Monday, December 31, 2012

Loss and Mourning

Many of us may connect the concept of mourning to the loss of life. While the passing of a loved one is a time of especially significant grief, we could benefit from taking the time to mourn other losses as well. The perception that a loss is relatively unimportant or typical may become a tendency to minimize our feelings. Developing a broader definition of the word loss and understanding mourning as a passageway to new experiences may help us recognize and attend more fully to our emotional needs.

To mourn is to recognize the feeling of losing something. When we mourn we seek to accept a new situation and thereby create the space in which something new can develop. Thus, mourning may be understood as an action of reorienting ourselves from the way things were to the way things are emerging and will become. By recognizing change as it happens and appreciating that change often involves loss, we can attend authentically to our situation in the present moment. Gaining new understandings of loss and mourning can lead to an appreciation of how these processes may play a role at various moments in life.

Think of a parent watching his or her five-year-old child go to school for the first time. Surely it is a joyous occasion to see a child enter this new phase, and in many ways a parent may feel relieved the child is growing more self-sufficient. At the same time, a parent may feel sad and afraid to face the loss of control over the child’s experiences in the world and grieve the end of the baby years. To miss acknowledging the full complexity of this milestone means that some parents also may miss the chance to process the full range of their feelings and come to a healthy acceptance of their child’s milestone.

Whenever we encounter change, momentous or minor, we have to readjust and accommodate. By remaining open to all our feelings surrounding the change and giving ourselves time and space to connect with those feelings, we increase our ability to move forward in a way that is honest and appropriate. The process of mourning may feel scary and deeply uncomfortable; in this in-between stage, we’ve lost something we previously had and haven’t yet adjusted to our new circumstances. During times of transition, it is important we stay open to opportunities for healing and renewal, being kind and gentle with ourselves, and trusting that change is hard but necessary for growth … and life itself.

-- Erika Rosenberg, M.A.

Monday, November 5, 2012

Sleepy Thoughts

In the October e-newsletter*, we explore issues of sleep. We see a lot of people at Willow who say they can’t sleep—or conversely, sleep too much. People with depression typically describe falling asleep OK, at times with a sleeping pill, but then waking up at 2 or 3 in the morning, unable to go back to sleep right away. They might get into patterns of staying up, then sleeping during the day to try to catch up. People with anxiety talk about “racing thoughts” and an inability to quiet the mind enough to sleep; they also might wake in the middle of the night, sometimes in a sweaty panic. Both might have nightmares, some meaningful, some just odd.

When poets are sleepless, naturally, they write poems. In the e-newsletter, we introduce a wonderful little collection of “insomnia poems” entitled Acquainted with the Night. Collected by Lisa Russ Spaar, the poems range from Shakespeare to modern verse, and beautifully capture sleep’s seeming elusiveness and the different ways that people experience its absence—from frustration, loss, despair, fear, longing, isolation, betrayal, loneliness, numbing, exhaustion … to wonder, excitement, imagination, peace, even full awakeness to life and to the fertile space where the boundaries run thin between dream and reality, spirit and earth, life and death.

The editor writes, “Poets remind us that insomnia, in all its insufferable and fruitful manifestations, is an experience shared across temporal and cultural boundaries; it can make us more aware of our own sleeping places, our own lit windows, our own watching and the dark we watch against. And who better to speak of this complicated experience than the poets among us?”

Here are a couple of poems that caught my attention; perhaps they’d (and others in the book) be good company the next time you find yourself sleepless.

Weary with toil, I haste me to my bed
by William Shakespeare

Weary with toil, I haste me to my bed,
The dear repose for limbs with travel tired,
But then begins a journey in my head
To work my mind when body’s work’s expired;
For then my thoughts, from far where I abide,
Intend a zealous pilgrimage to thee,
And keep my dropping eyelids open wide,
Looking on darkness which the blind do see;
Save that my soul’s imaginary sight
Presents thy shadow to my sightless view,
Which, like a jewel hung in ghastly night,
Makes black night beauteous and her old face new.
Lo, thus, by day my limbs, by night my mind,
For thee and for myself no quiet find.



A Clear Midnight
by Walt Whitman

This is thy hour, O Soul, thy free flight into the wordless,
Away from books, away from art, the day
erased, the lesson done,
Thee fully forth emerging, silent, gazing, pondering the
themes thou lovest best,
Night, sleep, death and the stars.



* Sign up for the e-newsletter at www.willowwellness.com

Saturday, September 29, 2012

Creativity: A Commentary

By Erika L. Rosenberg

A commentary building on the September 2012 Willow Wellness Center e-newsletter focusing on creativity and aging (sign up at willowwellness.com):

Many of us may believe that a creative person is one who paints, sculpts, draws, or practices some other aesthetic art. We may think of creativity as a force that flows effortlessly, almost magically taking form in just the right way. Yet when we define creativity in such narrow terms, it is challenging to understand how we can actively initiate it in our lives. In his book The Courage to Create, psychologist Rollo May identifies several different types of creativity. He explains that at the most basic level, being creative means moving through the world in a new way. It means discovering novel ways of being, expressing, thinking, or interpreting. Thus, Dr. May acknowledges that some bravery is required when approaching life creatively.

We all have scripts we follow, and to an extent, we need our routines. Without them we would be too bogged down by details to get anything done. Our go-to ways of moving, thinking, and relating allow us to free up enough mental space and energy to meet all our more complex responsibilities. However, by relying on our scripts, we risk becoming overly rigid and missing opportunities to experience new things. Being creative can mean choosing not to let a conversation with a family member go down the same argumentative path, or trying something new for lunch. Of course, stepping outside our comfort zones can feel risky. Knowing what we’ll get, even if it’s the same old dissatisfaction or boredom, can seem preferable to facing the unknown. This is one reason why creativity requires courage.

Another reason is that being creative—adding something new to our experience—might mean deviating from the expected in a broader sense, in terms of our societal norms. Expressing a unique voice can be scary because it may invite criticism. How many times have you had an idea and, just as it emerged, shut it down because you’ve imagined the ways it could be negatively received? The thing is, even if an expression borne of your own creativity doesn’t come out how you intended, others will likely respect and appreciate the bravery of your unique self-expression. More importantly, you might find new respect and appreciation for yourself.

By opening ourselves to novel experiences we can keep life interesting. Paints and a canvas are not required for creativity, though they are certainly a fun way to approach it. Challenging yourself to take a class, cook or taste a new dish, or see a play or movie outside of your usual genre are ways each of us can feel relatively safe but also experience new aspects of our world. By risking a bit of security to relate to others, our world, and ourselves in new and interesting ways, we have so much to gain. Life is short. The world is big. What can you create today?

Wednesday, January 25, 2012

Overcoming Loneliness in Later-Life Depression

At 80, Agnes was struggling with depression for the first time. She could handle the moments when she felt “blue” or “down.” She could understand that moving into her new apartment was a change, and that change could be stressful. She could even accept that she was forgetting more things, more often, than usual.

But what she could not stand, just could not get used to, was the loneliness. She thought she’d been through the worst after her husband died, but this was different. Her daughter lived only 10 minutes away, her new neighbors seemed nice enough, but still she felt so completely alone. And the more she told herself how fortunate she was, how grateful she should be for her family and her health, how others had it much worse, … the more deeply lonely she felt.

So what is loneliness exactly? Being lonely is similar to being alone, apart from others, but it is also very different. Think of being alone: Isn't it possible to picture a situation when you’d feel OK being alone, maybe even peaceful? Perhaps you'd be knitting a sweater, or walking along a waterfront, or reading a good book. Some people find solitude helps them think clearly and creatively, without distraction.

Now think of being lonely. Isn’t there a completely different tone to your thinking? Loneliness stems from one’s perception of loss, or absence; wanting someone (perhaps someone special) around and not being able to have that. In that sense, some people describe feeling lonely even when they’re around other people, yearning to connect at a meaningful level but being unable to do so.

Loneliness, of course, is a natural part of being human in our imperfect world, in the same way that sadness and grief are normal, expected responses to life’s losses. Older people tend to experience more of these losses, simply by living longer—loved ones die or move away, physical health declines, homes get sold, dreams drift beyond reach. And the fast-paced, youth-oriented nature of our world makes meeting new people difficult for anyone not comfortable with the internet, let alone for people who are depressed.

The kind of loneliness associated with depression is the loneliness that doesn’t ever seem to go away, and is not necessarily affected by whether or not we’re surrounded by people. It may feel like it follows you around, like a dark cloud. Loneliness may begin as a cause of depression, or it may develop later as a symptom. Regardless of how it starts, loneliness is neither natural nor healthy to feel for any extended period of time, nor is it necessary, given proper attention and treatment.

For Agnes, holidays proved especially lonely. Of course she looked forward to being with her family, and to celebrating with her church community. But the depression seemed to sap so much of her energy and get-up-and-go that her usual preparations wore her out just thinking about them. And partway into the festivities themselves, she found that she couldn’t enjoy being with her loved ones at all. She simply stopped putting on a happy face for the occasion, and really wasn’t present anymore. Instead, she had begun dreading the moment when everyone went home, when she'd be alone again.

Depression works like a thief. It steals away your ability to take comfort from the people who love you, to really hold on to their love and keep it warm inside you. It steals away your connections, isolating you from your loved ones, from your neighbors, even from your God. It steals away your identity, your sense of self, making you feel different from other people. "Nobody else could possibly feel so sad/lonely/empty." And so ashamed of your differentness that it's hard to be with other people and imagine that they might want to be with you.

But there are ways to take back your life from the depression, and to ease your loneliness. The first step is to understand that you’re not “crazy.” Depression is a real illness; it is not a normal part of aging. Every year, approximately two million Americans 65 and older experience some form of depression. Other people do feel some of the same feelings that you do; some people might understand what you’re feeling and thinking.

The second step is to realize that loneliness is a real part of depression—just like waking up at 2:00 in the morning, struggling with your memory, and feeling negative or angry about everything. Loneliness is related to low self-esteem and a negative sense of yourself and your future.

Becoming clear that you are not “crazy” should help turn down the volume on the obsessively self-conscious voice that often plays in depressed persons’ heads. Also helpful is learning to be comfortable in your own skin, and learning to be a good friend to yourself. You might consider taking up practices that increase your ability to be “present” in your life and in your body, rather than stuck in your head and your thoughts, practices such as mindfulness meditation or yoga.

This is also a good time to assess your relationships and your social life in general. Do you have at least one or two good friends, people you can trust? Do you have occasion to be with other people working on a common project, such as volunteering at a soup kitchen or cleaning up a local park? What are some interests that you might like to share with other people, perhaps through a book group, knitting class, spiritual community, or neighborhood improvement project?

Resources abound to help you understand both depression and loneliness. To learn how other people have experienced and coped with loneliness specifically, search your library or the internet. You’ll discover books, stories, poetry, and artwork spanning hundreds of years (at least)—and witness just how universal the presence of loneliness has been in human existence.

If you find that your self-help efforts do not provide enough relief for your depression and/or loneliness, please seek professional help. Many psychologists, clinical social workers, and counselors provide psychotherapy designed both to help you learn to be at peace with yourself and to encourage the development of truly meaningful personal and social connections. Some clinicians also teach classes in mindfulness meditation and other alternative healing practices. In those cases where depressive symptoms are particularly severe or long-lasting, antidepressant medication combined with psychotherapy has been shown to be beneficial, sometimes even life-saving.

Saturday, January 21, 2012

How is depression assessed and treated?

by Dr. Bob Campbell
Everyone gets sad or feels down now and then. For the most part, this sadness is not depression; it’s just the normal sadness of life. Grief over the death of a loved one is also not depression, although if prolonged normal grief can become depression. What is depression then? Depression is a much more serious condition than the usual sadness or grief; it can be extremely debilitating, and can even lead to suicidal thoughts or attempts. Depression is also surprisingly common – more than 16% of people in the U.S. will get it at least once in their lifetime (Kessler, 2003) – and there have been many famous people who have suffered with it, including Billy Joel, Woody Allen, and the author William Styron, who called it “darkness visible.”
Someone who is depressed often exhibits symptoms such as low energy, changes in sleep habits, significant mood shifts, loss of interest in activities usually enjoyed, hopelessness, or a change in appetite and body weight (up or down). These symptoms commonly cause missed work, low productivity, and relationship difficulties.
The good news is that depression can be effectively treated, and individuals can get better. It may seem straightforward to recognize depression, but it is best assessed by a professional, so that the most appropriate treatment can be initiated. Antidepressant medications have often been prescribed for people who don’t need them, resulting in significant side effects.
Once depression is diagnosed, it can be treated in a variety of ways. Talk therapy has proven to be quite effective for many people, and comes in various types, including cognitive-behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), psychodynamic therapy, Adlerian therapy, and existential therapy. All of these treatment methods are available at Willow, and can be discussed with your therapist. For more severe levels of depression, antidepressant medication may be needed. Research has shown that most severe depressions respond best to a combination of medication and psychotherapy. Rare treatment-resistant depressions can also be treated with electro-convulsive therapy (ECT), which is administered in a hospital, and which has become much more refined and safe over the last several years.

The bottom line is that depression is serious, but can be treated effectively. At Willow, we are committed to providing you with the latest evidence-based treatments to bring hope and joy back into your life.

(For more detailed information, see Kessler, R.C. et al. (2003) 'The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R)', Journal of the American Medical Association 289 (23): 3095-3105.)

Monday, December 13, 2010

Ho, Ho, Holiday Pounds!

How to keep winter weight to a minimum.


by Dr. Sandra G. Carey

It is not uncommon to gain some weight during the winter months, and a few extra pounds can even be healthy. The cold weather and winds of winter calls for insulation from body fat, which may keep us warm and strengthen the immune system. However, holiday parties and family gatherings, which provide ample opportunity to indulge in the goodness of the season, may lead to unwanted pounds. Below are some ideas for enjoying the many festive occasions this season while minimizing extra weight.


  • Eat a light meal or snack before going to a party

  • This will decrease feelings of hunger and limit sugar cravings, lessening the likelihood of overindulging on cookies and cakes.


  • Wait 20 minutes before going back for seconds at holiday meals

  • This amount of time gives the body a chance to register what you have eaten. If you are still hungry after 20 minutes, please enjoy a second helping, but if you do not feel hungry refrain from extra helpings to keep extra pounds at bay.


  • Remember: “The feast is in the first bite.”

  • Take time to give full attention to what you are eating. Explore the textures, tastes, and smells of the food you eat by chewing slowly and thoroughly. This will slow down the time it takes to eat, and helps avoid that “stuffed” feeling. This mindful approach to eating can also bring awareness to the love and time it took to prepare the food and may increase your sense of thankfulness and joy.


  • Increase movement during the day

  • Winter weather may inhibit your desire to get outside and be active, so create new opportunities to keep the blood and calories flowing through your body. Take the stairs up to the office, or park towards the end of a parking lot, when safe, to add in a few extra steps to your day. Add some stretching or isometric (contracting muscles while standing still) to your work breaks or after a meal.


Be well!

Thursday, August 12, 2010

Basic Guidelines for Good Digestion


  • Eat in a relaxed environment and an attentive manner
    • Stress impacts the body’s ability to digest nutrients

  • Chew food completely before swallowing
    • Poorly chewed food is not digested well
    • Nutrients are not available to the body if food is not digested
    • Partially chewed food particles can compromise intestinal health and be attacked as a foreign object by cells, lowering the immune system

  • Include raw foods (uncooked) into your diet
    • The enzymes present in raw foods aids digestion
    • Eat warming foods to help aid digestion, such as Ginger and Curry

  • Avoid substances that hinder digestive health
    • These include:
      • Cigarettes
      • Caffeine
      • Alcohol
      • Pesticides on foods
      • Antibiotics

  • Exercise
    • This stimulates digestive organs

  • Drink plenty of water throughout the day
    • Water helps digestion and elimination



References
  • Bartholomey, Paula. Hawthorn University, 603.1 Lecture Series, Whitehorn, CA, 2006.
  • Lipski, Elizabeth. Digestive Wellness 3rd ed. Los Angeles, CA: McGraw Hill/Contemporary Books, 2004