Wednesday, December 18, 2013

Medication: Menace or Miracle?

Medications can be a valuable adjunct to therapy in helping to resolve some of the distressing symptoms clients experience. Low mood, perseverating thoughts, worry, and more severe symptoms like hallucinations or extreme mood swings, are usually very responsive to the correct psychotropic medication. And yet, I often find clients balking at a referral to a physician for an evaluation for medication. Like counseling and mental illnesses themselves, taking medication can be a stigmatizing experience. Clients worry they will become dependent on the medicine, or perceive that they are "weak" when they are unable to improve their symptoms with talk therapy alone. Sometimes clients voice a concern that their insurance premiums or job security could be threatened by a record of taking an anti-depressant or mood-stabilizing drug. Additionally, I've heard some clients voice a belief that adding a psychiatrist to their team of health providers somehow makes the clients look and feel "sicker." Some of these fears can be addressed by adequate education and debunking the myths associated with these treatment tools. Most of us can understand how a diabetic's pancreas stops producing insulin, and therefore, to maintain life, a patient will have to take insulin shots. When a person's thyroid begins underfunctioning, clients are usually willing to accept that they will be on thyroid medication for the rest of their lifetimes to provide their bodies with the chemicals necessary to keep bodily systems functioning well. And many people swear by daily multivitamins to supplement their bodies' needs for necessary elements and compounds that enhance health. Psychotropic medicines, however, are often viewed differently, despite the fact that they work in exactly the same way the aforementioned drugs do. Depression, anxiety, bipolar disorder, obsessive-compulsive disorder -- all of these illnesses share common ground with diabetes, cancer, and epilepsy: they are all biologically driven. Many mental health diagnoses are a result of too much or too little of a neurochemical in the brain. We may think that symptoms that largely are experienced or made evident in our emotions, feelings or energy level couldn't possibly be created by a biological problem. But the efficacy of psychotropic medications proves exactly that. When the dosage and type of medication is appropriate, the majority of clients taking these medicines will find their troublesome symptoms improve, sometimes dramatically. Accepting the biological, neurochemical origins of psychological distress can allow appropriate and effective utilization of medications that can greatly improve clients' quality of life.

Wednesday, December 11, 2013

Embracing the Humbug

From retailer commercials, to holiday movies and stories, we are deluged this time of year with images and messages of family harmony, abundance of gifts, treats and parties, and messages of good cheer and joy. But we all know reality can be a quite different experience. Many of us struggle with feelings of melancholy -- if not outright sadness and grief -- during the holiday season. This time of year, we feel the loss of loved ones, missed opportunities and the limitations from aging or illness in a most profound way. Sometimes, we even feel guilty or flawed because we can't seem to grasp the holiday spirit, despite our decorating/baking/shopping/carol-singing marathon of activities. I suggest we experiment with a paradigm shift this winter. Rather than force ourselves to feel jolly when we feel more like emotional Jell-o (shaky and transparent) what would happen if we gave ourselves permission to grieve our losses, to consciously choose to reminisce about those dear ones who will not be around our hiliday table this year? What would it cost us to be gentle and compassionate with ourselves and allow ourselves a holiday-free weekend unencumbered by party invitations, gift wrapping obligations and cookie-baking demands? After all, I'd wager that while some of our treasured traditions are built on generations of shared joyful experiences, others are crafted more from guilt and obligation. Do we REALLY have a genuine desire to have a freshly cut tree in the front window, even though the dog is likely to use it for a toilet, and we will be hoovering pine needles well into spring? Are we EXCITED to invite Uncle Harry to the Hannukah party, despite knowing the evening will end with Harry passed out in the hallway, like he's done the past 20 years? When my grandmother died some years ago, her baking traditions were assumed to pass on to me, her only grand-daughter. (Apparently, even in 21st-century Italian American families, grandSONS are not expected to bring anything to the holiday meal beside their appetites.) The thing is, Gram's honey-rum cookies are a b%+@! to make, and I never really liked the pizzelles, despite their pretty, lacy designs and cool waffle-maker-like baking appliance. I chose to let my sister-in-law take the honors for those recipes, and I bake the two -- and only two -- kinds of cookies I like. It was one small choice I made to avoid a weekend stuck in the kitchen preparing desserts I detest just so I could demonstrate a devotion to my Gram's memory. In fact, honoring my Gram is more evident when I choose to model her love for her family, or when I enjoy a glass of her favorite Chianti (which is also my own, thanks to Gram's introduction to the joys of the screw-top jug.) I will cop to still feeling a slight panic if I have to deviate from my extended family's decades-long history of producing typed, catalogue and photo-laden Christmas lists at the dessert table on Thanksgiving. And I've not yet developed the courage to tell my Mom it would be more convenient for my family if we could push Christmas breakfast back an hour or so. But come December 26th, I will risk my wife's displeasure and my son's eye rolling when I continue my lifelong tradition of lolling about the house all day in my pajamas. My wife is welcome to hit the mall for a frenzy of returning gifts and scoring after-Christmas deals. My son is free to keep a wide berth from my flannel-clad form. I have found that learning to honor the parts of the holidays that bring me joy -- and to avoid the ones that don't -- may be one way to ensure I'm able to add some cheer to everyone else's.

Wednesday, December 4, 2013

The New Pioneers

I'm continuously amazed by the creativity, courage and resilience of transgender folks, as they carve a path through the unchartered world of transitioning between genders. We are a binary society: we are most comfortable with black and white, right and wrong, male and female. Transgendered clients don't fit easily into this "if not this, than that" mold. Who else has to consider which public bathroom to use? Who else fears for their personal safety based on whether they appear feminine "enough" to avoid a second glance from strangers? Who else has to worry that her newly legal first name doesn't match the gender box checked on a job application or a drivers license? The potential obstacles to everyday activities seem never-ending to my transgendered clients. Fear, rejection, frustration -- these emotions are constant companions to these brave souls who want, more often than anything, to simply fade into the background, to garner no more attention than any other person in the room. And yet, due to society's ignorance and rigidity, transgendered folks are barraged with discrimination, ridicule and regularly singled out for harassment and abuse. Insurance rarely, if ever, covers medical treatment beyond hormone replacement therapy. The economic costs of legal processes and employment instability can threaten the well being of even the wealthiest client. In the 15 years I've counseled transgender clients, I've not met a person who hasn't experienced suicidal thoughts, hopelessness and the loss of significant relationships as a result of their bodies not matching their internal experience of who he or she is as a person. As a culture and a society, we lag woefully behind in our efforts to understand, embrace and celebrate the gifts that transgender people can teach us about what it means to be male, to be female, to be human. To walk beside these extraordinary human beings is an honor, and a chance to witness people who are destined to change not only their physical selves, but also the course of history.