Ask and Listen: Parts We Wish We Would Have Known Reflections on Kate Spade and Anthony Bourdain

We lost two beloved, complex, creative souls to suicide last week – reminding us that suffering not only affects all types, but remains largely hidden, even from loved ones. Time and again, the suicides of public figures who seem to live fulfilled and privileged lives have revealed this important take home message: Mental illness is nothing to be ashamed of. In the wake of Kate Spade’s and Anthony Bourdain’s suicides, many ask – how can I help a loved one who is suffering?

First, it’s important to note that there are many myths surrounding suicide. Check yourself if you believe these are true or false:

• Asking someone if they have thought about suicide may trigger them to actually do it. It may put the idea in their head or make them angry and impulsive.
• Once someone has made up their mind about suicide, you cannot stop them.
• Only experts can prevent suicide.
• People who consider suicide keep their plans to themselves.
• Those who talk about suicide don’t actually do it.
• Depression is the only risk factor for suicide.

All of these myths are false. Suicide is a highly preventable type of death and it’s everyone’s business. Providing a person who is considering suicide with a safe space to talk about their thoughts and feelings will actually lower their risk of completing suicide. Asking someone directly about suicide helps lower anxiety, opens up communication, and lowers the risk of an impulsive act of self harm. Other than depression, risk factors for suicide are plentiful, including financial or relationship losses, health concerns, legal issues, substance abuse and dependence, and other psychiatric illnesses.

The key is to ask and listen. Survivors report that being asked about suicide was a relief, and that the most important part was feeling listened to without judgment. Feeling connected and not alone has powerful healing properties for the person who is suffering.

Here are some tips on how to talk to a loved one who you suspect may be considering suicide:

• Ask them if they are thinking about killing themselves. (This will not put the idea into their head or make it more likely that they will attempt suicide.)
• Listen without judging and show you care.
• Stay with the person, or make sure the person is in a private, secure place with another caring person, until you can get further help.
• Remove any objects that could be used in a suicide attempt (weapons, pills, etc.).
• Do NOT offer advice or try to cheer them up. This can cause the person to feel invalidated and shut down.
• DO offer to help the person make an appointment with a health or mental health provider and to accompany them to the appointment.
• Enlist the help of others. Do NOT agree to keep someone’s suicidal thoughts a secret.
• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and follow their guidance.
• If danger for self-harm seems imminent, call 911.
• Remember, suicide is highly preventable, help is out there, and people do recover.

Here are some additional resources:
American Foundation for Suicide Prevention: afsp.org/resources
Live Through This Project: livethroughthis.org/the-project

Tips to Beat the Winter Blues

You are the sky...Everything else, it's just the weather. ~ Pema Chodron

Winter, with its shorter, colder and darker days, can give rise to occasional feelings of sluggishness, low mood, or Winter Blues. Below are some simple strategies you can use to help these occasional feelings.


Do:

• Try to have regular sleeping patterns. As you feel down, the urge to escape everything by just staying in bed can become stronger. Try to resist this (unless you are genuinely physically tired) as it can make things harder to deal with.
• Try to have a plan of what you need to do day-to-day and week-to-week. Make it realistic and review it regularly. Use it to check your progress. 
• Keep in contact with your friends and loved ones. Cultivate relationships that are close and supportive. If your family is supportive, try to tell them how you feel. Remember you are not alone. Consider the advice and help that others might try to give you as a positive thing in your life.
• Remember to do some of the things that you have enjoyed doing in the past. Reading, movies exercise, playing sport, spending time with friends, getting back to nature, etc. What works for you is what is most important. Sometimes just having a routine to follow can give you a sense of structure in your life.
• Practice ways to distract yourself away from negative patterns of thought. Activity and getting out of the house are good in this respect. 
• Negative thoughts can generate feelings of anxiety. Learning relaxation techniques can help a great deal. A therapist can help you to learn a variety of physical and mental relaxation techniques that will be useful for you in the future.
• Try to explore the way you are feeling. If you can recognize your emotions, talk about them with friends, and/or with a therapist. Write them down, and see how they may relate to your own thinking about yourself or to things that happen in your life. By doing so, you can avoid them controlling you. Then you can begin to get some control back in your life.
• Think of things that have helped in the past, if you've experienced the Blues before. Write these things down and remind yourself to keep using them. Allow yourself the time for them to have an effect.
• Daily exercise and a nutritious diet are important. If your appetite is low, try nutritious smoothies or juices - a liquid diet can be easier to manage if you are prone to gastrointestinal stress.

Don't:

• Don't be passive and allow your mood to take over, if you can help it. Make some plans for each day. 
• Try to avoid falling into the trap of "automatic negative thinking". Identify your negative thoughts, learn to monitor them and learn to challenge them. (i.e., look for evidence to support your negative thoughts or assumptions about yourself). Then you can begin to substitute more positive and therefore more useful patterns of thought. Try writing these things down in a notebook. A therapist can help you to develop this approach so that you can be more realistic about those things in your life that are positive. Click here to learn more about strategies for negative thoughts.
• Don't overindulge on alcohol. It’s a central nervous system depressant and it may make your blues worse.

What distinguishes occasional Winter Blues from Clinical Depression? Check these symptoms of depression or read information about depression. If you check 5 or more of these symptoms for 2 weeks or more, please talk to a mental health or medical professional.

• Frequently feeling sad and/or guilty
• Eating more or less (including significant weight loss)
• Sleeping more or less
• Loss of interest in things you usually enjoy
• Low energy, fatigue
• Irritability
• Difficulty concentrating and making decisions
• Thoughts about death and suicide

While the above signs are more common, everyone is different. The following may also indicate depression for some people:

• Increased use of alcohol and drugs
• Anger
• Difficulty envisioning a hopeful future
• Helplessness
• Increased aches, pains, or bodily ailments

Seeking appropriate mental health care for depression is important and possibly life-saving. Please contact a licensed mental health professional if you are concerned about depression in yourself or a loved one.

Winterize Your Heart for the Holidays

Pain is inevitable. Suffering is optional. - Haruki Murakami

As the cold is upon us, many of us are in the process of winterizing - taking precautions to protect our bodies with extra layers, and our animals, plants, and dwellings with extra heat. The days are getting shorter, darker, and colder, which for many also has emotional effects. For some, it may be a mild and temporary case of the "winter blues" as you adjust to the season.

For others, emotional changes may be more intense. You may feel a lot more tired, your brain may feel sluggish, and your body may feel heavy. You may wake up in the morning only to spend all day looking forward to getting back to bed as soon as possible, with not much energy or motivation to socialize or do more than the bare minimum. There may be habits like spending too much time with electronic devices, and turning to unhealthy food and drink on a more regular basis. With the festivities and chaos of the holidays upon us, this feeling and need to cocoon may get more intense, which can create an extra burden if there's a social expectation to be out, about, and celebrating.

If this sounds familiar, you might have Seasonal Affective Disorder (S.A.D.). S.A.D. is a type of depression that affects some people during the fall and winter season when days become shorter and colder. The exact causes of S.A.D. are not fully understood, but it is likely the body's reaction to outside seasonal changes - causing changes in circadian rhythm and levels of melatonin and serotonin. Women, people with a history of depression, and those who have a family history of S.A.D. and/or depression are at the greatest risk for S.A.D.

Regardless of your susceptibility to the winter blues or S.A.D., it's a good idea to winterize our hearts and souls, if anything, for preparation and prevention's sake. Don't wait until you're caught in the chaos or out of sync. Here are some things you may wish to consider to take care of yourself this season.

• Get outside. Even though the instinct may be to hunker down, just a bit of time spent in daylight can help increase energy levels and improve mood. You can layer up and try a walk, or even jog or run. Even going for a drive, getting a cup of coffee, or meeting up with a friend can help reset your mood and activity level. 
• Move your body. Again, snuggling with Netflix may sound a lot more appealing. However, exercise doesn't have to take long, and joining a friend in an outdoor movement activity can boost positive effects with activity and social support. Or join an exercise class - knowing that others are there sweating with you can boost motivation. A body in motion stays in motion. 
• Eat high quality foods. When it's cold and dark, fast, fatty, and comfort foods become more alluring. Just make sure your food includes healthy components - dark, leafy greens, fruits and veggies across the color spectrum, nuts and seeds, whole grains. Omega 3 fatty acids have been shown to boost brain power. Healthy soups and stews can be made ahead and frozen for later use. Try to avoid alcohol over-use, as it is a depressant and can lead to more sluggishness. 
• Nourish your spirit and soul. Lots of small things are at our fingertips to do so. The trick is to add soothing, positive energy and take away draining energy. Spend time with a quality friend who adds positive energy to your life. Meditation, yoga, hot baths, nice candles, aromatic oils, and a good book can provide much needed nourishment that isolation and electronics cannot give. 
• Reach out to others in need. Stepping outside of ourselves and giving back helps draw attention to the bigger picture in life and away from internal negative rumination. Check in on a friend or smile at random strangers. Buy coffee for someone, or pick up volunteering if you can.
• Practice gratitude. 
• Ask for help. If it is difficult to get out of the winter blues or you believe you may have S.A.D., help is available from physicians, psychologists, counselors, and other healers. By working with a professional, you can determine how to best manage your concerns. 

I am a Houston psychologist. For more information about my practice, visit DrGortner.com.

Understanding Depression

A startling finding: The World Health Organization has determined that depression is the most burdensome disease in the world today. It robs adults of more productive days of life than AIDS, cancer, or heart disease.

What is depression?  What is it not?  We all know the feeling of being sad or "blue" after experiencing a loss or disappointment.  It may last a few days or a few weeks.  But when do we start talking about an actual "depression" in clinical terms?
Common signs of clinical depression include:

• Frequently feeling sad and/or guilty
• Eating more or less (including significant weight loss)
• Sleeping more or less
• Loss of interest in things you usually enjoy
• Low energy, fatigue
• Irritability
• Difficulty concentrating and making decisions
• Thoughts about death and suicide

While the above signs are more common, everyone is different.  The following may also indicate depression for some people:

• Increased use of alcohol and drugs
• Anger
• Difficulty envisioning a hopeful future
• Helplessness
• Increased aches, pains, or bodily ailments

Depressive episodes can be situational - that is, they occur after a stressful event or events (for example, death or loss of a loved one, diagnosis of severe or terminal illness, children leaving home, divorce, persistent stressful job conditions, academic stress/difficulty, job loss, and other extremely stressful situations).  Or, it can happen for what appears to be no reason at all, literally out of the blue.  Research shows that clinical depression can also occur when stressors in the environment combine with a genetic or biological disposition.  If depression runs in your family, you are likely more vulnerable to also being depressed.

Depression is a complex and serious illness, comparable to diabetes or heart disease.  You can't just "snap out of it" by pulling yourself up by your bootstraps or thinking happy thoughts.  People with depression need professional treatment, just like people with diabetes and heart disease do.

What helps?  Talk therapy can help individuals determine what life circumstances may contribute to their depression and how to address them.  Therapy can also teach important skills to lower stress and address recurring negative thoughts that happen with depression.  Antidepressant medications can help normalize chemical imbalances in the brain that contribute to depression.  A helpful analogy to consider when thinking about antidepressants:  Just like insulin can help a person with diabetes whose pancreas no longer produces it, antidepressants can help a person with depression whose brain may be low on certain chemicals, or neurotransmitters.  More and more novel treatments are being researched and becoming available for people with recurring and treatment-resistent depression.

Only about one-third of individuals with depression seek treatment.  It is quite common for someone to live with depression for years, even decades, before deciding to seek help.  The sooner a person can get treatment, the higher their chances for recovery.  

If you know someone who is depressed, offer a supportive, non-judgmental, and listening ear.  Then offer your support in getting the person professional help and treatment.  Remember - depression is an illness that can linger, worsen, and/or recur if left untreated.  Remember, there is hope and there is help.

 I am a Houston psychologist who specializes in treating depression.  Visit my website for more information on my services.  

Please click here for an inspiring article in the New York Times on new approaches of treating depression in developing countries, impacted by war, famine, AIDS, natural disasters, and other trauma.

Job Burnout - Are You At Risk?

"Without work, all life goes rotten, 
But when work is soulless, life stifles and dies." - Albert Camus


Feeling stressed at work and unfulfilled by one's job is a familiar topic to most people.  But there is a difference between having a difficult set of days or weeks and actual job burnout.  Burnout is not an all or nothing phenomenon.  Fluctuations in motivation and enthusiasm are normal.  Job burnout occurs when enthusiasm and motivation have completely dried up while your job skills and knowledge remain intact - a very frustrating feeling.  Those hardest hit by job burnout are people in the helping and medical professions, those who make high stakes or life and death decisions, and those whose work is very detail oriented.


Burnout is a cumulative process and it is important to be in in tune with early warning signals:
- Loss of interest in work
- Emotional fatigue
- Increased moodiness and irritability in both personal and professional situations
- Increasing frustration with everyday responsibilities at work
- Inability to re-charge your internal batteries while not working
- Interpersonal problems marked by decreased tolerance and patience
- Social withdrawal - becoming aloof and inaccessible
- Indifference towards people and dehumanization of those you work with (eg, thinking of clients as objects not people)
- Health problems as a result of chronic tension or stress
- Substance abuse as a way to cope with difficult feelings
- Declining performance at work
- Being emotionally or physically absent from work
- Ceasing to find meaning in your work

Most people suffering from burnout share an experience of powerlessness, hopelessness, and helplessness.  They lose a sense of being able to control their work and self-confidence takes a major dwindling hit.  Re-establishing a sense of empowerment and confidence is key to addressing job burnout.  Before deciding whether or not to quit a job, it is important that you get yourself to a replenished and rational place first.


Here are some tips to help you reclaim a sense of personal control:
- Learn better ways to manage stress.  Healthy coping is key to replenish those dead batteries and get you to a place where you can clearly assess and evaluate what to do next about your job situation.
- Seek social support.  Even though the first instinct during burnout may be to withdraw from others, it is important to counteract this instinct.  Build a solid network made up of friends, family, and coworkers.
- Increase your knowledge base.  By continuing to build your marketable job skills set, you increase your personal and professional sense of empowerment.
- Manage negative thoughts.  See previous blog entry on Talking Back to Your Internal Chatterbox to learn how to manage types of thinking that can take control of your emotions.
- Develop detached concern.  This means learning to let go of attachment to how things could or ought to be - a skill that becomes immeasurable especially when you are working with serious or impossible situations.
- If all else fails, consider changing jobs.  However, it is paramount that you analyze the source of your job dissatisfaction first and explore what is needed to improve the situation.


Talking to a mental health professional who specializes in job burnout can be a powerful tool to regain a sense of control.  It can help to have a neutral person to process the above topic with.  I am a Houston psychologist and enjoy working with job burnout concerns.  Visit my webpage at DrGortner.com for more information.

Negativity: Talking Back To Your Internal Chatterbox

Thousands of thoughts run through our head every day.  Just consider your own internal dialogues all day long – about your own actions, about others’ behaviors, about the world as a whole, about what has happened in the past, about what is yet to happen.  The way we talk to ourselves can be positive, negative, or neutral.  Or even a mix of all of those.  Self-talk is often a mostly automatic and even unconscious process.  These dialogues can turn very unpleasant – such as beating yourself up in the face of perceived “failure”.  

Needless to say, the way we talk to ourselves can give rise to many different emotions. For example, if you tell yourself that if you don’t do well on tomorrow’s presentation at work, then you’ll never get promoted.  Or if you feel like a conversation with a friend felt awkward and you find yourself wondering if they now think less of you.  Both of these examples of self-talk can result in feelings of anxiety or hopelessness.  The key about making self-talk more constructive is learning to be more gentle and compassionate in the ways we talk to ourselves.
 
Cognitive and cognitive-behavioral therapists work with their clients to change negative self-talk into more rational responses.  The goal is that if we can start recognizing our own automatic negative thoughts and then turn them around, we can feel better about ourselves and the world around us.  Much research has been done to back this up as an effective form of therapy, especially for anxiety and depressive disorders. 
 
There are different categories of negative self-talk, and if you work with a cognitive or cognitive-behavioral therapist, you will get to know them intimately.  Below are some examples of negative self-talk (also called “cognitive distortions”) and more gentle alternatives.  Note that these are simple examples for illustrative purposes. 
  
1. Should statements:

• Negative Self-Talk:  I should be able to deal with stressful situations better.
• Better:  I know how to deal with stress and I am having a hard time right now.

2 .  Disqualifying the positive:

• Negative Self-Talk:  I hate my life, it always is so difficult.
• Better:  There are some things going on right now that are difficult and also some things that are actually going right.

3. Emotional reasoning:

• Negative Self-Talk:  I don't feel good right now, so it feels like I can't handle anything.
• Better:  I feel like I can't handle things right now and I know I can.

4.  Catastrophizing: 

• Negative Self-Talk:  If I don't do well on this work presentation, my boss will think poorly of me, I'll never get that promotion, and eventually I'll be jobless and homeless.
• Better:  Nobody's perfect.  I'll do my best on the presentation and know that less than perfect is not the end of the world.

If negative self-talk is ingrained in the way you think, and is regularly impacting your mood and relationships, you might consider working with a psychologist or other licensed mental health professional.  Also look for a future installment on this blog about how to foster more self-compassion.  I am a Houston psychologist – to learn more about my services, visit DrGortner.com. 

What To Do About This Pesky Anger...

Anger is an interesting and powerful emotion.  We have all felt it – perhaps as a fleeting annoyance or even as full-fledged, out-of-control rage.  Anger is a normal human emotion designed as a “red flag” to let us know something is causing us stress.  But when anger takes a hold of our life, it can lead to problems at work and in relationships.

Some experts consider anger a “secondary” emotion – meaning it is formed as a reaction to and cover-up for more primary emotions, such as sadness or fear.  It may feel easier or more acceptable to express anger rather than sadness or fear. It is therefore important to first understand triggers for our anger – what in our lives is causing us this emotion.  Is it irritability with rush hour traffic, or is it flying off the handle unexpectedly after the death of a loved one?  Both involve anger but the causes are very different.  It is often helpful to determine the true cause of anger and address it directly.

Here are some thoughts about anger, meant to help guide you in the right direction of addressing it:

• Do you bottle up your feelings rather than expressing them?  Your anger may be an issue of learning effective and assertive communication to express feelings in an appropriate and timely manner.
• Simple relaxation tools, such as deep breathing and relaxing imagery, can help calm down angry feelings.  An example would be breathing in for 4 counts, holding your breath for 4 counts, and exhaling for 8 counts.  As you exhale, tell yourself a relaxing word, such as “peace”, “relax”, or “let go”.  Do this at least 3 times.
• Rigorous exercise can help address anger – this is especially effective if the underlying cause is anxiety.
• Changing your environment may be the key to address angry triggers.  This may become an “If all else fails” strategy.  For example – if it becomes increasingly difficult to control your road rage, consider public transportation.  If anger is a reaction to a toxic person in your life that drains your resources, it may be time to learn to set concrete boundaries.
• Pick your battles.  One powerful tool to address anger is learning to distinguish between what we can and cannot change.  Then invest your energy into those aspects of your life that are worth the effort.  This may be particularly helpful if your anger is accompanied with a sense of helplessness or powerlessness.

If you feel that your anger is out of your control, impacting your relationships and important parts of your life, you might consider counseling to learn how to handle it better. A psychologist or other licensed mental health professional can work with you in developing a range of techniques for addressing and managing anger.  I am a Houston psychologist – to learn more about my services, visit DrGortner.com. 

Great Expectations and What's Love Got To Do With It

Romantic relationships are one of the most frequently discussed concerns in counseling.  Lots of people would agree that it is at least as hard to maintain a relationship as it is finding that special someone. 

What constitutes a healthy relationship?  Mutual respect, trust, and support are basic building blocks.  Honesty and safety, both physical and emotional, must be a given, not a privilege to be earned.  Open communication and willingness to negotiate keep relationships steady.  In addition, we all deserve to be respected by our partner as a unique individual, while acknowledging that we can make conscious choices to mutually make positive changes in our behaviors and attitudes towards our partner.

There are clear warning signs that a relationship is in trouble and that something fundamental needs to change.  Possessiveness and controlling behaviors, as well as threats or use of violence are obviously huge red flags.  Less easy to detect are unfair and unrealistic expectations that may slowly seep into a relationship once the initial romance wears off.  These expectations can be of your partner, yourself, or the relationship as a whole.  Some examples of common unrealistic expectations in relationships are:

• Expecting that he/she will change.
• Hoping that he/she will never change.
• Assuming that your partner thinks and reacts as you do.
• Assuming that your partner knows your wants and needs.
• Expecting that he/she has the same priorities, goals, and interests as you.
• Believing that the relationship will fulfill all of your social, intellectual, and personal needs.
• Giving up other interests, activities, and friends.
• Seeking improved self-esteem through the relationship.
• Feeling incomplete without a relationship.
• Expecting that each new relationship is "the one."
• Expecting that he/she will never make mistakes.
• Viewing conflict as a threat to the relationship and to be avoided at all costs.
• Working hard to get the relationship started, but exerting little effort to keep it going.
• Trying to be what he/she wants, rather than being yourself.
• Not understanding that feelings of love and passion change with time, as do your priorities and expectations.

Most people recognize themselves somewhere in these expectations.  Individuals who succeed in relationships are able to recognize and work on unrealistic expectations of oneself and others.

Finally - what many forget is that within a relationship, you also have to be accountable to yourself.  This means that being part of a healthy relationship is taking care of yourself.  This can be deduced from several of the above bullet points.  By being yourself – from the beginning, keeping your own life balanced, and not losing yourself in the relationship, you plant seeds of stability and health within a healthy partnership. 

If you are struggling with finding or maintaining a healthy relationship, talking to a psychologist or other licensed mental health professional can help. I am a Houston psychologist and I work with both couples and individuals.  Call me for a free consultation at 713-364-8328 or visit DrGortner.com for more information on my services. 

Hot Summer Days Got You Down?

 We are in the midst of another heat wave in Houston as we are braving another hot summer.  For many, being outside during this time can be torture – not just physical, but also mental.  The common expectation is to be happy and outdoorsy in the summer, attending barbeques and other outdoor events.  However, you may find yourself feeling actually more depressed and irritable these days.

You may have heard of Seasonal Affective Disorder (SAD), a form of depression that affects people in colder climates during winter months when days get shorter and colder.  It is connected with less exposure to sunlight.  What few people know is that there is a summer version of SAD. It is actually more common in the Southern United States and in countries near the equator. Like winter SAD, summer SAD affects primarily women in their 20s to 40s.

Summer SAD is thought to be related to increases in temperature and light, along with decreases in the brain’s production of melatonin, a hormone associated with sleep. Other hypothetical causes include fluctuations in barometric pressure and physical difficulty with regulating body temperature.  Individuals who are naturally sensitive to light and heat may be more vulnerable.

The primary symptoms of summer SAD are the following:

• Poor or increased appetite
• Insomnia
• Increased anxiety
• Increased irritability and/or agitation
• Weight gain or loss
• Increased or decreased sex drive
• Loss of interest in your usual activities
• Hopelessness
• Feelings of Depression
• Suicidal thoughts

If you think you might suffer from summer seasonal affective disorder, here are some recommendations.

Limit your exposure to heat. Stay indoors in air conditioning.  Plan some indoor social activities (for example, game night).  Some people with extreme forms of summer SAD prefer windowless rooms and using ice packs to cool down their body, especially at night.

Get enough sleep. Make sure your sleeping quarters have a consistent cool temperature.

Eat light meals and keep a regular exercise schedule.  Stick to indoor exercise during extreme heat.

Plan your vacation in a cooler climate, if possible. 

Wear Polarized Sunglasses.  This is important for everyone, but especially light skinned and blue-eyed people.  For some, wearing these types of glasses already translates to mild to moderate mood boost.

Recognize you are not alone! The difference between what we think we “should” feel in the summer (energetic, happy, carefree) and what we may actually feel (anxious, bored, uncomfortable) can alone lead to feelings of irritability and depression. Remember, even though it may seem as if everyone else is having a wonderful time frolicking in the sun, many people are not and are coping with some of the same concerns as you!  

Recognize there is help.  If you are having suicidal thoughts or have been struggling for more than two weeks with the symptoms listed above, get help from a psychologist or other licensed mental health professional.

I am a Houston psychologist specializing in depressive disorders such as SAD.  Call me for a free consultation at 713-364-8328 or visit DrGortner.com for more information on my services.