February 26, 2013


Lately I've been feeling impressed by the courage of my patients and my friends.

Once a month at the clinic where I work, two members of the team conduct a psychological evaluation with a new patient, while a group of medical residents and psych interns observes. Each time, I'm struck by the courage of the patient who sits before the group and describes in detail the manifestations and origin of the presenting mental health problem, the distress or impairment it causes, current and past relationships, and goals for treatment. How brave is that!

I was similarly struck a few weeks ago when a colleague told me that her patient with panic disorder willingly ran up and down the stairs inside the clinic, trying to expose himself to the terrifying breathlessness that triggers his panic attacks. I feel the same respect when a patient with chronic health anxiety successfully writes, records, and listens to an exposure scenario describing himself dying of cancer, or when a painfully shy patient reports that she successfully completed her plan to initiate a conversation with one of the other parents in her son's class.

It's not just my patients who are impressive: my friends are, too. A few months ago, one of my friends was diagnosed with schizoaffective disorder, a difficult-to-diagnose mix of depression, mania, and psychosis that neatly explains symptoms he's been experiencing for years. Following the diagnosis, he took his mental health into his own hands--seeking out a support group and tirelessly navigating the overwhelming bureaucracy of the health care system until he found a doctor who understood the diagnosis, prescribed medication appropriately, and addressed his concerns about side effects. Another friend recently began psychotherapy to deal with a procrastination problem that has plagued her for years. A third friend called me up for a referral for a couples therapist so that he and his partner could address some issues they were unable to resolve on their own.

My friends' and patients' initiative touches and impresses me. There's still a stigma attached to mental health care and there are still people who believe that seeing a psychologist or psychiatrist or taking medication is a sign of weakness. I'm pretty sure that acknowledging a problem and seeking help demonstrates the precise opposite.

Think about it.

February 09, 2013

First World Problems

Are you distracted from the truth that everything is basically okay? I often am. 

I didn't get my favourite seat on the bus yesterday morning; it was snowing and there were no cabs when I left home to go out for dinner last night; I woke up this morning feeling anxious about work; a friend said something that hurt my feelings; the market didn't have the kind of cheese I wanted; and my hair doesn't look right as I'm getting ready to go out tonight.

I know what you're thinking: rough life, right? Yet each of these things bothered me, however briefly, and created annoyance or hurt or stress or disappointment.

When I teach mindfulness-based stress reduction (MBSR), one of the classes in the eight-week program is dedicated to coping mindfully with unpleasant emotions. In the discussion about mindful emotion regulation, we identify that negative feelings often stem from wanting--and not getting--things our way. That is, we want there to be taxis at the taxi stand, we want our favourite seat on the bus, we want our friends to be sensitive to our feelings, we want to look good all the time, and we want to be in a good mood. We want things our way.

It's easy to get so caught up in wanting what we want that the smallest deviations make us all worked up and unhappy. What's more, as soon as we get what we want, we usually want something else or something more. On the bus yesterday morning, I was initially pleased to get a seat on a very busy route that usually has standing room only. But no sooner did I sit down than I was distracted by the thought that I would prefer to sit further back. This morning I definitely was getting my way as I leisurely drank my coffee and read a magazine before heading to the gym--yet I was irritated and upset by my lingering anxiety. Although my Saturday morning was actually pretty lovely, I wanted it to be completely lovely. I wanted it my way.

What helped me snap out of it was one of the phrases we use in MBSR in the meditation related to painful emotions. Participants are asked to sit quietly and reflect on several questions, including the following: "Am I distracted from the truth that everything is basically okay?"

This question is great because in 99% of cases, the answer is YES. Yes, everything is basically okay and yes, I'm distracted from that truth. Yesterday, I was distracted from the pleasure of getting a seat on the bus by the existence of a "better" seat. Today, I was distracted from the truth that I was having a lovely morning by the prospect of the even lovelier one I wasn't having. Last night, I was distracted by the lack of cabs from the truth that I was happily headed to nice restaurant to enjoy a meal and a bottle of wine with good company. In each case, there's no question that the truth was that everything was basically okay.

The examples above are mostly minor upsets, but the lesson is equally applicable to weightier matters. Consider expecting parents, for example: All they want is for their baby to be healthy. Once a healthy child is delivered, though, it's easy to immediately switch to unhappiness with the hospital food and irritation with the grandparents, forgetting the truth that everything is basically okay. 

Asking yourself "Am I distracted from the truth that everything is basically okay?" is a genius cross between getting over yourself and counting your blessings. The next time you're fretting, moping, or seething, try asking yourself the question. If you're like me, most of the time, the answer will be yes.

Let me know what happens!

PS: You can also try "Does everything have to be perfect in order for me to be happy?"