Showing posts with label cognitive behavioral therapy. Show all posts
Showing posts with label cognitive behavioral therapy. Show all posts

Gingerbread Houses and Cognitive Behavioral Therapy

Thanksgiving is one of my hypomanic seasons. I'm getting better at not taking on projects that worry my wife. In fact, I have given up gingerbread houses altogether. Which is not to discourage you, just to acknowledge that they were once my one great weakness. That woman in the fringed dress down there? - Each bit of fringe was an individually placed sprinkle, separated out from a container of red, green, and white sprinkles. See what I mean?

But I did learn some things from my hypomanic gingerbread houses. And learning is good for the brain. The following post is a repeat from ten years ago, when I was in the throes of it. It explored the relationship between gingerbread and cognitive behavioral therapy. I am one of many who have a love/hate relationship with CBT, which I freely acknowledged to my CBT therapist in our first session. Nevertheless, she persisted, and I persisted, and I do rely on it daily and have written about it from a variety of angles. So here it is again, for those of you who want to explore CBT and also for those of you who want to know how to make a nine patch quilt out of fruit rollups:


Cognitive Behavioral Therapy - Gingerbread Style, 11-25-2010

First Cognitive Therapy Technique -- Distraction

Misconceptions about Therapy

Continuing the press kit-inspired series...

No, therapists aren't like friends that you pay

Therapists make you work. The work you do depends on the kind of therapist you see. Interpersonal therapists get you to examine your relationship patterns. Are they working for you? Are you sure? Social rhythm therapists make you track your schedule. For people with bipolar, an off kilter schedule results in an off kilter brain. (The chart I use is here.) Cognitive behavioral therapists even give you work sheets! Mostly this homework involves learning to examine your thoughts. Just because your brain tells you something doesn't mean it's true.

No, therapists don't give advice

Where Is My Therapist?

I could have talked to my therapist yesterday by phone. She's not on vacation. But this week I decided to forgo an appointment. That may have been a mistake. . .

So I turn to a rerun from eight years ago, For When Your Therapist Goes on Vacation. I think I'll be focusing on humor for the next few weeks. Keep coming back! If you've got any good jokes, put them in the comments (click on the little envelope icon at the bottom.)

People With Schizophrenia Who Recover

Among the top five factors that limit recovery for people with mental illness:

The false belief that it's all about the medication.

Medication indeed is part of mental illness recovery. It's a bigger part for some mental health issues (like schizophrenia) than others. And its effectiveness varies from drug class to drug class.

I created a bit of a twitter storm when somebody tweeted: Please quote this tweet with a thing that everyone in your field knows and nobody in your industry talks about because it would lead to general chaos.

To which I responded: Antipsychotics cause loss of brain matter.

 Last week's post described the research study that demonstrated that claim. The study was led by Nancy C. Andreasen, MD of the University of Iowa Carver College of Medicine. One should not reject antipsychotics on the basis of the study. They do what they are supposed to do. They reduce the positive symptoms (like, psychosis) that cause so much suffering. Payoffs and price tags. But they don't do the whole healing.

I continue this week with a broader picture, the what else of recovery in schizophrenia. This post was first published in 2013 with the title:

Fabulous People with Schizophrenia

Giving Thanks for John Moe

Is depression funny?

John Moe begins every broadcast of The Hilarious World of Depression with that question. Then he and the comedian/musician/celebrity of the week talk.


My therapist told me about Hilarious World. I was preparing to do a seminar, OK2Talk about Mental Illness, eight hours total, five segments.  The third would be on humor. It is, after all, part of the Prozac Monologues brand.

Return to the Chemistry Experiment

What is it like, this chemistry experiment, you ask.  Somebody did ask, honest.

Prozac Monologues strives to be journalism, not journaling.  I write for education (mine first, then yours), not for therapy.  So when the story turns to the Chemistry Experiment, a topic I write about so often, it gets its own label, I have tried to season my prose only lightly with my personal story.

But the Chemistry Experiment has been excruciatingly personal these last several weeks.  And nowadays, the personal story is one way that journalists frame their reporting.  So here goes.

Looking Under the Hood - A Better Depression Diagnosis?

Corrected July 7, 2013

Maybe my writer's block is an Ecclesiastes issue.  There is nothing new under the sun.

But finally, there is.  No, not the DSM.  Keep reading.

The DSM. Sigh.

But regarding the DSM, and it makes no difference at all which edition, you have to wonder when somebody who is suicidal, losing weight, irritated at the drop of a hat and can't sleep gets the same diagnosis as somebody else who is immobile, gaining weight, couldn't be bothered about anything anymore and sleeps the night and day away.  It's all depression -- the DSM's junk drawer.

Finally, somebody thought to sort the junk drawer, by looking inside the brains of these two sorrowful souls, both taking the same meds for God's sake.

PET Scans - Looking Under the Hood

Helen Mayberg and her team at Emory University School of Medicine used PET scans to look under the hood (to use John McManamy's favorite metaphor).  PET scans use a radioactive tracer to determine where glucose is being used in the brain, i.e., what part of the brain is busy.

Fabulous People With Schizophrenia

People With Schizophrenia Who Recover

My guess is you don't know people with schizophrenia who have jobs, own their homes, are married and join clubs and congregations.  My guess is, even if you work in the field or volunteer in homeless shelters, you do not count among your friends, your real friends, the ones you invite to your house for dinner, anybody with schizophrenia.

My guess is you do not know that such a thing is possible.

Lionel Aldridge decided to change that.  Lionel Aldridge played defense for the Green Bay Packers and won two Super Bowl rings.  (Go Cheeseheads!)  He lost them when schizophrenia took his life out of control.  Literally, his ring fell off his hand; he couldn't find it in the gutter.

But he came back.  He got treatment.  He vowed that if he got better, he would not remain silent, so that other people with schizophrenia would know they are not alone, so they would know they could recover, and so you would know that, too.  His story is in this link.

Inductive Research

Schizophrenia -- Taming the Dragon

Imagine you have a dragon in the house.

It has been there a long time.  When it was little, you could hide it.  You knew your parents didn't like it when you talked about it.  So you guarded it as a secret for the longest time, even with its nasty habit of singeing your fingers.  But when the couch caught fire, they knew, and insisted you get help.

They want you to get rid of the dragon.  Some of them think you can.  Others think you can tranquilize it, and the couch will never catch fire again, and nobody need ever know you have a dragon in the house.

Iron Rule #1:  You cannot get rid of the dragon.  It is here to stay.

More Guns = More Suicides


Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it?

Grief/Depression IV - Not the Same/Maybe Both

So a woman goes into the doctor's office, three weeks after her husband died. I got through the funeral just fine. But now I feel awful. There is this ten ton weight on my chest. I'm exhausted; I don't have the energy to wash the dishes. I'm trying to pack up my husband's things, and I am too weak to pick up his shoes. I can't eat. Sometimes I get hit so hard with this wave of anxiety, I think I'm going to throw up.

What are the chances the doctor will say, Of course you feel awful. These are all very natural symptoms of grief. You just need time. But if you still feel like this a month from now, call my nurse and set up an appointment. What are the chances the doctor will not pull out the stethoscope and listen to her chest?

Answer: It depends on whether the doctor is stupid.

Or a psychiatrist.

These are classic symptoms of heart disease. There is significant overlap between the symptoms of heart disease and the experience of grief. But there is no Bereavement Exclusion for a diagnosis of heart disease. Instead, family physicians and cardiologists take the time to examine whether the person presenting these symptoms may have both.

For When Your Therapist Goes on Vacation

I have two therapists and they were both on vacation the week I got home from my mother's funeral and all those issues and all the family and all those issues.  And still on vacation the week after that!  My brother-in-law subbed - thank you, Darryl - with the following email.  I offer it as a resource for when your therapist picks a lousy time to go on vacation.

For extra entertainment value (my entertainment, anyway), I have identified which one I hear Michael telling me with >>, and which ones I hear Liz telling me with **.  One of them regularly irritates me.  I'll let you guess which one.  I have to keep both, because the double-teaming seems to help.

Wisdom Learned From the Seat of a Tractor


Your fences need to be horse-high, pig tight, and bull-strong.

Recovery In Progress -- My First NAMI Convention

Dr. Ken Duckworth's job at the Ask A Doctor about PTSD session was to make some opening remarks and then let people ask their questions. He rattled off a list of treatments and said, The good news about PTSD is, we know what causes it -- trauma that was not able to be processed adequately. The bad news is, the treatments just don't work so well.

Short and to the point. Actually, I am not so negative (right this very minute, anyway) about treatment as Dr. Duckworth, because I am not looking for the magic med anymore. I know about recovery.

Recovery is about collecting tools and pulling them out when the occasion requires. I will illustrate. But first the setting...

Last week I attended my first NAMI (National Alliance on Mental Illness) Convention in Chicago -- 2300+ people who have mental illnesses, family members, advocates, volunteers and caregivers, with a few scientists thrown in for good measure. As a friend said to prepare me, A NAMI Convention has a certain kind of energy. Yes, it does.

I have been to big conventions before, used to be a legislator (called Deputy) for the Episcopal Church, which gathers 8-10,000 or so Deputies, Bishops, exhibitors, visitors, volunteers and the like every three years. I stopped doing that when I figured out that every three years General Convention tripped my hypomania and was followed hard on by a depressive episode.

So this was my largest gathering in some time, with plenaries, workshops, symposia, networking and ask-a-doctor sessions, drumming, theater, yoga and talent show, internet cafe and peer counselors, exhibitors, book sales and an information booth which was the best hidden spot of the whole damn Chicago Hilton.

You can expect a number of blogposts out of this event, including dueling comments between me and fellow blogger John McManamy. Now that we have finally shared a beer, does that make us blogmates?  I began writing this piece in the hotel room, late after the last gasp, the rawest of my posts to come.

I knew it was a mistake to make Ask-The-Doctor-About-PTSD the last thing I attended. It's just, that was the schedule. Most helpful take-away: The brain is simply not designed to metabolize certain experiences. PTSD is the result of incompletely metabolized traumas. Bottom line, it is a normal response to an abnormal event or series of events.

The brain keeps trying to metabolize these unprocessed events/memories/emotions/bodily sensations. They lurk beneath the surface, waiting for the next opportunity to emerge, when triggered by some reminder.


Oh, I was triggered, alright. The last question of the day was about a particular symptom I don't talk about and religiously avoid. I left the room reliving it, dizzy and disconnected.

Walking out, I heard the voice of my therapist, who once ended a session saying, The things we have talked about today probably have triggered your past traumas, and you will be dealing with the effects after you leave. So how are you going to take care of yourself today?

Time to pull out that toolbox.

The Ask-A-Doctor doctor listed half a dozen treatment modalities for PTSD: meds, support groups, EMDR (Eye Movement Desensitization and Reprocessing), sleep regulation and aerobic exercise. He mentioned Prazocin for nightmares.

First off, pop my anti-anxiety rescue med, put on my walking shoes and go get some aerobic exercise. Work off that negative energy.

Just outside the door was Grant Park. An art exhibit diverted me from my aerobics. But art is good, very good. Change the channel -- that's Cognitive Behavioral Therapy 101.


I stood still and drank in paintings inspired by water. Not this painting, actually, which is exhibited just down the street. But I thought of it.

Water is good. It evens out the emotional turmoil. -- So says my other therapist, the one who does eastern-based energy work. You see, when even the doctors acknowledge that western treatments (they don't call them western, because they don't speak of there being any other treatments) work poorly, I am not going to limit my tool box to only half the planet, especially not the more rigid half.

I spoke with the artist about perspective. He paints on a flat surface, so doesn't think it matters which side is up. I breathed into the here and now. Thich Nhat Hanh taught me here and now. But here and now is my worst subject. And somebody interrupted to talk about showings and art business. There were too many people -- had to reduce stimulation.


My energy therapist would recommend grounding. I headed back to the gardens, flowers, trees, dirt, all good, all grounding. Eating is good for grounding, too. Maybe I should eat something.

From Alcoholics Anonymous: HALT = pay attention to when you are Hungry/Anxious/Lonely/Tired. No, a martini is not in the recovery toolbox.

So I bought my inner child a strawberry ice cream -- a drippy cone instead of my usual adult cup. Sugar isn't really the best choice, but it was red and a gift to my inner child. Then I head off to find some meat. Meat feeds the first chakra. First chakra is about safety. PTSD is about the amygdala is about safety is about the first chakra.

Still I was struggling. I don't just have my own pain; I suck up the pain of every person with whom I have spent the last three days. All those stories -- how can there be such a world? How can I live in such a world?

I picked up my whole personal Book of Traumas, the traumas that never got resolved, that get retriggered today when I try to resolve them in therapy, the distrust I try to pretend does not exist toward the people who try to help me but they end up retriggering the traumas I can't resolve because they never seem to address that they are retriggering them and my retriggered shame prevents me from telling them and I truly believe the result will be retrauma anyway.

There are exceptions to that negative thought. List the exceptions -- Cognitive Behavioral Therapy 102. But how do I know who is for real...?

So I head back to the convention, walk over the train tracks. And there is another trigger, another overpass, another trip to Chicago, another episode, another long time ago. How quickly is that train traveling?  How far away?  How fast does a body fall that far?  How to time the collision of the two?  Velocity problems were the one thing that defeated me in high school math.

But I am not in the right spot anyway. Geometry I got. I need to be right -- there -- where -- a woman is pushing a baby stroller.

Oh. Okay. Not tonight. I have an Iron Rule. In a world filled with trauma, to the extent that it lies within my power, I will not cause trauma. A two-year-old is sitting where my demon would call me. The two-year-old wins.

God bless the internet that led me to David Conroy some years ago. The first sentence of his book Out of the Nightmare brought sense out of the chaos that compounded the pain of my suicidal symptoms. Suicide is not chosen; it happens when pain exceeds resources for coping with pain.

Tonight my pain was painful. But I have survived worse, much worse. And tonight my resources are many. Tonight the thought was more than a mosquito, but it wasn't a tiger. I do not underestimate the lethality of this disease. One in five people with bipolar II do not survive it. Tonight, I am still of the four.

I know people freak out over the suicidal ideation part of mental illnesses. I apologize to my friends for causing them pain by bringing up the subject -- even though my need to protect you from this pain adds to my own. I try not to bring it up, except with people who know what I am talking about. But this is one of the tools in the Recovery Toolbox. Those who do know what I am talking about need this tool. And this post is for us.

Ironically, the state of the art treatment for people who have a lot of suicidal ideation and behavior, people with a diagnosis of Borderline Personality Disorder, is Dialactical Behavioral Therapy, radical acceptance. Starting, not ending, but starting with acceptance even of that symptom that freaks out so many of you.

Yes, sometimes I have those thoughts. They are well-worn grooves in my neurological pathways. Any number of things will trip the cascade that leads there, including things you might not imagine, a cold sunny day, my doctor suggesting a new medication, an overpass. These are not reasons. Suicide is not about reasons. These are triggers of neurological pathways that have a current of their own.

It is what it is. Those five words sum up Dialectical Behavioral Therapy, an offshoot of CBT. They were the chorus sung by one of the players in the lunchtime drama troupe. Saturday night, I repeated them to myself. Often when that thought appears, somewhere between a mosquito and a tiger, I say, There it is again. That's all. Mindfulness. The thought doesn't have to freak me out, doesn't have to freak you out. It is what it is. Move on.


As I crossed the overpass, I felt a draw, a pull toward the hotel. It was an energy, a spiritual energy on the side of life, two thousand people in that building, rooting for me, for my life, for one another, for you. One of them even blowing a didgeridoo, accompanied by a flute, to be followed later by another who whistled Somewhere Over The Rainbow, all spiritual energy on the side of life.

The wisdom is ancient. Two are better than one, because they have a good reward for their toil. For if they fall, one will lift up the other; but woe to one who is alone and falls and does not have another to help. Again, if two lie together, they keep warm; but how can one keep warm alone?  nd though one might prevail against another, two will withstand one. A threefold cord is not quickly broken. [Ecclesiastes 4:9-12, New Revised Standard Version]

So that is my first report of my first NAMI Convention, the most confusing and most compassionate experience I have ever had with 2300 people.


(Find your local NAMI Chapter here.)

photo of toolbox by Per Erik Strandberg and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
General Convention Seal for the Episcopal Church in public domain
Olaus Magnus's Sea Orm, 1555 in public domain
Water Lilies by Claude Monet, 1906, in public domain
photo of Grant Park in Chicago by Alan Scott Walker and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
root chakra by Muladhara Chakra and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
photo of Chicago Orange Line by Daniel Schwen and used under the Creative Commons Attribution-Share Alike 2.5 Generic license
photo of Coal Creek Falls by Walter Siegmund and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license
fresco at the Karlskirche in Vienna by Johann Michael Rottmayr, in public domain
book covers by amazon.com

Cognitive Behavioral Therapy -- Gingerbread Style

First Cognitive Therapy Technique -- Distraction

My therapist said Think of something you might find enjoyable.  You don't have to do it.  You don't even have to enjoy it.  The goal is not to move your mood from 1 to 10.  Any mood change is a bonus.  The goal is simply to give you something else to think about [-- besides what I had been thinking about.]

Distraction is one of those really irritating CBT techniques.  I am traumatized and can't stop thinking about this.  Okay, so think about something else.  I pay money for this?

But my other therapist, totally different method, said pretty much the same thing.  And I was six weeks from a major project I had promised for the holiday season.  And I am not sure it would have worked except that the wheel was ready to turn from early autumn danger to late autumn hypomania.  But he did and it was.  So...

She said think about it.

I guess I overshot the mark.


Ya think?

To Diagnose Hypomania -- Pay Attention

I used to churn out 10-12 gingerbread houses each season, back in my undiagnosed days.  I used the Joy of Cooking recipe and floor plan.  But each and every one was one of a kind: a log cabin made of pretzel sticks and peanuts for the chimney, another with candy canes on the roof for a chalet effect... No, I wasn't manic.  I was excited...

It could be said I don't know when to quit.  So a simple suggestion, think about something you might enjoy instead of what you are thinking about right now, became a fourteen inch high, furnished gingerbread house.


See what I mean?  Once I decided to tile the kitchen floor with candy corn, I was gone.  Note the faucets for the aluminum kitchen sink.  And the handles on the refrigerator.  There is a fireplace hearth down there, made of a Milano cookie.  Even as I was installing these things, I knew I was out of control.  But I could not stop.

Here is a nine patch quilt, made from fruit rollups.  Plus a teddy bear on the pillows.  Should you decide to start quilting with fruit rollups, here are my methods.  Unroll them a few days in advance to dry a bit.  Don't overreach.  Let the materials tell you what they are willing to do.  Use liberal amounts of vegetable oil on your fingers and cutting utensils.  Keep the knife clean.  I recommend an exacto knife, under supervision if you have a problem with sharp objects.  Place your product between oiled sheets of cling wrap, then between sheets of paper.  Iron at LOW heat for five seconds.  Breathe.

I refer to this as my diagnosable gingerbread house.


By doubling the dimensions, I had introduced engineering issues.  I needed weight bearing walls.The closet was designed for that purpose.  I made a double wall facing the living room.  But I failed to double the wall with the door.  Two by twelve inches, it was the first piece to break.  The pretzel sticks inside the closet hold it together.


Metaphor Alert -- Community

If I were to get philosophical -- and while I bent over this project, holding my breath and waiting for icing to turn to cement, I had plenty of time -- I would reflect that sometimes things or people are created that do not have the structural integrity to withstand the pressures to which they will be submitted.  Nevertheless, they can get by with a little help from their friends, even friends that brittle themselves, like pretzel sticks.  This is the essence of support groups.  Get into one.

Some of us are not particularly unstable, but we collapse under pressures beyond normal experience.  If we don't have to bear the weight by ourselves, we can make still our own creative contribution to the whole.  The fireplace wall fell into three places.  Twice.  It stood, once it received a full back brace.  The brace is not flashy.  It is not even visible, covered by the outside of the fireplace.  But it is essential.

This is the essence of community.  Christians call it the Body of Christ.  If the house were all ribbon candy, how would it stand?  If the house were all support, what would cover the kitchen floor?

Anyway, diagnosable.  The roof also collapsed, the weight bearing walls notwithstanding, because I pushed too hard while attaching it.  Be gentle with yourself, my friends.  The stronger parts can injure the weaker.  Self-restraint is especially important where you are strong.

But we can learn from our mistakes, and turn them into more creative opportunities.  The roof went for snacks to a bible study group.  I replaced it with a lighter version.  And then I broke one side again.  This time I finally listened to my spouse, and put up just half a roof, so people could look in on that nine patch quilt.  None of us has all the answers.  And sometimes irritating advice is good advice.

Even if it is irritating.

Another Cognitive Therapy Technique -- Dialectical Thinking

Even in the midst of this craziness, I kept aiming at sanity.  My mantra was Prototype, prototype.  The point of a prototype is to make as many mistakes as possible, in order to learn, and not make the same mistakes while doing the real thing.

I was making a lot of mistakes.  Boy, was I learning.

Dialectical thinking means that life is not divided into black and white.  One can hold a painful thought and a positive one in the same brain at the same time.  That and valium got me through.

I learned not to use a double barrel aged single malt scotch as a brace to hold up a wall while assembling, like the soup cans above.  The bottle was missing only as much as is pictured here before I made that particular mistake.  Sigh.

After mopping up the nearly full bottle of scotch and as much shattered glass as I could find, it was time, it was time to stop working on the prototype.  Well, after I built the fire in the fireplace.


Two hot tamales, cut on the bias, a couple little pretzel sticks and a sprinkling of ribbon candy crumbs.  The back of the fireplace is the inside of a mint Milano with the white frosting scraped off.

Like I said, diagnosable.

It wasn't finished.  It still isn't finished.  But the time for prototype was at an end.  The time for the real deal had begun.

To be continued...



all photos of gingerbread houses by Helen Keefe 
photo of scotch by Suat Eman

PTSD: The State of Treatment

This is the second part of a series on Post Traumatic Brain Syndrome.  Let me recap last week and expand on what we know about the neurobiological mechanisms (how the brain works) of PTSD, and then discuss treatment strategies.

When something stressful happens, the brain prepares the body for action.  The hypothalamus, pituitary gland, amygdala, locus ceruleus and opioid system all release hormones to speed up respiration, raise blood pressure, reduce sensitivity to pain, all useful conditions for the proverbial fight or flight.

Under normal stressors, as soon as these hormones are released, feedback systems go into operation.  The hypothalamus tells everybody else that their job is done and they can back off.

These hormones, especially cortisol, damage brain structures, notably the hippocampus, whose job is to regulate emotion and to perform the "that was then, this is now" function.  I named it that, and am very proud of it.  My own brain has almost no "that was then, this is now" function.  Pretty much zip.

Release the Kraken!!

Well, it's one of those weeks in a remitting/recurring disease. "Release the Kraken!" -- my favorite line from Clash of the Titans, a 1981 movie to be remade and released this summer.  Oh, you gotta check out that link to the trailer!

My apologies to regular readers who are looking for a new post.  It's an interesting one, Shadows.  Maybe I will be able to write it next week.  Come to think of it, the image on the right would fit that post, too. (Anonymous, in the public domain for copywrite expiration). For now, here is a reprint from last July:

What is Depression, Anyway?

When I thought the meds would work, I didn't ask this question (referring to the title, not the caption!) Depression is a disease of the brain and also of the mind. The best results are obtained by working on both fronts. Take your meds. Talk to your therapist. Simple.

Then I discovered that the meds made me worse. Whenever I say that, I rush to say that, my experience notwithstanding, for most people they work. They can save your life. And then I rush to say, but not for everybody. If you think they make you worse, you might be right.

The rhetoric keeps shifting on this point, depending on what the speaker is selling. I
think the current prevailing stats are that the meds help half of us, harm a quarter of us, and for another quarter, they just don't work. And for most of us in any of those groups, the disease does go away on its own anyway, though it leaves its wreckage behind. But that is what I am gleaning from the research. Nobody in the scientific community has summed it up so simply.

Spiritual Practices for the Dark Night -- Tithing

Yes, I'm serious.  Tithing.

I knew about tithing because I am a Christian.  The concept comes from the Old Testament. I used to think it was interesting -- from a distance. Like fasting. Of course nobody except the legalists actually did it. Still, I suspected I was missing something.

Then two things happened within two months. I left the person to whom I had turned over all decisions that mattered. And I attended a conference about what was called the "Alabama Plan." We did bible studies about money, about tithing, about abundance and God's promises. And then we were asked, What is preventing you from claiming God's promises? I realized my answer was -- nothing. Nothing prevented me.

So I became a tither.

Now remember the context. Having just moved out on the chief money maker of the family, my household income had plummeted to 40% of what it had been. It occurred to me -- this was the perfect time to begin tithing. Instead of 10% of what I was used to living on, now it would cost me just 4%. The difference between living on 40% and living on 36% didn't seem like that bit a deal.

I was so excited by my new resolution that I decided to tithe for the previous two months as well. So I sat down with my checkbook. That's when the magic happened.

Suddenly, I had $300 to give to whatever cause I wanted.

I had never had $300 to give to whatever cause I wanted.  I was rich!

And I have never looked back. In the years since, I have purchased honey bees, rabbits, trees, a pig, a llama, a sheep, and this year a goat from the Heifer Project. I have purchased mosquito nets from UNICEF. I have fought hate crimes and taught tolerance through the Southern Poverty Law Project. I am helping secure marriage equality through the Lambda Legal Defense Fund.

My most satisfying sense of wealth was the opportunity to purchase four chlorinators for $300 a pop. They provide four villages in Swaziland with clean drinking water. The last time our diocese sent a team to partner with the Anglican Church there, they sent back word, "One elder welcomed us with great thanks. He said, 'Ever since you came, we have not buried a child.' It's a much bigger project than my contribution. Now the Swazis are making the chlorinators themselves.

And I have given lots of money to old churches in small towns. I make no apologies for paying heating bills of drafty old buildings. Hearts starve as well as bodies; Give us bread, but give us roses. In out of the way places, stained glass windows are the only art most people see. So I am glad to support the furnace repairs of my church home. We are family. Paying the bills is part of belonging.

I couldn't do all this if I hadn't made a commitment -- 10% on the first line item of my budget. If I had to decide each month whether I could afford it, well, of course there are other things I "need." But with that money already allotted, my only decision is where I get to spend it. Frankly, it's almost the only discretionary money I have. That there is so much of it makes me feel rich.

And what on earth does this have to do with Prozac Monologues: reflections and research on the mind, the brain, depression and society?  This:

Regarding depression: those of us with mental illness experience loss piled on loss, often including financial loss. We live in a world so programmed for consumption that it consumes us. We are surrounded by images of things we don't have. It hurts to feel poor.

Regarding society: the "Crazy Delusion" consumes all the rest of us, as well. Do you realize that of the almost 7,000,000,000 people on the planet, most of them do not have cable?

Regarding the mind: think of tithing as Cognitive Behavioral Therapy. First, pay attention to your feelings about money. Money is the quickest way into what we value. Examine the assumptions behind your feelings. Challenge your assumptions. Do they have a basis in reality? Explore and test options.

Nothing has ever matched the rush I got when I wrote those first checks. If you have to be careful about mania triggers, you might start slower. Figure out what you gave away last year. Calculate the percentage. Double it this year, and double it again next year, until you reach your goal. The trick is to make it a line item in your budget, as intentional as your light bill.

Tithing is a spiritual practice for the dark night, a way to push back your feelings of loss and your anxiety about the future. I am not going to promise that you will be rewarded by an unexpected windfall. Rather, it will occur to you that you already have enough.

So like thankfulness, tithing is a form of mindfulness, paying attention. The Torah has given us this great gift. Claim it. As Moses said, Choose life.

P.S.  I seem to have given a lot of advice lately. Too much.  There will be no third spiritual practice; the series ends here.

Mother Amygdala, Have Mercy Upon Us

Once upon a time I wanted to be a neurosurgeon. But I had this idiotic fear of science class -- it was in the water that they gave to girls in the 1950s. So I headed in another direction. Still I am fascinated by the brain, and will keep sharing the stuff that I learn about it. Today's topic is the amygdala.

Ah, the amygdala, the reptilian brain. It is among the oldest parts of the human brain, regulating memory, emotion and fear. The amygdala associates a strong emotional reaction with a piece of information to imprint that information in your memory. You remember best what you associate with strong emotion. If you walk under a tree in the tropics and a poisonous snake falls on top of you, it is highly beneficial from an evolutionary perspective to remember that tree where those poisonous snakes linger. That's when the amygdala is your friend.

OMG!!! That's What They Said! Relapse


"The goal of treatment was to maximize the number of patients achieving clinical remission because this would then render them eligible for the mood challenge." [italics added]


The winners of this month's Omgodthat'swhattheysaid Award are
Segal, Kennedy, Gemar, Hood, Pedersen, and Buis in "Cognitive Reactivity to Sad Mood Provocation and the Prediction of Depressive Relapse," Archives of General Psychiatry 63:7 July 2006.

They wanted to answer a question I asked in my last post, why does depression come back? Cognitive Behavioral Therapy (CBT) says that automatic negative thoughts cause depression. CBT is designed to make people aware of these thoughts, to interrupt and reframe
them. It is often as effective as antidepressants in treating mild and moderate depression, and better in terms of relapse rate. Nevertheless, people treated with CBT do relapse. One explanation is that CBT addresses the cognitive processes that dominate during a depressive episode, but there are underlying and ingrained thought processes that persist even in remission. Give people a list of adjectives, ask them which apply to them, and those who have been depressed but are in remission will nonetheless pick out more negative words than those who have never been depressed.

Cognitive Behavioral Therapy -- aka Cake or Death

Cognitive-Behavioral Therapy (CBT) is a... treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking... In CBT, the individual is encouraged to view such beliefs as hypotheses rather than facts and to test out such beliefs by running experiments. Furthermore, those in distress are encouraged to monitor and log thoughts that pop into their minds (called "automatic thoughts") in order to enable them to determine what patterns of biases in thinking may exist and to develop more adaptive alternatives to their thoughts. -- NAMI.org 

Books on Cognitive Behavioral Therapy

Popular Posts