Inhabiting Solitude


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By Tanya Ruckstuhl LICSW

“All I want to do is eat chocolate cake and sleep.”

“I accidentally tried to hug my neighbor whose brother just died, and she shrank back like I was a cobra.”

“Some guy told me to stop petting his cat.”

These are weird times.

My therapist friends and I have all been messaging each other about the transition to telehealth in response to the pandemic.  We miss the immediacy and vibrancy of in-person sessions. Between audio glitches and freezing screens, we miss the ease that being in the same room as our clients provided. Like all of us, we are doing our best, figuring it out as we go along.

None of us know how long this situation will last. We don’t know how bad it will get. We don’t know if all of our loved ones will survive. We don’t know if the supply chain will be interrupted. We don’t know the long-term effect on the economy.

Humans like to quantify. We want to know what to expect and how to prepare. To feel safe, we want know what’s coming and how to endure or enjoy it.

And that is precisely what we don’t get to know right now. In the absence of certainty, many of us default to following the news as closely as we can. In this new landscape of invisible enemies, virologists and epidemiologists are the leaders. Doctors and nurses the front-line soldiers.

We must take this pandemic seriously enough to radically change our behavior for the foreseeable future. No more get togethers. No more movie theatres, or restaurants or nights out on the town. No more school. Every surface that someone touched is a possible transmission spot.

On the other hand, we still need to walk the dog, cook meals, vacuum, fold laundry. Focusing on small, doable tasks brings a sense of normalcy, of continuity to our lives.  We need to balance taking appropriate personal responsibility for protecting others along with continuing to have a full life that includes love, learning, exercise, joy, mindfulness, flavor, progress, and creativity.

As we drill down deep in to our time at home, with family if we are lucky enough to have them in the same household (and you’re right, it doesn’t always feel like luck) I wish for you an opening into realms you haven’t visited since childhood. I wish for you thinking time, staring into space time, imagining time. Dream time is slow and mysterious and a rich source of creative inspiration.

On the other end of this situation, we can emerge rested and connected to our deepest selves, ready to engage with one another from a place of deep gratitude.

ADHD: Above Average is Normal


The average spoken number of words per minute is 160.  While interviewing New York-based psychiatrist, therapist and author Dr. Don Kerson, I kept fighting an urge to pull out a stop watch and start counting.   He speaks like a cross between a MIT-trained theoretical physicist and a sports announcer on cocaine:  smart and impossibly fast.  (I considered writing up the interview without any punctuation to convey the speed of his speech.) 

I first came across his article published in ADD Resources September newsletter about two of my most beloved mental health topics: mindfulness practice and executive function enhancement

This led to my discovery of Dr. Kerson’s unique focus:  mindfulness training for adults with hyperactivity which is surprising.  Kind of like creating chocolate dipped deep-fried pizzas for anorexics… as helpful as it is unlikely. 

Me: How did you come to combine mindfulness training with psychiatry? 

Dr Kerson:  I became interested in neural plasticity and right brain ability through Daniel Siegel’s book The Mindful Brain.

Dr Lidia Zylowska, of the Mindful Awareness Research Center at UCLA, where Dr. Siegel also works  (www.marc.ucla.edu) adapted Dr Jon Kavat Zinn’s  (mindfulness Based Stress Reduction ) work for people with ADD shortening the required meditation time to 15 minutes.

We added to the meditation and psycho-education of Dr.Z’s paper attention to the effects of trauma on the developing person with ADD, and the use of neo-Ericksonian post-traumatic ego state therapies to address the procrastination and disorganization caused by that post-traumatic dissociation.

Me:  And so you decided to combine meditation with ADHD because….? 

Dr. K:  ADD is about difficulty turning on the prefrontal cortex.  If there’s more electricity (interest) in the brain then there is more available for the prefrontal cortex.  But if the left and right brain are less integrated, then there is less electricity in the prefrontal cortex. 

Meditation creates integration between executive functioning with the more experiential aspects of the self.    

In addition to meditation, I teach time management techniques such as time mapping, which is using our very well developed spatial abilities to track our activities.  ADD’ers have difficulty transitioning between activities.  Every event or activity can be sorted by frequency of occurrence such as one time, once per week, several times per week, once per month, several times per month, once per year, etc…  It’s like a musical score with its own rhythm.  By creating a map of the week you know what rhythm to anticipate.  The more you have the basics over-learned the more room you have to be spontaneous and creative. 

It’s the job of the left brain to create an atmosphere in which the right brain can emerge.

Me: How does this topic personally interest you? 

Dr. K:  I’m obviously a hyperactive guy.   I came from a high functioning family.  My mother was a psychiatric social worker and I had the best possible upbringing.

Me: For a family with an ADD kid, what is the best possible upbringing?    

Dr. K:  First of all, only one third of people with ADD get diagnosed in childhood.  Often we’re not recognized because the definitions emphasize the dysfunction

Smart people with ADD naturally used other brain systems; (adrenaline; fear and dopamine; will and pleasure) to compensate for their attentional difficulties.  When these systems wear down from overuse adults with ADD get depressed/ill  in a couple of different ways.  At that time that the undiagnosed adult with ADD needs to be identified. Two thirds of adults with ADD are undiagnosed in my estimation, and I think they make up the overwhelming majority of what is usually called “treatment resistant” depression.

The world is over-stimulating.  We were born to live in tribes and instead we live in boxes and look at glowing boxes in the dark.  Focus is comfortable and lack of focus is uncomfortable.   

Parents must notice the patterns of attention that their children have.  What does the child like to do which creates focus for them?  It’s all about letting the kid occupy himself in his own rhythm. 

The three things that ameliorate ADD are:   

  • The emotional tone of the home
  • The material and non material resources of the home
  • Intelligence

 Unleashed, ADD folks can do everything.  We are smarter and have more energy than the average person.  People with ADHD are 15% of the population but we do 80% of the (interesting) tasks.  We have more energy so we need to do more

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Dr. Kerson recently wrote and published Getting Unstuck, Unraveling the Knot of Depression, Attention and Trauma available through his website http://www.theattentiondoctor.com.   I have already ordered my copy.

Oh No! Not Another Learning Experience!


What is it about illness that seems to make it strike at highly inconvenient times?  Is this phenomenon somehow related to how tornadoes always seem to attack trailer parks? 

It’s been an over-busy, highly educational week for me.  Tuesday, I attended a training on treating returning combat veterans with Post Traumatic Stress Disorder.  The presenter, Edward Tick, runs an organization called “Soldiers Heart” dedicated to helping soldiers emotionally integrate their war time experiences.  He is the first trainer I have seen cry while presenting.  It was a powerful day.  I took the class because I am considering volunteering for the North West Soldiers Project, a collective of therapists who provide free PTSD treatment to veterans and their family members. 

Friday I attended a course taught by David Wallen on attachment, a key concept in the field of psychotherapy which boils down to: the quality, consistency and comfort of the connection a baby has with his mother or primary care giver shapes the child’s self-worth and formation of attachments later in life.  Mammals are hard-wired to seek safety and nurturing from parents (as opposed to fish who frequently eat one another as a contrasting example).  If our parent is inconsistent, scary, or unavailable, it creates a double bind: the baby has an instinctive need to approach their caregiver for comfort, and an experiential knowledge that this doesn’t work.  Wallen spoke extensively about the practice of Mindfulness (being fully present in the moment without expectation of outcome) as a method of healing emotional damage from poor primary attachment experiences, for both the therapist as well as the client

Mindfulness is showing up everywhere these days, from Eckhart Tolle’s best-selling (and Oprah Winfrey covered) book, A New Earth, to Starbucks marketing aimed at getting us to associate coffee-drinking with moments of inner peace, to mainstream therapy trainings on emotional healing.  For once there’s a fad I am fully on-board with (commercial co-opting attempts not withstanding). 

Friday evening I gave a presentation on EMDR at the Puget Sound Adlerian Society, which was very kindly received.  Adlerians are good-hearted folks who follow the teachings of Alfred Adler, a contemporary of Freud.  Unlike Freud who developed extensive theories of neurosis, hysteria and complex hidden drives, Adler choose to see the good and the possibility in people, to see human behavior as rational and goal-oriented.  As such he is considered the original humanist in the field of psychology. 

These various engagements happened while my children were fighting off a stomach bug, so between seeing clients, attending trainings and presenting I was snuggling sick children, calling doctors, timing and dispensing fluids, washing mountains of laundry, and dashing around disinfecting door knobs and light switches to keep the infection from spreading.  Naturally it didn’t work (viruses are so smart and wily!) so by Friday morning I was fighting the infection myself and trying to move very slowly.  Now it is Saturday afternoon and we are all four back in the swing of feeling restored, if tired.  I once again resolve to slow down, seek balance, and be less busy.  In this way, I make room for more mindfulness.  This is the biggest lesson I take from this week of trainings, and like so many lessons it’s something I already knew, but needed to be reminded of.  Thanks stomach bug!

Listening to All the Parts


Saturday afternoon I did something I’ve never done before:  I took a “Mindful Improvisation” class for actors—not because of some hidden theatre longing (or if I have one, it’s really, really well hidden from me) but because I love taking classes of any sort, mindfulness is one of my major interests and one of my best friends was going. 

We started out with some whacky, fun exercises and alternated with writing about our experiences. 

One journal question in particular spoke to me, so I wanted to share it with you.  We answered the following question:  What project or creative activity calls to me at this time?  I was blown away by my answer because it was something I have never thought of before, unlike the usual “chatter” in my mind (a boring, highly repetitive mantra involving what to make for dinner, which bills are due, and how to inspire my children to stop clowning around and listen to me blah-blah-blah-ing).   

I wrote “I want to create a self-help coloring book for adults struggling with anxiety issues.”  Wow!  Weird!  Fun!  This heretofore unthought-of idea pulls together many strands of professional and personal interests: emotional self-soothing, creative play, repetitive motion to stimulate relaxation, and most important of all, it would be at least as much fun for me to create as it would be for others to use.  (My litmus test for extracurricular activities: is it more fun than work?)

This journaling technique of asking a question and answering it as if you were holding a conversation with another person is known in mental health as inner dialogue journaling.  Used the field of addictions and mental health (as well as—who knew?—theatre), inner dialogue journaling is useful for getting in touch with the various aspects of our personalities and giving them “voice.”  Why should we do this?  So that we won’t be sabotaged by their acting-out behaviors, or accidentally ignore them in the serious business of adulthood. 

Want to try this at home?  Think about a behavior or habit you have that is problematic for you.  For instance, if you have a big credit card debt and can’t seem to pass a “sale” sign without pulling over and going shopping, you might have a dialogue with your shopping urge.

 Count on spending ten to thirty minutes alone, depending on how quickly and comfortably you can go “inside” and how fast you write.  Go to a quiet place and take out a pen and a notebook.  Address your Shopping Urge directly (Note: This may or may not be loosely based on my relationship with Book Buying and Chocolate Eating, my own top two drugs of choice):

You:  Why do I turn to you so much when I know you are only temporarily satisfying?

Shopping Urge: Don’t blame me!  I’m not the one with the Visa, baby.

You:  Sorry.  What is it about you I find so compelling?

Shopping Urge:  I’m new experiences, color, texture, social acceptability and hope.  I’m all of the things you feel lacking in your life when you get anxious or depressed.

You:  But what can I do instead of leaning on you?

Shopping Urge:  so glad you asked!  You could feel your feelings.  You could make space and time to be less productive and more slothful.  You could take care of yourself in more meaningful ways and then you wouldn’t need me as much.

You: Okay.  I’ll try.

Shopping urge: good!  I’m so sick of malls I could scream!  I’m really more of a “Comfort Urge” than a shopping urge, after all. 

(Noticing a theme here in this blog?  An obsessive preoccupation with writing and storytelling as a form of healing, perhaps?   I am nothing if not a consistent, predictable [and maybe just a touch boring—see repetitive self talk, above] therapist.) 

Holding an internal dialogue is just one of the many ways you can open up and listen to the various aspects of you.

Try it and let me know how it goes!   And if you want to try out one of Zoe Wright Bell’s Improvisation classes, you can email her for class info at zoright@yahoo.com. 

Additionally Freehold theatre http://freeholdtheatre.org teaches improvisation classes as well as a course on “The Artist’s Way*” a class in allowing personal creativity based on the book by Julia Cameron.

And let me know what you think of the coloring book idea!  I’m pulling out my crayons as soon as I hit “upload.” 

(*Full disclosure: The “Artist’s Way” teacher is a dear friend of mine.  While I generally frown on [read: hate] blogs that promote BB’s, or blogger buddies, thus turning the internet world into one big nepotism-net, this woman is brilliant as well as being a buddy).