Wednesday 26 April 2023

Ten Things I Want You to Know: An Open Letter from a Supportive Friend

My dear friend,

One of the things I love most about us is that we’re open and honest with each other. We talk about pretty much anything and everything. There are some things, though, that maybe I’ve never told you. Things I’d like you to know. Maybe you already do. You’re a smart cookie! I want to tell you, nevertheless, because sometimes it’s good to hear things, even when we know them already.

You are never a burden. I’m putting this one first because it’s fundamental to who we are as friends. You take me at my word when I say call or message me any time, day or night. You’re respectful of times you know I’m busy or with other friends but if you need me I know you’ll reach out and ask. You understand I’d much sooner you did that, than for you to feel you shouldn’t bother me or I’m too busy. Maybe you do feel that way sometimes. If so, I get it. I feel that way too at times. It says a lot about us that we’re able to overcome those inhibitions and ask for help when we need to.

The flip side is that I know I’m not always who you need. I used to struggle with this one. It’s natural to want to fix things for those we care about when they’re in pain, or poorly, or struggling. We want to take the hurt and difficulty away and make everything okay again. It’s natural, but profoundly unhelpful. Often, you don’t need anyone to fix things. What you mostly need is someone to hear you, to listen to what you’re going through and not judge you for what’s happened or the situation you’re in. We do that all the time, and I know it helps. There are practical things I can help with too. I’m happy to do so. But at other times I’m not the person you need — and that’s okay. Maybe you need professional help and support, or you need what other people can offer better than I can, or space to deal with things on your own. We’ve come a long way in handling these times, and I’m as grateful for your honesty in telling me when I’m not who you need, as when you tell me I am.

I won’t always understand but I’ll always want to learn more. You know I have no mental health diagnosis. I also have very little experience that’s relevant to what you’ve lived through and live with. I used to feel that put me at a disadvantage in being a supportive friend, because how could I understand if I’ve not gone through something similar myself? There are still times when I feel my lack of experience gets in the way, but it’s never been an issue between us. That’s partly because we’re honest about it, but also because you help expand my awareness and understanding. It’s not your job to educate me, but I learn from you sharing the day-to-day realities of your life with me. I want to understand as much as I can. Not so I can tell you what to do or how you should behave — that wouldn’t go down well! — but so I can be the friend you want and deserve.

You’re the expert in being you. No matter how much I learn about what you live with, I will never know as much as you do. The same is true of doctors and other professionals. They are the experts in treating the conditions you’re diagnosed with, but they don’t know what it’s like for you to live with those conditions. Most times I’m likely to encourage you to take whatever help and support they offer you. More generally, if you ask for my opinion, or I’m particularly concerned for your safety, I’ll tell you what I think about the choices you’re making and the options available to you. But my starting point will always be to respect your lived experience and what you want to happen.

It means the world to me that you feel safe sharing how things are for you, but I don’t expect or need total honesty. I understand there’ll always be things you can’t share with me, or choose not to. That used to hurt, if I’m honest. Surely if we’re true friends (I’d think) you’d be able to tell me anything? But I realise now how ignorant, selfish, and plain silly that is! It’s right that you pay attention to your boundaries, in terms of what you share and who you share with. You have a right to expect me to respect those boundaries, just as you respect mine.

I love that you tell me when I get things wrong! There have been several times when I’ve messed up badly, and you’ve told me in no uncertain terms what I did and why it was so hurtful, triggering, or unhelpful. It’s hard to hear, but by being honest you give me the opportunity to learn how to do better in future, not only with you but with other friends. It’s also good when you tell me I’m getting things right! That “thank you for listening” or “what you did there really helped” lets me know I’m on the right track and helps me become the friend you need me to be.

One of the best things about our friendship is its mutuality. We are there for each other. My needs and concerns are often less immediate, critical, or severe than yours, but you never dismiss or make light of what I’m dealing with. Likewise, you celebrate my successes, small and large, as much as I celebrate yours.

There are times I wish our friendship was enough to keep you safe. That’s understandable. Who doesn’t want those they care about to be kept from harm? It’s ignorant, though. It’s also profoundly disrespectful, because it implies you’re incapable of taking care of yourself or asking for the help you need. In a crisis situation I would do everything I could to keep you safe, even at the risk of damaging our friendship. But I have no right to try and take the responsibility for your wellbeing and safety away from you. That responsibility is yours and I honour it as I honour you.

I don’t worry about you but I care. You know this one! Not everyone understands it, because we’re programmed to equate caring about someone with worrying about them. If I’m totally honest, there are occasions when worry gets the better of me, but I recognise how toxic it is. When things are rough, you don’t need me adding my worry energy into the mix. What you need is to know I’m here, that I care deeply, and that I’ll do whatever I can to help you through to the other side. I trust you to ask for help if you need it. You trust me never to turn you away or ignore you. That’s what caring is. That’s what love is.

After all that you’re probably glad I’m almost at the end! What else, you must be wondering, does he want to say to me? What else is there? Perhaps the most important thing of all. I’m glad you’re my friend! More than glad, I’m happy and proud. I don’t know if we’ll be friends for always. I hope so. I can’t imagine not having you in my life and being in yours. But no matter what happens, I will always be grateful for you and for our time together.

Your friend,

Marty

 

Image by Brad Neathery at Unsplash.

 

Wednesday 19 April 2023

Left or Right? Nine Strategies for Making Wise Decisions

Always make decisions that prioritize your inner peace. ― Izey Victoria Odiase

We make hundreds of decisions every day. What time to get up. What to wear. Where and what to eat. The majority of our decisions are minor, even trivial, and we make them without weighing all the options and consequences. But every now and again there’s a decision to be made and we just — stop. We’re unsure which way to turn, or if we even need to decide right now. That’s when we turn to our strategies for decision making. But what are they, exactly? In this post I explore eight techniques I use, and one I don’t because I’m scared to.

1. The 51% Test

In a recent conversation with Fran I shared that I was undecided about whether to reach out to someone I’d lost touch with. There was no obviously right or best path to take. Fran listened to me for a while, then asked, “Are you 51%?”

I knew what she meant. It’s an approach we’ve used on numerous occasions. I closed my eyes, gauging how I felt about contacting my former friend. “I think I’m 51%, yes.”

“Then do it,” Fran said.

I wavered. “I’m only just 51%.”

“51% means yes,” she reminded me. That’s the beauty of this technique. It doesn’t require you to feel very sure, just more than half sure. If you’re unclear of your emotional response, you can reverse the test. In my case, that would mean testing how I felt about not contacting the person I was thinking about. I remained undecided, so Fran offered me an alternative strategy, the ring of fingers.

2. The Ring of Fingers (Self Muscle Test)

Fran invited me to join the thumb and forefinger of my left hand into a circle, then form an interlinked circle with the thumb and forefinger of my right hand. Unsure of where this was leading, I did so. Fran instructed me to move my hands apart, first resisting, and then allowing my fingers to part. Once I understood the technique, she told me to close my eyes, imagine myself contacting the person, and move my hands apart. Whether my fingers instinctively opened or resisted opening would give me my answer; yes if they opened, no if they resisted opening. I did so and found my fingers instinctively resisted opening.

I later learned that this technique is better known as the self muscle test. It’s one of several methods based on connecting with the body’s state of tension or resistance to various scenarios. I haven’t tried them enough to comment on their validity, but they provide an interesting approach to when I’m unsure about which decision feels right.

3. Imagine You’ve Already Decided

The third strategy is one I’ve used many times. It works best when you’re struggling to decide which of two or three options feels right to you. Close your eyes and imagine you’ve already taken the first path. The decision is behind you. You’re on the other side. Focus on your emotional response to having taken this path. How does it feel? Do you feel warm, positive, and optimistic about the path you’re now on; or uncertain, anxious, regretful, or scared? Open your eyes, then after a few minutes repeat the exercise with each of the other options. I find this technique useful because it takes me out of the decision making process, and allows me to focus on how I feel about the options themselves.

4. T-Chart

The T-chart is a simple technique for thinking through the advantages and disadvantages of taking a particular decision. Write the option or decision at the top of a sheet of paper. Draw a horizontal line below what you just wrote, and a vertical line down the centre of the page, to form a large “T” shape. On the left side, list as many advantages, positive outcomes, or justifications you can find for taking this option. List disadvantages, negative outcomes, or reasons for not taking this option on the right hand side. Once you’ve finished, review what you’ve written to help reach a decision. I find this works best for yes/no decisions.

5. Best in Class

This technique works well when you need to choose between several different options. I’ve used it recently when trying to decide which mobile phone to buy. On a sheet of paper, draw vertical lines so you have one column for each phone you want to compare, plus one extra column. To compare three phones, divide the page vertically into four columns. Label the first (left-most) column “Features” and label each of the remaining columns with the name of the phone you are considering.

Down the first colum, list key features, such as price, memory, storage, size, plus any others you’re interested in. For each phone in turn, research and fill in the relevant details. Once you’ve completed the grid, highlight or circle the best result for each feature. In the price row, circle the lowest price. In the memory row, circle the highest or best memory. When you’ve finished, review the results and see which option scores highest in the most categories.

Due to its grid structure, this approach works best on lined or squared (graph) paper, or in a spreadsheet if you prefer to work digitally.

6. Write it Out

I’ve kept a daily diary for decades so I’m used to exploring what’s going on for me by writing about it. I also blog here on a weekly basis, often incorporating events and situations from my life into my blog posts. Exploring things in these ways helps me clarify my priorities, thoughts, and feelings, which can help me towards making a decision about what’s best for me.

7. Talk it Out

Talking things over with people I trust to listen without passing judgment can help me move towards a decision. The conversation with Fran that I mentioned earlier is a great example, but other friends help me in different ways. It’s important to me to have people who will let me share my thoughts and feelings without pushing me down any particular path. There’s a good example in our book High Tide, Low Tide. In this case the roles were reversed; Fran needed to reach a decision about whether to embark on a three month trip around Europe with her parents. She needed me to help her reach a decision, but it was important I didn’t influence her unduly. My role was to remind her of her options, and hold a space in which she could explore things for herself.

Martin: You can still decide not to go.

Fran: i wanna go.. it’s just that it won’t be easy.. it may stretch me beyond what i am capable of.. i have some peace to make with my mother.. i want an adventure and am scared shitless.. afraid of getting lost.. of not knowing where i am.. of how to do things.. but the adventure lures me.. i want to be there for my mum.. it would mean a lot to her and to me.. it is the right thing to do..

Martin: I think I just helped you clarify some things.

Fran: yes.. thank you for drawing that out.. i will need to keep reminding myself when i feel like giving up.. it won’t be easy..

8. Random Strategies

When you’ve tried every strategy you can think of but still can’t make up your mind, you might consider letting chance decide for you. If it’s a yes/no decision, you might toss a coin. If there are more than two options, you might roll dice or employ a pseudo random number generator such as random.org. I’m personally wary of delegating my decision making to chance. I can trace my feelings to the novel The Dice Man by Luke Rhinehart. The lead character begins basing his everyday decisions on the throw of a die. It begins innocently enough but the practice leads him into some very dangerous situations. The blurb was enough for me. I’d be scared to read the book in case I was tempted to try.

Discussing this, my son Mike offered sound advice about using random processes safely. “Toss a coin,” he said. “And if you get a strong negative feeling about the decision, choose the other one.”

9. Defer the Decision

The desire to make the best decision — or to avoid making the wrong one — can get in the way of us seeing things clearly. It’s worth remembering that defering your decision is often a valid option. Maybe you need to gather more information, seek expert guidance or advice, or talk things over with others. Maybe you need time to process what’s happening until you’re ready to reach a decision you’re comfortable with.

We discussed one deferral approach recently in The Box on the Shelf: A Strategy for Handling Difficult Issues and Situations. As we described it, “[the box] is a strategy for dealing with troublesome or persistent issues a little at a time, setting them aside in between so you can get on with other things. It’s not intended as a way of hiding things away or putting them off altogether.”

What Is a Wise Decision, Anyway?

I’ve described techniques I use to help me make what I hope are wise decisions. I’ve said nothing about what constitutes wise decision making, because that’s a very personal thing. What is a wise decision for one person might be folly to someone else. It’s a topic I may return to on another occasion. For now, I’ll share two quotations which shed a little light on my own perspective. The first is by author and speaker Deepak Chopra. It counters the stifling notion that there’s always a right or best decision to be made.

If you obsess over whether you are making the right decision, you are basically assuming that the universe will reward you for one thing and punish you for another. There is no right or wrong, only a series of possibilities that shift with each thought, feeling, and action that you experience. (Deepak Chopra)

This resonates because I’ve never been someone to regret past decisions. There are choices that didn’t work out well for me or for people I’ve impacted, but to me regret is a pointless indulgence. The honest response to making “wrong” decisions is not regret but acknowledging and owning their consequences. That’s how we grow and mature. As Mark Twain put it, “Experience comes from making bad decisions.”

The second quotation is spoken by the character Meredith Grey in the medical drama Grey’s Anatomy.

We’re all going to die. We don’t get much say over how or when, but we do get to decide how we’re gonna live. So, do it. Decide. Is this the life you want to life? Is this the person you want to love? Is this the best you can be? Can you be stronger? Kinder? More compassionate? Decide. Breathe in. Breathe out and decide. (Meredith Grey)

Although it does speak of being the “best you can be” (and thus hints at making the best decisions towards that goal), I like this quotation. It’s the perfect antidote to indecision and prevarication, and a call to each of us to own our decisions and take responsibility for how we live our lives.

Over to You

What are your thoughts on the techniques I’ve presented? How do you approach decision making? What techniques or approaches work for you? Do you regret decisions you’ve made in the past? Fran and I would love to hear from you, either in the comments below or via our contact page.

 

Photo by Burst at Unsplash.

 

Wednesday 12 April 2023

Exploring the Depths of Mental Health: Who Are You, Alone, Yourself, and Nameless?

Artificial Intelligence (AI) is a hot topic these days, so I thought I’d check it out. I downloaded an app called AI Chat and began giving it writing prompts. After a few interesting but fairly generic results, I decided to request something more specific. I chose a quotation from The Lord of the Rings by JRR Tolkien which I’d been working with in another context. Here is the writing prompt, exactly as I presented it to AI Chat.

Write a 1200 word blog post relating to mental health, inspired by the JRR Tolkien quotation “Tell me, who are you alone, yourself and nameless?” Include a title for the blog post optimised for SEO.

I haven’t edited the resulting article in any way.


Exploring the Depths of Mental Health: Who Are You, Alone, Yourself, and Nameless?

J.R.R. Tolkien, the beloved author of The Lord of the Rings, once asked the question: “Who are you, alone, yourself, and nameless?” This introspective query, while seemingly simple, is imbued with profound depth and complexity. In fact, it is a fundamental question that touches upon the very essence of human existence — our identity.

For many of us, mental health challenges can exacerbate this question of identity, further complicating the already murky waters of self-discovery. Whether it is anxiety or depression, bipolar disorder, or any other condition, one thing is certain — mental health issues have the power to disrupt, distort, and even dismantle our sense of self.

As someone who has experienced mental health challenges, it can be tempting to define ourselves solely through the lens of our illness. We may assume that our diagnosis is the sum total of who we are, rather than recognizing it as just one aspect of our multifaceted identity.

The truth is that our experiences, emotions, and thoughts — both negative and positive — are all valid components of our identity. To truly understand who we are, we must examine the totality of our being, including our mental health.

Mental Health and Identity

Our identity is the sum total of our experiences, beliefs, values, and attributes that make us unique. However, for individuals struggling with mental health challenges, their identity can become overwhelmingly wrapped up in their illness.

In some cases, people may feel as though their mental health struggles define them — that they are only seen as their diagnosis, rather than as a complex, multifaceted human being. This sense of identity loss can be distressing, and can even worsen symptoms of mental illness.

It can be difficult to reconcile our mental health with our sense of self, but it is necessary for a healthy, fulfilling life. We must recognize that our struggles with mental health do not define us; they are just one piece of our identity.

Additionally, we must acknowledge that mental health is not static — it can and will change throughout our lives. This means that our identity, too, is a fluid concept that can evolve over time.

By embracing the complexity of our identity, including our mental health challenges, we can move towards a greater understanding of who we are as individuals. We can also find support and compassion within our communities, knowing that we are not alone in our struggles.

Mental Health and Stigma

Unfortunately, mental health challenges are often accompanied by stigma and discrimination. This can make it difficult for individuals to seek the help they need, and it can also make it challenging to form a positive sense of self.

Stigma can lead to feelings of shame and isolation, further exacerbating existing mental health challenges. It can also perpetuate the myth that mental health struggles are a personal failing, rather than a condition that requires care and support.

To combat stigma, it is important to educate ourselves and those around us about mental health. By challenging stereotypes and misinformation, we can work towards a more compassionate and understanding society.

We must also acknowledge that mental health struggles are a common experience — one that can affect anyone, regardless of their background or circumstances. By recognizing our shared humanity, we can cultivate a sense of connection and community, rather than isolation and division.

Mental Health and Self-care

Self-care is an essential aspect of maintaining good mental health. It involves taking intentional steps to prioritize our physical, emotional, and mental well-being.

Self-care looks different for everyone — it may involve practicing yoga or meditation, getting enough sleep, seeking therapy, or engaging in creative pursuits. Whatever form it takes, self-care is an important tool for cultivating a positive sense of self and managing mental health challenges.

It is important to remember that self-care is not a selfish act. Taking care of our own well-being allows us to show up as our best selves for our loved ones and communities.

If you are struggling to prioritize self-care in your life, start small. Make time for activities that bring you joy and relaxation, and seek support from loved ones or mental health professionals as needed.

Moving Forward

The journey towards understanding ourselves and our mental health is ongoing, but it is one that is worth taking. By examining the depth and complexity of our identity, we can move towards a greater sense of self-understanding and compassion.

Remember, your mental health struggles are just one aspect of your multifaceted identity. By embracing the totality of who you are, you can work towards a positive sense of self and a fulfilling, meaningful life.

As J.R.R. Tolkien once said, “Not all who wander are lost.” In the same way, our journey towards understanding ourselves and our mental health may involve wandering — but it is not a lost cause. By asking the question “Who am I, alone, myself, and nameless?” and embracing the complexity of our identity, we can move towards a more positive and hopeful future.

 


Over to You

I chose this writing prompt because I was interested to see how the app would handle questions of identity and authenticity. I was frankly blown away at what came back. I’m interested to know what other people think of this piece in particular, and the idea of AI content in general. Incidentally, I ran the article through the AI detector at GP Zero, which accurately determined it was “likely to be written entirely by AI.”

What do you think? Is the article of interest? If I hadn’t told you, would you have suspected it was generated by an AI process rather than written by a human writer? What difference, if any, does knowing that make to you? Fran and I would love to hear your thoughts on this, either in the comments below or via our contact page.

 

Image by Andy Kelly at Unsplash.

 

Wednesday 5 April 2023

ECT: A Patient's Perspective

By Eric Russell

I want to begin by expressing my gratitude to Martin Baker for allowing me this opportunity to share my experience with electroconvulsive therapy (ECT). His book, High Tide, Low Tide, focuses on the intersection of mental health and relationships. So here I come down a side street to narrate my journey along the ECT path. I have bipolar disorder.

After all the medications I tried failed to calm the episodes and manage the symptoms my doctor asked if I were ready to discuss ECT. She explained that while medications have a success rate of 30-35%, ECT sees a roughly 80% efficacy rate in academic studies. However, at that moment I was too nervous to hear the favourable comparison. Although I was afraid of the unknown, my doctor convinced me to educate myself and make a fully informed decision. In the end I opted in.

As a part of the preparation my primary care physician had to sign off that I was physically healthy enough to undergo ECT. This involved both a regular physical and an EKG to get a sense of how the heart would respond. Another step in the process was to interview with two different psychiatrists. This is really for patient safety as the doctors must verify the patient has the capacity to give consent for the treatment. In my case it was my regular psychiatrist and the psychiatrist who would be administering the ECT. The double interview might seem a hassle, but governing bodies want to protect patient rights.

Although not required, I did the initial series inpatient. This was for two reasons. First, the initial series is three times a week for three or four weeks. Going inpatient meant my family didn’t have to sacrifice all those days driving back and forth. (I live two hours from the hospital.) Secondly, family was also spared taking that time off work. Consequently, I was introduced to the experience all on my own. Looking back on that time though, I can’t recall any of it other than what got written down in my journal.

It wasn’t long after getting home that I realised I had memory holes. At times I struggled to recall the names of individuals close to me, details of autobiographical events, and how to navigate once-familiar landscapes. While this can seem disconcerting, it reinforced my determination to live in the present and cherish the loved ones who surround me.

At the same time, I have learned that the memories are not actually gone. For example, one day on my way to the hospital for ECT as usual I passed the Civic Center and a flood of memories came rushing back to me. I was riding in a bicycle race which went under the Civic Center’s arches. I could see the road as it curved through a descent. I could hear the tires on the road, the shifting of gears. I could feel the breeze. The memory had come to life in my mind again, giving me a confident new attitude toward those memory holes. I can refill them.

It’s important to make clear though, ECT is not a cure-all. I still had to take medicine and continue with ECT. After the initial series my doctor scheduled me for treatments once a week. Before too long the interval was extended to every other week. Eventually, it was stretched to every fourth week, and there it stays.

On treatment days I arrive early at the ECT department’s Pre-Op staging area to make sure I don’t throw the schedule off. I’m taken to a private room to change into my pyjama bottoms and a hospital gown. We take my vitals then there’s usually a bit of a wait before a nurse comes in to start my IV so I wrap my arm in a warm blanket as this seems to make the stick easier when it’s time. That done, we go over health and health care as well as medications I’ll be given in preparation for the procedure and those I take on a regular basis. Then, after speaking with my doctor, I’m left by myself while the IV replenishes my fluids.

With the IV bag near empty the OR nurse comes to get me. After a quick visit to the lav I’m ready for the procedure. We go back and I settle in on the gurney. I meet the anaesthesiologist as staff attach all the monitor leads. As I’m filling my lungs with pure oxygen, my doctor attaches electrodes to each temple. (I get bilateral treatments. Unilateral electrode placement would be the temple and crown.) At about the same time, the anaesthesiologist lets me know the muscle relaxant and anaesthesia are flowing. From that moment when I fade into sleep it seems only seconds before the Recovery Room nurse calls my name.

It wasn’t as simple as waking up and walking away from the crushing depression, but through the dedication of my care team it did seem like an awakening in a way. I had been struggling for a long time and finally began to feel good. I did things with and for my family; I even returned to interests I’d had in the past. I had my life back.

In conclusion, as I look back over my years of electroconvulsive therapy although it is typically thought of as a treatment of last resort, I don’t feel it should be. I consider it all a small price to pay for the benefits I’ve gained and a reliable tool to keep in mind.

 

The image is a sketch I drew in 2015 while inpatient during the initial series.