Tuesday, November 29, 2011

Snap out of it


A few years’ ago, I attended a training workshop and at the end of the workshop, the trainer gave each participant a memento. It turned out that the mementos were fridge magnets and they came with different tag lines. They were randomly given out, not in any particular sequence or order and some certainly looked more attractive than others. Mine read “Snap out of it”. I did not like the words on my magnet and the girl in the picture looked unfriendly and hostile. The image was a little too jarring for my liking. I would have preferred something, which had more flowers or floral designs, one with a more tender and kinder look. I brought the magnet back to my office and carelessly left it on my whiteboard, dismissing its existence.

Over time, I forgot about that magnet.

“I have to snap out of it!” Debbie exclaimed, with much exasperation. At that point, the image of the forgotten magnet with “Snap out of it” boldly printed on it, appeared in my mind. I understood why the girl in the picture had her hands on her waist and an angry look on her face. I recognised that look in Debbie’s expression.

Debbie had been feeling stuck after the June holidays. It had been five months and she did not feel any better.

“I am burn-out. Can you tell me what I can do to stop feeling this way?” Debbie felt lethargic and unmotivated. She did not feel like doing anything and had no interest in her life. Each day went by like a monotonous, uninteresting routine and this made Debbie very frustrated because she wanted her life back.

"To keep the lamp burning, we have to keep putting oil in it." - Mother Teresa

Debbie ran out of “oil” and forgot to replenish it. During the first half of the year, she had numerous engagements and a variety of commitments. Contrary to what you think, she did not feel distressed and she enjoyed executing the projects and taking on new responsibilities. In fact, she was enthusiastic with her academic study and performed well in school. Life seemed to be going well for her and suddenly, everything came crushing down after the June holidays.

How could someone who is doing something she enjoys, experience burnout? Besides, she felt motivated and energised by the activities she was participating in. Perhaps, as the saying goes “too much of a good thing is a bad thing” – Debbie over-committed herself and was not even conscious that she was depleting her internal resources over time. She attempted to rest more, reduce her activities and even went for an overseas trip with her family after the examinations but nothing worked. She felt depressed, which must not be confused with being in depression. She contemplated going to see a psychiatrist to obtain medication so that she will not feel so awful. She resisted coming to see me because she was concerned that seeing a counsellor will affect her applications for scholarships in the future.

I realised that some people are more comfortable to see a medical professional like a psychiatrist for their psychological ailments because the general impression is that they may not need to talk too much or reveal too much about their deepest, darkest thoughts and fears. In addition, a pill a day may just take away their distress! However, to many people, psychotherapy and counselling seem to have a more iffy and mysterious approach with regards to addressing one’s distress.

One client said to me, “I did not want to see a counsellor initially because a counsellor is able to read my mind! That’s really scary!” Wow! If I can read people’s minds, I must be some mystic or spiritual being! No, therapists do not have such powers. But I can appreciate the fact that it is difficult to talk about issues that cause a great deal of emotional pain and to feel vulnerable in front of another human being.

Another client asked me, “Do I really have to talk about my feelings? Can’t you just tell me what to do? It’s tiring to get emotional.” I do not have the practice of dishing out “what-to-do” advice in step-by-step bullet point tips because I see each human being as unique and different. What works for one client may not work for another. Just as Irvin Yalom wrote, “…the therapist must strive to create a new therapy for each patient.”

The other day, I was listening to a talk by Michael Yapko, a clinical psychologist, about treating depressive clients. He mentioned that one of the best advantages of psychotherapy is that it does not have the range of possible negative side effects of psychiatric medication. He also raised another important point that in order to “get better”, you will need to make changes in your life – your perspective to life, how you live your life and what you do with your life. Issues that you struggle with or relationship difficulties that you experience cannot be resolved by the mere act of pill popping. There is unfortunately no miracle pill for curing psychological and emotional pain.

"It takes more than a sudden leap to change a life. It takes a conscious act, a decision to take our life into our hands." - Mildred Newman

We often blame our unhappiness to our personality, lack of insight, lack of time, lack of money, bad luck and poor upbringing. Mary Pipher reminded me in her writing that we cannot ignore the effects of “meaningless jobs, long commutes, sterile suburbs, and fears of poverty, war, violent death, and environmental catastrophes.” At the end of that paragraph, she grimly concluded, “Life makes most of us unhappy.”

As much as we want to be optimistic about life, there is a great amount of pessimism, negativity, self-centredness and despair in the world. Consider the amount of sensationalised bad news sprawled all over the daily newspapers and its proliferation throughout the Internet. Even our interactions with one another, conversations and various forms of communication are pre-occupied with gossips, complaints and lamenting about life. At times, even when there is something good which happens, we become a little skeptical by finding faults with it and believing that it is probably just a figment of our imagination or that it will not sustain.

The happenings of life around us will impact us and affect how we feel but it is not helpful to dwell on them either. The question which we have to ask ourselves is how we can live in this world in spite of what happens around us and how people around us are like. Each of us is responsible for our own life and how we live our life can potentially influence other people as well as their lives.

“The good life is a process, not a state of being. It is a direction not a destination.” – Carl Rogers

********************

“What can I do to get better?” Debbie was desperately looking for solutions and antidotes. When she first talked about experiencing burnout, I instantly thought that she needed to rest and take a break. However, she had not been doing much and she took a holiday with her family – she seemed to have rested enough. Hence, we discussed about the aspects of her life she needed to change, new routines to put in place and adjustments to the way she was living her life. We talked about taking part in physical activities, making use of art, getting in touch with nature and connecting with people. After the session, I thought that it may be helpful to include the aspect of spirituality (this is not to be mistaken with being "religious") in our conversation as well. Perhaps I will mention it the next time I see Debbie.

“...have a life. Have relationships and interests besides your work. Do things that make you laugh and recharge your batteries.” - Mary Pipher

Sunday, November 20, 2011

The turning point


A few days’ ago, my best friend, Arlene, asked, “Is a mid-life crisis a psychiatric condition? Or is it just an urban myth?”

I am no expert in the subject of ‘mid-life crisis’ but responded from my own understanding, “It is not a psychiatric condition. It is just something that happens as one of the phases of life. It is normal and natural.”

“Can a person not ever have a mid-life crisis?”

“Possibly. That’ll be one who just cruised along without noticing anything about his or her life! Or someone who just numbed himself or herself throughout.”

Arlene was hopeful, “Or someone who is incredibly well-adjusted throughout.”

“Not necessarily well-adjusted. Oblivious to life!”

“Or perhaps someone in denial.”

“Denial is possible.”

“Why does it happen at this age?”

Arlene was asking very pertinent questions and I felt that she wanted some sort of expert perspective, which I felt inadequate to be able to “correctly” elaborate. I am sure that there are many different viewpoints and some professional stance or definition. But I shared my thoughts anyway, “It’s a turning point in one’s life. One would have accomplished oneself in some ways, work, family, studies etc. It’s kind of the midpoint of life, looking back at the years, what one has done so far. And really contemplating how one wants to live for the next half of one’s life. It’s kind of existential as well. How meaningful has life been? How happy are you with your life thus far? Is this how you want to live for the rest of your life? What else do you want to do or achieve before you die? While you still have the time and energy to do so?”

“But why is a crisis a necessity?”

“Crisis, because there is a lot of uncertainty, emotional turmoil, may rock relationships, changes in lifestyle, economic status, struggles, difficulties, discontent with life, yearning for something more and so on.”


About half a year ago, Clyde Murthy, my clinical supervisor of four years, observed, “It sounds like you may be going through a mid-life crisis.”

I laughed and looked at him with great disbelief, “You've got to be kidding! At this age? Isn’t it too young to have a mid-life crisis?”

Well, there has been a lot of changes and transformation in my life in the past year so it does look like I am going through my very own mid-life crisis!

I just turned 35 on 17th November and I felt compelled to reflect on my life thus far. If this is the middle of my life, I expect to have at least another good 35 years to go. In the days leading up to my birthday, I wrote a series of five wall posts on my personal Facebook wall to appreciate what I have, to acknowledge the positive changes in my life in the past year and to give a glimpse of my hopes for the year ahead.

“…happiness is about appreciating what one has… It means finding pleasure in the ordinary.” – Mary Pipher

First, I shared about my “marriage” with my work. This term was used by David Whyte in his book entitled “The Three Marriages: Reimagining Work, Self and Relationship”. I feel that I have discovered a good marriage with the work that I do as a psychotherapist, something which resonates with who I am. I left the engineering profession five years’ ago to embark on an ongoing journey with my clients. This was what I wrote about on my first Facebook wall post. In July this year, I moved on to a school setting and I feel that the environment is a lot more suitable for me, my personality and my style of working where I feel more affirmed, appreciated, empowered and validated. In addition, I have had several opportunities to interact with psychotherapists around the world to learn from them, learn with them, and be moved by various books, writings, talks and presentations. Hence, I am in a very good place, professionally.

The “marriage with the self” is one of the most complex of the marriages but I feel that I have started the process to make way for the re-construction of the self. A year ago, I felt that deep down inside, I was broken and in pieces. I was not intact inside and was unable to hold myself together if I faced difficulties and challenges in my life. Hence, I dedicated the second and third Facebook wall posts to the changes, which I have made in my life to have a better marriage with myself.

My second wall post was about discovering long distance running. The turning point of my life was on 1st February this year when I received a phonecall from Karen, a Running Lab sales representative. She congratulated me for winning a lucky draw prize to run a marathon in Los Angeles. I thought that she was joking because I have never been lucky in lucky draws and I thought it would be crazy since I have never run a marathon before. I took up the challenge and trained for the marathon, which was scheduled seven weeks later on 20th March. I think that I completed the marathon out of shear determination and endurance because I did not think running was my cup of tea. However, after that marathon, I feel as though I have been running like Forrest Gump since! Long distance running is a way for me to connect with my physical body with every step that I take, to allow the energy to flow between the ground and me. Grounding. Foundation. Connection. Flow. The most therapeutic part about long distance running for me is the time for solitude, to be able to reflect and clear my mind. This is one part of the marriage with myself, which I have strengthened.

The other part (my third wall post) is bringing choral singing back into my life. Music is like language to the soul. Music has an element of rejuvenation and reinvigorating. Listening to music is one aspect of it, which I do a lot. At times, I play the piano, which provides a kind of solace for me. However, choral singing is what speaks to my soul. Singing is like bringing a musical instrument, my voice, anywhere and everywhere I go. There is no hassle at all. It doesn’t take up space. It doesn’t require an electrical supply. It is part of me. Although I have sung solo before, I am more intrigued by singing in a choir, which is the bringing together of many different voices of diverse qualities to make music. How miraculous and marvelous is that! After eight years of hiatus from choral singing, I now spend my Saturday afternoons with my fellow choristers in One.

My fourth wall post pays tribute to the marriage with relationships, which is appreciating the relationships with significant people in my life. I have a few good friends who have been great company on my journey of life. They are people whom I have endless conversations over meals and coffee – laughing and rejoicing and sharing the joys of life; comforting and empathizing over the tears and crying of the pain experienced in life; and just being there for me, always. The other constant in my life is my parents. I do not always share the gory details of my life with them but I can always count on them to be there for me when I need them. This is when I appreciate that blood is thicker than water. I was supposed to meet a friend for dinner on my birthday but it was called off at the last minute due to work commitments. There was no fuss at all. I felt as though my parents dropped everything and took time to be with me, to have dinner with my children and me on my birthday.

Finally, my last wall post is like my new year (or new birthday year, which is more apt) resolution of what I hope to work on for the year ahead.

Excerpts from my wall post read, “For the year ahead, I look forward to improve my emotion regulation, self-soothe more, cope with my vulnerabilities and feel more comfortable with myself as a person.”

“And in the end, it’s not the years in your life that count. It’s the life in your years.” – Abraham Lincoln

I am going to make the life in my years count.

Wednesday, November 9, 2011

Numbing the pain


About seven and a half years’ ago, I was lying in the hospital in a lot of pain – labour pains. It turned out that my baby was in distress and I had to go through an emergency Cesarean procedure instead of the normal delivery. I was looking forward to experience what my mother had to go through to give birth to me so I was somewhat disappointed that the birthing experience was going to be replaced by an operation. An anesthetist was called in to administer epidural to numb the pain, so that I will not feel any pain during the process. Indeed there was no pain. I was a passive participant in the entire procedure, just a spectator observing the nurses and doctors do what they are supposed to do to bring the new life into this world. I was drowsy and sedated so I have only a very faint memory of what happened that evening.

As the hours went by, the effect of the painkillers started to wear out and I felt pain at my abdominal area, where the 10 cm-wound was located. The pain was immensely unbearable and I had to take the prescribed dosage of painkillers, to numb the pain. It was easy to have epidural or painkillers numb my physical pain, but what was more painful was feeling like an inadequate and incompetent mother, who was unable to give birth in the “normal” way. When I was wheeled out of the operating theatre to face my mother, I thought I saw a face of ridicule - I had a few points taken off from my scoreboard as a mother, even before I even started. There were no painkillers available to numb that painful feeling.

However, human beings are such creative creatures. We sought out “painkillers” for life’s pain, to numb the pain, to avoid, run away from and hide from our difficulties. In school, we strive towards academic excellence, learning the grammar of languages, the complexity of mathematics, the intricacies of science and the poetic discourse in literature. Alas, there is no curriculum for dealing with life’s challenges. I must admit that it is tough to face our problems and difficulties. It is much easier to avoid them instead of having to deal with them because we often do not know how to resolve them and we do not know how long it will take to resolve.

For a number of my friends, the “painkiller” of choice is alcohol. They often call it “social drinking”, just to have a couple of drinks with their friends, to chill and chat with their drinking buddies. Some go on to disguise their need to indulge in alcohol as a form of “necessity” to socialize with their business associates, to seal the deal. Their explanation seems reasonable and legitimate.

At the end of every work day, Steven returns to an empty home. He lives alone. He has been living alone since his divorce. It has been many years but he still felt the emotional pain from the breakdown of the marital relationship. The pain of loneliness haunts him as soon as he walks through the door to the deafening silence of the emptiness. The only company he has is the sound of his own footsteps and the tiny stream of warm air from his breath. Occasionally, he may hear the neighbour's dog barking or the chime of the lift when a neighbour returns home from work. All these are terrible reminders that no one is witnessing how alone he is, how isolated he feels deep down inside. Steven has his television set on constantly. It gives a sense that there is life and activity in his home. He has the company of the newscaster, the actors and actresses of some TV drama series or hosts of some variety programmes.

On some days, Steven resorts to drinking, so that he is not completely sober when he returns home. The effect of the alcohol dulls his senses and he becomes less aware of his loneliness and he quickly falls asleep. By the time he wakes up in the morning, it is yet another work day, where the routine repeats itself. Steven never allows himself to deal with his pain, to face his pain, to go through his pain and to eventually heal his pain. Instead, he skillfully numbs his pain, with varying amounts of alcohol. It is certainly easier avoid having to face his pain.

For some, spending long hours at work keeps their feelings in check. They bury themselves under piles of paperwork (not so common in this era of modern digital technology) and go through the regular flow of e-mails into both their work and personal e-mail accounts. The happiest people who benefit most from these workaholics are probably their employers because they present themselves as being hardworking, productive and dedicated workers. You may ask them why they work so hard and their usual reply would be, "I can't help it. There is just so much work to do." In some cases, the inherent nature of the job demands the person of his time and his life. However, for the large part of it, it may be the unconscious result of the individual loading himself or herself with immense amount of work, leaving little spare time to dwell on any difficult emotions.

Mei fell out with her friends. They used to hang out together all the time. They studied in the library together; they ate in the canteen together during recess and lunch breaks; they shared many interests and did a range of activities together. Unfortunately, there was a misunderstanding and their feelings were hurt by one another. You know how difficult it is to mend relationships under such circumstances. Mei did not know what to do and no matter what she tried to do or say, there was hostility and tension. It was no longer important to try to ascertain blame or trying to figure out who caused the friendship to turn sour. Each of them distanced themselves from each other, feeling sad, hurt, pain and isolated, no longer able to seek comfort from the closeness they used to have as friends.

“Never mind. I’m used to it already. I shall just focus on my studies.”

Mei decided that she will turn to her books and study. She can hang out with her books any time of the day. Her books will never get hurt or angry with her. They are much more reliable source of company. The advantage is that her grades will probably improve since she will be studying a lot more. She will spend so much time on her studies that there will be no time to think about friends, friendships or touchy-feely stuff like emotions.

We can be very effective at avoiding our pain, numbing our pain. Mostly, it involves some kind of obsession or compulsion. Some people consume alcohol, illicit drugs or food. Some people indulge in gaming, online activities, watching drama series, shopping or gambling. Others hide behind a more acceptable façade of excessive working, intense studying, obsessive exercising, involvement in multiple activities and so on.

"Don't numb yourself to your trials and difficulties, nor build mental walls to exclude pain from your life. You will find peace not by trying to escape your problems, but by confronting them courageously." - J. Donald Walters

There is no single remedy or solution for the trials and difficulties which we face. By numbing ourselves, building those walls and trying to escape our problems, it seems that the problems have disappeared. But once the effect of the “painkillers” wears out, we are reminded that our pain is still very present, lingering somewhere in our experiencing self. What is the pain that you are running away from? How are you hiding from it? Do you need to grieve sufficiently over some loss in your life? Do you need to let go of a lost relationship? Do you need to forgive yourself? Do you need to accept yourself for who you are? By confronting your difficulties courageously, you would have to struggle and there will be discomfort. The only way out of pain is through it.

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For a long time, I struggled with feelings of inadequacy as a person, as a mother, as a daughter and as a sister. The face of ridicule which I saw outside the operating theatre was not my mother’s. It was my own. A reflection of how I saw myself – the face of contempt, jeering at me and looking down at me. I conjured a huge amount of courage to confront my self-critic and started the process of learning to accept the person that I am.