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Psychological issues have been found to live in our bones, brain, and cells. Trauma impacts the whole body, not just the mind, altering cells and causing physical symptoms. Trauma isn't about the event size; it's about the nervous system's response and its physiological impact. Trauma is a biological injury needing holistic and somatic care. How many times have you heard someone say “it’s all in your head” in response to a mental health issue? Being a mental health provider myself since 2011, I've probably heard it over thousands of times from friends, family , physicians, and countless, misinformed, but well-meaning mental health providers as well. While well-intentioned, this response can often feel quite dismissive or minimizing to emotional pain, especially trauma . It can also further discourage the mental health sufferer from sharing their experiences and can imply it's their fault for not thinking their way out of their suffering. But science—and lived experience—tell us something very different: trauma isn’t just psychological (van der Kolk, 2014). It’s deeply physiological as well. It resides in the body, bones, cells, brain, and your nervous system. This isn’t just poetic language; it’s biological reality. Trauma Is a Full-Body Experience When we go through a traumatic event, our nervous system kicks into overdrive instantaneously before we can even cognitively process what happened. The brain’s fear center, the amygdala, activates the fight-or-flight response, flooding the body with stress hormones like cortisol and adrenaline. In a healthy recovery process, this activation would settle down. But with unresolved trauma, the body can become "stuck on activation," and subsequently struggle to its healthy baseline. It can stay hypervigilant—looping in a mode of "always scanning for danger," even when we’re physically safe. This is why trauma survivors often report physical symptoms like muscle tension, headaches, digestive issues, chronic fatigue, and sleep disturbances frequently. According to research cited in van der Kolk's (2014) The Body Keeps the Score, the body literally “keeps the score” from traumatic events. The experiences are encoded not only in the brain, but in the entire nervous system spanning across every nook and cranny of the body and its emotional programming. It’s Not Just in Your Head—It’s in Your Cells Research in the field of epigenetics strongly supports this mind-body link. Studies show that trauma can lead to changes in gene expression—essentially changing how your body responds to stress in the future. One study (Yehuda et al., 2016) found that children of Holocaust survivors had epigenetic markers associated with trauma, suggesting that the biological imprint of trauma can even be passed down through generations. Similarly, researchers have found higher levels of inflammation and stress-related biomarkers in individuals with PTSD . These physical imprints are not the result of being “dramatic” or “too sensitive”—they’re evidence of a system that’s been overloaded and hasn’t been given the chance to reset. Mind-Body Therapies Are Key Because trauma lives in the body, effective healing must involve the body too. While traditional talk therapy can be helpful, many people find that somatic (body-oriented) modalities like EMDR (Eye Movement Desensitization and Reprocessing) , Emotionally Focused Therapy, Somatic Experiencing, yoga, or even body and breathwork can be essential parts of recovery. These therapies help release trauma from the nervous system—not just analyze it cognitively. Dr. Peter Levine, creator of Somatic Experiencing, emphasizes that healing requires a “bottom-up” approach—starting with the body, not the intellect. His research and clinical work show that trauma recovery involves gently guiding the nervous system out of its frozen or hyper-aroused state, allowing the body to complete the defensive responses it couldn’t during the original trauma (Levine, 1997). Common Misconceptions That Harm One of the most harmful myths about trauma is that it’s only serious if something “big” happened—like combat, assault, or natural disasters. But trauma isn’t defined by the event; it’s defined by the nervous system’s response to the event. A child who felt chronically unseen, criticized, or emotionally neglected may carry the same trauma imprint as someone who experienced a major external catastrophe. I repeat, it's a widespread, pernicious myth is that trauma is purely psychological or "in your head." This can lead people to seek help only through medication or talk therapy, without addressing the physical dimensions of their symptoms. Trauma is not a mental weakness—it’s a biological injury to the nervous system that needs holistic care. Conclusion Understanding that trauma resides in the body can be incredibly relieving and validating. If you’ve ever wondered why you can’t just “move on” or “think positively,” it’s not because you’re broken or weak—it’s because your body is still trying to protect you from a threat it had determined is still very much present (even if it's not). That’s its job; prioritizes protecting us, and sometimes it gets so entrenched in this role that it can continually misperceive threat. And healing isn’t about pushing through or toughing it out. It’s about listening deeply to what your body is trying to tell you and working gently with it, not against it, so it can move through us and reprogram over time. The good news is the body can also be a powerful vehicle for healing. Neuroplasticity—the brain’s ability to rewire itself—combined with somatic healing practices means that recovery is not only possible, it’s deeply embodied. Trauma is not only treatable but curable. It was never “just in your head.” Trauma becomes programmed into your body—and with the right support, it can be unprogrammed (and reprogrammed) as well. Jason N. Linder, Psy.D., LMFT - Website - Blog - References Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books. Porges, S. W. (2011). The Polyvagal Theory. Norton. Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Guilford Publications. van der Kolk, B. (2014). The Body Keeps the Score. Penguin Books. Yehuda, R., Daskalakis, N. P., Bierer, L. M., Bader, H. N., Klengel, T., Holsboer, F., & Binder, E. B. (2016). Holocaust exposure induced intergenerational effects on FKBP5 methylation. Biological Psychiatry, 80(5), 372–380.

Cynical depression is a dark veneer, and more common than we think. Cynical depression is hard to detect as it takes on masks of adrenaline or sedation. Cynical depression breeds paranoia. Sufferers of common depression blame themselves to some extent. The cynically depressed blame everyone else, especially those who are successful in love and life. Cynical depression is one form of refractory depression , which is a multi-faceted emotional disorder notoriously resistant to treatment. The dictionary definition of “cynical” reveals why it persists and is so hard to treat. “Believing that people are motivated by self-interest, distrustful of human sincerity or integrity. Concerned only with one's own interests and typically disregarding accepted or appropriate standards to achieve them.” – Oxford Languages Not all persistent depression is cynical. The distinguishing factors are the ways that sufferers mask their depression, typically with adrenaline and sedation. They don’t look or feel depressed in the classic sense. They are not lethargic or weepy. Adrenaline mitigates against a depressed mood , and sedation numbs it. They're suspicious of others, which can make them appear a little dangerous. Adrenaline masks include risky behavior, chronic resentment, anger , jealousy, envy, dogmatic zealotry, and abuse of others. Adrenaline provides a surge of temporary energy and confidence that changes facial expressions and body language so that they don’t look depressed. Adrenaline works like amphetamine. After the surge of energy and confidence, you crash, requiring more adrenaline to climb out of the emotional hole. Sedating masks look like entitlement, self-righteousness, or abuse of substances, which temporarily numb the pain of depression. Regardless of the mask it takes, cynical depression breeds paranoia. It’s a short step from regarding people as lacking sincerity or integrity to attributing malevolent and persecutorial intentions to them. A telling distinction between cynical and ordinary depression is the object of their tendency to blame. Those who suffer from recognizable depression tend to blame themselves. The cynically depressed blame almost everyone else, especially people who are successful in love, sex, or industry. Active shooters are cynically depressed by all reports, at least those who are not delusional. The Endorphin Remedy If you or a loved one suffers from adrenaline or sedating masks, address the underlying depression. Depression has many causes, some of them physiological. Get a physical to rule out physiological causes. Walk 30 minutes a day! 10 minutes a day in sunlight! An hour a week in nature! Focus on how bad you feel just long enough to validate the feeling so you can effectively change it. Never justify that you feel bad, focus instead on what you can do to become the person, partner, and parent you most want to be. The brain is unlikely to give up masks of adrenaline and sedation, without practice of behaviors that increase endorphins. Exercise and brief prosocial behaviors—motivated by compassion, kindness, or affection—should become routine. Acting on our humane values makes us feel more humane and a lot less depressed. Steven Stosny, Ph.D., - Website - Blog -

Difficulties with accurate Bipolar II symptom identification. There is a lot of web-based information that assists people in identifying symptom sets that serve as criteria for the diagnosis of bipolar disorder . For those whose bipolar mood elevations are quite strong, particularly when their symptom profile fits patterns of bipolar I disorder, identifying the diagnosis is not that difficult. Full mania, however it presents, is usually unmistakable. The salient elements of intense physical energy, accelerated cognition, lessened need for sleep, distorted perceptions of self and very intense mood are not typically seen in other forms of psychopathology, with the exception of substance induced states or florid psychotic episodes that are part of schizophrenia. By the way, mania may or may not entail psychosis. What distinguishes mania from lesser intensity mood elevation or hypomania is: The manic individual is typically out of control and unable to function safely without close supervision or hospitalization. If one has had one or more manic episodes, he or she usually knows it. It's like wondering whether or not an area has been hit by a hurricane. Usually, the downed trees and the interrupted electric service adequately tell the story. The more challenging aspects of bipolar symptom identification involve the subtler aspects of mood elevation associated with bipolar II disorder. Because BP II mood elevation is not as intense, it’s simply more difficult to spot, especially on the low end of the hypomanic continuum. Imagine that we had some kind of mood intensity meter that could measure the strength of mood elevation…kind of like a blood pressure cuff. This cuff would be able to determine strength of things like mood, physical energy and speed of thought. Now imagine this BP II cuff could combine these different components and create a five-point range, which would yield the following hypomanic intensity readings: 1=slight elevation 2=mild elevation 3=moderate elevation 4=strong elevation 5=very strong elevation It’s a nifty cuff. The interesting piece here, besides the fantasy of a bipolar cuff, is that for many who were experiencing low-end elevation (#1 or #2), had they not measured their BP mood intensity, it’s quite possible they wouldn’t know that they were mildly elevated. After all, our moods exist on a broad continuum. If we graphed people’s mood intensity as well as mood direction (up or down) we’d see that for some the mood graph would remain fairly level, others would have mild dips and elevations, still others would show a high degree of variability with deep lows and highs. The point here is that because mood does vary, it can be difficult to be aware of the progression into low-end hypomania. It isn’t necessarily accompanied by obvious warning signals. There are two additional dimensions that make symptom identification challenging for those living with bipolar II disorder: Individuals who are in the early stages of their BP II Disorder (first year or two post diagnosis) Individuals with bipolar II whose baseline functioning also entails a fair degree of emotional reactivity. Imagine experiencing mild to moderately elevated energy for a few days along with rapid thinking and irritability; or mild mood elevation (feeling positive and optimistic), along with a mild degree elevated energy such that your body’s sleep clock isn’t winding down when you’re usually ready for bed. This might not be the norm for you, but think about it. Early on, would it register that something might be wrong? After all, living with normal mood doesn’t necessarily mean living with flatness. Sometimes mood intensity is a normal reaction to the intensity of life, and sometimes it can mean you’re positioned somewhere on the bipolar spectrum. Without enough experience of bipolarity, how does one distinguish between symptoms of an illness versus times when you're simply stressed and mildly agitated or feeling enthusiastic and productive as a function of positive mood? The individual who has lived with up and down mood for three to five years is in a better position to have some perspective on what his or her pattern looks like. But what if you’re in the first or second year of mood instability? What if you’ve had a year or two of intermittent depressive episodes and you’ve just been diagnosed with bipolar II following your first week-long hypomanic episode? It is this early period of time, post-diagnosis, when it’s most difficult to distinguish between normal ups and downs vs those that may be bipolar-related. There’s both good news and bad news here. The bad comes first: during the early course of low-end or mild acuity bipolar II disorder, it's really difficult to arrive at these distinctions with accuracy. Having worked with bipolarity over the last 20 years, I usually don’t see a quick route towards this kind of self-knowledge, as it’s only born out of one’s own unique experience. You won’t find a field manual of bipolar symptoms written specifically for you. Yes, there are websites, mood charting apps and a gaggle of books that describe bipolar II symptoms, but they’re not talking about “you.” The good news is that over time, your use of available resources as well as your own increasing self-awareness will help sharpen your self-observing capacities. Most with mild bipolarity will have a lot more clarity about their symptom patterns after several years of experience. And, as a function of better clarity, individuals can more effectively take steps to offset the negative impact of mood instability. Adjusting the dosing of one or two of your meds, becoming stricter with your adherence to a stable sleep schedule, increasing exposure to daylight or darkness (depending on which end of the mood continuum one is trying to modulate), increasing session frequency with your psychotherapist, incorporating regular exercise into your weekly routine; these are all part of the adjustments one will make in the process of trying to lessen the negative impact of bipolar mood intensity. The second challenging dimension of living with BP is a bit trickier. On top of your bipolar II instability, what if you’re also someone with strong emotional reactivity ? If that’s the case, how do you distinguish between emotional reactivity and bipolar mood variability? Some people have big emotions. They react strongly to life and to relational issues. In the intensity of the moment they’re not always good at keeping things in perspective. Instead, their emotional responses are full, strong, and passionate. Taken more to the extreme, this kind of reactivity can represent someone positioned on the personality disorder spectrum. Again, we’re talking about continuums of intensity. The point at which individuals identify psychopathology vs normal intensity entails the relative degree adaptiveness of their emotions and accompanying behaviors. If life works for them, if they flow with their fullness without there being a recurrent downside, then we might just say they’re fortunate to experience a fair degree of “joie de vivre.” But what happens when the emotional intensity causes repeated difficulties and relationship ruptures, when the aftermath of big feelings involves frequent conflict, hurt, disagreements and a long trail of relational debris? One simple answer is that when emotional intensity comes with a lot of negative cost, we’d probably agree that it’s less of an attractive or desirable attribute. Potentially it’s problematic. Potentially one may be living with maladaptive personality traits in the realms of borderline or narcissism (see post “Misdiagnosis of Bipolar Disorder, Part II”). But let’s be cautious. Big emotions in and of themselves, do not a personality disorder make! OK, now to the essential piece. Bipolarity reflects two distinct ends on a continuum of mood. The bipolar diagnosis is rendered when there are enough repeated symptoms of elevation and depression that create problems in living for the individual. BP II mood elevation can often entail strong emotions, along with a host of other mood-elevated symptoms. These can include, but are not limited to: elevated energy, lessened need for sleep, rapid cognition, strong optimism, feelings of elation or euphoria, elevated self-confidence sometimes bordering on grandiosity, elevated libido (felt and sometimes acted upon), impulsivity, excessive spending, irritability, strong impatience, distractibility, intense strong goal-directed behavior, and preoccupation with religion, spirituality or any other kind of central organizing ideal that the BP II mind latches onto. And there are more, but the ones just listed tend to be more common. With regard to the broader picture, think of an energetic system that is overcharged, running at peak intensity and doesn’t need as much recharging at night (sleep). I’m not delving into the depressive end of the spectrum here as it tends to be more commonly understood. Most people have had some direct experience with depression, or they have a close connection with someone who has. In addition to elevation and depression, there’s the experience of bipolar mixed symptoms where an individual experiences a blend of symptoms from each side of the continuum. Mainstream bipolar literature used to refer to the mixed symptom picture as relatively uncommon. More recently, J. Phelps, MD, has spoken to the frequently overlooked aspects of mixed symptoms in the context of bipolar spectrum disorders (see J. Phelps, MD, Psychiatric Times; plus his two books, “A Spectrum Approach to Mood Disorders.” Phelps, 2016, Norton and “Bipolar, Not So Much.” Aiken and Phelps, 2017, Norton). An example of a mixed symptom set would be high energy, rapid thought, negative pessimistic thinking, irritability, impulsive expressions of anger and lessened need for sleep. One of my patients described it as “being positioned on a sharp electrified edge and being unable to get down.” There’s an equally important part of the bipolar symptom pattern that’s not often written about, called “episodicity." Bipolar symptoms tend to occur as a cluster. The period of time during which they are present represents an episode and the symptom set remains “on” until it has run its course and the symptoms begin to remit or transition into different symptoms. Mood elevation, including mixed symptom elevation, typically lasts between a few days to several months (though one of my patients once experienced a two-year long bout of strong hypomania). Depressed mood episodes tend to remain in place for longer – several weeks, up to six months, and sometimes more. The point is, when bipolar mood becomes destabilized, then the individual’s unique symptom sets become activated. Now I want to loop back to my earlier reference regarding the challenge of living with emotional reactivity while also living with bipolarity. The critical piece here is that they can be different. Strong emotions such as euphoric feelings during hypomania or irritability during an episode of mixed symptoms can absolutely be reflective of bipolar mood. But they can also be more personality based. When strong reactivity is personality based you’ll see it peppered throughout one’s experience. It will almost always be interpersonally and situationally based. In other words, if you’re struggling with personality-based issues (how you relate to the world), your strong reactions will be in response to the world. But if you're going from mid-range (not up/not down) into elevated mood for no good reason and your cluster of mood intensity symptoms remains in place for few days or longer, that’s more likely to be a manifestation of hypomanic mood. One of the common errors I see being made by individuals new to their bipolarity is that they can over attribute the illness as the cause of most of their difficulties. This isn’t good for a number of reasons. First, it gives the illness more of a role than it deserves. And second, by seeing bipolarity as the universal culprit, it further dis- empowers the individual. The perception that bipolar disorder sits at the root of all of one’s strong emotions will cause you to feel worse about the journey that lies ahead. Two brief case examples: Jorge is a 22-year-old, Latino male 4th-year university student who has lived with bipolar II disorder since his first significant hypomanic episode during his second year at school. He was also diagnosed with attention deficit disorder during middle school. The combination of his mildly impaired executive skills as well as some mild cognitive side effects from his mood stabilizing medication have him feel increasingly concerned or insecure about his ability to stay on top of things while multi-tasking. Jorge recently had a job interview for a post-graduation position. The interview went well enough but following the interview he found himself filled with self-doubt as to whether he could perform adequately if he were offered the position. When Jorge came to his next psychotherapy appointment he was distressed by his interpretation that his bipolarity shuttled him from a strong job interview into an anxious, worried, self-doubting frame of mind. Janice is a 32-year-old, unmarried female diagnosed with bipolar II when she was in her mid 20s. She experiences mild to moderately depressed mood much of the time but several times each year she’ll find herself spiking into elevated mood (mostly positive) for several days duration. Additionally, she’s very emotionally insecure about finding and keeping a quality love relationship. The presence of her bipolarity has her even more concerned due to her perception of self as “damaged goods.” Janice does experience some borderline personality traits, though she’s become good at modulating the intensity of her behavioral expression of intense emotion. Janice teaches fifth grade at a private boarding school and she was recently asked out by a male colleague. Janice felt thrilled since she had had fantasies about a relationship with this teacher since they had first met. For the next two days her mood was up. She had difficulty falling asleep. She was preoccupied with anticipatory thoughts about the wonderful new man in her life…until she saw him on Sunday afternoon walking with an attractive female at a nearby shopping mall. Janice plummeted. She was convinced she was getting her hopes up for nothing. In fact, she was certain he was going to call and convey that he recently met someone new and was having second thoughts about going out with Janice. In therapy Janice lamented that she could never have an on-going relationship due to the roller coaster life she lived as a function of her bipolarity. What’s wrong with these pictures? Each individual was struggling with their own unique vulnerabilities and the activation of intense emotions secondary to self-esteem/self-doubt. In Jorge’s example his self-esteem was shaken as he questioned his ability to manage complex employment-related tasks and responsibilities. In Janice’s case, she was feeling lonely and desirous of a love relationship. The recent interest from a colleague activated strong idealized fantasies of fulfillment and a rapidly plummeting sense of disappointment based on very flimsy evidence. Both were sure that their bipolar disorder was responsible for their distress. And both were wrong. Jorge’s medication side effects may have added to his concerns about his employment-related performance. But he’s also had difficulties staying on top of complex detail since his early teenage years. Beyond that, he was worried about the approach of his first real, grown-up job following college graduation, as are most twenty-somethings who are about to receive their degree and enter the work force. Janice is very insecure about finding a love relationship. But Janice is also insecure about most of her relationships. Her strongly felt needs lead her into prematurely idealized attachments, corresponding fears of loss and rapidly changing intense emotions. Both Janice and Jorge live with bipolar too (no typo here), but in the midst of their situational and relational difficulties, that which calls out for their close attention is not their bipolar II disorder. Russ Federman, Ph.D., A.B.P.P. - Blog -

Shifting perspective when fertility treatment outcomes don’t match your effort. Society often links effort directly with success, deeming efforts wasted if outcomes don't match expectations. Fertility journeys require a unique emotional resilience, making effort meaningful regardless of results. True courage could simply involve giving yourself permission to rest and honor the worth of your actions. Jemma sat quietly on her couch, wrapped in a blanket. Outside, the city continued its restless hum, indifferent to the quiet stillness within her apartment. Her phone rested in her hand, displaying a message from her therapist: "I want you to rest. Take some time to write out all the things you did right, all the steps you've taken in your fertility journey. I know this is contradictory to the outside world and results right now." Jemma sighed deeply, feeling the full contradiction between those supportive words and the stark reality of her recent failed embryo cycle. How could she think or feel successful when her body had refused to cooperate yet again? Listing the Steps Despite her skepticism and her natural urge to turbocharge ahead, Jemma picked up a notebook and pen, realizing she needed to slow down. She began to write hesitantly, carefully listing each step. First came the courage to decide she wanted children—a decision she never found easy. Then the medical consultations, where she learned medical terms she couldn't pronounce and faced vulnerability as strangers examined her. She noted managing her Hashimoto’s through nutrition, diligently maintaining a gluten-free and dairy-free diet, exercising consistently despite limited visible results, and staying committed to her medication and endocrinologist appointments. She had carefully adopted a non-toxic lifestyle—from beauty products to household items—and significantly reduced alcohol consumption. She listed countless acupuncture sessions, daily Celluma treatments, and comprehensive supplement routines. She documented significant medical efforts: laparoscopy, platelet-rich plasma treatments, and numerous fertility-related flights around the country. Jemma also faced emotional struggles , including her sister declining to donate eggs and experiencing a failed donor cycle after extensive emotional and logistical preparation. Finally, she noted daily sacrifices such as missing work, canceled plans, and challenges navigating holidays and events. Challenging Society’s Message Although the results hadn't matched her dedicated efforts, Jemma felt profoundly validated recognizing each challenging step she had navigated. Society typically links effort directly with success, deeming efforts wasted if outcomes don't match expectations. However, fertility journeys require a unique kind of emotional resilience, making effort meaningful regardless of results. Looking at her extensive list, she began to see her story as one of perseverance and deep commitment rather than failure. Her phone buzzed, interrupting her thoughts. A message appeared from a friend checking if she was OK. Jemma hesitated, then typed honestly: "It’s tough. But I’m seeing I've done more right than I realized." A Shift in Perspective She glanced around the room, now recognizing signs of courage rather than defeat. Fertility books stacked neatly, carefully organized vitamins, and even the tiny injection marks—all silent proof of her strength. Perhaps the world measured success by results, but real bravery might mean acknowledging your efforts regardless of outcomes. True courage could simply involve giving yourself permission to rest and honor the worth of your actions. Jemma recalled how her therapist often spoke of identity collapse versus identity expansion, terms she'd initially resisted but suddenly understood clearly. Identity collapse was exactly what she'd been experiencing—her sense of self shrinking each time fertility treatments failed, leaving her feeling defined solely by loss and inadequacy. Identity expansion meant gently recognizing that each painful step was reshaping her, broadening her resilience, deepening her empathy, and enriching her understanding of who she was beyond motherhood alone. Perhaps success wasn't about becoming the person she'd planned to be, but embracing the more complex, compassionate woman her experiences had shaped. In this gentle acknowledgment, Jemma found peace. The cycle had not succeeded, but she had not failed. Fenella Das Gupta, Ph.D., MFT, - Website - Blog -

Subtle messages teach gay men to stay small, but healing helps us to expand. Many gay men grow up learning that acceptance comes with staying quiet about who they are. Conditional acceptance can lead to self-monitoring, code-switching, and shrinking in relationships. Integration begins with small choices to stop editing and start being. Some messages are loud and explicit. Others are quiet and subtle enough to slip in under our radar. One message that is particularly pervasive that many gay men get is: It’s OK to be gay…just don’t flaunt it. For many of us, this message shows up after we come out. It might not be something we’re explicitly told, but we see it in the split-second facial expressions when our voice lifts, the reactions when we gesture too freely, or the subtle shift in energy when we speak with too much enthusiasm or flair. So many gay men are taught to read these micro-reactions like survival skills—quiet corrections that signal we’ve crossed an invisible line. It’s a kind of conditional acceptance—“You can be who you are, just as long as you don't make me uncomfortable.” I didn’t realize how much I had internalized this message until I began noticing how often I code-switched depending on who I was around. I live in Los Angeles, but whenever I would visit my family in Arizona, I noticed my voice would drop and my mannerisms would shift. Especially around straight men or in unfamiliar environments, I’d instinctively adjust myself—without even realizing it. It was like my nervous system had learned that being “too” openly gay wasn’t safe, even if no one had explicitly said something. I remember once getting a manicure, and near the end, I casually asked the nail technician about polish colors. We’d been chatting warmly, getting to know one another, and she had even mentioned that her son and I shared the same name. After I asked about nail polish, she laughed and said, “Oh, you don’t want nail polish! People will think you’re gay!” I just smiled and didn’t say anything—not because I agreed, but because it felt easier in the moment, and I didn’t want to disappoint her heteronormative assumption. I was also put in a position where I had to decide whether or not I wanted to come out to a stranger at a nail salon. That can take a lot of energy—and honestly, sometimes I just don’t have the bandwidth. Experiences like these aren’t isolated moments. They’re part of a larger pattern—the subtle, persistent message that shapes how many gay men learn to move through the world. That’s what this message does. It teaches us to self-monitor. To scan the room. To anticipate rejection before it arrives. And it tells us, time and again, to stay small—not for our safety anymore, but for other people’s comfort. Even after coming out, many gay men carry this internalized message: It’s OK to be gay, just not that gay—don’t hold hands in public. Don’t talk too much about your relationship. Don’t use that voice, wear that outfit, post that picture, or take up too much space. This kind of self-policing isn’t about shame in the way we might have experienced it as closeted kids. It’s more insidious. It sounds like “tone it down,” but what it really means is “don’t be too visible.” And the moment we buy into it, we begin editing ourselves in ways we may not even realize. I’ve heard it from clients, too—gay men who are out and openly gay but still feel like they have to manage how much of themselves they reveal. One client recently told me, “I’m out at work, but I don’t talk about my partner. Not because it’s a secret, but because...I don’t know, I just don’t want to make it a thing.” But why shouldn’t it be “a thing”? Straight people talk about their partners all the time. They wear wedding rings, post anniversary pictures, and share weekend stories with ease. Yet many gay men, even in seemingly accepting environments, second-guess how much is “too much.” We internalize these messages not because we’re weak, but because we’re adaptive. We’ve learned to scan spaces for danger, to minimize risk, and to keep ourselves emotionally safe. But the coping strategies that helped us survive aren’t the same ones that help us thrive. We don’t need to apologize for how we love, speak, dress, or show up. And we definitely don’t need to shrink ourselves just to make someone else comfortable. Healing from this message takes conscious awareness and practice. It means noticing when we’re editing ourselves and asking why. It means remembering that discomfort isn’t danger and that our visibility isn’t a threat, but a gift. For me, healing started with small actions: letting my niece paint my nails despite some family member’s disapproval, not caring if my voice rose a little when I got excited, and letting myself take up space in conversations, relationships, and rooms. Each choice was a way of helping myself unlearn the message: “Don’t flaunt it.” Because identity and self-expression aren’t “flaunting”—they’re just being. Human being. Chris Tompkins - Website - Blog -

Which lingers longer, joy or sadness? And why? Every now and then I run across a neuroscientific study that makes me think in a new way, because it tries a fresh angle or studies something no one has studied before. A study from 2014 I just encountered accomplishes exactly that. The study, published in Motivation and Emotion, by Verduyn & Lavrijsen, 2014, asked the apparently simple question, how long do emotions last? The answer is fascinating, and not at all simple. It’s not the case that negative emotions last and positive ones are fleeting, for example. An apparently random collection of positive and negative emotions come and go very quickly, whereas a similar set of both kinds of emotions last a good deal longer. Nor is it always the case that the importance of the event triggering the emotion determines how long it lasts. Of course, trivial events that come and go by the score during the day won’t necessarily cause emotions to stick with you, and earth-shaking moments will probably last longer, emotionally speaking. But we can never be sure how an event will strike us. One of my first summer jobs was working for my dad, a scientist, in his lab. I was sixteen. My job was to feed a culture of anaerobic amoebae he was using in his work. One day I accidentally introduced some oxygen into the mix, instantly killing the culture. It was not a catastrophe, but it did set him back a week or two, and Dad was annoyed. In his pique, he said, “Obviously you’re not cut out to be a scientist.” He forgot the comment in a few weeks, probably when the new culture was established, but I have remembered it for half a century and the sting of it is at least in part why I never did become a scientist. OK, my career choices aside, what does determine how long an emotion lasts? In a word, rumination. Saskia Lavrijsen, co-author of the study, says, rumination “is the central determinant of why some emotions last longer than others. Emotions associated with high levels of rumination will last longest.” At the short end of the emotional race, we have disgust, shame, humiliation, fear, and compassion. Irritation is in a dead heat with compassion, which makes me a bit sad to learn. These emotions typically last a half-hour, give or take. On the long side, we have anxiety , hope, desperation, joy, hatred, and the winner by several lengths: sadness. Sadness is the outlier, lasting five days, or twice as long as the next closest entrant, hatred. Of course, sadness is a marker for depression , and that’s a tough, quiet killer of human feeling, relationships, and happiness. So perhaps it’s not surprising — surprise being an emotion that itself only lasts about two hours. Some emotions that naturally seem to pair together sit at opposite ends of the spectrum – our fear is brief, but anxiety lasts a long time – typically 24 hours. Shame goes quickly, but guilt stays with us, three and half hours compared to 30 minutes. Again, the key seems to be how much we are inclined to ruminate on the emotion and the incident that brought it up. Brene Brown’s wonderful book, The Atlas of the Heart, helps make us aware of the incredible richness and nuance of human emotion. This study complements her work nicely, and shows us, in a very concrete way, how different emotions have much different weight in terms of their duration. It’s an important reminder that we have a responsibility to our fellow humans, whether we are colleagues, teachers, family, or friends, to understand what we are putting them through when we invoke an emotion in them. We should be very careful about the longer-lasting emotions especially, given that we may affect someone’s life for almost a week by introducing, in particular, the emotion of sadness. The Buddhists teach that the mind is like the sky, and emotions are like clouds that pass through the sky. One should just watch those clouds float by, rather than attaching oneself to them. This study suggests that that work may be considerably harder or easier depending on the emotion in question. Nick Morgan, Ph.D., - Website - Book -

Preparing delicate discussions about death or illness with a young family. Parents can proactively plan to discuss death with children to soften the blow. Children may know more about death and illness than parents believe. Choosing where and how to have a potentially traumatic conversation can create a safe space. Recently, Princess Catherine, affectionately known as “Kate,” the Princess of Wales, publicly announced that she has cancer . She also has three young children. As she begins chemotherapy, she reminded the world that she and her husband Prince William also have to explain to their precious loved ones what is going on. Her poignant message resonated around the world with parents who are facing the same dilemma, how to best break bad news to young children that Mommy or Daddy has become ill. Thankfully, there are ways to soften the blow. Knowledge Is Power Children know more than you think about death and tragedy. They hear about it at school or, worse yet, watch it in real-time on the smartphones of classmates or on their own devices that parents have permitted them to have to keep in touch with them. So, in preparing to discuss a classroom shooting or a cancer diagnosis, parents can begin by exploring how much their children already know about the underlying issues. Sarah-Jane Renand et al. (2013) explored the process of talking with children about death.1 Participants, which included 130 parents of children from 2 to 7 years old, shared the explanations they provided to their children, including perceptions of their children’s emotional and physical reactions. The likelihood of having such conversations to begin with increased with the age of the child. Among other findings, Renand et al. noted that the most frequent types of discussions involved religion or spirituality, and that the degree of religiosity was negatively correlated with providing a biological explanation of death. Researchers have also investigated the question of whether parents prefer to be the sole or primary source of information about death and dying or whether children should learn about it in school. Agustín de la Herrán Gascón et al. (2022) investigated the extent to which parents want the subject of death to be included within educational curriculum.2 In their sample of 917 mothers and fathers of children and adolescents, they found moderately positive attitudes toward education including the subject of death. The attitudes of individual parents ranged according to religious beliefs, gender, and children’s educational stage. Overall, their study results weighed in favor of the educational incorporation of death into families and schools. Strategies to Soften the Blow Whether or not children are likely to learn about illness and death through other means, parents can take steps to soften the blow, especially when the topic involves their own illness and negative prognosis. Here are a few tips: Words matter. Make your explanation easy to understand. When describing death or illness, avoid difficult phrases such as “passed on” or “under the weather.” Children may find it easier to process concrete terms they are more familiar with such as references to someone being “sick” or having “died.” Comfort counts. Make sure a child is in a familiar space, such as your home living room, and has their favorite stuffed animal or a blanket with them before beginning an emotional conversation. Prepare yourself first. Sort out your own emotions before talking with your children, because they will filter the significance of your words through your feelings—which they can perceive more readily than you think. There is safety in numbers. Have difficult conversations with your children in the presence of other trusted adults who will be there for them to provide a sense of security in crisis. Proactive preparation is powerful here, also, including details of how things will change. The bottom line is that age-appropriate discussion of difficult subjects such as death and dying can prepare children emotionally and physically and bring comfort to every member of the family. Also, remember that professional help is available. Wendy L. Patrick, J.D., Ph.D., - Website - References 1. Renand, Sarah-Jane, Paraskevi Engarhos, Michael Schleifer, and Victoria Talwar. 2013. “Talking to Children about Death: Parental Use of Religious and Biological Explanations.” Journal of Psychology and Christianity 32 (3): 180–191. 2. de la Herrán Gascón, Agustín, Pablo Rodríguez Herrero, and Bianca Fiorella Serrano Manzano. 2022. “Do Parents Want Death to Be Included in Their Children’s Education?” Journal of Family Studies 28 (4): 1320–1337. doi:10.1080/13229400.2020.1819379. reprinted with permission

... and the particular dangers of atypical major depression. Major depressive disorder has eight subtypes. Each subtype has unique treatment considerations. Some subtypes are associated with increased suicide risk. Others can indicate endocrinological complications and others harbingers of bipolar disorders. Major depressive disorder (MDD), perhaps the most common form of depression (APA, 2013), has many subtypes, each with its unique characteristics and treatment needs. I was recently reviewing this with a supervisee, who felt it was important to know subtypes but found it overwhelming to study them all. I provided a cheat sheet of the most salient points to help them gain basic familiarity. That experience led to this post for people who may be in the same part of the learning curve on MDD. Basic Major Depressive Disorder First, the basic format of MDD is defined as at least five of the following symptoms, present for two or more weeks; one of the symptoms must be one of the first two listed: Depressed/unpleasant mood (dysphoria) Lack of ability to experience pleasure (anhedonia) Inability to concentrate Preoccupation with worthlessness or feelings Increased or decreased sleep Increased or decreased appetite Fatigue Agitated or markedly slowed movements. Thoughts of death, suicidal ideation MDD Subtypes MDD subtypes follow the above algorithm but are marked by concentrations of particular symptoms or occur at a particular time. Each of these is briefed below, along with notes about specific interventions and connections to other mental illnesses . Each is linked to an earlier post reviewing the subtype, with references, in-depth. Anxious Distress: Depression and anxiety have a 60 percent co-occurrence rate, so it’s not surprising that anxiety can be present while someone is depressed. However, anxious distress indicates that anxiety not normally present arises during the MDD episode, or that baseline co-occurring anxiety is significantly exacerbated during the episode. Common expressions of anxiety in the anxious distress form include ongoing panic attacks , or a package of feeling on edge, being tense, and having worrisome thoughts. This obviously compounds the depression and is thus associated with increased suicide risk. Providers ideally focus on dampening the anxiety while addressing the depressive episode. (See "What is Major Depression with Anxious Distress?") Atypical Features: This MDD is marked by excessive sleep, overeating, weight gain, fatigue to the point of feeling paralyzed, and the ability of the patient’s mood to brighten for some time in the presence of good news and positive events. It is called atypical because it was considered “atypical” to the usual melancholic depression that people went to doctors for centuries past. This subtype tends to have the most enduring episodes and is thus associated with suicide completions. It is also the most common form of depression in bipolar disorders. This means that providers should be vigilant for emerging manic or hypomanic episodes if someone’s MDD fits this profile. (See "Can Atypical Major Depression Signify Bipolar Disorder?") Catatonic Features: This is when the person experiences a state of waxy flexibility with unresponsiveness, stupor, or agitation that can include echoing what others say and do (echolalia and echopraxia, respectively). I once had a patient who would become so depressed, that he would periodically shut down, lose muscular control, and soil himself. The etiology of catatonia remains poorly understood but responds well to benzodiazepines. Given catatonia can incapacitate someone, it can be dangerous if they live alone, for they might not eat or be able to escape danger. Further, catatonia might be mistaken for marked agitation, present in many with MDD, but not respond to typical interventions. Thus, careful evaluation of agitation should occur, as ECT, an effective catatonia treatment, may be indicated. (See "How to Recognize Catatonia in MDD.") Melancholic Features: The melancholia profile is marked by a palpably dark and brooding mood, severe insomnia with a tendency for early morning awakening, significant loss of appetite, weight loss, excessive and inappropriate guilt, and sufferers tend to be highly agitated or slow in their movements. Melancholic MDD is a genetic condition, and what is termed a purely “endogenous” depression, meaning it arises from within, in the absence of any psychosocial stressor. It is believed to be generated by significant disruption in the hypothalamic-pituitary-adrenal (HPA) axis. It thus does not respond favorably to psychotherapy alone and requires psychiatric intervention, including electroconvulsive therapy (ECT). In fact, mecancholic MDD sufferers make up the bulk of ECT cases. (See "The Darkest Mood.") Mixed Features: This indicates that there are at least a few manic-hypomanic symptoms superimposed on the MDD episode. For instance, while depressed, the person might have racing thoughts, feel energized despite lack of sleep, and be impulsive. It is not unusual for people with bipolar disorders to have mixed feature episodes. However, some MDD sufferers never advance to fully mixed episodes (MDD with a full superimposed manic or hypomanic episode) or cycle with manic-hypomanic episodes to make a bipolar diagnosis. However, providers should be vigilant for an emerging true bipolar pattern. Further, this form of depression responds well to mood stabilizer medications that are used in bipolar disorder. Lastly, the added impulsivity and agitation can increase suicide risk if someone is considering suicide. (See "The Spinning World of MDD with Mixed Features.") Peripartum: This is more than the baby blues, common to many new mothers. Peripartum MDD are episodes directly related to gestation and delivery timeframes. Of course, women prone to MDD while not pregnant are more prone to this experience, but it can happen to any woman. Episodes can be anxious distress, mixed features, or psychotic features. Provided the correlation with mother-child bonding disruption and failure to thrive in extreme cases, or with psychosis leading to infanticide in the most severe instances, anyone working with pregnant women prone to depression should carefully monitor the patient for the slightest emerging symptoms of depression. It is important to collaborate with a psychiatrist, OGBYN, and midwife if available, to best support the woman. (See "Is it Peripartum Major Depression or Just the Baby Blues?") Psychotic Features: Symptoms like hallucinations and delusions, most associated with schizophrenia, aren’t uncommon in other disorders. About 20 percent of people with MDD experience one or both during their depressive episode, but only while depressed. It is pervasive enough that psychiatry is inevitable for antidepressant and antipsychotic medications, and sometimes ECT. Oftentimes, the content of the hallucinations or delusions can inform clinicians about the root of the depression, for they involve themes of paranoia and guilt, which point to disavowed parts of the self the person is struggling with. (See "MDD Can Include Psychotic Features.") Seasonal Pattern: This last category relates to MDD, which tends to arise with a decrease or increase in sunlight. While the latter is much rarer than winter depression, some patients, instead of feeling dysphoric as daylight fades, experience an onset with increased light. Individuals can be so sensitive to the season, that the mood can begin changing in the early fall or spring. Once established, seasonal depression is predictable and a person can be prepared for it. A patient with seasonal depression might have a first aid kit: Return to therapy or increase frequency, exercise more, socialize more, perhaps change their diet for more depression-fighting foods, and be evaluated for vitamin D levels in case supplementation is required, as a deficiency is correlated to seasonal patterns. (See "3 Seasonal Depression Myths.") To find a therapist, visit the Psychology Today Therapy Directory. Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual’s provider or formal supervision if you’re a practitioner or student. Anthony Smith, LMHC

How to stop fighting them and take away their power. Intrusive thoughts do not have meaning, suggest intent, or indicate bad character. Anyone can have occasional intrusive thoughts, but they are highly stressful for those with high anxiety . The first step in coping is to label the thought(s) as "intrusive." Intrusive thoughts are any unwanted or stuck thoughts that come on suddenly and cause anxiety. They are different from most worrisome thoughts in that they do not reflect any real concerns, such as losing a job or being unable to pay bills. Intrusive thoughts often have content that is violent, sexual, or socially unacceptable. Sometimes they come to mind in the form of images that stick in your mind after you try to shake them off. If you’ve ever held a kitchen knife and imagined stabbing someone with it, or ran a stop sign and then imagined you hit someone, you’ve experienced intrusive thoughts of violence. At another time, you might have been stuck with images of your own funeral or of the sudden death of loved ones. As disturbing and unwanted as these thoughts might be, they have no real meaning or importance. Who Might Have Intrusive Thoughts? While they can be similar to the thoughts that occur with obsessive-compulsive disorder (OCD), intrusive thoughts can happen for people who have no mental health condition. They can happen to anyone who is under a high level of stress or uncertainty. They are seen by therapists as a symptom of stress, possibly a need for more certainty about life circumstances or for more control over one’s personal environment. When intrusive thoughts occur in someone who is already dealing with a mental health condition, they can take on more power because the person tends to give them more meaning or importance. Mental health conditions that make people more prone to intrusive thoughts include OCD, generalized anxiety disorder, posttraumatic stress disorder (PTSD), postpartum depression, and eating disorders. False Assumptions About Intrusive Thoughts It’s important to be clear about what intrusive thoughts are not. There have been longstanding myths about intrusive thoughts that have made them more disturbing to those who have them. Once these myths are called out as false, the tips for coping with them become more intuitive. Intrusive and unwanted thoughts are… Not a sign that you want to do the thing(s) that come into your mind out of nowhere. People fight these thoughts because they do not represent real intentions or even wishes. Unfortunately, fighting the thought actually makes it persist longer. A person with intrusive thoughts of violence is most likely a very gentle person, while someone with intrusive thoughts of death most likely embraces life. In other words, such thoughts don’t indicate anything about a person’s character or morals. Not a signal, warning, or message intended to help you. Giving this type of meaning to such thoughts reinforces their staying power and has no constructive purpose. Not the same as an impulse. Having a thought is not the same as engaging in that behavior. The thoughts do not suggest poor impulse control. People with a strong capacity for impulse control are actually more prone to these thoughts than the average person. Tips for Coping with Intrusive Thoughts Label the thoughts as “intrusive” and unwanted. This discredits them immediately and lightens their impact. Accept that they happen and that they are only thoughts. Allow them to exist. Expect that they’ll probably happen again. And then they’ll fade away again, with no consequence. Over time, these thoughts will occur less frequently when less importance is given to them. After applying this approach for a few weeks, the anxiety that had been associated with the thoughts also becomes less intense. Address your underlying anxiety , including any triggers that you become mindful about. For example, maybe you’re having these thoughts right before a big exam because you’re worried about your academic standing. Or maybe they occur while you are driving because you witnessed a car accident recently. Whether the stressor is chronic (e.g., school stress, health issues) or acute (e.g., recent trauma, relationship conflict), a combination of self-help and therapy will be helpful in reducing the frequency of intrusive thoughts. Steps to Address the Underlying Anxiety Take some time outdoors to benefit from the relaxing effects of being surrounded by nature. Get some exercise. Physical exercise activates the release of the neurotransmitter GABA, which has a natural calming effect after as little as 10 minutes of movement. Try deep breathing for stress management. Try deep muscle relaxation exercises. Consider meditation, which has been shown to decrease our tendency to ruminate. If you're concerned that you may have a more serious problem, seek help from a therapist with experience treating anxiety disorders. Cognitive-behavioral therapy in various forms is effective for anxiety treatment. You might start by asking your physician for a referral or use an online provider finder. Intrusive and unwanted thoughts can cause intense concerns about what they might mean. Don’t give them any power by assigning meaning to them. They are a symptom of anxiety, which can come and go without consequence once you know the truth about them and stop fighting them. Sometimes, the help of a therapist is needed to overcome this struggle, particularly if you are also having other symptoms of anxiety or depression. “You don’t have to control your thoughts. You just have to stop letting them control you.” —Dan Millman Dianne Grande, Ph.D. - Psychology Today Blog -

What does it take to stay in shape during pregnancy? Just as women tend to their physical health during pregnancy , tending to emotional health is also important. Valuable tools include mindfulness, time alone, and asking for support, among others. Managing stress during pregnancy can benefit mothers after the baby is born as well. What does it take to stay in shape during pregnancy? There are tons of articles about physical exercise, but not enough about how to keep emotionally healthy. Pregnancy can be as challenging for the mind as for the body; it’s one of the greatest lives changes most women ever experience and there’s often so much that goes with it—new responsibilities, changes in lifestyle and relationships, and alterations in career, finances, and living arrangements. The stress can be enormous. So here are a few tips to help you stay emotionally healthy. 1. Mindfulness matters. Being mindful might sound like something for coastal hipsters, but early research from small studies suggests that it may help you stay emotionally healthy during pregnancy by reducing stress. Being aware of your body’s changes and the things that you stress about most and savoring the small victories may help ward off depression and anxiety . 2. There’s an app for that. Studies are also showing that meditation is an excellent companion to pregnancy, but most people don’t know where to start. Fortunately, there are some great apps out there to get you started. 3. Put date night on the calendar. One of the greatest sources of stress during pregnancy is your changing relationship with your significant other . That’s why it’s absolutely essential to start planning a regular weekly date night during pregnancy and sticking to it. It doesn’t have to be expensive—taking sandwiches to a scenic spot or a long stroll in the park is every bit as good as dinner and a movie. 4. Private time is essential. The most important person to make a date with is yourself. Do what you must to carve out some personal time for yourself every day, even if it’s only 20 minutes with an iced tea and a magazine. Having some breathing room now and once the baby arrives will help you relieve stress. 5. Ask for what you need. Here’s a great tip for staying emotionally healthy—learn to state exactly what it is that you need. Asking for help may sound obvious, but when you’re exhausted and overwhelmed it can be tough getting to the point. If you were raised not to ask things of others, it can be doubly hard. This is where practice helps and no better time to practice than during pregnancy to prepare you for the demands of being a new mother. Bottom line Even if you have a history of anxiety and depression, there’s a lot you can do to keep healthy and avoid triggers that will increase your level of stress. Starting these now can pay dividends after the baby is born. Dawn Kingston, Ph.D., RN, - Website - Book -

Personal Perspective: And three reasons why I quit. Drinking blocks any ability to healthfully analyze destructive behaviors. I didn't know how to stop drinking, and I was good at the status quo. "I just don't want to think about it" became my mantra. Somewhere in my early thirties, my drinking became self- abuse . From there, it slowly worsened, mainly because I was not willing to stop and think about it much. This is not typical of me, as I am a gifted naval gazer who mulls over nearly every aspect of my existence given the chance. But alcohol does a pretty good job of bungling up introspection. Often, drinking ended up putting me in a haze of self-hatred, so I circumnavigated that by simply drinking more. You can’t think too much about your life if you are blitzed. It’s science. As I got sober and have been blessed to keep doing so, I have had a lot of time to think about why I allowed all this to happen. And how I finally found the courage to quit. So, here are some additional reasons why I slowly succumbed to addictive behaviors. And also, here are three discoveries I made about quitting drinking. I kept drinking because... 1. I’d been doing it for over 20 years and almost on a daily basis for the last 10. That’s a lot of synapses grooved into a pretty solid bad habit. It was what I did when I was happy and needed to celebrate. It’s what I did before, during, and after social events. It’s what I did on holidays, or before holidays to get ready for them, or after holidays because sad. It’s what I did after work to “take a load off.” It’s just what I did. 2. No one was really able to tell me that I had a problem. OK, my husband had tried, but he didn’t count. The others—the friends, the coworkers, the ones that “mattered” in this equation—none of them had a clue. I was highly functioning and highly good at it. My husband didn’t have a voice in this because I loved him, and so I didn’t accept his opinion because that’s how we treat people we love sometimes. He was too close to the problem and to me to matter. It’s a hugely dysfunctional paradox, but I wasn’t up for analysis of that. It hurt too much. 3. Postpartum depression had me reeling, so I drank at it. Or, because I drank, postpartum depression had me reeling. Who knows? It was the totally drunk chicken and egg thing. Was I willing to really analyze any of this, either? No. 4. I just loved wine. I loved it so much. It was a boyfriend who always told me I was pretty, listened, and just gave me all the good feelings. OK, this boyfriend did become pretty abusive at the end, but I wasn’t going to analyze that either. 5. I was scared to death that life without wine would be awful. I constantly analyzed that stark reality. A “dry life” came up wanting every time. There was a lot of mulling about the greyness, the despair, and the boredom of sobriety. A lot of brain energy (what was left of my brain, anyhow.) was spent on this idea. So, why did I quit? 1. I don’t really know, actually. In the early days of sobriety, I actually didn’t have a rock-solid reason or plan for why I was doing this. I just had to. I knew my soul was sick. 2. When I talked about sobriety for the first time in a group meeting, I felt like something inside of me unclenched, loosened, and lifted. And I felt peaceful, which is a really strange and wonderful feeling that I don’t think I had experienced since sometime in my childhood. 3. I was utterly exhausted. One of the main reasons I write and talk about my sobriety is because these stories gave me so much hope in my early days of recovery. I needed to hear from other women about how they had crawled out of their pits of despair. Really, how did they survive? Did they laugh again? Will there ever be life after wine? Their stories heartened me. So, my hope is that this will help someone today to know that if your soul is sick, quitting is tough, yes. But it’s so much better. Dana Bowman, - Website -

How to repair, instead of repeat, family relationship patterns. There is a transformative power in understanding relationship dynamics through our family history. We repeat relationship interactional patterns established in our family of origin if we don't repair them. By consciously working to repair family patterns, we improve our relationships and lay a healthier foundation. In our romantic relationships, we often find ourselves repeating or attempting to repair the interactional patterns established in our family of origin. According to Bowen's family systems theory, these patterns can significantly influence the dynamics within our partnerships, marriages, and even future generations. However, recognizing and addressing these patterns is not a daunting task, but rather an empowering journey that can pave the way for healthier, more fulfilling relationships. With Bowen's family systems theory, individuals are profoundly affected by their family systems, which consist of interconnected and interdependent relationships. One key concept is "differentiation of self"—the ability to maintain one's sense of self while still being emotionally connected to others. When differentiation is low, individuals might unconsciously replicate family patterns in their romantic relationships. For instance, Judy and Jonathan sought therapy to address ongoing conflicts in their marriage. Through the therapeutic process, they discovered they were repeating the over- and under-functioning dynamic present in their respective families of origin. Over-functioning occurs when one person takes on the tasks and responsibilities of others who can do those tasks themselves. Under-functioners look to others to do what they can for themselves; this pattern often occurs reciprocally within a relationship. Judy was identified as the person who over-functioned in their relationship. She took on most of the responsibilities, from managing finances to organizing household tasks. This behavior, as revealed through her family genogram, is traced back through at least three generations. Her mother and grandmother had similarly taken on excessive roles within their families, often at the expense of their well-being. This pattern conditioned Judy to believe taking charge was necessary for the family's stability. On the other hand, Jonathan grew up in a family where he was used to being cared for, especially during stressful times. His family consistently stepped in to manage his responsibilities, leading him to depend on others. This dynamic made it natural for him to assume the role of the under-functioning in his marriage with Judy. Recognizing and Repairing Patterns Through therapy, Judy and Jonathan began to understand how these ingrained patterns influenced their interactions. Bowen Family Systems Theory gave them the tools to recognize and address these dynamics constructively. Here's how they worked toward repairing their interactional patterns: 1. Increasing Self-Awareness: Judy and Jonathan engaged in self-reflection to understand their roles in perpetuating the over and under-functioning dynamic. They explored how their family histories shaped their behaviors and expectations in the relationship. 2. Developing Differentiation: They worked on increasing their differentiation of self. For Judy, this meant learning to set boundaries and delegate responsibilities without feeling guilty. For Jonathan, it involved taking more initiative and becoming more independent. 3. Improving Communication: Open and honest communication is not just crucial, but also liberating. It allows for the discussion of feelings and fears without blame, fostering empathy and understanding of each other's experiences and motivations. 4. Setting Mutual Goals: They established shared goals for their relationship, focusing on creating a balanced partnership where responsibilities were equitably distributed over a slow process. This included practical baby steps such as dividing household chores and making joint financial decisions. 5. Therapeutic Support: Ongoing therapy provided a safe space for Judy and Jonathan to practice new behaviors and receive feedback. In therapy, they navigated setbacks by discussing what each would do differently the next time. They also talked about positive changes and how they could continue making those changes. Benefits for Future Generations By consciously working to repair their family patterns, Judy and Jonathan improved their relationship and laid a healthier foundation for their future children . They understood that modeling a balanced and supportive partnership would influence their children's perceptions of relationships and help break the cycle of over- and under-functioning. When seen this way, romantic relationships offer a unique opportunity to address and transform unresolved patterns in our family of origin. By applying Bowen's principles, individuals can develop healthier relationship dynamics, ultimately benefiting themselves and future generations. Recognizing these patterns is the first step toward meaningful change, paving the way for more resilient and fulfilling relationships. Ilene S. Cohen, Ph.D., - Website - Blog - References Bowen, M. (1978). Family therapy in clinical practice. Jason Aronson. Cohen, I. S., & Richardson, E. D. (March 26, 2024). This Isn't Working for Me: A Practical Guide for Making Every Relationship in Your Life More Fulfilling, Authentic, and Intentional. Bridge City Books.