with many positive traits. In this way she gained a sense of inner strength and substance. I have had similar experiences with people who engage in codependent relationships with others. They often have very little sense of identity and try to establish a sense of self through merging with people outside themselves. This often causes them great pain and stress. By going inside themselves they can begin to gain a sense of substance and self worth.

Another positive aspect of looking inside ourselves is that it can help us gain a sense of stability. When we depend on the outside for stability we find that there is very little permanence and that we have very little real control. People who have suffered from childhood abuse find that the outside world causes them great stress and anxiety. As a result of their childhood they see the outside as a threat. When they look inside themselves they can begin to find a constant source of identity and stability. As a result they can establish a source of safety that is constant and controllable.

Beginning from our childhood we are given the message that our sense of self esteem is gained from the outside of ourselves – our possessions and how we can prove to others that we are worthy people. However, the truth is that we cannot really grow if we only rely on the outside. In order to truly heal and gain a sense of strong identity we need to heal from the inside out.

Mental Fitness

Therapy Is about developing mental fitness rather than focusing on mental illness. Over the years I have become aware that one of the biggest problems I face as a therapist is the negative attitude of people towards emotional and psychological health. Compare it to the attitude towards physical health. The attitude towards physical health often has a positive, preventative proactive element to it. People look at physical health, to a large extent, in terms of cause and affect. Because of  this many people exercise, practice healthy nutrition, avoid unhealthy practices like smoking and generally read and research aspects of physical health. Of course, not everyone is dedicated in this manner, but even those who aren’t are often aware that a healthy lifestyle exists if they choose certain options.

In contrast, the perception of mental health is quite different. Its negative focus is about failure and shame. If you suffer from depression you are considered weak, unfit and self indulgent. If you have PTSD or other problems that originate from childhood abuse you are told that you are ‘unwilling to let go of the past’. Similarly, if you experience addiction you are said to have ‘no will power’ and are ‘self destructive’. The result of this negative perception of mental health is that people are not inclined to look at their emotional problems in terms of self improvement as they would if they were physical problems. Instead they view these problems in terms of weakness and shame. Consequently they often avoid dealing with their emotional and psychological difficulties.

By the time many people arrive at my office, their lives have reached a point of crisis. They tell me that they have avoided these problems for years. They arrive, both ashamed for coming to see me, and desperate. I explain to them that they are not mentally ill or a weak, rather they are untrained in mental health as are most of us. They need to learn to acquire mental fitness in order to deal with their problems. I explain that the concept of mental fitness consists of 3 parts: 1/ Self reflection 2/ Awareness of feelings 3/ Regulation of Feelings. Each of these needs to be understood and practiced as one would any skill. I will explain them.

Self Reflection – Self reflection is the ability to understand who one is. I believe that the majority of people have limited self knowledge. In large part this is because they are often defined by their early environment and their family. For example, a client came to me with depression, self esteem and addiction issues. When we talked about his identity he said, “I am a big hole, there’s nothing inside.” His early life, as a child of an alcoholic father and a codependent mother, had a very powerful affect on his lack of sense of self. Because the family was so focused on the alcoholic father there was very little attention paid to him. As a result he never acquired a sense of self or any tools of self reflection. Our work together helped him understand his background and to start thinking of how he had lost himself and to begin looking at who he is.

Awareness of Feelings – A very important resource for mental fitness is awareness of feelings. Often people who feel lost, emotionally injured, stressed and anxious about their lives come to me feeling that they ‘have lost it’ and are mentally ill. I point out to them that they need to develop the skill of emotional awareness. When I say this, they often admit that, for the most part, they are unaware of their feelings. For example, a codependent client told me that she ‘just goes around feeling angry’ at her husband. When I asked her to identify other feelings she was unable to do this.. Anger was her ‘go to’ feeling. However, when we examined her feelings in greater detail she became aware of her sadness, loss, shame and lack of self esteem underneath the anger. This awareness  helped her to focus more on herself and what she needed, rather than just being angry and stuck.

Regulation of Feelings – Certainly knowing one’s feelings is a necessary step in mental fitness. However, in order to exert a healthy control of  these feelings we need to learn how to regulate them. This requires the ability to moderate one’s feelings, rather than react to them. How do we do this?  It is my belief that we have to learn to ‘stand back’ from our feelings by gradually becoming an observer of  them. We do this by learning a mindfulness or meditative practice that can give us some distance from our feelings. Through this we can focus on how they make us react in our bodies, emotions and thoughts. By doing this we can slow down our emotional  process, create neural connections and pathways that give us a stronger base to regulate our feelings in a positive manner.

All of these skills: self reflection, awareness of feelings and regulation of feelings concern the development of mental fitness. They are not about mental illness, they are emotional and psychological skills that most of us are not taught as children. Too often we are taught as children to react, hide feelings, feel shame and generally look at emotional illness in terms of weakness. If we can shift this perspective to correspond to the way we deal with a physical illness that needs to be positively attended to, then we, as a society, can move forward.


The Main Cause of Mental Health Problems – Human Beings

Over the years I have treated many people suffering from a variety of psychological and emotional problems. When I listen to what has happened to them I am aware that many of their difficulties originated from what other people had done to them.

There are many theories as to why people suffer in the way they do. Certainly physiological factors such as genetic predisposition, chemical makeup and neural brain structures have real affects on mental health. There are also tragedies that affect our lives such as the death of a parent or sibling, illness or other events that we have no control over. These are real factors that do great damage to people. However, for the most part I am aware that, by and large, what we humans do to one another is the greatest cause of psychological and emotional pain.

How do we hurt others? This may seem like an obvious question, yet it isn’t so obvious when we come to think of it. Of course there are the obvious cases where we purposely hurt others for a variety of reasons. This type of hurting often ‘goes around’ where one person or group hurts another and the victim then attacks the victimizer. Both take turns hurting one another. Now this type of hurting is obvious, but often only from the outside. As we can observe with individuals and countries it often happens that each entity feels like a victim and denies being an aggressor. Denial frequently occurs in the case of hurt. I see this in the case of families.

It is my experience that a great deal of individual hurt begins in the family. That is the reason that I will ask people to give me a family history. During the history I am aware that not only the family members denied hurting one another, but the individual will deny that they were hurt. For example, I will ask someone who is suffering from something like depression and/or addiction what it was like growing up in their family. Often they will talk about parents who judged, belittled, hit, ignored, tormented and generally abused them in one manner or another. Yet in the next breath they will say that the parent was ‘loving’, or ‘did the best they could’. I will often agree that there was love shown, but I need to emphasize that there was also hurt. Children of alcoholic families are prime examples of denied hurt. Nevertheless, I want to make it clear that people are often not aware of hurting one another, especially in the family. How can we become aware that we hurt others?

I believe that a person needs to begin by seeing that he or she is indeed hurt. Wounded people hurt other people. We pass the hurt around – a pecking order, so to speak. Again, we often need to confront our denial that our hurt began in our family of origin. I realize that it causes clients a great deal of stress and anxiety to admit that their parents hurt them. However, I will explain that many relationships are mixed, with positive and negative. One does not have to negate the other. For example, a codependent parent can do harm to a child by trying to take over that child’s life. Nevertheless, the codependency and the harm it causes will often be denied by the parent and child because there often was a conscious good intent on the part of the parent. Nonetheless, even in the case of outright injury there is usually denial present.

Alice Miller, a Swiss psychiatrist, wrote about this in her book, ‘For Your Own Good’. In it she explains how many societies rationalize child abuse and call it a form of love. This also confuses children. The result is that the person is left with many issues such as poor self esteem, anger management problems, PTSD, depression, addiction and other problems. Yet they are unwilling to admit these, since it will implicate their parents. In addition we will not admit that we hurt others. Thus, this whole destructive pattern of hurt is held in place through denial. This is the core of many mental health problems.

We have to begin, as a race, to admit that we are hurting one another constantly. We were hurt and so we carry this on. Mental health is often not such a complex matter of genes, chemistry or any philosophical or religious origin. We not only hurt the ones directly around us, but we indirectly hurt others through social and national policies that harm individuals and nations. And when we hurt others we do harm to ourselves. Mental health begins and ends with responsibility.

How can we take responsibility for our own lives and the lives of others? We can take responsibility by facing who we and the truth of our lives. We must learn to accept how our words and actions affect other people. We must listen rather than judge, support rather than blame, be kind rather than stern, connect rather than avoid. Yesterday at a restaurant in Toronto I heard a young woman say to her friend as she spoke of her father; “He never listened to me, he never asked me who I was, he never was interested in my life, and he never understood me.” It is in this way that people are harmed. And it is in responsible relationships that people are healed.