Wednesday, July 25, 2018

Meaning...what?

I checked in with a friend of mine recently and she said she was "okay but still searching for the meaning of life." I responded, "that's a given, the search never ends, does it?" She responded in a way that suggested I knew what the meaning of life is and I needed to share my secrets. So why just tell her when I could tell a whole bunch of people at once?
I used to think the meaning of life was a search for love - true love. I was young then. So... very... young. But as I grew older and I had more and more life experience under my belt, that goal changed. The goal kept changing. Why? Because I met the goals. I was growing, learning, evolving, gathering, every day of my life. What good would it be to hold onto something that was years behind me as a goal? Like goals, meaning is what we make of our experiences, and what we crave above all else. And when we find it - will it be enough? Will it fill that empty space inside us that we can't define with any words?
That depends. You'll know when you get there, right? It's different for everyone, because we're not robots. Some want money and derive meaning by making money. Go ahead and roll your eyes, but that means it's not Your Meaning. Some want to see their kids be successful and happy, some find meaning in music or art, some find meaning in friendships and relationships. There is no Meaning Of Life, in other words, for everyone. There is no old man on the mountaintop who holds the secrets and riddles you to get the answer out of him. I also think that once you stop searching, and settle into a life where days melt together and you hardly feel the will to live, you need to get back to your search. Actively.
You may need help getting up and getting motivated to do this. I have been facilitating a book club this year for Self-Help books. I never read very many before but I find them, well, helpful. None of them promise a 3 step program to making all your dreams come true. They offer inspiration, advice, philosophies, research findings and stories of experience. Starting there on your new journey could be right for you. If you think you are too deep into your funk, finding a therapist might be the right first step. I know, you don't want to do that. It's embarrassing, and they make you talk about your past and your pain. It's hard work to look at all the things that have been holding you down. It's also very freeing. You might find that you can finally move forward. And when you can move who knows where you will go?
My friend and I are both going on 50 years old, in the next couple of years (she's older than me nah nah nah nah nah). So neither of us can expect to find meaning in the same things we might have found meaning in when we were going on 20. When we were 20 and in college together, we were just trying to get our papers written, meet boys, and not gain the Freshman Fifteen. I tell my kids that college sounds stressful, but it's the best time of your life; in the best of circumstances of course. No real bills to pay, away from home, but still tethered safely, time to learn and time to play. There will be no other time like that. So meanings change. We get jobs and have families to support and have to fix the car when it breaks down and take care of our older parents.
It's not about being famous or doing something "amazing" with our lives. Being ordinary or average isn't the worst outcome we can have. We watch our friends have kids, we watch our kids grow up, we go on vacation either to a resort or in a tent. We can make meaning out of all of that ordinariness if we want, little by little every day. With some bigger pushes in between. So what do you want? What do you value? Who are the people you need around you? Is there anything holding you down that you are avoiding dealing with? Be introspective, question your world, notice things, learn new things, talk to people you might not otherwise talk to, get out of your safe box. The meaning will be there.

Wednesday, May 9, 2018

Someone who makes you feel like you are "crazy"

It's spring here in Colorado and I have been very busy with so much - just not blogging. So... I had better write something, right? Well, I am seeing and getting a lot of questions about something that therapists used to refer to as "Axis II issues," when we had that sneaking suspicion that there was more going on than simple depression or anxiety. Axis II refers to a disability, such as a cognitive delay that compounds mental health issues. Axis I is the primary mental health issue, Axis III is the medical concerns or diagnoses, Axis for is the level of stress, and Axis V is the Global Assessment of Functioning (GAF) score. Zero means your dead, 100 is frankly impossible. Most people who come in for therapy fall between a 45 (outpatient level) and 65.
Many years ago I took a training with Dr. Greg Lester who lives here in Colorado. I saw him teach in New York and I have since been to a keynote speech he did at a local conference. The title of this post is from the manual I still keep from that first training. Someone with a personality disorder can make us feel like we are crazy. The DSM IV and prior (the big psychiatric "bible") used to break down personality disorders by type and title - the immature types, the anxious types etc. The DSM V, the most current publication, just lumps them into Personality Disorder. Similar to how the authors renamed autism and put it all under one title - Pervasive Developmental Disorder.
The aforementioned training was probably the most useful one I had ever attended. It broke down all of the types and behaviors, gave clear examples -mostly using TV and film characterizations, and how to treat and manage these clients, and perhaps even "cure" them of these dysfunctional patterns of interacting with others.
People who have personality disorders create drama. Drama is used a lot when we find ourselves talking about disagreements we might have with people, or sometimes even just referring to someone who has strong feelings. Clinically, drama is the creation of issues that are not initially present. The person might take on a role of victim and seek help. However when the help is not given or not viewed at helpful, they switch roles. They then take on the role of persecutor or rescuer. This switch of drama creation is the hallmark of every type of personality disorder. People who come into treatment who say they do not respond to any treatments or "always" have felt a certain way most likely also have a personality disorder. The clinician often needs to draw upon their own feelings for information - does this client make you anxious? Or angry? Do they attempt to bait you into discussions, redirect you, confuse you? These are big indicators that it is NOT you. If you are a family member, your feelings will also guide you. It's helpful to recognize these behaviors and most importantly, NOT engage with them.
This last part is extremely difficult to do. We as social creatures are hard wired to engage in debates, justify ourselves, become defensive, and want to make things work out for the best. When you are being led around through another's drama, you will feel crazy.
When someone is smart, it is harder to manage this, as a therapist. Often the treatment looks one sided. The client simply talks and talks while the therapist does not engage. This will be a very different experience for the client as most friends, relatives, and anyone else who comes into contact with them will naturally engage, defend, justify, argue. They will suddenly find themselves in a new territory that forces them to use other skills. Dialectical Behavior Therapy (DBT) is a good modality for this - the clients learn about mindfulness, what boundaries are, general social skills. Once the client becomes genuine, an engagement can happen. This is the real person after all, undefended and wanting to make a real connection despite how frightening that can be. When clients are lower functioning and very disabled by trauma and a resulting personality disorder, setting limits, learning skills of daily living and problem solving are essential.
There isn't a complete explanation of how these behaviors and traits come to be. Sometimes there is abuse, and the personality developed as a way to survive childhood. Sometimes it is a general lack of being held accountable for many years, the narcissist believes he or she is special, perhaps because they were always told this and that they could do no wrong.
Some examples of TV and film characters with Personality Disorders (just for fun) and might help you, if you are a clinician, learning to be one or just curious:
Sheldon - The Big Bang Theory (schizoid)
Hugh Grant - About a Boy (schizoid)
Nicole Kidman - To Die For (narcissistic)
Pheobe - Friends (schizzotypal)
The entire cast of Amelie (paranoid, avoidant, histrionic, borderline etc)
Mary Tyler Moore - Ordinary People (obsessive compulsive)
Michael B. Jordan - Black Panther (anti-social)
Mel Gibson - Conspiracy Theory (paranoid)