by Heidi Vermeer-Quist, PsyD
“Be careful how you think; your life is shaped by your thoughts.” Proverbs 4:23 (GNT)
I am a HUGE “Keep It Super Simple” (KISS) person, so I like to boil down thought processes into two major themes: Victim Thinking and Victor Thinking.
Victim Thinking is characterized by thinking from a survival perspective. We all go there at times. To some degree, we have to when we are faced with a life threatening situation, but by no means do we have to be in survival mode all the time. How many of us are truly under constant attack? When I am stuck in victim thinking, I believe that I have no options or at least no “good” options. I feel extremely anxious, hopeless, perhaps depressed, and desperate. If this is my perspective, and therefore my reality, it is likely that I will either cower in a corner or become aggressive and abusive toward others in order to survive.
There are four Fear-based survival reactions, each starting with the letter “F”. When we view ourselves as Victims it is likely that we will react with Freeze, Fight, Flight, and/or Fix behaviors. A statement that motivates me to move out of victim thinking is the statement, “Victims stuck in victim thinking will become abusers.” I know this to be true in my own life. While I may not overtly abuse someone else, it is highly likely that I will lash out at those closest to me when I’m stuck in victim thinking. How about you?
Victor (or non-victim) Thinking is largely characterized by a mentality of “I’m Okay. This situation may be bad, but I’m okay.” When we hold onto an internal sense of security we are able to think more clearly and search for options to get through difficult situations. If I embrace a victor mentality, I am able to draw more effectively from the positive resources both inside and outside of myself. Conversely, when I’m stuck in victim thinking, I perceive very few positive resources inside and outside of myself.
From a Christian perspective, we believe that God provides us with everything we need at all times. Consider with me some of the basic gifts we receive every day: from oxygen, food and water, to values and social resources, to changes and options arising in our lives and environment every moment. As we turn to God as our source of everything, we begin to hope again, to see a more positive perspective, and to take “the good” into our thought lives. We can take comfort in that moment as we notice God’s loving presence.
We may consider the supportive people that are available to us. We can choose to engage in activities we CAN do (rather than focusing on what we can’t). For example, focus on basic activities I can change, like washing dishes, self-care (healthy eating, sleeping, exercise), and exploring options while remaining grounded in the present moment. As I calm myself down (reducing my fear), I open myself up to embrace other options that are already at my disposal. Rather than being driven by fear, I’m committed to hope and finding solutions. I may even be able to experience joy in the midst of difficult times. As a result, I am more able to connect with other people honestly and respectfully, rather than reactively or fearfully.
Heidi Vermeer-Quist, Psy.D. is a licensed clinical psychologist working at the Pine Rest Des Moines Clinic since 2002. She provides psychotherapy to people struggling with depression, anxiety, relational conflicts, unresolved grief and adjustment, and personality disorders.
by Carolyn King, MD
Since April is National Autism Awareness Month, it provides a great opportunity to offer some information about autism.
What autism is not.
It is sometimes easier to say what autism is not. Autism is not mental retardation. It is not a serial killer. It is not contagious. Autism is not that different from our own idiosyncrasies or quirks.
What autism is.
The autism spectrum of disorders is a group of developmental disabilities that can affect social interaction, communication skills, and behaviors. Symptoms may range from very mild to severe.
Mild symptoms can be displayed in someone who is considered quirky, geeky, and often bullied. For example, the person doesn’t pick up on jokes or doesn’t make friends easily. People with mild symptoms can become obsessive, or very focused on one thing or area such as dinosaurs, astrology, computers or electricity. These people have a normal to high intelligence quotient (IQ).
People with severe symptoms may have an inability to communicate in words and be very focused on light switches or blocks. They often require “sameness,” or routine. These people can easily be over-stimulated with sounds, smells, lights, people or change. These people usually have low IQs.
Why become aware?
Awareness can lead to better options for treatment. Think of how awareness of breast and prostate cancer has created improved health outcomes when faced with the diagnosis of cancer. The illness becomes less scary.
Awareness of a problem validates that a problem exists. It gets people looking for ways to solve the problem and helps decrease negative events, such as when people with autism are bullied and ostracized. People who are bullied and ostracized sometimes retaliate with unhealthy outcomes. Awareness of autism allows people more opportunities to collaborate towards healthy outcomes.
How to begin treatment
Intervention can involve behavioral treatments, medicines or both. A diagnosis is based on observed behavior. Often a comprehensive evaluation will include information from more than one professional discipline, and rule out problems of vision and hearing acuity as well as possible contributing medical conditions.
Research indicates that children who start treatment at an early age achieve better outcomes. To determine if your child might need an evaluation, contact one or more of these resources: your child’s physician; your school district; or the Michigan Early On Program.
What can you do?
Increase awareness by searching and researching autism websites and materials, and share the results on your social media sites. Donate to autism organizations and research.
We built ramps for people in wheelchairs; it’s time to build bridges and social applications for people with autism. We can do better.
Carolyn King, MD, is a psychiatrist working with adults, adolescents and children in both outpatient and inpatient settings at Pine Rest. For more information go to www.pinerest.org or call 1-866-852-4001.
When I was growing up, every summer my Grandma and Grandpa Vermeer took my cousins and I fishing up in Canada. Looking back, it was quite a treat, though I often did not fully appreciate it at the time. We would get up early every morning, usually before 6 a.m., which was “sleeping in” for my grandparents. Sleepy eyed and chilled, we’d shuffle to the table for a hot fisherman’s breakfast. During breakfast, we’d talk about the day, which lake we’d go to, and what Grandma would pack for our lunch. Then we’d get out onto the water as quickly as possible. Within two to five minutes of putting minnows on our hooks and letting our lines down, one of us would get a “hit”. Then the fishing frenzy would begin. We caught beautiful (well, if fish can be beautiful), big fish. Walleye and Northern Pike mostly.
Honestly, while on these over-stocked lakes, we would catch our fishing limit every day…sometimes we’d catch it within the first hour! Sickening, eh? (I always have to say “eh?” when I’m talking ‘bout Canada ). Once we caught our limit, we’d start weeding through our stringers full of fish and decide which ones we wanted to keep and which ones we wanted to release and replace. Finally, after about two whole hours of fishing we’d be just “exhausted” (remember we were kids), so we’d head back to shore for our gourmet lunch consisting of either fresh cooked fish or premade PB&J.
Catch – Release – Replace. This fishing experience serves as a great analogy for mental health. Did you know that we go fishing all the time? We cast out our attention like a fishing line, baited and hooked, trying to connect with the next great “catch”. And typically our mental ponds are stocked full. We catch something immediately. What we reel in may or may not be a “great keeper”. We are the ones judging its value. We may reel in something quite disappointing, and it is up to us to hold onto it or to let it go. Unfortunately, sometimes we get in the habit of catching and holding onto unhelpful thoughts, unhelpful expectations (for others, outcomes, or holding onto old memories – “coulda”, “woulda”, “shoulda’s”) and not releasing them. It is vitally important for us to release and replace those thoughts that are toxic to our mental health.
Try to apply the “catch – release – replace” analogy to your mental health management. What are you catching in your mental pond? Just be aware what you are “catching”. What is “hooking” your mind or thought patterns? We are all fishing…all the time. Just pay attention to your thoughts.
Now ask yourself, “do I want to keep these thoughts or let them go”? Are my habitual thoughts keepers? Or are they throwbacks? Hint: the throwbacks would definitely include the 3 O’s – others, outcomes and old stuff. In all honesty, whenever I do the above exercise many of my thoughts are throwbacks – something to do with old stuff, something about someone else, or some worry I have about the future. HOWEVER, when I catch it I realize that I can free myself by simply releasing it to God’s care and replacing it with something better. Perhaps putting my mind on something tangible in the present; focusing on gifts from God given to me in every moment; adopting an attitude of acceptance, thanksgiving, and trust. Take some time to reflect on and use this “catch – release – replace” mental health methodology. May God guide and bless your fishing expeditions.
PRAYER: “The way I see things determines how I think about them. The way I think about things determines the way I feel about them. The way I feel determines how I will act, react and choose. That will determine the results I will have to live and with. I choose to side with Your (God’s) ways in all things.” – A Daily Affirmation from Christ Life Ministries.
I grew up in the lovely little town of Pella, Iowa. People who grow up in Pella are expected to be well-put-together, responsible, hardworking, God-fearing and independent. As a good Dutch Reformed girl, I figured I had “boundaries” down pat. I grew up in a church and community with lots of clear rules. I never got in trouble. People liked me (at the least most seemed to like me). And I genuinely loved God and desired to follow His commands. So, imagine my shock and dismay, when three years into my doctoral degree, my psychologist told me that I had problems with healthy boundaries. It took me a good year or so to even consider that she might be right. She was. That same year, a chaplain who I was working with on my inpatient rotation, told me I was a “control freak”. Again, I experienced shock and dismay, not to mention major offense. She was way off…until I realized she was way on.
I carried tons of extra stuff on my shoulders that I simply could not control. I felt very responsible for keeping other people happy, succeeding in everything I did, knowing the right answers and not making mistakes. I worried constantly, planned obsessively, and struggled with a good deal of shame and “not-good-enoughness”. Developing a healthy concept of Boundaries was critical to my own well-being, and I find it to be a missing piece for almost every client who walks through the door.
From a Christian perspective, we are created in the image of God but born in sin (thinking we can actually do God’s job better than He can). As a result, we all often have problems realizing our own limits. Here is a simple overview healthy boundaries:
Basics of Healthy Boundaries
(some concepts taken from Boundaries by Cloud and Townsend)
o Attitudes or thoughts (directing or redirecting them)
o Behaviors (choosing and acting with them)
Watch Out for the “O” Zone and Garden Your Life with God.
We naturally let the three O’s into our minds and dupe ourselves into believing that we can control them. Focusing on the “O’s” of others, outcomes and old stuff, and trying to change or control them is a losing battle. Instead, catch yourself when you are in the “O” zone, commit your “O’s” to prayer, and focus on managing your own Feelings, Attitudes, and Behaviors one moment at a time. Ask God, your Master Gardener, to guide you and provide you with His wisdom and grace. Ask supportive others to help you as you adjust your boundaries and garden your life. As we manage our own FAB-ulous treasures, we are energized to connect well with others. We are able to live and give freely.
by Susan Yoder, NP, RN
“He never attempted to sleep on his left side, even in those dismal hours of the night when the insomniac longs for a third side after trying the two he has.” - Vladimir Nabokov
We all have a bad night every once in a while, but It is estimated that 25% of us suffer from more persistent insomnia. That’s 82.5 million people in the US. No wonder drug companies are making millions selling over-the-counter and prescription sleep medications. Insomnia includes problems falling asleep, problems staying asleep, or problems waking up too early in the morning. We have no idea how many people never report their sleep problems to their doctor because they think it is too trivial, that there’s nothing anyone can do, or they treat it on their own with over-the-counter sleep aids or alcohol. (More on that later.)
Insomnia is a serious health issue. It can impair your memory. It increases the likelihood that you could develop heart problems (high blood pressure, heart attack, congestive heart failure), have a stroke, develop diabetes, be obese, be in a car accident, or die sooner. One study found that reduced sleep time increased mortality more than smoking, high blood pressure, and heart disease. People with sleep deprivation are more impaired than people who drive when intoxicated. But just what constitutes sleep deprivation?
How much sleep is enough? We all learned that we’re supposed to get eight hours of sleep a night, but the reality is we are all different. Each individual has a unique sleep requirement which depends on genetic and physiological factors. Most adults can function on six to eight hours of sleep per night with minimal negative effects, and some on as little as five hours. It is interesting to note that people can have negative effects on their health with too much sleep – anything over nine hours a night.
In order to determine how much sleep you need, you have to be able to sleep as long as you would like until you wake up naturally, feeling refreshed and awake. Not too many of us have the luxury of doing that, especially not for a long enough period to make up for any pre-existing sleep deficit and then determine what our consistent sleep time is. In general, if you do not have excessive daytime sleepiness, do not have mood problems (most often depression, irritability) nor do you have problems with memory, concentration or productivity, then you are probably getting enough sleep. If you have any of the above problems, you should talk to your doctor. They may be caused by insomnia, but you need to eliminate a number of other possible causes which might also be causing the insomnia.
So, you’ve figured out that you are not getting enough sleep. You lay in bed at night waiting for hours to fall asleep, but you can’t. You wake up in the morning feeling like you’ve been awake all night. The three most important things to do are:
Regardless of what is actually causing your insomnia, making these three changes will help improve your sleep. Limit caffeine to 16 ounces per day. The last intake of caffeine should be at least six hours prior to bedtime. Caffeine level peaks in your body five hours after you drink it. If you have a Mountain Dew at 7:00 p.m., it will max out at midnight and only then start to decrease its effect.
Limit alcohol to no more than one or two servings and none within two hours of bedtime. Alcohol produces fragmented sleep, shallower sleep, and results in more nighttime awakenings. Alcohol can also make sleep apnea worse. A glass of wine at dinner does not usually interfere with sleep. NEVER mix alcohol with sleeping pills. This is a deadly combination.
Becoming a nonsmoker is important because nicotine is a stimulant. It raises your blood pressure, heart rate, and brain wave activity. Smokers wake up frequently during the night due to nicotine withdrawal. (How often do you go for eight hours during the day without smoking even one cigarette? Most people experience nicotine withdrawal after two hours without a cigarette.)
So you’ve limited your caffeine, alcohol and cigarettes but you still aren’t sleeping. Insomnia: Part Two will describe proven strategies to improve sleep.
Susan Yoder, NP, RN is a Certified Nurse Practitioner. Susan works in the Campus Clinic and has extensive experience working with individuals who are coping with depression, anxiety, mood swings, the effects of abuse and trauma, as well as those who hear voices and have psychotic symptoms.
This column first appeared in the February 24, 2013 edition of the Grand Rapids Press
By Bruce Springer, MD
What is addiction?
Most health care professionals would agree that addiction is a disease.
Like high blood pressure, diabetes, heart failure, and leukemia, it shares many disease-defining characteristics and like these, if left untreated, is often fatal. Unfortunately, addiction, whether to drugs, alcohol, or even gambling, is a relapsing disease that is all too common.
There are more deaths, illness, and disabilities from substance abuse than from any other preventable health condition. Today, one in four deaths is attributable to alcohol, tobacco and illicit drug use.
Addiction finds its home in some of the deepest parts of the human brain and yet reaches outward to affect all of health, family life, law and even history.
Terms used to describe and differentiate people’s relationship to potentially addictive substances are important to understand. Frequently, these terms are used interchangeably and this adds confusion to an already confounding topic.
Most people using opiates for severe pain relief may develop tolerance and require higher doses for continued pain relief. Some of these same patients may become dependent and experience uncomfortable withdrawal symptoms if the opiates were stopped abruptly. The majority of these patients, however, will not develop the disease of addiction.
A college freshman may abuse alcohol and drink to intoxication frequently throughout his early college experience, but after failing an important course or frequent morning “hangovers,” will decide that moderation and responsibility are important to his health and success. His best friend, however, may lose control over alcohol consumption and develop addiction to alcohol (alcoholism), drinking despite dire consequences.
Addiction is a disease located in the brain
Many view alcoholism and addiction as a moral weakness or disease of the will. We are now learning addiction begins when significant changes take place deep within the human brain.
The brain is made up of billions of individual nerve cells that must be able to communicate with each other. They do this with tiny appendages called axons. These cells send chemical messages back and forth with neurotransmitters such as serotonin, dopamine, and norepinepherine. Many medications and all substances to which human beings become addicted affect the quantities of these chemicals and how they interact with nerve cells.
Within the substance of the brain lie clusters of nerve cells which allow us to feel joy, happiness, and satisfaction. These are known as “pleasure centers” and are connected in a tract of nerve tissue running near the bottom of the brain between the right and left hemispheres.
It is thought that people susceptible to addiction may experience changes in the interaction of these neurotransmitters and their receptors. For persons having a predisposition to addiction, the introduction of a substance bringing a pleasurable feeling may begin to disrupt the receptor / neurotransmitter function of the nerve cells. What once was a source of pleasure becomes a desperate need for the substance bringing pleasure.
The disease of addiction may bring with it distinct molecular and biochemical changes in the human brain. Addiction takes a toll on the addict. Any drug of choice eventually begins to destroy the physical and psychological health of its victim.
Conclusion
It is not difficult to see that if we are not ourselves victims of addiction, we may well care about someone who is. Because it is felt by many to be our number one health problem, it is important to become more familiar with addiction as a disease and not a moral weakness.
People with addiction are in great pain and their suffering can be lessened and even eliminated through treatment. We must be willing to commit ourselves to offering and supporting that treatment.
Bruce C. Springer, MD, specializes in treatment of addictions and is a physician in Pine Rest's Addictions Services. He has more than 30 years of experience. Pine Rest provides a continuum of addiction services, for more information visit our Addiction Services page or call 1-866-852-4001.
I did an exercise with a depression support group a few years ago. I encouraged participants to turn to one another and take turns asking the question, “Who are you?” One of the ladies graciously agreed to demonstrate the “Who are you?” dialogue with me. Instead of having her ask me first (which I should have done, so as not to put her on the spot), I asked her first, “Who are you?” She responded immediately with a laugh and the statement, “I am fat!” She then continued a litany of other things about herself that were wrong. I don’t remember any of them because I wanted to stop and redirect her ASAP. I encouraged her to focus on more simple, factual (less negative and judgmental) self-statements.
Now, some of you may be wondering, “Well, was she fat?” She was overweight but not morbidly obese. Still, isn’t it sad that her first self-statement was “I am fat!”? What does that tell you about how she sees herself?
Is this woman alone in her automatic perceptions of herself? By no means! I frequently have automatic thoughts that are self demeaning. I’m pretty sure you have those types of automatic thoughts too. Certainly we all seem to struggle with “I’m not good enough” or “not acceptable” thoughts.
Take note right now, however, that those descriptions are simply not true! They are more likely statements of a negative self-concept or an expression of negative feelings. If I confuse “Who I am” with “How I am feeling”, then the “worlds” I create with my words will be very dramatic, unstable and probably dark. Who I am is NOT a negative perception or judgment. Who I am and who you are is amazing and well designed. We are more unique than anything else in all of God’s creation. As far as I can tell, we are the highest functioning beings on the planet…and likely in the universe!
Who am I? I am a human being. I am created by God and in God’s own image. I am also a person created to be utterly dependent on God for all things. He made me female. I am a wife, mother, daughter, sister, cousin, friend, co-worker, psychologist, and musician. I love pumpkin spice lattes (with half the syrup) along with most hot drinks; critters like dogs and horses; crisp fall days; wearing blue jeans, colorful socks, comfy shoes and cozy shirts; going to hang out in a coffee shop with nearly anybody; making music; laughing at and with my husband; marveling at the growth all around me (especially with my kids) but also within me. When I turn my mind to all these things, I’m compelled to say, “Praise God from Whom All Blessings Flow” and I’m much more okay with myself.
How about you? Who are you? Remember, your life is a gift to you. You are not to judge it, but to embrace it, unwrap it, and value it. Take time this day to write out who you are. Perhaps do the “Who are You?” exercise with a friend or family member. It will make your world a brighter place.
by Tom Karel, MA, CAAC
Sigh… it is that time of year once again: the after the holidays winter blues that we who live in Michigan have come to expect. For many of us, about 90 percent, we notice a mild decrease in energy and increase in lethargy that mildly interferes with our everyday functioning. However, for about 10 percent of us, the “winter blues” can become moderate to severe in its effect. The problem is called Seasonal Affective Disorder (SAD).
This illness has been well studied and documented over the last 30 years. What has been determined is that those of us in the northern hemisphere during the cloudy, gray, gloomy fall and winter months have significant increases in depression related symptoms. If you reside in Florida during these winter months, your chances of experiencing SAD are 1.4 percent; however if you live in New York, your chances increase to 12.5 percent.
Symptoms of this illness include: feelings of hopelessness and helplessness, depressed/irritable mood, loss of interest and pleasure in things usually enjoyed, increased social isolation, fatigue/loss of energy, increased appetite, especially for carbohydrates, and weight gain.
The tendency for most is to ignore these symptoms. We say, “I’ll just tough it out,” in the hope that it will improve. If left untreated, these symptoms usually do not automatically improve; in fact, they can worsen to include thoughts of death and suicide.
If you have had thoughts of death, harming yourself or suicide: Do Not Wait to Get Help. If these thoughts have occurred, you also think that, “my family and friends are better off without me.” However, let me reassure you: your family and friends are better off with you getting well.
In getting help for yourself, it is important to talk about what’s going on so you can receive the support and encouragement of your family and friends. Reaching out beyond family and friends is also important:
Additionally, it is essential to fight, rather than feed, this illness. For example, if you don’t feel like exercising, don’t wait until you feel like it. For most of us, that won’t happen; instead make plans with a friend to exercise together.
With help, there is hope. We at Pine Rest wish you all a Healthy and Happy New Year!
This article first appeared in the January 27, 2013 edition of the Grand Rapids Press.
Tom Karel, MA, CAAC, is a limited licensed psychologist and certified advanced alcohol and drug counselor at the Pine Rest Campus Clinic. He has worked at Pine Rest since 2000. Pine Rest offers a continuum of behavioral health services; for more information visit www.pinerest.org or call 1-866-852-4001.
Part Four in a series (Originally posted on July 26, 2011)
by Gretchen Johnson, MSN, RN-BC
The good news is postpartum depression (PPD) is treatable. Those who suffer from it are not bad parents. They are not monsters who will hurt or damage themselves, their child, or others. They do have an illness that can be treated. Postpartum and other perinatal mood disorders (PMD) can have serious consequences when left untreated. These consequences affect not just the sufferer but those closest to them as well. The littlest yet most important victims of untreated PMD are the babies.
Research has shown that left untreated, PMD can have serious ramification for the children of those who suffer from it. Problems in babies and children include behavioral issues, problems with emotional and social development, cognitive delays, and a greater risk for lifelong struggles with depression. Some of the research findings include:
• Depression during pregnancy causes problems for the newborn such as inconsolability, sleep problems, decreased appetite, and less responsiveness with facial expressions. • Babies with depressed mothers have a high incidence of excessive crying or colic. • Mothers with PPD report infant sleep and crying problems more frequently than non-depressed mothers. • Children whose fathers suffer with depression are about twice as likely to have behavioral problems in preschool. • PPD in the mother is linked to poor cognitive test scores in children which can include learning to walk and talk later than other children the same age, learning difficulties, and problems in school. • PPD in parents can lead to emotional problems later on for children such as increased anxiety, low self esteem, and less independence. • Older children in the family may lose part of their childhood due to emotional detachment from the child as part of the PPD. • In rare but serious cases, there are instances where a parent commits suicide due to PMD. Children whose parents commit suicide are at greater risk for suicide later in life.
PMD Impacts Children
PMD can and does impact children. The adverse effects can start during pregnancy and occur for multiple reasons. Untreated depression and anxiety during pregnancy impact the developing baby as maternal hormones cross the placenta. These hormones lead to complications after birth such as fussiness, crying, and inconsolability. In one study, researchers looked at the brain activity of babies born to depressed mothers. These babies’ brain activity matched the brain activity of adults diagnosed with major depression.
The effects of untreated PMD continue after birth, changing from biological to environmental. It is difficult for people struggling with depression (not sleeping, irritable mood, tearfulness, appetite problems) to care for an infant. Bonding between mother and baby can be interrupted when the mom is depressed. The mom may have difficulty responding to the infant’s cues. Babies bond with their mother by giving cues (crying when wet or hungry, smiling, cooing) and having the cues responded to appropriately (changing the diaper, feeding, smiling and talking to back). Mothers with PMD may be withdrawn and at times even feel hostile towards the baby making it difficult to respond to or many times even recognize cues.
It is important for all parents struggling with PMD to know that it is not their fault. Please note that it is untreated PMD impacts children. The message for people struggling with PMD is that there is hope and healing but they need to get help. It is easy to read all of the negative impacts of PMD on children and feel discouraged. But getting help not only will allow the parent feel better, but can prevent negative impacts in c