depression

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The sound of a defensive arrow

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My fingers are freezing. Several people around me are sitting with their sleeves drawn down as far as possible, to keep the trinkets of warmth alive. The air-condition is spitting out its icy message: ‘I’ll make sure no drop of sweat manifests itself on your forehead’. I register it and think about the irony. Outside it’s actually quite warm, much warmer than it would be in Norway, but it seems people would rather feel cold than warm. I’m at the bus from Baltimore to New York and have for three hours read a book about self-harm.

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Reflections are important for me

Several times I had to just stop and let my eyes rest on the view, since some emotions rose in me. It was some sense of happiness, growing in me after reading about different treatment-approachs ( to self-harm and problems with emotion regulation).

I also grew fond of the author, because of his integrity and obvious respect for his patients. He truly cares about them all, and this compassion awakened his ability to creative new thoughts that elegantly weaves into well-known models. He made them rich partly because they associated with other ideas. Together this was pure mind-candy for my psychology-hungry state of mind (who said not working was great?).
The spider-web of associations made my thoughts light up with memories of people I’ve met. So many of them have shown me love, and I feel gratitude curling itself like a cotton nest in my stomach.

The reason for putting the book aside and writing down this now, was because I read about a lovely metaphor that I just had to share with you. My heart immediately reacted with speeding up its heavy thuds, since what I read made perfect sense and resonated within me.
Maybe you will like it as much as me ?

Defensive walls in a bloody war

Imagine a wall def20130916-173515.jpgending a city. In the book this safety-precaution was compared to the defensive walls in the movie ‘the lord of the rings’. In one battle scene a city is on the brink of invasion by the orks. This means that every boy and man have go into battle regardless of their preferences or experiences. Even a little boy, shaking in his boots so that the too huge helmet clatter, must defend the city against the enemy. Everything looks hopeless until the elves suddenly appear. They help them so they survive and win, but only until they can fight for themselves.

Different constructions
The author of the book compares the war to defense. Their defense is iron-wrought pillars gathered from cuts that colored its surface. Sometimes their enemies (thoughts, emotions, memories or people they can’t trust) are lurking and they try to cement their construction with the few materials and resources they got or collected. Examples of the defensive actions can be to distract the beasts with carving their skin, believing this piece of art will awaken the hunger of the beasts. Like martyrs they settle for contributing what little they know and can do.

If the enemy has been inoculated against bloody fingerprints the fierce fighters can jump over the walls in full destruction-mode (By acting out and possibly hurting both friend and foe). As the enemies draw closer,the unexperienced heroes of war, become afraid and desperate. This in turn colors the type of defensive strategy they unmask. Often they go from mental to continually concrete and physical types of defense (from denial and avoidance to self-harm or violence). Ignoring the orks will sadly mean feeding the orks with their souls. For an eternity.

Is it really strange that they use the only defense they can think off when it looks like the20130917-093800.jpg walls will not hold ? When one feel control slipping away, ‘irrational things’ like cutting themselves might be the only mechanism they had that brought relief.

Think about the samurai’s from Japan: By killing themselves, they didn’t have to face the shame of losing against their enemies. Further; What about all the lovely people who tries to hide their ‘dark’ emotions because they think people will shunt them if not? Isn’t it understandable that instead of letting other respond to their emotion, they rather run away from it than to face it, especially when considering the addition burden of trauma many have in their pasts?

A child who misbehaves and gets punished for it might harvest their own baskets of anger. Is it strange they can be terrified of their parents ‘discovering’ they’ve been cutting their skin, when they sometimes believe they always do wrong and deserve what they get?
What can we therapists do ?

When a patients shows you the honor of telling about their shameful thoughts and actions, try to not be the ‘enemy’ who wants to breach the walls. Let them see that you come in peace, and wait until they feel safe enough to look over the wall for a bit, thereby letting us discover their battle scars from earlier war-zones. Remember that they naturally can be extremely sensitive and guarded after such experiences .

It’s sometimes easier to attack first than risking getting an arrow in your heart, and our job is to respect that and fight along with them, just like the elves.

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His blog:

http://t.co/Vy9v342PB5

on twitter:

@SveinOeverland

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Svein Øverland

More on self-harm

Sebrapiken
Sofia Åkerman, Humanist forlag 2011
-En selvbiografi om spiseforstyrrelser og selvskading-

other Norwegian pages:

ung.no – informasjonskanal for ungdom
Drevet av barne-, ungdoms- og familiedirektoratet

Psykisk Helse i Skolen
Opplæringsprogrammer i psykisk helse

Si det med ord
Drives av interesseorganisasjonen Mental Helse Norge.
Lavterskeltjenester for mennesker som trenger noen å snakke med eller skrive til.

Klara Klok
Spørreside for ungdom og unge voksne i aldersgruppen 10 – 30

  Behandling.

 

The sound of death

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When I started this blog, I had a vague idea of what I wanted: To share some of the knowledge collected over a lifetime with the readers, and maybe find others who wanted to do the same. I love to find and share post I find inspirational.

Suicide is a topic that never can be talked enough about. Psychologists in Norway are taught (but not enough) to ask questions related to killing yourself, and most luckily take this seriously. Most therapists will once in their lives lose a client (I am dreading when it happens to me) and it is a real trauma when and if it happens. I have talked with therapists who have lost somebody, and they never forget it. Considering how much I care for many of my patients, I know how much it would hurt if they were not here anymore, and I have seen and read enough to know that the pain never seizes completely. For this reason everything I learn that can make me a better therapist, is extremely valuable. For this reason, I want to share some interesting research I`ve stumbled into lately.

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In 2003, during his first year teaching at Harvard, Nock approached his colleague Mahzarin Banaji with a proposal. Banaji had helped develop the Implicit Association Test, which was introduced to social psychology five years earlier and has become famous for its ability to measure biases that subjects either don’t care to acknowledge or don’t realize they have on topics like race, sexuality, gender and age. Nock wondered if the I.A.T. could be configured to measure people’s bias for and against being alive and being dead, and Banaji thought it was worth a try. They experimented with several versions in Nock’s lab and at the psychiatric-emergency department at Mass General. Then they put their best one on a laptop and offered it to Mass General patients, many of whom had recently threatened or attempted suicide; 157 agreed to take it. Hunched in plastic waiting-room chairs or propped up in cots as they waited for a clinician to admit or discharge them, they were often grateful for a distraction.

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Some things are automatic for us. Why not use this knowledge ?

Balancing the computer on their thighs, the patients held their pointer fingers over left and right keyboard keys. The heading “Life” appeared in the upper left corner of the screen, “Death” in the upper right. In the center, words associated with one of the headings popped up one at a time. Patients jabbed the left key to link “alive,” “survive,” “breathing,” “thrive” and “live” with “Life”; the right key matched “funeral,” “lifeless,” “die,” “deceased” and “suicide” with “Death.” The researchers asked the volunteers to do this as quickly as they could. Each word had a correct response. If patients put “thrive” with “Death,” for instance, a red X appeared, and the test paused until they hit the proper key. The sorting continued as the words reappeared randomly. After about a minute, the headers switched sides, and the process repeated. Then new rubrics popped up — “Me,” “Not Me” — along with new words to sort: “self,” “I,” “myself,” “my,” “mine,” “other,” “theirs,” “they,” “them,” “their.” Again the headers flipped places, and the sorting continued.

Once the patients had established a rhythm, the test began to measure bias. The headers doubled up: “Life” above “Me” and “Death” above “Not Me,” forcing test-takers to hit the same button to group “thrive” and “breathing” with “self,” “my” and “myself.” “Die” and “funeral” went with “theirs,” “they,” “them.” Theoretically, the faster the patients were and the fewer mistakes they made on this part of the test, the more they associated themselves with living.

Then “Life” and “Death” switched places, swapping the associations; the same key grouped “myself” and “my” with “funeral,” “suicide,” “die,” “deceased.” Agility on this part of the test would suggest an association with dying.

Doctors of all kinds, including psychologists, do no better than pure chance at predicting who will attempt suicide and who won’t. Their patients often lie about their feelings to avoid hospitalization. Many also appear to mislead by accident, not realizing they are a risk to themselves or realizing but not knowing how to say so. Some 90 percent of young people who kill themselves have visited their primary-care doctors within a year; nearly 40 percent of adults have within a month. The opportunity to help them seems enormous, if only there were a way to see past appearances and identify an inclination they might be hiding — perhaps even from themselves.

dontrainThe Mass General patients and their clinicians rated on separate scales how likely they thought they were to try to kill themselves in the future. When researchers checked on each patient six months later, they discovered that, as expected, clinicians had fared no better than 50-50 in their predictions. Patients themselves, it turned out, were only slightly more accurate. The I.A.T., to everyone’s surprise, bested them both. People who sorted words more quickly when “Death” was paired with “Me” than with “Not Me” proved three times as likely to try to kill themselves as people who sorted words more quickly when “Life” was paired with “Me.” The I.A.T., it seemed, was picking up a heightened signal of suicidal tendencies that the most commonly used method for assessing risk — a clinical interview — had been powerless to detect.

One of the comment (there were many)  to this post was:

A letter written by my daughter,16,on tumbler

Dear you,

i’ve been there, okay? i’ve been in the position you are right now. you want to do it, you want everything to end. you think that this world is going to be so much better without you. you think that it won’t matter if you’re gone. you figure people can just go on with their lives, and eventually you’ll be nothing but a memory. it’s better for yourself, and everyone around you.
i’m here to tell you that you’re dead wrong.
Suicide is never the answer. Even though it may feel like the one thing you have control over, the one thing you can take, you can never take it back. There are no do overs. You can’t commit, die, and then decide you want to be back here again. It doesn’t work that way.
Your mom’s smile slowly withers away after the years of your passing. She clamps her hand over her mouth as she rereads those same familiar words, “It’s not your fault, Mom.” Even though she wants to believe you, she can’t.
Remember the guy who would never cry? That was your father. But that was the past. He needs to convince everyone—and himself—that he’s okay. He constantly thinks about what would have happened if he walked into your room, only a half hour before it happened. In his mind,it was his fault.
Remember.You are beautiful. I don’t need to see a photo of you to know that. You’re so much more than what you’ve become. You are so loved.
Stay strong. Keep holding on. Everything is going to be okay.

With love,

Me

 

Protected: Narrative part 7: Without my wings

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Movies about all the mental illnesses (from anxiety to personality disorder)

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

This summary was derived from several of the articles listed in the resource list, from the suggestions of our ADMSEP colleagues, and from our own personal experience. We have not personally reviewed all of the movies on the list, and suggest you view any film before choosing it for teaching purposes.


Axis I Disorders

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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summary was derived from several of the articles listed in the resource list, from the suggestions of our ADMSEP colleagues, and from our own personal experience. We have not personally reviewed all of the movies on the list, and suggest you view any

Protected: The sound of vulnerability

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The sound of turning around

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National Suicide Prevention Lifeline
National Suicide Prevention Lifeline (Photo credit: Wikipedia)

I found this on the web and really loved it

Joy Turns to Pain When You Flip Over These Clever Suicide-Prevention Ads Real message is upside down

By  David Gianatasio

Publicis’s poignant print ads for suicide-prevention group Samaritans of Singapore use ambigrams to give upbeat messages negative meanings when viewed upside down. “I’m fine” becomes “Save me,” “Life is great” morphs into “I hate myself” and “I feel fantastic” reads “I’m falling apart.” The tagline, “The signs are there if you read them. Help us save a life before it’s too late,” is also printed upside down. The campaign does a fine job of depicting the subtle, often hidden nature of depression and anxiety disorders. It’s novel for the category, taking an approach that’s clever enough to generate broad coverage, extending the message far beyond its original market. Perhaps those reading about this work will question declarations of happiness from friends and family members that don’t quite ring true. The writing may be on the wall, but sometimes you’ve got to look at things in a different way to avert disaster.

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I feel fantastic or I`m falling apart
Samaritans-2
“Life is great” or “I hate myself”

 

 

 

 

 

 

 

 

 

 

 

 

Samaritans-3
“I`m fine” or “save me

Related articles

For Broken, but being repared

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I want to dedicate this to my blogger-friend: brokenbutbeingrepaired, since she had a tough day. Just wanted you to know that I am thinking about you, and sending some extra strenght your way. When it`s dark, it feels hopeless, but remember that when it feels better, you have overcome another day and fight. It`s okay to feel down once in a while, but I promise, it won`t be like this forever.

Here is a reminder of some good things in life and some words I want to share with you:

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Take care of yourself.

http://80elle.wordpress.com/

You do?

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Earth covering your shoulders. You try to shake it off, but there is enough to press you firmly down. Fighting seems like such an effort, isn`t it maybe better to just call this defeat? You feel your weakness, and are sure this can`t change.

People running up and down the streets, in rain, snow and wind. Always up, aiming higher. Best you don`t also. They deserve it more than you, and grabbing a ticket for the show feels wrong, you rather linger on the back, ushering others forward, giving them a gentle smile.
But the black, smelly earth is restricting your ability to push anymore. Your hand is broken by the effort, and you would never let anyone fix it.

It`s best if you just give up.

What would you do if somebody talked like that to your son?

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The sound of the gifted and depressed

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Great Potential Press – Guiding Gifted Learners

Dr. Webb is co-author of the book Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger’s, Depression, and Other Disorders

It has been my experience that gifted and talented persons are more likely to experience a type of depression referred to as existential depression. Although an episode of existential depression may be precipitated in anyone by a major loss or the threat of a loss which highlights the transient nature of life, persons of higher intellectual ability are more prone to experience existential depression spontaneously. Sometimes this existential depression is tied into the positive disintegration experience referred to by Dabrowski (1996).

Existential depression is a depression that arises when an individual confronts certain basic issues of existence. Yalom (1980) describes four such issues (or “ultimate concerns”)–death, freedom, isolation and meaninglessness. Death is an inevitable occurrence. Freedom, in an existential sense, refers to the absence of external structure. That is, humans do not enter a world which is inherently structured. We must give the world a structure which we ourselves create. Isolation recognizes that no matter how close we become to another person, a gap always remains, and we are nonetheless alone. Meaninglessness stems from the first three. If we must die, if we construct our own world, and if each of us is ultimately alone, then what meaning does life have?

Why should such existential concerns occur disproportionately among gifted persons? Partially, it is because substantial thought and reflection must occur to even consider such notions, rather than simply focusing on superficial day-to-day aspects of life. Other more specific characteristics of gifted children are important predisposers as well.

Because gifted children are able to consider the possibilities of how things might be, they tend to be idealists. However, they are simultaneously able to see that the world is falling short of how it might be. Because they are intense, gifted children feel keenly the disappointment and frustration which occurs when ideals are not reached. Similarly, these youngsters quickly spot the inconsistencies, arbitrariness and absurdities in society and in the behaviors of those around them. Traditions are questioned or challenged. For example, why do we put such tight sex-role or age-role restrictions on people? Why do people engage in hypocritical behaviors in which they say one thing and then do another? Why do people say things they really do not mean at all? Why are so many people so unthinking and uncaring in their dealings with others? How much difference in the world can one person’s life make?

When gifted children try to share these concerns with others, they are usually met with reactions ranging from puzzlement to hostility. They discover that others, particularly of their age, clearly do not share these concerns, but instead are focused on more concrete issues and on fitting in with others’ expectations. Often by even first grade, these youngsters, particularly the more highly gifted ones, feel isolated from their peers and perhaps from their families as they find that others are not prepared to discuss such weighty concerns.

When their intensity is combined with multi-potentiality, these youngsters become particularly frustrated with the existential limitations of space and time. There simply aren’t enough hours in the day to develop all of the talents that many of these children have. Making choices among the possibilities is indeed arbitrary; there is no “ultimately right” choice. Even choosing a vocation can be difficult if one is trying to make a career decision between essentially equal passion, talents and potential in violin, neurology, theoretical mathematics and international relations.

The reaction of gifted youngsters (again with intensity) to these frustrations is often one of anger. But they quickly discover that their anger is futile, for it is really directed at “fate” or at other matters which they are not able to control. Anger that is powerless evolves quickly into depression.

In such depression, gifted children typically try to find some sense of meaning, some anchor point which they can grasp to pull themselves out of the mire of “unfairness.” Often, though, the more they try to pull themselves out, the more they become acutely aware that their life is finite and brief, that they are alone and are only one very small organism in a quite large world, and that there is a frightening freedom regarding how one chooses to live one’s life. It is at this point that they question life’s meaning and ask, “Is this all there is to life? Is there not ultimate meaning? Does life only have meaning if I give it meaning? I am a small, insignificant organism who is alone in an absurd, arbitrary and capricious world where my life can have little impact, and then I die. Is this all there is?”

Such concerns are not too surprising in thoughtful adults who are going through mid-life crises. However, it is a matter of great concern when these existential questions are foremost in the mind of a twelve or fifteen year old. Such existential depressions deserve careful attention, since they can be precursors to suicide.

How can we help our bright youngsters cope with these questions? We cannot do much about the finiteness of our existence. However, we can help youngsters learn to feel that they are understood and not so alone and that there are ways to manage their freedom and their sense of isolation.

The isolation is helped to a degree by simply communicating to the youngster that someone else understands the issues that he/she is grappling with. Even though your experience is not exactly the same as mine, I feel far less alone if I know that you have had experiences that are reasonably similar. This is why relationships are so extremely important in the long-term adjustment of gifted children (Webb, Meckstroth and Tolan, 1982).

A particular way of breaking through the sense of isolation is through touch. In the same way that infants need to be held and touched, so do persons who are experiencing existential aloneness. Touch seems to be a fundamental and instinctual aspect of existence, as evidenced by mother-infant bonding or “failure to thrive” syndrome. Often, I have “prescribed” daily hugs for a youngster suffering existential depression and have advised parents of reluctant teenagers to say, “I know that you may not want a hug, but I need a hug.” A hug, a touch on the arm, playful jostling, or even a “high five” can be very important to such a youngster, because it establishes at least some physical connection.

The issues and choices involved in managing one’s freedom are more intellectual, as opposed to the reassuring aspects of touch as a sensory solution to an emotional crisis. Gifted children who feel overwhelmed by the myriad choices of an unstructured world can find a great deal of comfort in studying and exploring alternate ways in which other people have structured their lives. Through reading about people who have chosen specific paths to greatness and fulfillment, these youngsters can begin to use bibliotherapy as a method of understanding that choices are merely forks in the road of life, each of which can lead them to their own sense of fulfillment and accomplishment (Halsted, 1994). We all need to build our own personal philosophy of beliefs and values which will form meaningful frameworks for our lives.

It is such existential issues that lead many of our gifted individuals to bury themselves so intensively in “causes” (whether these causes are academics, political or social causes, or cults). Unfortunately, these existential issues can also prompt periods of depression, often mixed with desperate, thrashing attempts to “belong.” Helping these individuals to recognize the basic existential issues may help, but only if done in a kind and accepting way. In addition, these youngsters will need to understand that existential issues are not ones that can be dealt with only once, but rather ones that will need frequent revisiting and reconsideration.

In essence, then, we can help many persons with existential depressions if we can get them to realize that they are not so alone and if we can encourage them to adopt the message of hope written by the African-American poet, Langston Hughes:

Dreams

Hold fast to dreams,
For if dreams die,
Life is a broken-winged bird
That cannot fly.

Hold fast to dreams.
For if dreams go,
Life is a barren field
Covered with snow.

– Langston Hughes
gifted and depressed

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