Seasonal Affective Disorder (SAD) is a kind of recurring, short-term depression or dysthymia. It is, of course, more common in colder climates and in areas that receive limited sunlight in the winter. 

SAD is difficult to diagnose in the first episode because it is indistinguishable from depression, but when a pattern becomes clear, your clinician can determine that this is what you're experiencing. 

SAD has been linked to a lack of vitamin D, which we make through contact with direct sunlight. People with darker skin produce less vitamin D from the sun, and some of us use sunscreen, which prevents our body's contact with sunlight. 

If you're worried about your vitamin D levels, your doctor can do a test for this and can talk with you about over the counter supplements if necessary. Vitamin D also is found in fatty, dark fishes, fortified cereals, fortified dairy and orange juice, and mushrooms. 

SAD has several factors, though. If you love the outdoors and that's one of your coping skills, it can be hard to have it taken away during the winter. Some of the usual activities with friends disappear during the cold season, too, and with SARS-COV-2 floating around, some people are reluctant to gather indoors, so you may be missing friends and family. 

Physical activity is decreased during the winter, which can lead to depression, and the stretch between winter holidays and spring holidays can feel like a long one. 

SAD treatment is similar to depression treatment, and may include some vitamin D support and behavioral interventions. If you find yourself feeling down and unable to enjoy your normal activities, you don't have to wait until spring to feel better. Contact us to schedule a session - our clinicians can help! 

Although it's declined, the word 'boundaries' was one that came up in a lot of sessions several years ago. It's still popular, and that's a good thing. 

Some clients tell me that they know this is important to their relationships, but that they don't really know what reasonable boundaries look like, or that they aren't sure where they want to set them. 

That does introduce a challenge. But let me give you a look at the way that I help clients find where 'the line' is for themselves - maybe it'll inspire you. 

Many of us know instinctively when our rights have been violated, but others aren't sure. For example, we all know that we have the right to invite whoever we want to an event that we're paying for, the right to be spoken to respectfully, or the right to deny someone's requests. But some people will allow their family or close friends to bypass some of these rules. 

As a general rule, look at where the control sits in any scenario to determine where you might place a boundary. For example, you would have a hard time in controling all of the speech that takes place in your presence, so you can't decide that no one is allowed to curse around you. But you could control whether you invite those people to your home, and maybe that's where you put the line. 

Legal codes in your area can help you decide, too. Just as it's illegal to tamper with another person's food or drink, you can decide that no one should pressure you to eat or drink anything you don't want to. 

Consider your values, as well. Some people who have an unexpected set of preferred pronouns are very forgiving with others, and some have decided that this is a hard line for them. The preference is the same, but one group has decided that this is worth fighting for, and another group hasn't. 

Some boundaries are for others as much as they are for you. If you don't want your daughter to allow people to scream at her, then you need to make sure that you don't put up with that, either. She'll know what's acceptable based on what she sees you doing. 

Keep in mind that not every preference can be a boundary. Doing so will help people take you seriously when you tell them that they need to respect your rule. 

If you'd like to talk this over with someone, come see one of our clinicians. We can help you consider your options and come up with some boundaries that will put you back in control of your life!

The bunny who lives in our yard has a firm boundary: if we go outside, she runs away. Good work, bunny.

What comes to mind? Are you thinking padded rooms and horror films? I'm about to reveal the shocking truths I learned when I did my internship at Linden Oaks, the psych facility at Edward Hospital in Chicago. 

Every hospital is different, but modern psychiatric facilities are very much like any other hospital. Some are even like resorts! 

When you arrive at the hospital, you'll be interviewed to see what services are appropriate. You will speak with more than one person during this time, and then if necessary, you'll be admitted to the hospital. 

When admitted, you'll see the psychiatrist and psych nurses, and counselors or therapists as well. One of the goals of your stay is the same as any other hospital stay - to stabilize your condition so that you can get back to your life. In service of this goal, you'll be evaluated for medication changes if necessary and referred for other services as appropriate. 

During your hospital stay, you'll be expected to participate in group and individual therapy sessions as well as classes that are designed to help your psychological health. This structure is similar to an intensive outpatient program. 

Hospitals often have a step-down approach that provides the appropriate level of care to a patient leaving the hospital. This means that, if you aren't admitted to the hospital and assigned a bed, you may be assigned to an outpatient day program part-time or full-time. 

Although you'll still note some of the medical paraphernalia around the psych wing (wide hallways, hand rails, mobility aids), the psychiatric hospital usually looks more like a residential facility, with social areas, a dining room, a kitchenette, outdoor space, and some kind of gym or recreation area. You may share a room, and you'll notice that some personal belongings are not allowed due to the risk of self-harm. 

Your time at the hospital is meant to provide stability and care so that you can return to your daily life, and most people don't spend more than a week or two in the inpatient setting, unless they're recovering from addiction or eating disorders, in which case their physical health needs monitoring. 

You'll notice that the staff uses keys to open the ward doors, and this is for the safety of the patients. 

What about the straitjackets and scary stuff?

While restraints are sometimes necessary, they are very rarely used in modern hospitals, because they aren't needed or recommended. If they are used, the hospital staff will give the patient the chance to control his/her own behavior first, then offer counseling and medication to help the patient control him/herself before resorting to any kind of restraint. I never saw the restraints used during my time at the hospital, because they weren't needed. 

Before you are discharged, you'll probably need to have an appointment for follow-up care, and your staff can help with this. 

If you're looking for follow-up care, use the email form on this site to contact us for a consult.

Medical history display

Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions and Hurtful Acts by Caroll Tavris and Elliot Aronson

I picked up this book over the holidays at the recommendation of a science podcaster, and I highly recommend it in turn. Skip the introduction to the 3rd edition if you want to avoid politics. 

I won't be able to do justice to all of the excellent research and science here, but I'll cover one of the most useful pieces for our everyday lives. Tavris and Aronson describe some of the errors and biases in our thinking that can cause us to vary so greatly in what we believe to be 'acceptable behavior.' 

One of the things they discuss is the question we ask about the truly egregious in our world: "How can they sleep at night?" Aronson and Tavris explain the way that two people could make a single different decision, and then, in an effort to continue to see themselves as good people, they continue to make decisions in line with the first one, to the point that they have ended in radically different places. At the end, they both find it impossible to believe that the person who began where they did has ended up so far away. 

One of the exceptional things about this book is the way that it humanizes those who make these cognitive errors, since we all make them. It provides the skills for more fruitful conversations with our ideological opponents and better understanding of their positions. 

I found that the book wavers in its purpose toward the end of the third edition, as the authors decided to take on modern politics. While their views are immaterial, I think they run the risk of alienating potential allies - after spending the rest of the book in a more neutral stance, they give the truly stubborn a license to ignore all of their good points simply because they disagree with the last part of the book. That last part of the book has made me reluctant to recommend it to a few of my friends and family, but I've recommended it to many of them. 

The clinicians at Sweetwater do continuing education each year, reading material like this in order to ensure their training and interventions are in line with the best science and theory.

(Read last week's post before you read this one)

The point of the post last week was to show you the steps in a successful manipulation. These steps and techniques come naturally to some people, and they may not even know they're using them! 

People who feel that they have little control in their lives sometimes try to gain that control by manipulating others. To them, the needs feel geniune, and it doesn't make them bad people. But if you're exposed to these people, you need to be able to recognize the patterns they use and the ways they exploit your humanity. 

Notice the way that the manipulation depends on your obedience to social norms. As soon as you decide to simply issue a firm "No," the manipulator fails. 

The strategy I described also depends on the use of cognitive dissonance - the phenomenon we experience when two things we believe or know conflict with each other. Our brains are capable of reconciling these things in this instance: you could be a generous person and still not give money to everyone who asks. But the con artist is relying on the fact that our brains don't do that work quickly when we're focused elsewhere. 

You may also have noticed the way that your foe expects politeness. While we think it's rude to walk away from a conversation, or to ignore someone who is speaking, it's also rude to pressure a friend into doing something they don't want to do! Two rudes don't make a right, of course, but sometimes you might have to simply avoid responding in order to stop the conversation. 

Also, note that the manipulator has brought you into a situation that makes their problem into your problem. They've laid this issue in your lap and then refused to take responsibility for it, knowing that you'll take on some of it. But you don't have any requirement to handle their problems, and you can walk away without feeling guilty, as long as you remember that this problem is theirs alone. 

Next time someone tries to use your emotions against you, you'll be able to recognize what they're doing, and then make your own decision.

Manipulating an oyster into giving up its pearl

In the tradition of Evil Week, I present to you: something you probably shouldn't do. 

When going in for a manipulation, you'll find it easiest to exploit the natural vulnerabilites in human nature. For example, most of us feel bound by some rules of politeness. If you put someone in a position where they'd have to break these rules to refuse you, you have a better chance of success. 

Like this: If you ask someone to help you with something, and they hesitate, the polite thing to do would be to note the hesitation and back off. But if you push forward, particularly in front of someone that the target wants to impress, the target may be so surprised that they'll agree. Most people aren't used to resisting social pressure.

Exploit the target's view of him/herself. If you're asking for money, point out the target's generosity. Now, if your target refuses you, s/he will have to adjust his/her view of self to include that s/he isn't generous or suffer cognitive dissonance. You might even say that one of your mutual friends was commenting on the target's generosity lately. This brings peer pressure to bear. 

Still seeing hesitation? Now it's time to lay on the emotion. 

Add a piece of information that puts you in a vulnerable light. Preferably one that's true (always easier to avoid lying because it saves you from having to remember the lie later) and sad. You might want to gently remind your target that your mom had surgery and that you haven't been able to stop worrying, between caring for her and balancing your job and family, you've just been exhausted. You're sorry for even asking, but things have been difficult. 

As you add these things, glance downward as though you're ashamed. Most humans have been conditioned to connect with each other, so your target will feel pressure to say something comforting. And you've already asked for something that you need, so they already know how they can help! 

It'll be awkward for you, but resist the urge to fill the silence. Let the silence build until your target capitulates under its weight. 

If this still doesn't work, make eye contact, and then shrug sadly and apologize for even asking. Tell them that you weren't sure who else to ask, and very slowly look away. Do not assuage your target's guilt by saying "It's okay," or "Don't worry about it" - you want them to worry! 

What on earth is a therapist thinking, telling you all of this? I have a method in my madness, so come back next week to read about it!

Dune: Imperium game involves some intrigue and manipulation

It's happened to everyone - you have a nasty fight with a friend, or you've got a big project at work, or you caught your daughter in some risky behavior, and now that's all you can think about. 

When you try to focus on something else, you hear your friend's voice in your head, saying that hurtful thing again. Or maybe when you're trying to sleep, you keep rehearsing all the ways your project could fail. Whatever you're doing, your thoughts return to the same place. It's almost like a cognitive earworm. 

There a few different names for this. If the thoughts burst in on you without warning, you're dealing with intrusive thoughts, which can be a part of anxiety. If you feel like you can't control the pace of your thoughts, and they are spiraling, then a clinician might call that "racing thoughts." 

Either way, these kinds of thoughts can be distressing. What's happening in your brain might be compared to a forest path - the path that's most used becomes wider and more obvious, smoothed by feet and paws over time to be the easiest way to travel. In your brain, the path that you use most (the familiar one that your perseverent thoughts follow) gets stronger as you exercise it. The next time your thoughts get close to this path, they are more likely to take the path that is the widest and most familiar. 

But you can stop them, and eventually you can extinct this thought pattern! It will take practice, because you've been practicing the current thought pattern, but you'll be able to fix it faster if you keep these tips in mind:

• Stop your thoughts by working on something challenging - a puzzle, a creative project, or exercise

• Reach out for social stimulation, thus distracting you with the company of a friend

• Use prayer or other spiritual practice to connect you to something bigger than yourself

• Deliberately take your thoughts to a pleasant place, like a vacation you'd like to take or an event you're looking forward to attending

If you are struggling with a thought that you can't shake, one of our therapists can help! You can ask for just one or two sessions to work on this - no commitment needed. Use the email contact form on our site.

Cat with deep thoughts

Everyone is familiar with the importance of social support to psychological health. We've all heard that your support system is the best predictor of those who get well and stay well. 

But whether you have friends or are trying to make friends, it's not easy to reach out for help. 

Part of this is due to the nature of psychological struggles. When you're experiencing depression, your brain is telling you that you're not worth helping, or that no one likes you. If anxiety is prevalent for you, that anxiety may be telling you that everyone will think you're weak or whiny if you tell them how you feel. For those with paranoia, it seems that no one is trustworthy. 

For some clients, culture may play a role, too. Each family and community handles stress differently, and some strongly discourage discussion about negative topics or worries. If you heard a lot of "Life isn't fair" or "No use crying over spilled milk," you might have no practice in expressing your struggles, or you might think that they're not important. 

Of course, you can gain some comfort from just being with your friends and family, so if you're not ready to talk to them about how you're feeling, you should still reach out to them to say hello. 

But if you're ready for best results, or if you really need help, there are ways to talk to your friends and family about it that can make you feel more powerful:

• Be clear on what you're asking for. If you need a listening ear, tell your friend that's what you're looking for and not advice. 

• Ease into it. You can start by telling your friend that you're feeling down lately and see how they take it. 

• Ask your friend if they have a minute to listen, so that you're sure of getting their undivided attention. 

• Reach out to more than one person so that you have multiple sources of support. 

• Remember that your friends aren't professionals. If you're struggling with your daily life, or if your symptoms are causing significant distress, use the Contact form on our website to get in touch with someone who can help.

This is just a picture of a co-op board game called Obscurio, and is only tangentially related to friendship.

Our last post talked about age-related cognitive impairment, and when to see a doctor. If that time comes for your parent or loved one, raising the topic can be intimidating. How can you bring up a conversation on a sensitive topic like this one? 

The Emily Post Institute, an authority on etiquette, has some excellent advice on this topic. The experts, Lizzie Post and Dan Post Senning, recommend that you start by asking permission to have the conversation. This gives your conversation partner some warning that the topic might be touchy, and it allows them to pick a time that they'll be open to listening. 

Next, think about what your motives are for the discussion. If you can identify your own fears or emotions, you'll be in a stronger position to explain why this is important to you. For example, if you start with "You're forgetting things more often," you are practically inviting the answer, "No, I'm not," or "So?" But if you begin with your emotion, "I'm worried about you and I don't want to you to get hurt," it's much easier for your loved one to hear (and harder for them to dispute). 

Consider your goal for the conversation. Are you hoping to convince someone of a point of view, or would you be happy enough with a lesser action? If you feel that you need to convince someone, you'll have a much longer conversation. But if your goal is a single action, like having your loved one agree to see a doctor, then keep that goal first in your mind. A family member or friend might be willing to go see a doctor without having to agree with you that s/he is struggling. 

Think about the ramifications for the other person in the conversation. In the example I'm covering, the person struggling with cognitive impairment may see this as much more than a simple doctor visit. The fear around cognitive impairment may cause them to lose independence, to lose a job, or to feel that they aren't respected by others. Considering these issues will put you in a better place to hear your loved one's objections to your idea. 

If you'd like help strategizing about an upcoming difficult conversation, one of our therapists would be happy to work with you. Use the contact form on our website to send an email!

The feline approach to difficult conversations may not work for you.

"Senior moment" or dementia? Should you worry about mild forgetfulness? What about word retrieval issues? What's normal? 

Jokes about elders with memory problems are a part of our culture. Many clients assume that age-related cognitive decline is inevitable, and that they should ignore it. But our brains don't automatically start to deteriorate as we age. Only some kinds of cognitive changes are normal, and some are preventable. 

You can continue to learn new skills and new information, and your vocabulary can increase with age, as can your perspective on life. It's easier to weather the ups and downs when you can remind yourself of all that you've overcome in the past.

Some of the normal cognitive decline you might notice is in areas like processing speed or short-term memory. But just because these things are normal, you don't have to embrace them without a fight! 

The brain is like a muscle - if you never challenge it, you'll never gain strength. You can build new brain structures by trying new activities or hobbies, meeting new people, and other novel stimulation. Working through puzzles like crosswords can help you practice word retrieval, and of course, exercise benefits your brain's circulation. 

Sometimes, cognitive impairment falls outside the normal range. If you notice that you're having trouble remembering very familiar faces, or getting lost in a place you know well, or if your loved one has trouble following a set of instructions, it's time to ask your doctor for a cognitive screening. Since there are many possible causes for cognitive impairment, it's better to get a doctor's advice than to assume that it's age-related. 

Aging challenges can cause family conflict, too, and caregiver stress can impact your relationship with your loved ones. If you want to talk to someone about these issues, a Sweetwater therapist can help.