A Sermon on Uncertainty

AIN’T NO MAN RIGHTEOUS-- SITTING IN THE SHADOW OF NOT-KNOWING

Jana Svoboda/ Unitarian Universalist Fellowship of Corvallis/ Aug 21, 2005

Opening words: Poem

If There is the Seed of Something in You

if there is a seed of something in you, and
all you can think is house on a hill,
house on a hill; built by the river and
thank god for the hill-- maybe you
live too close to both safety and danger
to either enlarge or relax. if the
seed needs water, do you resent your choices,
the well you never bothered drilling,
the bucket you let rust? you
look down at the swollen river;
even the river's pregnant, you think,
bursting its confines-- and you, more
like the seed, dry and hard and contained,
but within you some untapped largesse,
something wanting to be wet, and to break open.
from the hill, the river looks dangerous.
you forget that water is just what you need.

                 JLS, May, 2005

In Plan B: Further Thoughts on Faith, spiritual writer and professional neurotic Anne Lamotte begins: “These are desert days… I feel we began witnessing the end of the world in super-slow-mo...and some days it takes everything I can muster not to lose my hope, my faith, and myself.” I relate closely to her fear, and the paralysis that wants to follow it. She takes her fear to a theologian friend and asks, what can I do? He tells her—“left foot, right foot, breathe”. Because sometimes that is all we can do—sit with our uncertainty, and connect—through our breath—with something deeper and more divine. In the desert, Anne writes, we “know” what we should do. Stay out of the sun. Seek shelter, and safety. The desire to go back, to retreat into nostalgia—the pain for home-- is a natural reaction to dangerous and uncertain times. But courage, as the saying goes, is not being without fear—it is doing what needs to be done despite the fear. 

At a workshop with Jungian psychoanalyst and writer James Hollis, he asked us to rank our values.  What did we see as the most important tasks of our lives? I've done this many times.  But then he asked something else: to estimate how much conscious intent we put towards the items at the top of our list. A middle-aged man remarked: “The top of my list is love and growth. But I realize I spend most of my days just trying to avoid discomfort.”

I believe this is true for many of us. And for some, religion becomes a way of doing that. A hope for easy answers, for formulas: if I do this, that will happen. It is both a hope for the illusion of control and predictability, and a retreat from facing in ourselves and the world that which we cannot know. Rabbi Kushner referred to it as “God as Santa Claus”—we follow the rules, we get the goodies. 

James Hollis talks about these competing agendas living with in us: the drive for growth and actualization, and that for regression-- the wish for “the confident hubris of youth”, and for the familiar and the comfortable. When the desire to go home, to go unconscious prevails, “we will choose not to choose, to rest easy in the saddle, remain amid the familiar and the comfortable, even when it is stultifying and soul-denying… Each morning the twin gremlins of fear and lethargy sit at the foot of our bed and smirk. Fear of the unknown, the challenge of largeness intimidates us back into our convenient rituals.” But he admonishes us: “To be recurrently intimidated by the task of life is a form of spiritual annihilation.”

Hollis continues: “The recovery of personal authority is a daily task imposed upon all of us by the soul. It means to find what is true for oneself and live it in the world. If it is not lived... we abide in what Sartre calls “bad faith, the theologian calls sin the therapist calls neurosis. Respectful of the rights and perspectives of others, personal authority is neither narcissistic nor imperialistic. It is a humble acknowledgment of what wishes to come through us.”  It is also the maturity of realizing we don’t have all the answers. We don’t even have all the questions. “...from this encounter with our limitations the wisdom of humility comes: to know that we do not even know what we do not know.”

And yes—dealing with this will make you anxious. Coming forward always does. Kierkegaard said: move away from what makes you depressed, and toward what makes you anxious. The former is to regress. The latter—scary as it is to leap into unfamiliar territory—is growth.

In Plan B, Lamotte says: “In my experience, there is a lot to be said for desperation. Not exactly a bright side, but something expressed in the word formed by one of the the acronyms for the names of God—gifts of desperation. The main gifts is give up the conviction that you are right, and that God thinks so too, and hates the people who are driving you crazy. And this forces you to listen deeper, with your heart.” This is where we come up with wisdom, instead of information. 

If we are students, and we really want to learn something, it’s best not to steal and memorize the answers-- BBACACC. That’s not knowledge. It’s certainty—but it’s not wisdom. Unitarians have accepted that task as a foundation of our principals: the individual search for truth and meaning. But it’s not unique to us.

Buddhists teach it:
“Do not believe in anything simply because you have heard it. Do not believe in anything simply because it is found in written in your religious books. Do not believe in anything merely on the authority of your teachers and elders. But when after observation and analysis, you find anything that agrees with reason, and is conducive to the good and benefit of one and all, then accept it and live up to it.” (from the Kalama Sutra)

And Daoists:

“A tree that is unbending is easily broken. The hard and strong will fall. The soft and yielding will overcome.” -- Tao te ching, 76.

And Confucians:

“To learn and never think—that’s delusion”. Analects 2.15 

The Koran states:

"Do not accept any information unless you verify it for yourself.  I have given you hearing, the eyesight, and the brain, and you are responsible for using them."  Koran 17.36.

Christians, at least in the early church, agreed:

"Test everything. Hold fast to what is good".  I Thessalonians 5.21

But when times get scary, we regress. Like children, we look for external authority. Benedictine Sister Joan Chissiter writes: “We suckle ourselves on clear or comfortable answers because we fear to ask the questions that make the real difference to the quality and content of our souls. The spiritual life begins when we discover that we can only become spiritual adults when we go beyond the answers, beyond the fear of uncertainty, to that great encompassing mystery of life that is God.” Uncertain times are nearly always accompanied by a rise in fundamentalism, and I see it happening now. We divide into us and them, good and bad. This tendency to split, present since birth, becomes urgent. 

Writer and Buddhist Nun Pema Chodrin quotes one of her spiritual teachers, who said, “"The essence of bravery is being without self-deception.” Pema’s favorite mantra is “"Om, grow up!" It takes great courage to meet life on life's terms and accept responsibility for our actions. "To stay with that shakiness -- to stay with a broken heart, with a rumbling stomach, with the feeling of hopelessness and wanting to get revenge-- that is the path of true awakening. Sticking with that uncertainty, getting the knack of relaxing in the midst of chaos, learning not to panic-- that is the spiritual path." It’s also about the very Adult goal of accepting reality and letting go of attempts to control it. Anne Lamotte puts that into her spiritual practice with her morning prayer of “Whatever”, and her evening prayer of “Oh Well.”

Thomas Moore said: “You cannot do good by thinking of yourself as good. You have to sink into the complexities and go down far enough into life that you realize that it is not even good to be good. To do what others may judge as bad may be the best you can do.” (Here I am thinking Rosa Parks). “Certainly you have to admit to your moral ignorance in many matters. Can any one be certain in every design they are doing the right thing?...

Religion often avoids the dark by hiding behind platitudes and false assurances. Avoidance and defense are not the true purpose of religion. It shouldn’t whisk you away from daily challenges but offer an intelligent way of dealing with all the complexity involved.” 

Another Jungian thinker uses the story Jekyll and Hyde to illustrate. Jack Sanford writes: “Striving for a pure goodness results in a pose or self-deception about goodness, a persona. Dr Jekyll had a very big persona and believed in it completely, but wasn’t really good and became compulsive about expressing Hyde. He went to religion, not to find God, but as protection against his own Hyde. Religion often attracts persons struggling to exorcise the shadow rather than understand and make peace with it but what we cannot see in ourselves, we cannot forgive in others.” When otherness takes over, evil takes root.

Jung said “I would rather be whole than good.” Before we ate the apple, we were a thoughtless people. We were a GOOD people, but not by choice. We were thoughtless.

Christianity has seen evil as something that destroys the soul-- but originally the tradition recognized we carried both, and the Bible said —“For the good that I would, I do not; but the evil which I would not do, that I do.” Knowing we are capable of evil and no different helps us to choose. It also helps us to understand that “Ain’t No Man Righteous”, as Bob Dylan says. And if that’s true, we are all in this together. Being without self-deception, and seeing our own capacity for evil, we then can responsibly manage it rather than act it our or project it into the world. When we don't accept our contradictions, we act them out. When we turn away from our true natures-- even those we are uncomfortable with-- we are asking others to act them out for us.

Part of the work is in learning to sit with our discomfort without reaction. To just be with it. if we are lonely, to be lonely. If we are angry, to see our anger. Not to feel we have to manage it, do something with it, or even change it. When we are sad and someone starts to tell us all we have to be happy about, we feel compelled to defend our sadness, and explain why they are wrong. The shadow must have that same instinct of self-preservation. Perhaps the battle is in befriending it. Not feeding it, but not turning away from it either. Just sitting with it. Like Jesus sitting with the sinners. 

Given the burden and gift of thinking and choice, we may want to regress to certainty. We are pattern-seekers. We want to know. But often knowing, or thinking we know, prevents us from seeing what is truly there. There is a Buddhist sutra that says: Protect me from the disaster of my own thinking. Realizing we don’t have all the answers may prevent us from uninformed decisions, or worse yet, stuckness in our thinking. We need to allow ourselves the bravery of loosening our grip on what we believe to be true to find even deeper questions. Maybe, in sitting with the mystery we’ll find what for us is true. 

Closing Words: Rilke, from letters to a young poet.

Have patience with everything that remains unsolved in your
heart. Try to love the questions themselves, like
locked rooms and like books written in a foreign language.
Do not now look for the answers. They cannot now be given
to you because you could not live them. It is a question
of experiencing everything. At present you need to live the question.
Perhaps you will gradually, without even noticing it,
find yourself experiencing the answer, some distant day.

Fall is coming!

The Pretty Much Very Bad Poet Basks in a Semblance of Glory

Part two of the Monkey-Minding Manual is in process. One of the tips is about engaging contrary emotion, being it's hard to stay anxious when you are laughing. In that vein, look what I got in my (virtual) mailbox today:

Your Very Bad Poem was just barely bad enough! From: Very Bad Poetry Staff
Good news! The poem you submitted to Very Bad Poetry was chosen to be on the front page in the near future. Tell your friends to expect that you'll be famous.

After their laughter drives you to the bottle, remember that Very Bad Poetry still loves you. By the way, you can see all of your poem by going to this link: verybadpoetry

Sincerely,
Stephen
Very Bad Poetry

Managing the Monkey Mind

Oh the nerves, the nerves; the mysteries of this machine called man! Oh the little that unhinges it, poor creatures that we are! --Charles Dickens

As promised, though belated, a few tips for managing anxiety-- part one.

1) Don't suffer twice. When we worry about something in our future, (and there's nothing to be done about it) it's a lose-lose situation. If it happens, we get to suffer twice. If it doesn't, we worry for nothing.

2) Mind your stories. A Swedish proverb says: Worry often gives a small thing a big shadow. We can tell ourselves pretty alarming stories that have no real basis in probability. Check for facts. How many times have planes crashed at PDX today? This week? This year? Chances are that same pilot who's already landed the plane safely 8 times this week will also do fine today.

3) Take a breath. When we are fretting, we are often literally holding our breath. We don't breathe out all the used up air, and we end up in a bit of an oxygen deficit-- which does nothing to soothe our anxiety. Try "box breathing"-- take as much time to breath out as in, and make sure to pause for a reasonable time between inhalation and exhalations.

4) Get some distraction action. Since what you feed (your mind) grows, look for healthier places to invest. Listen to some music, taste a lemon, do some art.

5) Fire up a more logical part of your brain. Think of your brain like a power grid. If one part-- say that pesky amydala, which is all about emotion-- is all lit up, chances are the areas that access logic and reason are a bit dimmed down. Shift the resources by engaging in a few minutes of algebra, or even sudoku. Firing up those neurons will take a load off.

More to come.
Meanwhile, a song to soothe you.





Worry often gives a small thing a big shadow. ~Swedish Proverb

And now we pause to travel through space and time...

Blogging has slowed while summer is celebrated, with lots of family visiting and a time machine to build for Da Vinci days. If you're traveling through the Corvallis dimension, look for the TARDIS as it floats about the festival.

Stuck in a (Bad) Story: PTSD

Been down this road so long...
Post Traumatic Stress Disorder (PTSD) is a type of anxiety disorder (see last blog). Ten years ago the average Joe wouldn't know much about it, but it gets a lot more media now. Not that it's new: our brains have done a fab job of storing terror for millennium. It's a survival mechanism. If something life-threatening (or deemed to be-- the brain can't take the time to differentiate) happens, the brain will store away details to recognize the danger should aspects of it reoccur. When it perceives those details again, a quick chemical spill often occurs: adrenaline, cortisol, and a slew of other bio-goodies. Adrenaline helps you run faster, be stronger-- have any of you heard the tales of mothers lifting cars off trapped children? Cortisol (in the short run) releases glucose for energy, reduces pain perception, and increases memory. Both of these are good in a crisis. And ideally, these compounds will get used up in your flight or fight reaction. Should the situation never recur, and the brain "understand" the threat as a one-time deal, you're ok. But often the storage system isn't quite that selective. Here's an example:

Let's say you are walking downtown on a beautiful July morning when, just like in all those old Three Stooges movies, you look up to see a piano being lifted by rope to a third story apartment. Say you look up just in time to notice the piano and think "Gosh, hope I sure hope that rope's secure." And that in that split-second or two, you see the fraying of the rope, and the swaying of the piano, and the next thing you know you are lying on the sidewalk surrounded by ebony and ivories.

We're going to make this an easy one. It's your mostly-lucky day, and you walk off with a sprained pinky and a few scrapes. But Brain doesn't know that. It was way ahead of you. You could've been flattened! And it knows it. Logic knows something else: you're basically fine. You hardly ever use that pinky and it will heal pretty quick. With the exception of the loss of thirty minutes to recover over a latte', nothing in your life has changed.

Except good old Brain. Maybe now every time you see a piano your heart starts to race. Going downtown has the same effect. July makes you sweatier than it should in the Northwest. Or it could be, because Logic had such good intervention in your near-death experience, that those things don't get you-- but really discordant piano music puts you in an unexpected panic attack.

In the last blog, I talked about a Viet Nam vet who had a physical flashback after unexpected exposure to a popcorn popper that sounded exactly like rear machine gun fire. Most of the time Brain does a good job of knowing when it really needs to worry, so the one-time freak accident that results in no real physical harm pretty quickly loses its punch. But when the trauma is repeated, the peril real, or when other factors such as threat to one's children is involved, Brain solidifes the information and Logic can't budge it.

Because of the developmental differences of children, their brains are even more likely to store information in ways that prove troublesome when resources and circumstances change. Early exposure or experience of abuse can cause serious problems with hypervigilance (constant alert for danger even when none has been around for a long time) and chronic anxiety even as an adult. That's because the adult body is wired around the child's experience and capabilities-- at a time when the child had few resources to resolve the threat or escape.

Symptoms of PTSD include a hypersensitivity for stimuli related to the event (like the piano in the previous example), avoidance of such stimuli, and re-experiencing of the trauma when the stimuli is encountered, such as in flashbacks or panic attacks. Some folks have a paradoxical reaction of numbing out rather than "activating" when exposed to a traumatic reminder-- the freeze, rather than fight or flight response.

The main thing to remember, if you have symptoms of PTSD, is that you are not crazy. It's a predictable response to an unpredictable event. If the activacting stimuli themselves are not dangerous (like a piano), then repeated reexposure is the best bet for convincing Brain to settle down and quit seeing it as a threat. Several years ago my family had a traumatic event in which one factor was breaking glass. I had never had a panic attack in my life prior to that, though I'd treated people with them for years. I learned a lot about compassion for sufferers of same when for a while thereafter I had panic attacks whenever I heard breaking glass. Lucky (?) for me, I am far sighted in one eye and near sighted in the other, which means I have the depth perception of Mr. Magoo and am just as clumsy. I break things pretty routinely. Within a year or two my body/brain settled down and instead of thinking lives were in danger at the sound of breaking glass, I'd just curse my clumsiness again.

EDMR is another research based treatment for addressing PTSD. I'm not trained in it, but there are several folks in this small town, so likely some in yours too.

Cognitive Behavioral Therapy has a good track record with PTSD and focuses mostly on re-exposure and correcting illogical thinking around the event.

Emotional Field Therapy is a less researched but self-teachable method that employs many of the same ideas as EDMR. Many swear by it, and you can do it by yourself with probably little risk (some people might want/need support of another to confront scary material).

Recreation of the event through debriefing is a bit more controversial. For some, it's re-traumatizing. But many find it very helpful to process their experiences, especially if they are unique, with others who have been through the same. Groups for survivors of domestic violence, sexual abuse, or war are available in most towns-- check the web or ask me if you can't locate them.

Quote of the day: The wish for healing has always been half of health. --L.A. Seneca

Vid of the day: Willy Porter's BREATHE. A fan download,but if you can make out the words, it's worth it. Better yet, go buy the single (or the whole CD) at your local independent store or from his site.


As noted, next blog will talk about techniques for managing anxiety in general. The material will apply to those with PTSD as well.

What Anxiety Wants is Predictibility

(Photo by Marla Dean Svoboda)
GOT FEAR?
The spectrum of human experience known in the biz as ANXIETY DISORDERS account for much of my office traffic. As noted in previous blogs, there's reason to believe some of what makes a good chunk of our population more jumpy is genetic, and evolutionarily beneficial. People with more anxiety have Great Big Radar-- they are more tuned in to (and reactive to) changes in environment, internal and external.

Anxiety disorders in the DSM-IV, my professional's travel guide, include everything OCD to Post-Traumatic Stress. There's also categories for the generally jumpy (Generalized Anxiety Disorder) to the specifically frightened (phobias). Panic attacks are discrete periods of high anxiety that can be brought on something in particular, such as being in a crowded place or on a bridge, to nothing obvious at all-- worse, because that's a little harder to avoid.

The brain is great at learning what scares it. Danger memories can get hard-wired to provide a quick spill of chemicals that ideally would serve us well-- to get us the hell out of dodge, or help us fight off our attacker. Brain is not particularly selective in what gets filed, which can result in some strange associations we may not even know exist. For example, if you're in a car wreck, Brain may file away not only screeching tires and breaking glass. You might find yourself also getting panicky feelings (the emotional interpretation of all those chemicals coming to fore) when you pass white Hondas, or that particular intersection. That one's easy to connect, but while you might not have noticed what was on the radio, Brain could have, and you may not understand why your heart races every time that Lady Gaga song plays. I had a boss once who was a Viet Nam War Vet. Once during a staff meeting someone decided to make popcorn and started up the air-popper. Next thing we knew, our normally composed boss was under the conference table. Turns out the sounds the machine make are very close to what rear-machine gunfire sound like. Now obviously his logical thinking knew a popcorn machine was no physical threat. But body thought different, and it took a while for him to dial down the adrenaline.

Anxiety is the dizziness of freedom, said Kierkegaard. We are faced with an avalanche of choices, and each choice carries a responsibility and the opportunity to go wrong. Anxiety just wants to know and be able to plan for what's next. That's why a lot of people with the Anxious Gene can look like micro-managing control freaks (and why OCPD is probably just a coping response to an anxiety disorder). It's why we become much more anxious after an event that is not predictable, like the beautiful fall morning in NYC that later became known as 9/11. It's the seductive attraction of fundamentalism-- a simple recipe we can follow so that everything is guaranteed to turn out OK.

Our attempts to make an unpredictable world more comfortable often backfire. Addictions often start as ways to soothe, and we use many means to become comfortably numb, like TV watching. We substitute relationships that feel more manageable for ones that can provide greater intimacy with its resultant greater risk of loss and heartbreak. We practice avoidance through procrastination (consult me for tips-- I should be doing billing right now). We adhere to rules and ritual, sometimes crazy ones, to give an overlay of structure. All things in moderation -- some structure is a great thing, and too much or too little is a bad thing.

I'll talk more specifically about PTSD next blog, and follow that one with some tools for managing anxiety in the moment and overall. If you missed past blogs on fear and anxiety, click on the links below:
Obsessive Compulsive Disorder
She With Her Head in the Clouds
Breathe
Tilting at Windmills
Be luminous! The day is over.

Song of the day:


Edu-Vid of the day:

Nourished by Community

Friday night I got my mojo refreshed at a celebration for a friend's graduating son. The party, held at her country home, was filled with music, dancing, and love. She'd prepared a traditional Indonesian feast-- a epicurean tableau of colors, smells, and flavors that drew many of us back for thirds. Ages of the festive ranged from 0-80 plus. Kids ran through the woods, sampled in the gardens and swung from the rafters and we all danced to a live band in a beautiful barn, playing original tunes with global flavors (with mama on keyboards!) . The night had all the ingredients of healthy living-- natural beauty, physical activity, creativity, wholesome AND interesting food, celebration of connection and life milestones, and involved, invested companions. I was rejuvenated by it.

We all need more of this in our lives. We get caught up in work, bills, disasters-- our created and life's unavoidable sufferings. Community makes it all more bearable, and reminds us of our generative potential.

Thanks, Evelyn and Mark, for reminding me what's important, and for throwing a heck of a party. And congratulations and best wishes for your future to Miro!

And if any of you need a band to play in your barn, email me for details---

150 ways to build community can be found at bettertogether.org

Today's quote: "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured." Author Kurt Vonnegut

Video of the day:

Diagnosis of the day: Obsessive Compulsive Disorder

CHECK CHECK CHECK: Obsessive Compulsive Disorder is the label given to a anxiety disorders that have two chief characteristics: Obsessions (unwanted thoughts, images, beliefs) and/or compulsions (ritualized or repetitive behaviors). There are several subtypes. In contamination OCD, the sufferer worries about being affected by touching or being exposed to specific (although often many) people or objects, or being infected by germs. The fear is controlled where possible by avoidance (never touching doorknobs, refusing to shake hands, etc). When avoidance is impossible, the sufferer often develops rituals to "cancel out" the contamination. These may be logical though excessive, such as hand washing or use of antibacterial lotions. A person with contamination OCD may wash, scrub or apply chemicals to hands to the point of damaging the skin. Illogical rituals may also be used: retracing steps, saying a particular phrase, and so on. The rituals can be very time consuming and do NOT feel like a choice.

Rituals aren't limited to contamination OCD. Some OCD folks have intense fears something terrible will happen to them or someone they care about if rituals are not followed. Checking disorder, in which a person has intrusive concerns about not completing a protocol, may lead to checking and rechecking to make sure the lights are off, gas isn't leaking from the stove, or similar. Last year driving to the airport I saw a bumper sticker on a car that said "Are you SURE you unplugged the iron?" Like most people, I have a touch enough OCD  that it nagged me for a minute or two. For someone who really is affected by OCD, that might have led to a drive back home from over an hour away.

OCD can cause intrusive, usually illogical thoughts that cause distress. They are "ego-dystonic", a fancy way of saying the person doesn't want them. Those affected seek constant reassurance to refute them. In one case many years ago, I worked with a young man who worried he might be gay. He had never been sexually involved with a man, and never wanted to be. He had perfectly satisfying heterosexual relationships. Yet every week he would ask me "Are you SURE I'm not gay?" Reassuring someone with OCD is not effective, and in some ways contributes to the worry. The person with OCD knows their behavior or thinking is illogical. But it is not a choice to them.

"Pure O" OCD is the name given when the primary symptom is intrusive thoughts and/or images.  Disturbing sexual or violent pictures and thoughts are common in this type of OCD, but the name is misleading-- there are almost always some compulsions around being used to try to control the behavior.  For example, a person may avoid driving because of obsessive thoughts about running someone over.

I read once that the chief difference between the OCD and non-OCD person with egodystonic thoughts is the "stickiness" of their brain. We all think crazy thoughts. But if we don't have OCD, we dismiss them as random. The OCD brain worries them like the place where a lost tooth came out. They just can't leave them be.

The causes of OCD are unclear. There is an obvious genetic component that accounts for at least half of occurrences. While no one gene appears responsible, it's rare to treat someone with true OCD who didn't have one or more direct family members with some sort of significant anxiety disorder. But environment also plays a role. Life stresses, maternal pregnancy factors and even childhood strep infections can be factors. Hormones appear a factor at least in women-- it is common for new mothers (some say around 30%) to struggle with some intrusive thoughts and compulsive behaviors. Of course, stress and anxiety in such situations would be a clear contributing factor: is the baby breathing? Did I feed her enough? But the frequency leads researchers to conclude that hormones may exacerbate the situation. You can see in that case the evolutionary effectiveness of increased vigilance. Worried-over babies are more likely to survive than neglected or ignored babies.

OCD is different from Obsessive Compulsive Personality Disorder. People diagnosed with OCPD don't usually have rituals. Personality disorders are considered more personality types that cause trouble for people rather than isolated disorders. If you're old enough to remember "The Anal Retentive Chef" from Saturday Night Live, you've seen a classic OCPD type-- obsessed with rules and order, inflexible, fussy, perfectionistic. As I mentioned in my first blog about diagnosis, at their most basic most diagnoses describe a particular type of genetic predilection that have both strengths and weaknesses. You probably WANT your chef, your surgeon, the guy that lays your tile to be a bit on the obsessive-compulsive side. That means you will get a job done right. But when either of these slips into the really disordered arena, you get someone impacted so much by rigidity, anxiety, avoidance or time-eating practices they cannot function at all close to their potential. That's when it's time to do something.

Therapy for OCD
The most demonstrably effective treatment for OCD is not pleasant for those who have it. It involves systematic exposure to the triggering events so that the brain can rewire these to be perceived as non-threatening. OCD "boot camps" provide this quickly, though overwhelmingly. A person with contamination OCD might be forced to touch a toilet, for example, then eat something without washing. Generally, in outpatient treatment, exposure is done gradually to desensitize the person.

Medication can also be helpful. SSRIs (antidepressants such as fluxoetine, better known by its brand name of Prozac, or others) seem to help some people. There are risks and benefits to using medication and it appears that they work best when exposure therapy occurs concurrently. Medications of these sort should NEVER be stopped abruptly because serious withdrawal syndromes and rebound effects (worsening of symptoms) may occur.

New treatments using deep-brain stimulation (which involves surgery), transcranial magnetic stimulation (non-invasive) and even good old ECTs are also actively being explored to treat more severe and disabling forms of OCD.

If you're worried now that you have OCD, remember that most people have a little bit of every "disorder". The key factors for figuring out whether it's a problem is how disruptive it is to your life. Who's complaining? How much is it limiting you? If it's a problem for you, there are many options. Most cities (certainly Corvallis) have therapists and psychiatrists who specialize in treatment of OCD. Here are some other resources:

ocdtribe is an online source with chat groups and information by and for OCD sufferers.

The International OCD Foundation, also run by persons with OCD, distributes information, research, and connects folks to treatment.

Dr. Stephen Phillipson has several good articles here at OCD Online.

Lots of successful, famous people have OCD. Click this post's title to see Howie Mandel talk to David Letterman about his.

We'll end on a lighter note: an OCD song.

What's in a name? Diagnostic dilemmas

One the pleasures and pains of my job as a clinical social worker is to give a label to the variety of human experience that lead people to my office. If my clients choose to use--and are lucky enough to have-- therapy coverage, their insurance requires I give a diagnosis. It's a devil's deal: if you want to stay or get well, you better start off labeled sick. I've trained in diagnosis, both in school and through my many mentors and jobs. And I see the benefit shown, at times, in the relief of clients at having a name for what is ailing them. But it's a messy business.

Some of these diagnoses are reflective of the maladies that are standard to anyone who's lived long enough-- say, the ubiquitous "Adjustment Disorder" to a divorce, layoff, or newly emptied nest. Though considered a mild diagnosis, the "disorder" part rankles me. The experiences of life changes can be very disruptive, but being disrupted by them is too usual to qualify as an illness. However, the stress they invoke can and does cause real illness, the sort that costs insurance companies real money. It makes sense to attend to them. Somewhere in school or at a work conference you may have taken one of those "life stressor inventories" that gives a point value to experiences good, bad, anticipated and unintended. As your points increase, so do your chances of having a major medical event within the following year. Helping people find real tools to mitigate the damage is my job. And insurance requires a name for that damage.

But naming those names can be problematic. There's the very real stigma that media and individuals attach to it. If your gall bladder isn't working properly, you may be really uncomfortable; it's unlikely you're ashamed. But if your emotions, behavior or thinking is off it's a different story. Now it's REALLY personal. Our brains are organs--pretty complicated ones at that. Brain's function is dependent and reflective of a variety of processes: environmental (the nurture part, that is), biological, such as hormonal systems, oxygen levels etc and genetics. We are no more in charge of the DNA that regulates our innate response to stress than we are of the DNA that determines our eye color.

I've long believed that most things we call "disorders" are really just variations of genetics that have evolutionary function. Sometimes the side effects of those functions cause trouble, especially now that we are living much longer than is needed merely to reproduce and raise our young to a viable age. Sickle Cell Anemia is an example of that. Persons with this genetic mutation (read: random change) were much more resistant to childhood malaria, thus living long enough to reproduce. Reproduction passed that change along. When the average life span was 30-40, that was a real benefit to the population affected. Not so much when malaria is no longer an environmental threat for some with the mutation, and when life expectancy is much longer.

Genes that create a hypersensitivity to environmental risk-- or its opposite, a risk-taking, fearless approach to change-- both have reproductive advantage. Safety-conscious persons who are hyper-aware of their environment and actively avoid threats would have reproduced successfully in certain environments where their braver brothers and sisters walked into harm. Those same people would have been out-reproduced when factors required persons to disregard potential harm and immediate danger or discomfort in order to relocate for food, shelter, and so forth. We seem to have a reasonable minority of each of these groups still reproducing-- the anxious and the manic. Persons with hypomania, at least in its more benevolent form, can work for hours without sleep, be extremely creative, and take risks the rest of us deem unacceptable. Persons with anxiety, who can predict dangers unapparent to the hypomanic, mandate things like 8 hour shifts and OSHA rules.

Asperger "disorder" is another cultural definition of a spectrum of genetic variation that has its ups and downs. The Asperger variation probably is responsible for much of humanity's technological and engineering advances. The Asperger brain is often extremely skilled at spatial understanding, categorizing, ordering and patterning. It's not so hot at understanding emotional nuance. Which brain would be more useful to you in designing a building code to protect harm from earthquakes?

We get the brain we get. It's going to have quirks. It's going to have strengths and weaknesses. It is surprisingly more malleable at any age than we have ever previously understood. Within limits, we can challenge our innate tendencies and create new pathways of understanding that occur not just on a psychological but on a physical level.

I'll write more on that, and on diagnosis, in my next blog. Meanwhile, here's some additional readings on the profession's most fallible touchstone, the Diagnostic and Statistical Manual of Mental Disorders (aka DSM):

"81 Words" This American Life devotes the entire broadcast of episode 204 to the events surrounding the dissolution of the category homosexuality as a Certifiable Mental Disorder. It deserves to be heard as a cautionary tale of how popular, or at least powerful, opinion can be reified.

Opening Pandora's Box: The 19 Worst Suggestions for the DSM V Author Allen Frances, MD, was the chair for the DSM IV, and it's not surprising he might react to the revisionists. His bias is evident in this read-- a bit bitchy, even . Nevertheless, his article makes some good points about troublesome indications of pathologizing normal human experience and suffering.

DSM V Org: find the whole lollapalooza here, with highlighted changes and their rationales.

"Be careful how you view the world: It is like that." - Erich Heller

That quote appears, tiny, on my office door, and summarizes one way in which I approach therapy.  It is, as I wrote here, all about the story we tell ourselves.  It's not that evil doesn't exist, or good-- but  rather which story we are attending to, and feeding.  Unfortunately, and probably evolutionarily, it's the bad ones that grab us.  Luckily we are more than our biology.  Consciousness offers us an opportunity to question our assumptions or the predominant paradigms that insist no one is to be trusted, and nothing good will come of all of it.  Remember, although suffering is real, so is joy.  Add to it.

(for the record, dead kelp muppet above is an unretouched beach find...)

Tending the Tangled Garden

I hauled the big Red Book to work today.  In case you aren't familiar, this weighty tome is a facsimile and translation of Carl Jung's personal journal, replete with luminous, hallucinatory paintings of dreams illustrating his Hero's Journey.  Access a great NYTimes article on its publication here:  The Holy Grail of the Unconscious, by Sara Corbett.

Jung broke ranks with his analytic companions, chiefly Freud, when he took a less medical/pathological turn into decidedly theosophical territory with his writings and analysis.  He saw the unconscious as a repository for a wealth of material to be mined for a more wholly realized life.  Access could be gained through art, writing, dreams, myths-- all were sources of soul.

This morning before starting my day's work I opened to this passage:  "Wondrous things came nearer.  I called my soul and asked her to dive down into the floods, whose distant roaring I could hear...and thus she plunged into the darkness like a shot, and from the depths she called out:  'Will you accept what I bring?' "  In the dream, soul returns first with the detritus of war, next the remnants of historical magics and superstitions, then the horrors of which humanity has shown itself capable, and "fear, whole mountains of fear".  Each in turn Jung accepts, saying "I accept all, how should I dismiss anything?" But when soul comes back from the depths with the wisdom and treasure of all past cultures, he is overwhelmed.  "That is an entire world, whose extent I cannot grasp; how can I accept it?  Soul chastizes him sharply.  "But you wanted to accept everything?  You do not know your limits.  Can you not limit yourself?"  From this, Jung seems to face his grasping and lack of discernment.  He writes:  "I see that it is not worth conquering a larger piece of the immeasurable...A well tended small garden is better than an untended large one."  (Page305-306, Red Book, Carl Jung, edited by Sono Shamdasani, translated by S. Shamdasani, M. Kyburz and J. Peck, published by Norton 10/2009)

Plunging into the collective unconscious, or even dipping our toes in our personal subconscious, can be a frightening task.  In America, we do a good job of avoiding it.  We keep ourselves crazy busy, fortressed in stuff, cut off from nature, each other, and our own soul.  We feel a vague or real sense of dis-ease, or sometimes terror, and we run in absolutely the wrong direction in hopes of comfort.

Pink Floyd sang it:

When I was a child
I caught a fleeting glimpse
Out of the corner of my eye.
I turned to look but it was gone
I cannot put my finger on it now
The child is grown,
The dream is gone.
but I have become comfortably numb."
                   "Comfortably Numb" , Pink Floyd, The Wall, 1979

It's true, as the country folks say, that if you beat enough bushes you are going to drive out some snakes.
But with compassion and what Jung spoke of as modesty and cultivation, there is much to be had by digging a bit deeper.  Our lives go by more quickly than we imagine.  We find the things we worried about so much in a moment are nothing in the bigger picture.   And what we put off-- as I said once to a client, well you can deal with it now and there will be hell to pay.  But if you put it off-- it's hell to pay, plus interest.

What little piece of your garden has been neglected too long?  What waits for you there?

Today's quote:  It is by going down into the abyss that we recover the treasures of life. Where you stumble, there lies your treasure.  Joseph Campbell

Today's song:   

This pretty planet

It's 40 years since the first Earth day--  40 years since Cleveland's polluted Cuyahoga River caught fire, waking us up to devastation we were wreaking on our planet.  Things have actually improved some since then.  The skyline is more visible in some cities, and not everything that comes into our houses ends up in our landfill.   But it isn't rosy.  We are in danger of reaching the earth's carrying capacity.  We continue to overload our atmosphere with carbon (and if you don't buy global warming, please, please check out the research).  


I went to a lecture last week by National Geographic executive editor for the environment's Dennis Dimick.  He showed horrifying pictures of the very real effects of human impact on our fragile home, and implored the audience to take action to stop the carnage.  It's easy to get so overwhelmed by the immensity of the issue that we are paralyzed.  Luckily, I saw Nobel laureate Jodi Williams give a talk a couple of days later at OSU's Peace Jam.  Entitled "When Ordinary People Achieve Extraordinary Things", it was medicine to many weary hearts.  Ms. Williams was a principle force  in the international campaign to ban landmines.  A down-to-earth, cowboy boot wearing gal, Jodi encouraged listeners to stop whining and DO SOMETHING.  She is a living example of how an everyday person can enact profound changes within a lifetime.  No time, you say?  She brooks no excuses.  Cut out an hour of, say,Seinfield reruns or Starbucks stops to churn up a little action about something that really worries you.  She's no partisan-- she doesn't care if it's landmines, education, poverty, civil rights.  She wants you, as Gandhi said, to BE the change you want to see in the world.   And she noted that if every citizen in Oregon devoted one hour a month to volunteer activism, well, that's 3 million hours a month!


What do you worry about?  What are you going to do about it?


Need a little inspiration?  If you're from these parts, visit this link of the Northwest Earth Institute and take a class that will shake up your life and maybe change your world.   
 Here's a few more useful links:
Earth Day home page :  Sign the Earth Day 2010 Climate Declaration.  Find ways to get involved.
Corvallis Environmental Center:  Take a hike.  Find out about local environmental initiatives.  Get to know your ecosystem and more.
Population information and impact here.
Science Daily's environmental new digest
Small things can make a difference:  Treehugger.com talks about some here
and there are 50 more here.
To keep your heart lightened, visit or subscribe to ODE magazine, for "intelligent optimists".
Today's quote:  "To know that even one life has breathed easier because you have lived, that is to have succeeded."  — Ralph Waldo Emerson
Today's song:  Big Yellow Taxi, by Joni Mitchell

Sticking to-- or getting stuck in-- your story

Most of you have heard the story of the three blind men coming upon an elephant in the jungle.  Each reaches out to touch a different part.  One grabs a leg and says, "We must have arrived at the pillars of the great Such-and-Such Temple."  Another, hitting the side, says, "Oh no, it's the Wall of Nazar."  The third, grabbing the tail-- who knows what he thought.

Our story about what we experience isn't reality, but the beliefs or understanding of our experience about it.  As someone more succinct said:  Don't confuse the map with the road.   I used to give a talk about this concept, and for illustration would show three maps of Portland.  One, a  topographic map, showed contours illustrating changes in elevation and landscape.  Another showed physical features-- rivers, forests, etc.  The third was a street map.  All were "true" stories of Portland-- but which would serve you better if you were trying to get to Powells?

How attached are you to your current story?  And is it getting you where you want to go?

We all have  stories about ourselves and our experience.  Sometimes our stories serve us, other times they can constrain us. And the more we hear any story-- even when we are telling it to ourselves-- the more likely we are to believe it, to internalize it.

No child is born believing they are worthless, terrible, stupid.  But a child who hears it often enough will believe it.  And we all grow up in a consumer economy that survives by telling us we are not enough-- how else to sell us things we don't need?  We have to be convinced us we are lacking.

Milton Erickson, a gifted psychiatrist, often helped clients create positive stories about their worth via hypnosis.  He would even invent a kindly aunt or teacher for adults who as children had no safe role models. His unique inventions of new stories had real-life benefits:  the patients began seeing themselves through healing, affirming reflections.

There are lots of stories about each of us.  What are the stories about your strengths, and possibilities?  Can you give them as much airtime as those about your limitations?

Quote of the day:  The destiny of the world is determined less by the battles that are lost and won than by the stories it loves and believes in. —Harold Goddard

(This was the headliner quote on a great page:  See the rest here at Storyteller.net)

With Love for Phoebe

Phoebe Prince was 15, an immigrant from Ireland's County Clare.  She moved here with her mother and siblings for a chance to experience America.  Her experience was horrendous, and ended up with her death by suicide.  More accurately, she was bullied to death.

A beautiful young woman, Phoebe faced the ire of the South Hadley, Massachusetts "Mean Girl" militia shortly after her arrival.  Her most grievous error according to articles about her death--briefly dated a popular senior football player.  She was harassed daily at school, online, and even after death on her facebook memorial page.  Administrators appear to have known, and turned a blind eye.  This week nine of her taunters were charged, after an investigation into the months of peer abuse that preceded her death.   It's a good start, holding those responsible to at least a public accounting of their behavior.  But it's action taken much, much too late.

Bullying is not child's play.  I see adults in my practice who still bear the scars of cruelty suffered at the hands of their then-peers.  Sometimes, like in  Megan Meier's cases, adults were involved in the bullying.  The effects are profound.  Although our school district in Corvallis, like many, has a written anti-bullying policy, I hear several stories every year that show intention is not enough.  We need to support a real "no tolerance" policy for bullying.  In-school suspension with mandatory counseling or anti-harassment education would be a start.  Teacher reporting is essential.  It's not a matter of "kids will be kids".  It can be a matter of life or death.

Several years ago, just a block or two from my home,  a youth was severely beaten by his school mates after being taunted about his sexual orientation.  My partner, profoundly disturbed that this could happen in our allegedly tolerant town, canvassed places of worship and community business to purchase an ad in the newspaper decrying the action.  The ad contained a half-page poster that could be displayed on doors to designate the home/building as a safe space where all were welcome, regardless of race, sexual orientation, ability, etc.  It's time to take up the banner again-- not just with words but with deeds.  Stand up against bullying.  Call it out when you hear it.  Educate, educate, educate.  Don't let hurtful words go unchallenged. Ask your school officials what they are doing to teach and support not just tolerance, but compassion.

Resources:  Mean Girls:  Tina Fay directed this funny but poignant movie about being on the outside of the "popular crowd". This is a good conversation starter for middle school girls and parents.  The movie was inspired by the book Queen Bees and Wannabes, by Rosalind Wiseman, educator and advocate.  Click on the link to visit her blog.
Click to listen to Janis Ian's At 17-- a classic song capturing the difficulties of being on the outs of the in crowd.
Tolerance.org is a site devoted to social justice and raising awareness about the problems of hate and intolerance in our culture.  They provide excellent curriculum to schools and other organizations at no cost.  Help them in their good work out with a donation.
Dr. Ken Rigby offers good resources on his site about school bullying and what can be done to address it.
An article about bullying and suicide, by Kevin Caruso can be found here, along with links to prevention sites. Read these four stories about those whose lives were cut short.  These were people's beloved sons and daughters.  Be part of the solution, in their memory.
Ryan's Story
Jared's Story
Maria Herrera
Jaheem Herrera
Be part of the solution, in their memory.

She with her head in the clouds

While out walking tonight, the weather shifted rather quickly and the clouds were amazing.  It's the second time this year I've seen what looked like the newly-named "asperatus" formation-- undulating, pitted looking waves that resemble a choppy sea.  Beautiful, awe-inspiring sky.

I'm surely one of the 10-20% of the population born with an anxious gene.  Evolutionarily, it would serve to have a stock of folks who tend to the signs around-- hyperalert for changes, radar always on, ready for action.  So I notice things, and I pay attention to all sorts of stimuli others miss. It might look like ADHD (and I am probably the poster gal for that too) but it's more over-attention than lack of it.  The plus part is I see the clouds. And a lot of other things-- tiny mushrooms, heart-shaped rocks, four-leafed clovers.  I have a super sense of smell-- walking at night especially brings a cascade of information about people's laundry, recent cigarette break, cats in the garden, etc.   I notice car bass thumping, airplanes passing,  the tv show at the neighbors. I notice moods and gestures of people too-- what some might call "vibes" but my pragmatic brain thinks is just subtle information that predicts behavior in other.

The down side of this-- it can be awfully busy inside my brain.

To soothe my over-active sensorium, I head for nature when possible.  I love being in the wild, with its lack of signage and its more lulling soundscape.  I sleep better on my much-too-rare camp trips, especially when I've had a day of rowing or other physical activity and synched with the sun's up and down.

"It's not the hand you're dealt, but how you play the cards," someone said.  We're made all kinds of ways.  We don't have a lot of choice in it, but we can make use of who we are and find ways to decrease the burdens of our particular proclivities.

I'll write more about theories on the "sensorially acute" in the future.  For interesting reading now, see these resources:
NY Times:  Understanding the Anxious Mind
Books:
Self Test: Are you Highly Sensitive?  by Elaine Aron.  She is the author of several books on the subject, including "The Highly Sensitive Person's Survival Guide.  Her website is here.
Two free short meditation downloads--using "brain-synch" technology-- can be found by clicking on this link at brainsynch.com.
Check out Richard Louv's book, The Last Child in the Woods.  As far as I can tell, he coined the term "Nature Deficit Disorder", and posits a powerful argument for how nature can cure what ails us.
Shut Up Already:  Read this short article from Wired mag on how rare quiet has become, even in nature, and what trouble that can cause.  "Biophonist" Clive Thompson finds that disruptions in the natural soundscape can profoundly and negatively alter the wildlife within it.

Now go find some peace and quiet--
Jana

With Love for Ansel, 9/20/85-3/18/06

Name me no names for my disease

With uninforming breath;
I tell you I am none of these,
But homesick unto death.

             ----Witter Bynner
 "The Patient to the Doctors"

     Ansel died at 20, waiting for a transplant that might have kept him journaling, poetgaming and mountain climbing.  A few weeks before he died, I visited him in New York.  When I asked what I could bring him from Oregon, he said: "Seaweed-- lots of kelp.  I want to take a bath in it and pretend I am in the ocean".  (I did, and he did).

       He packed more life into two decades than many of us could in five, and had a heart the size of Texas.  His family and friends miss him very much but are ever enlarged and grateful for our brief time with him. 

Give the gift of life:

GIVE BLOOD

BECOME AN ORGAN DONOR

Billy Collins :The Dead

Song of the day: A seeker and poet like Anselin, Dave Carter wrote his own eulogy song a few years before his unexpected passing.  He plays it here with the gifted Tracy Grammar.  More at daveandtracy.com

RELEASE

Barn's burnt down --
    now
I can see the moon.

---Mizuta Masahide, 1657-1723


It's springtime in Oregon.  We know, because on the rare occasion the sun is shining we can see the little furry patches of moss on our ankles starting to spore.    Time for a little spring cleaning.
I must have come from the gathering part of the hunter/gatherer tribe.  I collect.  A couple hundred heart shaped rocks are piled under the base of the front yard maple, and most are under a few years' worth of leaf litter.  There are bowls and stacks of rocks around my house, in my office, providing a nice natural counterpoint to rest of the clutter.  I'm a sentimentalist.  I have the orange my sweetheart brought me 20 some years ago on our second date-- I was sick, too sick to eat it, and it quickly desiccated on the window sill and has followed house to house since.  
Some of these things I am glad follow me.  But it's past time to goodwill, toss out or repurpose the several dozen mismatched socks, 80's business suits, old tupperware bowl without the lid, etc.  I like giving things away as much as collecting them.   I've rehomed many a sentimental piece of art or jewelry.
Here's some resources for reducing your load.
Freecycle is a national network devoted to keeping useful items out of the landfill.  "Useful" is a broad definition-- I've given away a nearly new but unfunctioning printer and ceramic heater to people with more mechanical savvy.  Group names and contact methods vary by location; find yours here.
http://www.freecycle.org/

Locally, the ARC, Cat's Meow, OSU thrift store, Vina Moses, Goodwill and Habitat for Humanity would love to sell your gently used items to fund their good works.
The Northwest Earth Institute offers nearly free classes in voluntary simplicity and sustainable living that will get you thinking about what you need and what it really costs to have it.Today's quote:  It's not the daily increase but daily decrease. Hack away at the unessential. --Bruce Lee
Song of the day:  "Just Let Go", by Karen Savoca
Inspiring vid of the day:  The Story of Stuff