In the WCPA winter newsletter, topics include Avoiding Despair in Today’s Discouraging World, Loss and Equanimity, Mental Health Stigma in Medical Settings – Family Caregivers, and Psychological Testing Available.
- Bad News, by Amy V. Maus, MSW, LCSW
- From the Director ~ Loss and Equanimity, by Mary Fitzbibbons, Ph.D.
- Treating Mental Health Stigma in Medical Settings Part 3: Family Caregivers, by Amy Neu, MSW, LCSW
- Psychological and Psychoeducational Testing Available
How Do We Avoid Despair in Today’s Discouraging World?
Amy V. Maus, MSW, LCSW
I recently received bad news. Not the worst news, mind you. Not the death of a family member or a terminal diagnosis, but still, truly, very bad news. I cried the entire way home and didn’t sleep that night. The next morning, I realized how very much bad news I have absorbed recently. The stories out of the middle east have been shocking and depressing. Political news – no matter your political persuasion – almost always seems disheartening. It’s easy to feel like the world is falling apart. Honestly, I couldn’t care less about football (yes, I know I’m the only one) or Taylor Swift, but since at least a portion of that story seems to be about young love and a new relationship, I find that I don’t mind hearing about it at all. At least it isn’t war. At least it isn’t another story about life around us seeming to fray. I think it’s become hard, at times, to avoid a sense of dread about the future for our kids, our grandkids, and our country. So, when I received my no-good, very bad news, it felt like life was piling on in a way that had become too much. My guess is that many of you can relate.
I remember a few years ago, during the height of the pandemic, a colleague and I discussed what gave us hope during dark times. It was interesting how very different our answers were. Like many people, my lovely colleague looked for the good, little things in life. She looked for the helpers, as Fred Rogers would say. She found a measure of peace by remembering the kindness of a neighbor, the silliness of one of her children, or the way her front porch flowers were blooming. Never one for the easy route, at that moment I had found comfort in the opposite direction, re-watching Neil deGrasse Tyson’s updated series of Carl Sagen’s Cosmos. As I pondered the incomprehensible vastness of space and time, that pandemic year’s events on the pale blue dot somehow seemed less all-encompassing and more ephemeral. I was able to put it into perspective, and that helped.
If we’re honest with ourselves, I think it’s hard sometimes to find things that really help us feel better during bad times. All too often, today, we find ourselves reaching for poor substitutes for happiness – scrolling social media, shopping and buying, busying our calendar with constant activities, and consuming calorie-laden treats – that give an immediate burst of Dopamine. The pleasure is quick, but it doesn’t last. We observe that we ourselves and the people around us seem to experience more anxiety and worsened depression, instead of the lifts in mood that we seek.
In his 2022 bestseller, Stolen Focus, Johann Hari described taking three months out of life, by himself at a borrowed vacation home, to disconnect completely from all forms of technology and social media, to live, think, and eat slowly again, and to set aside modern distractions. He expressed how surprisingly difficult and unpleasant this was for a while in the beginning. Without the constant companionship of his smart phone, he experienced the cravings and panic of an addict deprived of their substance of choice. Things changed, though, as his time there went on. He woke up feeling refreshed after full nights of sleep, not yearning for coffee. He could become absorbed again in reading good books and in completing his work. He wrote about how his health, mental health, and sleep improved over those months.
Few of us can afford that kind of lengthy reprieve from life’s busy-ness, but there are steps that the majority of us can take which have proven time and time again to bring greater well-being into our lives. These steps are not the quick fix of the bubble bath, glass of wine, or weekend fishing trip. Strategies for emotional survival often do not even feel good in the moment. Instead, the things that are actually effective in bringing long-term well-being can sometimes feel like work. We treat ourselves to sleeping in a few extra moments, but it’s getting up for that morning walk or workout that brings lasting improvement in our mood. We treat ourselves to binge-watching a favorite show late into the night, but it is getting to bed on time, consistently, that helps us feel better day by day. A lazy Sunday morning feels nice in the moment, yet for many of us there are more lasting benefits to engaging regularly with a faith community, and experiencing the support and hope that can bring.
So where can we find good news for ourselves and our mental health? What avenues toward comfort really work? Few things are better for mental health and overall emotional well-being than regular, moderate exercise. Unfortunately, in our country, we have conflated regular exercise with dieting and attempts to lose weight. Of course, nothing makes something less appealing than to attach it to the concept of calorie restriction. As a result, many people whose emotional well-being would benefit the most from physical exercise avoid it altogether. Research suggests that regular moderate exercise (30-45 minutes, at least 4-5 times per week) is as helpful to mental health as are antidepressant medications, and of course it comes with far fewer negative side effects.
Similar to exercise, almost nothing beats good, restful sleep when it comes to our well-being. But too often today we reach for melatonin and other sleep medications, which leave us feeling as if we slept through the night, but create a much poorer quality of rest. Far more effective is the work of good “sleep hygiene” – consistently prioritizing enough time for sleep, going to bed at about the same time each night, avoiding caffeine, alcohol, and screens before bed, and having a cool, darkened, quiet place to sleep. For those whose minds start to whir and worry after their heads hit the pillow, learning skills about relaxation, self-talk, and worry scheduling can also be helpful.
In addition to tending to the body, minding our close relationships also creates high rewards for happiness, studies consistently find. In one such longitudinal study from Harvard, researchers found that close relationships are what matters most to lifetime happiness. More than money or career success, close relationships with friends and family have a protective quality against depression and despair, and clearly appear to boost both longevity and quality of life. Older people who report having many good friends consistently score better on measures of health, cognitive skill, and emotional well-being. And every good therapist knows that what matters most to effective psychotherapy is not the therapist’s theoretical perspective or methods, but the quality of the relationship that develops between therapist and client.
This year, the American Psychological Association joined with the U.S. Surgeon General and six major national medical groups to make it clear that constant screen time and social media use are creating a tsunami of mental health crises in our country. Many of us are starting to experience the significant costs that come with our modern habits. When we spend our lives looking at little screens, we certainly suffer the negative effects of what we see there: the bullying, the graphic sexual content, the fear of missing out, the poor judgement and boundaries, and the bad news. But we also experience the opportunity cost, namely what we miss out on when we are absorbed in modern distractions. To be sure, this includes physical exercise, restful sleep, and time with our intimate relationships. It also includes spending time outdoors, reading, uninterrupted productive work, involvement with our spiritual or faith life, helping others, and engagement with our community. Among other things, these are the activities that most benefit our mental health and well-being. These are the experiences that make life better.
Today, so many of us feel in our gut that something is missing, something is wrong, but we don’t know what, exactly. We must make and take time for that which truly matters. These things are often slow, not fast. They require effort, but those efforts pay good dividends. The good news is that, unlike the author and his three-month hiatus, we don’t have to do it all at once. But, if we want to feel better, we do have to make intentional efforts. What can we do today, this week, this month, to decrease our pace of life and incorporate real self-care? Get to bed, take a walk, read a book, help a neighbor, see a friend. Put down the phone.
Amy V. Maus, MSW, LCSW
specializes in services to schools, serving students of all ages. She frequently provides training for school staff, presentations for parent groups, and consultation and training for Care Teams and community organizations. Amy also leads monthly consultation groups for area school principals and serves as an on-site social worker for schools that contract for weekly services.
From the Director ~ Loss and Equanimity
Mary Fitzgibbons, Ph.D.
As we age, I believe we experience more instances of loss and a greater sensitivity toward it. Yet loss is with us from the beginning stages of our lives. At birth, we are separated from the safety of the womb. We develop a symbiotic attachment toward our parents and other critical caregivers. But, if we want to develop healthy relationships with others, it is necessary that we separate from our parents at two later critical points in life: eighteen months to three years, and adolescence. This enables us to individuate and become our own person. This is the beginning of healthy emotional development.
As life continues, we experience numerous other losses, many of which we take for granted and may still have an impact on our lives. We feel sad in losing our place as the oldest child. Someone has taken the spotlight from us. We then feel the loss of childhood. Some of us leave it slowly, evidenced by the fact that the average age to leave our childhood home is now thirty. As life goes on, loss continues. We realize we can’t take good health for granted. Our body isn’t responding as it did when we were younger. We look at pictures from twenty years ago and we realize that this isn’t the same face that we now see in the mirror. It seems as though everyone we know is having hip or knee replacements. We talk much more about our health. Forgetfulness becomes an everyday part of our lives. And then the greatest loss. Our parents, our friends are seriously ill. Death of those closest to us becomes more common. We lose our purpose, status, security, and control. We may have not been able to contemplate the emotions concerning our birth, but as we age, we find ourselves spending a great deal of time thinking about our death.
As difficult as loss can be, there are also benefits that may arise as we age. Judith Viorst, in her book Necessary Losses, says that life consists of a series of losses. In reality, without losses there would be no gains. For example, if we did not lose the symbiosis or dependence with our parents as children, we would not develop the sense of independence of being able to survive in an adult world. What we work to achieve in our adult life is an attitude of acceptance. While there may be hardships, there are also graces to be had. For those who have come to the state of acceptance and serenity, what they’ve come to realize is that we possess tremendous power to make our lives miserable or joyous. In all situations, it is our response that decides whether a situation is a crisis or something to be dealt with. We decide how much emotional energy we want to expend.
One of the practices that demonstrate this, especially in terms of our troubled and chaotic times, is equanimity. It is not a term we use often. It is a state of psychological stability and composure which is not changed by the exposure to tense emotion or pain. Some would say that it is the secret ingredient in mindfulness, in that it leads to wisdom. It implies an acceptance of what is, not what we want or expect it to be. It helps us not to get overwhelmed and to meet challenging events without being shattered. It is a steadiness of mind and a calm understanding that allows us to be with the constantly changing and shifting landscape of our world. It is an evenness of temper. It is characterized by the ability to remain calm, composed, open, and non-reactive in challenging or distressing situations. Equanimity is crucial for our psychological well-being.
In the face of loss, we look for that which takes us out of our pain. We search to develop and enhance an inner peace. In the face of loss, we search for acceptance and equanimity. The following suggestions may give us a sense of how we can create this state within ourselves.
- Sit comfortably, give yourself a moment to arrive.
- Let yourself stop. Be here, in your body and this place.
- Let yourself relax fully.
- Edit any narrative in your head.
- Drop into the present.
- Stop the conversation in your head, stop the arguments with yourself and with others.
- Realize that there is nothing to do, no one to be.
- Feel the sense of being right here and right now.
- Don’t create tension with what is arising in your life,
- relax with it
- Don’t try to fix it.
- Let yourself be held by this stillness.
- Rest in this quiet, this awareness, this equanimity.
Loss is painful and it is inevitable, but it also has its gifts. The acceptance of loss brings us to a higher place. It gives us the opportunity to come to know ourselves in a deeper way. It gives us the opportunity to be our best self. It can bring us to a state of equanimity.
Treating Mental Health Stigma in Medical Settings
Part 3: Family Caregivers
Amy Neu, MSW, LCSW
“My husband is in rehab for the next few weeks, and I’m even more overwhelmed than usual. My friends tell me to enjoy time to myself while he’s taken care of there, but somehow, it’s even harder with him away from home. He calls me constantly, begging to come home, and I think the staff expect me to stay because he gets so difficult. I don’t know what to do anymore.”
– Stressed family caregiver
Family caregivers of adults with physical and mental health issues often feel stuck in the middle when a loved one is placed in a medical setting. The example above echoes what many family members in this situation express. Common advice given by well-intentioned friends is that while our loved one is at a facility, we should take the deserved time off to recharge and to catch up on all that has piled up while caregiving. However, caregiving comes with its own unique stressors when our loved one is being cared for outside of the home. These pressures often leave us feeling uncomfortable with the idea of “taking a break” away from the facility.
Caregivers often report feeling overwhelmed, frustrated, and exhausted during this time. While each caregiving situation is unique, there are pervasive stressors that family members face when their loved one is in a new facility. Our sleep quality decreases, anxiety increases, professionals we interact with can be new to our loved ones, communication can be challenging, we put less priority on our own nutrition and hydration, and the environment itself can be overstimulating to our senses. Our loved ones also struggle with the changes in routine, unfamiliar surroundings, continuity of care concerns, and the different assessments, tests, and treatments. Furthermore, these changes often exacerbate the underlying mental health issues of our loved ones, leading to increased erratic, anxious, or difficult behaviors while they are away from home and their usual routines.
It takes time for anyone to recover physically, mentally, and emotionally from these abrupt changes. We, like all humans, can only operate functionally for a brief period under these circumstances. In this state, we as caregivers cannot expect to rise above the chaos and become our own best self. Many of us, however, belittle ourselves at these times, and in turn become a more critical version of ourselves. Ultimately, this version is one that many of us do not wish to be, fueling a sense of being even more out of control and overwhelmed, continuing a vicious cycle.
If this sounds familiar, it is time to make some healthy changes and begin to take care of ourselves one step at a time. A good first step is to treat ourselves with more compassion and understanding. One way to treat ourselves with respect is to remind ourselves of the following concepts: We are only one person. We cannot do it all; no one could. This by no means implies that we are weak or failing. Quite simply, it means that we are tired and deserve relief.
Next, we can reflect on the universal caregiving challenges in this setting, discussed earlier. As we realize that we are not alone in these feelings and are deserving of compassion, we can more clearly explore options available that could alleviate some of the weight we feel. Keep in mind that we may not like the options available to us at a certain time and there rarely is one “right” solution. However, it helps us to recognize that we do have choices in many regards and can select the options that best meet our needs and values at the time. When we remember that we have choices and options, we are often able to be more present-oriented and patient with ourselves and those around us.
As we implement this new practice of mindfulness, we can more clearly identify what we are realistically able to do and what we cannot do; what is ours to do and what is someone else’s responsibility. There are many things in this scenario that we have little to no control over (i.e., the availability and length of time we speak with providers, how our loved one behaves, the course of illness) which understandably cause us stress. It is important to recognize and begin to accept our lack of control in these areas and try to refocus on the things we can do.
For example, we can keep records of who we speak with as well as the content of the conversation. We can consider the questions we want to pose to professionals and how we want to express these ideas. We can identify the staff members who genuinely appear to listen, care, and be knowledgeable about our loved ones’ situations and request their assistance for advocacy to the medical team if needed. We can let important people (staff, family, our loved ones) know our availability to discuss care and when we will be unavailable. We can listen to the opinions of our loved ones and do our best to advocate for them in the setting. We can choose to go home and sleep, knowing that a team of professionals is caring for our loved one. Yes, they may do it differently than we do at home; however, our loved one will be safe, and we will be a better family caregiver tomorrow after a night’s rest, shower, and meal.
It is a new idea to many of us as caregivers that we are not required to be available to people at all times. As with many new ideas, it takes practice to break ourselves of this habit. It is imperative to begin to form healthy boundaries for ourselves that we are willing to enforce. As we begin to brainstorm about the areas in our life we want to change, we can notice what feelings come up for us. What stops us from setting a boundary and taking care of our own needs? Guilt, fear, and feeling responsible if something negative happens are common barriers for many of us. As we gain awareness of what prevents us from doing what is healthy, we can decide what boundaries are worth taking the leap to set for ourselves. The article “Maintaining Boundaries as a Caregiver” provides a brief introduction and offers suggestions on how to create and reinforce healthier boundaries (https://mhanational.org/maintaining-boundaries-caregiver-go-guilt-glow).
Other ways to alleviate the stress is to take better care of ourselves physically and mentally. Follow basic tips, such as increase water intake, eat healthy meals (or at least pack some quick healthy snacks such as grab and go fruits, veggies, nuts), limit caffeine, and make a point to walk the hall every hour. These small habits help us maintain ourselves physically, mentally, and emotionally. Another way to care for ourselves is to locate resources for caregivers. There are many family caregivers who want and deserve support, and therapy is easier to access than ever before with telehealth platforms and in-person sessions as options. If you or a loved one would benefit from support, please reach out to WCPA to get connected to an experienced professional today.
*This article is the final in a three-part series, which covers the issue of mental health stigma in healthcare. The first article (Spring 2023) focused on individuals with mental health issues as they navigate the medical system. The second (Fall 2023) was centered around the experiences of medical providers and staff in senior living communities.
Psychological and Psychoeducational Testing Available
At WCPA, we offer a wide range of comprehensive psychological evaluations tailored to fit your individual needs. We serve children, adolescents, adults, and seniors.
WCPA clinicians frequently provide evaluation for issues such as: mood and anxiety disorders, ADHD, Autism, specific learning disabilities including dyslexia, intellectual impairment, behavior disorders, and trauma. In addition, we provide clergy evaluations for those considering religious life, pre-adoption evaluations, and disability evaluations.
Psychological evaluations typically involve a clinical interview, during which the clinician will obtain a thorough history and determine what type of testing is appropriate. The next step involves psychological testing, which may include cognitive, achievement, emotional, and/or personality testing depending on the presenting problem and referral question. After the evaluation, your clinician will prepare a report summarizing findings, diagnoses, and treatment recommendations, and will meet with you to provide feedback.
If you would like to learn more about accessing evaluation services, contact the WCPA office at (314) 275-8599.