Anxiety - The Facts Anxiety is the most common form of mental disorder facing every day Australians. In fact, the figures are as high as one in ten. What are the symptoms? There are different types including general anxiety disorder, phobias, obsessive compulsive disorder, and post traumatic stress disorder. The symptoms of general anxiety are constant worrying, fear, a level of anxiety that makes it difficult to conduct everyday activities such as work, study and socializing. You may tire easily and have difficulty sleeping and concentrating. What are the causes of anxiety? If there is a family history, this may predispose you to general anxiety disorder. Personality may be another reason and this includes important factors such as our relationship to ourselves and the way we interact with others. Another common reason is the level of stress in our lives including overwork or illness. What you can do? The most common and effective treatment is talk therapies such as counselling and psychotherapy. More severe cases may require medication and for this you may need to see a psychiatrist.

Did you know that in the USA, over 52.5% of all persons in prison are incarcerated for drug related crimes whereas only 6% are imprisoned for violent crime? 1 The USA imprisons more people than the USSR did under Communism or South Africa did under apartheid. The so called ‘war on drugs’ costs USA taxpayers $16 billion per annum during the late nineties. This is about the same amount that the American people spent per annum on buying illegal drugs. The cost for treating drug users as criminals has been an enormous failure and has let down those citizens with what is widely recognised as a medical problems and not an issue of weakness or morality. If you were as ineffective in the workplace as the ‘war on drugs’ has been in decreasing drug usage you would have been fired long ago. So why do we persist with a punitive approach when it simply does not work. Mostly it is because of ignorance, judgement and fear. In professional circles the debate is over, drug usage is a medical problem. Then why is it that a teenager caught with a joint of marijuana can still end up with a criminal record? Well people believe that if we are soft on drugs then the problem will rage out of control. Again, there is a very lengthy lag time before scientific facts and research are understood and taken up by society. There are several countries in Europe that have not only made marijuana usage legal or decriminalised it, but gone ahead and decriminalised it and the use of heroin and brought its regulation under government control. No one is saying that marijuana doesn’t create serious problems for people pre-disposed to schizophrenia and psychosis. Nor am I saying that heroin doesn’t destroy people’s lives. But let’s take heroin usage as an example. Countries that have legalised heroin and brought its sale under government control have seen no increase in its usage and have seen marked decreases in the transmission of HIV and hepatitis C. Even more importantly in the immediate future, it has decreased the occurrence of overdose, which is the main killer of intravenous drug users. Why? Because the main course of overdose is incorrect dose rates which is a problem that is caused by its illegality. When you buy heroin in the street you don’t know what’s in it or how strong it is. It is widely understood amongst health care practitioners that if we can keep heroin users safe until they are about 30 most of them will have stopped using of their own accord. In this country, we have seen fit to leave the management and control of this industry to organised crime. It is also true that the cost for addicts maybe in excess of a $1,000 per week, forcing young people into crime and prostitution whereas government controlled supply is at minimal cost to users, with no increase in the drugs usage. One of the ways that we avoid showing care and understanding for drug users is to compartmentalise our own behaviours. Many in the community who take prescription medications, drink alcohol or smoke tobacco do not see themselves as drug users or addicts. It is easier to be judgemental of others when we see ourselves as different to those people taking illicit drugs. While not necessarily recognising it there are many of us out there who are self-medicating. Alcohol helps to numb us and thus ease our suffering. It is also a powerful social lubricant. Cigarettes provide oral gratification and you may have noticed that when smokers are under stress they reach for a cigarette. This is because cigarettes provide an immediate relief to anxiety. The whole ‘say no to drugs’ campaign has been an insulting simplistic approach to drug treatment. We are complex creatures and most of us have valid issues that could cause us to take drugs. It is believed that up to 80% of all people in prison have drug related problems. Mind you it is not all doom and gloom. Injecting rooms, drug court and an increase in treatment and rehab programs show that we are starting to take notice and are showing greater care and compassion for those who are suffering. In finishing, if you are a drug user and wish to quit, we must first seek to understand our need to use and look to replace them with healthier life affirming actions and behaviours. Often this process takes time and is best handled by competent caring non-judgemental professionals. ------------------------ 1. Bureau of Justice Statistics. (2011). Federal Justice Statistics 2009 - Statistical Tables. NCJ: U.S. Department of Justice

Depression - Fact Sheet Depression is very common in our society affecting as many as one in six women and one in four men. What are the symptoms? Sad and unhappy most of the time. Loss of interest and pleasure in your day-to-day activities. Negative outlook on life. Insomnia. Withdrawal from family and friends. Loss of confidence. Lethargy. Who are most at risk? People with unresolved psychological issues. Unhappy family or relationship problems. People who are self critical, negative, perfectionists, low self esteem, shy and/or unassertive. What you can do? Different people respond to different treatments: Therapy. Medication. Exercise. Lifestyle changes. Full medical check up.

When we talk about anxiety, we are talking about fear in all its various shapes and forms. Some forms of fear are serving an important function. For example, fear of violence, bloodshed or rape are genuine fears, being alerted to dangers thus allowing us to take preventative action. The trouble begins when the fear and worry we experience is not proportionate or when these fears continue to escalate in the absence of any real danger. When this happens the impact on the mind and body can be very destructive indeed, creating both emotional suffering, unhappiness and even physical illness. On a mental level, chronic anxiety may impair our decision making and limit our ability to cope with stress, thus impairing our overall effectiveness. On a physical level, anxiety may cause impaired immune function, muscle tension, upset stomach, heart disease and tiredness. Anxiety may have many different causes. For some people, there is a biological predisposition to anxiety and worry. For example, some people have a neurological difficulty in producing serotonin which is a neurotransmitter effecting mood regulation. Alternatively there may be an overproduction of cortisol which is a hormone the body produces under stress. People falling into this category need medical attention. This said, not all forms of toxic worry is biological. There is a greater proportion of us for whom anxiety is a learned response. This is the place where counselling or psychotherapy may come into play as a useful tool for better understanding ourselves. For those of us simply facing day-to-day worries, then diet, meditation, exercise and a deeper sense of connection with other people and good therapy are invaluable for tackling anxiety. I remember a valuable tool suggested by the Dalai Lama who said that “if the situation you are worrying about is something that can be remedied, then there is no reason to worry. If alternatively, there is no solution or no way out, then there is no point in worrying because there is nothing you can do about it anyway.” Of course, in order to do this we must first address the problem head on. This form of remedy is something we may have to return to time and again. One very common form of anxiety experienced by all of us is to fear how we appear to other people. To address this kind of anxiety may be helped by addressing our motivation. If we have been sincere in our motivation eg. intended no harm, and we have done our best, then if we fail it is because the situation is beyond our best efforts. This sort of thinking helps to decrease both anxiety and regret.

Most of us recognise and accept honesty as a ‘virtue’. But what are the practical reasons for this? Most of us would agree that needing to be seen, heard and understood is of infinite personal value to us… particularly by family, friends and perhaps in the workplace too. These things cannot be achieved without being ‘up front’ about who we are, how we feel and what we want. For example, in our love relationship most would agree that intimacy and close companionship are the lasting characteristics we want built into our relationships. Thinking that just sharing good times is the answer is fraught with disappointment. This is because the good times are transient. They come and they go. Relationships that last the test of time need to support us equally in times of difficulty. True intimacy, not just sexual, has its basis in honest communication. Pretence in all its forms is unsustainable and lacks the grace of simple, open and honest commune. So why are people dishonest? I believe that behind most dishonesty is a desire to make things easier for ourselves and sometimes to make things easier for someone else. To be honest requires strength of character. If we don’t practice daily, we may find ourselves feeling isolated and emotionally impoverished. To be honest requires a commitment to self knowledge. The outcome of this is our level of emotional intelligence. Being honest in our relationships generally causes a deepening and strengthening of our circumstance. To apply honesty in these situations, we must look sincerely at presenting who we are, not just how we wish to be seen by the other person. A failure to do so may lead to our relationships being affected in a negative way. For example, you may feel criticised by your partner but have failed to address it. Over time this criticism makes you feel badly about yourself and resentful toward your partner. This resentment in turn erodes the love and generosity that are the glue that holds our relationships together. In the above circumstance you may have been avoiding the confrontation and the discomfort that comes from being honest about your needs and feelings. However in the longer term you pay the price with the loss of intimacy. If it happens that there are numerous places where you hold back on being honest, you may find yourself feeling stuck as opportunities to change and grow are lost. To be honest with other people, we must start in our own backyard To confront your partner about criticising you, you may have to look at the painful places that as a child you were rejected or abandoned around the issue of attending to your needs. So as you can see, we must first explore what is happening that causes distance in our relationships and then we must attend to our own part in this happening. Last but not least we need to take the risk of addressing the issue with the other person. To go through this process you may need to have a counsellor or psychotherapist in your corner helping you to steer your way through this involved process as sometimes you may need to address issues that are unconscious in you. Good luck on your journey.

I was talking to my wife the other day and I was mentioning some of the familiar scenarios that I see doing couples work. So I’m going to share some of my musings. This is not an attempt to write something comprehensive on the subject, just a few notes about common situations. One of these is that people enter therapy too late to reverse the problems. What I mean is that they come when the love in the marriage has already withered and died. Sometimes the love has died on both sides, but the circumstance that is most common is that one person has fallen out of love and the other person is trying to salvage the relationship and regain what they once had. It seems to me that our capacity for patience, kindness and understanding which are essential to conflict resolution, are rightly or wrongly, attached to whether we are in love or at the very least friends. So how does it come to this? Well, we either don’t talk about the things that are problematic or we lack the communication skills to negotiate our way through the problem to gain some amenable resolution. Sometimes having the conversation and not feeling seen, heard and understood is worse than no conversation at all. Something else that unravels our most cherished relationships is inequality. If you are in a marriage where the division of labour is lopsided then you are creating a breeding ground for resentment. Unfairness almost always damages our love and respect for the other person. Resentment though, is anger that builds on itself over time and eats away at the foundations of our love. Another relationship busting issue is control. Most relationships have one dominant partner and one passive person - opposites attract! This works well enough in some situations but is just as likely to be the thing that causes problems in the end. Here are some of the things that can go wrong. The dominant person may lose interest because they are not challenged or contested or the dominant person may lose respect for someone they can get it over. Control might allow you to get your own way, but it has potent limitations. On the other side of the relationship, the person who is controlled or dominated may suffer from low self esteem as a result of not feeling equal or feeling used. The person being controlled is also likely to feel that they are not valued for who they are. Last, but not least, is blame. Some research that I have read estimates that 90% of all marriages in the USA fail because of blame. The only way for relationships to grow and flourish is if people take responsibility for themselves. This is because you can only change the things that you consciously admit to.

There is a change that occurs when a child is approximately 18 months old. This change marks the movement of a child from a relationship with their mother that is symbiotic, into one that is about differentiation. It is at this stage that a child is beginning to develop a sense of being separate from their mother as opposed to being a part of her. The early stage of a child being reliant on their primary care giver for all things is slowly starting to change. A child is beginning to find self assurance and is increasingly becoming more mobile. This makes it possible for a child to seek some things for themselves. Children at this stage of development are discovering an exciting new world to explore, to touch and to hold. What makes this separation from their mother possible? It is the fact that that a child can now hold an image of their mother in their minds. An infant, when separated from their mother cannot conceptualise their mother returning. This means that infants need to be attended to immediately, whereas toddlers are beginning to explore some aspects of the world on their own and are beginning to enjoy their own company. For this change to progress in a healthy fashion, this separation must be managed in a particular way. The first thing that toddlers need is a safe and loving home base to return to after their adventures. This stage of development should not be forced on your child. It is very important for them to be able to regulate their comings and goings. So when they look back to see if it is safe to be away from you, they will find their mother and father’s loving attention at a safe distance. This can be an unnerving stage for parents as our fear for their safety can be overwhelming. There can be a strong urge at this time to over parent and to smother our child’s move towards independence and differentiation. So that we are parents are at ease, we must determine that the environment we choose to let our toddler explore is safe. If our children are in a situation where separation from us is forced upon them, this will create fear and timidness in them. If this happens regularly then it can create emotional and behavioural problems. So let’s talk now about setting boundaries and how to do this in a healthy and loving fashion. Firstly, the techniques we ought to avoid. We should avoid shaming, hitting, manipulation, bribing, dishonesty, and punishing. These methods may work after a fashion but are harmful to the relationship with your child and in the longer term they will backfire as your child learns to respond in kind. So how do we deal with highly energetic and oppositional toddlers? The key is to develop an open honest and emotionally authentic relationship with your child. I’m not talking about pouring out your problems to them but about letting your child get to know you as a separate person with needs and feelings. Showing your emotions to your child when you are frustrated, cranky, delighted, scared, hurt, in love, etc., are all valid lessons for them to learn about the needs of others, including your need to set boundaries. It is a slow process teaching our children about consideration for others. If our toddlers are encouraged and supported to feel their own emotions then a mutual respect is slowly developed. Toddlers have not yet learned to control their emotions the way adults do so we are often confronted by their strong feelings. This is completely normal. As much as possible, our children should to be encouraged to express themselves even when we are setting a boundary with them. We need to encourage their right to be angry and say no to us. This respect for oppositional behaviour and self assertion teaches emotional intelligence; it also teaches them to stand up for themselves and to have respect for others. It does not mean however that we should collapse our boundaries. We need to hold our ground and permit their opposition. It is often difficult to support their wilfulness because this was not permitted amongst our generation. When we consider the raising of our very young children, we would be best served by considering what we might need to learn to do the job well rather than just thinking about what they need to learn.

Self image is the internalised view that we have of ourselves. In a healthy person, this view would value ourselves and other people equally. It would also include a realistic understanding of our strengths and weaknesses. Unfortunately a great many of us fall on one side of the line or the other. By this I mean that we either suffer from low self esteem or an over inflated self image. Both are disturbances in the human psyche and an indicator to poor psychological health and well being. At first glance you may see these two states of mind as being polar opposites but in fact they are two sides of the same coin, both being an inaccurate view of our self worth and a sign of early childhood injury. So what are the causes and how do we deal with it? The view that we have of ourselves is formed very early in life, by age five or six, these matters will be already determined. The widely held view by psychotherapists and counsellors is that these conditions are caused by relationships between child or infant and parents that are not nurturing. In the case of the person with low self esteem their view of themselves simply mirrors the way that their needs were attended to. If you love me unconditionally and attend to my needs then I am loveable and worthwhile. If you don’t then it is a direct reflection of my self worth. Generally the person with poor self esteem has a negative, angry and critical voice in their head thus verifying the parent’s actions. People suffering from this condition have difficulty getting on with their lives as a degree of self confidence is required to achieve our goals. Ironically the person with over inflated self image has a potent defence against feeling the emptiness and worthlessness that is associated with all forms of parental neglect. That defence is arrogance or egotism. Something that in western society is often mistaken for self confidence. This too can create problems as people with inflated egos are regularly confronted by disappointment, anger and depression when the world does not validate the idealised image of the self. So how can we tell the difference between healthy self confidence and arrogance? The key is in the outcomes. As the Dalai Lama states “we must look at the consequences of ones attitude. Conceit and arrogance generally lead to negative outcomes where as healthy self confidence leads to more positive consequences”. It is important at this point to establish what is meant by positive and negative outcomes. “A negative outcome is when the person’s actions are purely self interested without regard or care for others. Whereas a positive outcome, would be one that would contain a genuine concern for the other person’s well being.” Both of these two character types are likely to make their way into therapy at some time or other. With gentle insightful and supportive care, therapists can help people to restructure and repair negative self image. This in turn leads to healthy self confidence.

Emotional intelligence (EI) is that aspect of the self that governs relationship and connection with yourself and others. EI relates to our ability to love and be loved, it relates to our ability to recognise and appropriately express our feelings. For a long time, our IQ has been highly regarded and has been considered to be central to our happiness and well-being. It has only been in recent times that we are beginning to take our emotional intelligence (EI) seriously. In fact in many circles it is now believed that EI is more important in determining our overall happiness than anything else. EI is responsible for our ability to love and be loved, self esteem, compassion and fulfillment in our daily life. Even our ability to recognise our feelings comes down to EI. It is now understood that we feel first, then speak and act in response to our feelings. So if this is the case, that is we are responding to emotional cues, then we must understand and be able to identify our emotions to be in control of our own lives. Why is it that some of us are not able to identify our emotions and to be in control of our lives? The primary factors involved in the shaping of our emotional world is the kind of upbringing that we received as infants and young children. Children that grow up in warm loving environments are likely to grow into adults with high levels of EI. Children growing up in unsafe and abusive environments are likely to suffer a list of emotional problems. So what causes these differences? In the first eighteen months to three years of life, the brain is growing at an amazing rate that will never be repeated. By age of three the brain has grown to 90% of its adult size. Did you know that by the age of six months your responses to stress have already been determined? This means that an adult’s capacity to deal with stress will be decided by the level of safety we experienced as infants. When I talk about safety, I am talking in the broadest sense about human connection. When we talk about an infant’s well-being we are almost always talking about connection on some level or another. Attending promptly and lovingly to our babies determines that persons ability to feel close to others when they grow up. When we talk about the issue of connection we are not so much talking about what you do but more about the quality of the doing. It is this quality of connection that determines our ability to love and accept ourselves. The qualities I am speaking of are love, warmth, emotional vulnerability and constancy. When I am loved, this makes me lovable. These feelings of connection that are so closely related to emotional intelligence can almost always be measured by our capacity for relationship. The growing brain is virtually being shaped by the nature of its experience. This is why it is difficult to change our emotional circumstances once we have grown up. But don’t despair because it is possible to change our emotional circumstances as adults if we work at it. Our relationship to self is measured by our degree of self acceptance. Our relationship to others is measured by our capacity for empathy, compassion, love and trust.