Ask and Listen: Parts We Wish We Would Have Known Reflections on Kate Spade and Anthony Bourdain

We lost two beloved, complex, creative souls to suicide last week – reminding us that suffering not only affects all types, but remains largely hidden, even from loved ones. Time and again, the suicides of public figures who seem to live fulfilled and privileged lives have revealed this important take home message: Mental illness is nothing to be ashamed of. In the wake of Kate Spade’s and Anthony Bourdain’s suicides, many ask – how can I help a loved one who is suffering? 

First, it’s important to note that there are many myths surrounding suicide. Check yourself if you believe these are true or false:
 

• Asking someone if they have thought about suicide may trigger them to actually do it. It may put the idea in their head or make them angry and impulsive.

• Once someone has made up their mind about suicide, you cannot stop them.

• Only experts can prevent suicide.

• People who consider suicide keep their plans to themselves.

• Those who talk about suicide don’t actually do it.

• Depression is the only risk factor for suicide.

All of these myths are false. Suicide is a highly preventable type of death and it’s everyone’s business. Providing a person who is considering suicide with a safe space to talk about their thoughts and feelings will actually lower their risk of completing suicide. Asking someone directly about suicide helps lower anxiety, opens up communication, and lowers the risk of an impulsive act of self harm. Other than depression, risk factors for suicide are plentiful, including financial or relationship losses, health concerns, legal issues, substance abuse and dependence, and other psychiatric illnesses.

The key is to ask and listen. Survivors report that being asked about suicide was a relief, and that the most important part was feeling listened to without judgment. Feeling connected and not alone has powerful healing properties for the person who is suffering.

Here are some tips on how to talk to a loved one who you suspect may be considering suicide:

• Ask them if they are thinking about killing themselves. (This will not put the idea into their head or make it more likely that they will attempt suicide.)

• Listen without judging and show you care.

• Stay with the person, or make sure the person is in a private, secure place with another caring person, until you can get further help.

• Remove any objects that could be used in a suicide attempt (weapons, pills, etc.).

• Do NOT offer advice or try to cheer them up. This can cause the person to feel invalidated and shut down.

• DO offer to help the person make an appointment with a health or mental health provider and to accompany them to the appointment.

• Enlist the help of others. Do NOT agree to keep someone’s suicidal thoughts a secret.

• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and follow their guidance.

• If danger for self-harm seems imminent, call 911.

• Remember, suicide is highly preventable, help is out there, and people do recover.

Here are some additional resources:
American Foundation for Suicide Prevention: afsp.org/resources
Live Through This Project: livethroughthis.org/the-project

How To Be Alone

It is not impermanence that makes us suffer.  What makes us suffer is wanting things to be permanent, when they are not. ~ Thich Nhat Hanh

Society is afraid of alone - a striking line in a poem I ran across. How much of life is made up of loneliness avoidance, as if our worth as a human being depended on it? Afraid of loneliness, we keep trying to fill this feared hole with filler behaviors, perhaps unhealthy habits, relationships that are draining rather than energizing, drugs, food, alcohol, shopping, material fads, work - the list goes on.

The experience of loneliness is complex. First, there is the simple, objective matter of being by oneself, which in itself isn't (usually) harmful or dangerous. And then there is the "story" we tell ourselves about being alone, what we tell ourselves about our loneliness. And this is where the emotionally destructive hook is. That story may be about how we feel unappreciated or misunderstood, how we are not worthy of love and affection, how there must be something wrong with us to feel this way. Conquering loneliness has little to do with whether we have friends or not—we all know the feeling of loneliness even when we’re surrounded by others.  It has everything to do with examining and ultimately rejecting the story we tell ourselves about what it means to be alone.

If you silence the stories you tell yourself about being alone, a whole new world of wisdom can open up.  One insight could be that you are always here and everyone and everything else comes and goes. Everything is temporary.  No material possession, relationship, feeling, health state is here to stay.  Rather than it being depressing, this can increase the "wow" factor of life: You are the only thing that is always here with you, so how can you be good to yourself, love yourself?

How To Be Alone by Tanya Davis

(Available as a highly watch-worthy, uplifting video poem here)

If you are, at first, lonely - be patient. 
If you've not been alone much or if, when you were, you weren't okay with it then just wait, 
you'll find it's fine to be alone... once you're embracing it. 

We could start with the acceptable places: the bathroom, the coffee shop, the library. 
Where you can stall and read the paper, 
where you can get your caffeine fix and sit and stay there, 
where you can browse the stacks and smell the books
you're not supposed to talk much anyway, 
so it's safe there. 

There's also the gym. 
If you're shy you can hang out with yourself in the mirrors, you can put headphones in. 
And there's public transportation
- because we all gotta go places - 

and there's prayer and meditation
no one will think less if you're hanging out with your breath
seeking peace and salvation. 

Start simple, 
things you may have previously avoided based on your avoid-being-alone principles. 
The lunch counter, where you will be surrounded by chow-downers, 
employees that only have an hour
and their spouses work across town
and so they, like you, will be alone. 

Resist the urge to hang out with your cell phone. 

When you are comfortable with eat-lunch-and-run, take yourself out for dinner, 
a restaurant with linen and silverware. 
You're no less intriguing a person when you're eating solo dessert
and cleaning the whipped cream from the dish with your finger; 
in fact, some people at full tables will wish they were where you were. 

Go to the movies
where it is dark and soothing
alone in your seat amidst a fleeting community. 

And, then, take yourself out dancing, 
to a club where no one knows you
stand on the outside of the floor
until the lights convince you more and more
and the music shows you. 
Dance like no one's watching
('cause they are probably not) 
and, if they are, assume it is with best and human intentions, 
the way bodies move genuinely to beats is, after all, gorgeous and affecting. 

Dance until you're sweating
and beads of perspiration remind you of life's best things, 
down your back like a brook of blessings. 

Go to the woods alone and the trees and squirrels will watch for you. 
Go to an unfamiliar city, roam the streets, 
there are always statues to talk to 

and benches made for sitting
give strangers a shared existence
if only for a minute
and these moments can be so uplifting
and the conversations that you get in
by sitting alone on benches
might have never happened
had you not been there by yourself. 

Society is afraid of alone though, 
like lonely hearts are wasting away in basements, 
like people must have problems if, after awhile, nobody is dating them 

But alone is a freedom that breathes easy and weightless
and lonely is healing if you make it. 

You could stand, swathed by groups and mobs or hold hands with your partner
look both further and farther
in the endless quest for company, 
but no one's in your head
and by the time you translate your thoughts some essence of them may be lost
or perhaps it is just kept, 
perhaps in the interest of loving oneself, 
perhaps all of those sappy slogans
from preschool over
to high school's groaning
were tokens for holding the lonely at bay. 
'cause if you're happy in your head then solitude is blessed and alone is okay. 

It's okay if no one believes like you
all experiences unique, no one has the same synapses
can't think like you
for this be relieved, 
keeps it interesting, life's magic things in reach. 

And it doesn't mean you aren't connected, that community's not present. 
Just take the perspective you get
from being one person alone in one head
and feel the effects of it 

Take silence and respect it. 
If you have an art that needs a practice, stop neglecting it. 
If your family doesn't get you
or a religious sect is not meant for you
don't obsess about it. 

You could be, in an instant, surrounded, if you need it. 
If your heart is bleeding make the best of it 

there is heat in freezing, be a testament

The Art of Self-Nurturing

Feeling tense? Running on empty? Maybe work, finances, relationships, changes in routine, or daily life have you feeling overwhelmed. Warning signs include feeling anxious, irritable, fatigued, and having repeated intrusive thoughts about a stressful situation. Extreme stress can make you feel like there is nothing you can do. The key to regaining control is a radical return to self-nurturing, to recharge your emotional and physical batteries. Here are some strategies to foster the Art of Self-Nurturing.

Admit your stress. Admit when circumstances have got you down and change is needed. Admitting this creates a moment of calm and stillness, a space to breathe, and a space for observation and awareness. Moving forward is difficult unless you recognize the situation and make a commitment to help yourself through it.

Identify Your Hot Buttons. Figure out what is causing the stress–a relationship to a co-worker or loved one, work demands, a financial commitment, uncertainty about the future?  Write this down.

Acceptance. Take a look at your list of stressors and identify the things that can be changed as well as the things that can’t. Accept that some things are always going to be stressful. Then, attention can be focused on the things that can be changed instead. Try focusing on action steps to make the future less uncertain, such as acquiring skills, making friends and setting goals.  This also means not sweating the small stuff - pick your battles and invest your energy wisely.

Notice how you talk to yourself about yourself and others. Observe the language you use to create your reality, to define and judge yourself and others.  For example, you may say to yourself, "Here I go again, stressing out", when a more effective, self-compassionate statement would be, "Stress is part of life and I'm learning to address it effectively by taking it one day at a time."

Get Outside. Taking in natural beauty, along with physical exercise, can reduce stress and improve physical health. The color green has been shown to have soothing effects on body and mind.  Nature can provide a peaceful soundtrack, beautiful scenery and fresh air to help soothe the soul. Try hugging a tree or walking barefoot in the grass.

Let It Out. Bottling up emotions can increase stress through accumulated feelings of loneliness and helplessness. Communication, both with yourself and others, is key in addressing problems quickly and honestly.  If you need help identifying what's causing your stress, and how to effectively address it, talk to a trusted person or mental health professional.

Tips To Beat the Winter Blues

You are the sky...Everything else, it's just the weather. ~ Pema Chodron

Winter, with its shorter, colder and darker days, can give rise to occasional feelings of sluggishness, low mood, or Winter Blues. Below are some simple strategies you can use to help these occasional feelings. 

Do:

• Try to have regular sleeping patterns. As you feel down, the urge to escape everything by just staying in bed can become stronger. Try to resist this (unless you are genuinely physically tired) as it can make things harder to deal with.
• Try to have a plan of what you need to do day-to-day and week-to-week. Make it realistic and review it regularly. Use it to check your progress. 
• Keep in contact with your friends and loved ones. Cultivate relationships that are close and supportive. If your family is supportive, try to tell them how you feel. Remember you are not alone. Consider the advice and help that others might try to give you as a positive thing in your life.
• Remember to do some of the things that you have enjoyed doing in the past. Reading, movies exercise, playing sport, spending time with friends, getting back to nature, etc. What works for you is what is most important. Sometimes just having a routine to follow can give you a sense of structure in your life.
• Practice ways to distract yourself away from negative patterns of thought. Activity and getting out of the house are good in this respect. 
• Negative thoughts can generate feelings of anxiety. Learning relaxation techniques can help a great deal. A therapist can help you to learn a variety of physical and mental relaxation techniques that will be useful for you in the future.
• Try to explore the way you are feeling. If you can recognize your emotions, talk about them with friends, and/or with a therapist. Write them down, and see how they may relate to your own thinking about yourself or to things that happen in your life. By doing so, you can avoid them controlling you. Then you can begin to get some control back in your life.
• Think of things that have helped in the past, if you've experienced the Blues before. Write these things down and remind yourself to keep using them. Allow yourself the time for them to have an effect.
• Daily exercise and a nutritious diet are important. If your appetite is low, try nutritious smoothies or juices - a liquid diet can be easier to manage if you are prone to gastrointestinal stress.

Don't:

• Don't be passive and allow your mood to take over, if you can help it. Make some plans for each day. 
• Try to avoid falling into the trap of "automatic negative thinking". Identify your negative thoughts, learn to monitor them and learn to challenge them. (i.e., look for evidence to support your negative thoughts or assumptions about yourself). Then you can begin to substitute more positive and therefore more useful patterns of thought. Try writing these things down in a notebook. A therapist can help you to develop this approach so that you can be more realistic about those things in your life that are positive. Click here to learn more about strategies for negative thoughts.
• Don't overindulge on alcohol. It’s a central nervous system depressant and it may make your blues worse.

What distinguishes occasional Winter Blues from Clinical Depression? Check these symptoms of depression or read information about depression. If you check 5 or more of these symptoms for 2 weeks or more, please talk to a mental health or medical professional.

• Frequently feeling sad and/or guilty
• Eating more or less (including significant weight loss)
• Sleeping more or less
• Loss of interest in things you usually enjoy
• Low energy, fatigue
• Irritability
• Difficulty concentrating and making decisions
• Thoughts about death and suicide

While the above signs are more common, everyone is different. The following may also indicate depression for some people:

• Increased use of alcohol and drugs
• Anger
• Difficulty envisioning a hopeful future
• Helplessness
• Increased aches, pains, or bodily ailments

Seeking appropriate mental health care for depression is important and possibly life-saving. Please contact a licensed mental health professional if you are concerned about depression in yourself or a loved one. 

Do's and Don'ts for Helping Someone in Emotional Pain

“Happiness is not given to us, nor is misery imposed. At every moment we are at a crossroads and must choose the direction we will take.” ~ Mathieu Ricard

What are the best ways to support someone who's going through a tough time?

Knowing how to best support a friend or loved one who is undergoing a tough time is an important relationship builder.  It's a skill that comes in handy in any relationship - with a spouse or romantic partner, family member, friend, or work colleague.  

One of the best ways to support someone who is experiencing emotional pain is to truly listen.  This is often easier said then done.  Take your time to truly sit down, spend time, and listen. Approach the situation with no assumptions or preconceptions in mind. Find a quiet, private space. Present yourself as a calm listener. 

  
There are several skills to convey empathy and care:

1. Practice Thought Empathy: Paraphrasing the other person’s words. Mirror what the other person is saying in a non-judgmental way
Goal: To truly understand where the other person is coming from.
Example: “It sounds like work has been getting tougher because of all these new demands at your job".  

2. Use Feeling Empathy: Acknowledge how the other person is probably feeling, given what they are saying to you.
Goal: To see if you are reading the other person’s feeling correctly.
Example: “Getting this feedback from your boss is stressing you out".

3.  Find something positive to reply to the person.  
Goal: To show genuine curiosity and respect.
Example: “I appreciate you trusting me with this problem".

4. Ask gentle questions about what the person just told you. Open ended questions work best.
Goal: To learn more about what the other person is thinking and feeling:  
Examples: How come...? This is because...? How did you come to be...? What do you think about....? How do you feel about…?
 

Are there things I shouldn't do when trying to support someone?

Even with the best intentions, we can directly or indirectly convey information to the person that may hinder the process of supporting and healing, or even shutting the person down.  One is by making dismissing statements.  Dismissing emotions can take many forms - watch out for these subtle statements.  
1. Minimizing what the other person is feeling.

Examples: "You'll get over it", "Come on, it's not that bad". "Just dust yourself off and try again".)
2. Making an assumption about the person's situation or feelings, or predicting the future (which no one can). 

Examples: "Tomorrow, you will feel better". "Give it a week". "He'll come around". "I have a feeling you will be just fine". "It will work out next time".
3. Making the situation or their problem about yourself. 

Examples: "This reminds me of when my grandmother died…." "I feel the exact same way, let me tell you about….". "When my aunt had cancer, she tried this new treatment…." "After my miscarriage, we tried again right away and it worked! You should do the same!"

With trying to fix the situation, you risk making wrong/faulty assumptions, which can put distance between you and the person who is experiencing a tough time. It may also feel to the person like you are placing yourself above them with expertise, rather than meeting them where they are. Try to stay away from these assumptions:

1.The person wants "fixing", rather than perhaps just wanting someone to listen, sit with them or hug them.
2. Whatever you believe works for you or others you know, will also work for this person, in this situation. It may be far from it.

Some other helpful things to remember when supporting someone who's hurting:

Remember that their emotion isn't your emotion. Being a good friend or support doesn't mean you have to feel that same emotion or intensify the emotion for you and the person. Set healthy emotional boundaries for yourself so that you can truly be present with the person.

Also, when offering concrete support to someone in crisis, the question "Is there anything I can do?" can at times feel overwhelming to the person. They may not want to burden you or feel overwhelmed by trying to figure out what they want you to do for them. Offer something concrete: "I'm bringing over dinner tonight. If you don't feel like talking, I will simply leave it at the door".  

Winterize Your Heart for the Holidays

Pain is inevitable. Suffering is optional. - Haruki Murakami

As the cold is upon us, many of us are in the process of winterizing - taking precautions to protect our bodies with extra layers, and our animals, plants, and dwellings with extra heat. The days are getting shorter, darker, and colder, which for many also has emotional effects. For some, it may be a mild and temporary case of the "winter blues" as you adjust to the season.

For others, emotional changes may be more intense. You may feel a lot more tired, your brain may feel sluggish, and your body may feel heavy. You may wake up in the morning only to spend all day looking forward to getting back to bed as soon as possible, with not much energy or motivation to socialize or do more than the bare minimum. There may be habits like spending too much time with electronic devices, and turning to unhealthy food and drink on a more regular basis. With the festivities and chaos of the holidays upon us, this feeling and need to cocoon may get more intense, which can create an extra burden if there's a social expectation to be out, about, and celebrating. 

If this sounds familiar, you might have Seasonal Affective Disorder (S.A.D.). S.A.D. is a type of depression that affects some people during the fall and winter season when days become shorter and colder. The exact causes of S.A.D. are not fully understood, but it is likely the body's reaction to outside seasonal changes - causing changes in circadian rhythm and levels of melatonin and serotonin. Women, people with a history of depression, and those who have a family history of S.A.D. and/or depression are at the greatest risk for S.A.D.

Regardless of your susceptibility to the winter blues or S.A.D., it's a good idea to winterize our hearts and souls, if anything, for preparation and prevention's sake. Don't wait until you're caught in the chaos or out of sync. Here are some things you may wish to consider to take care of yourself this season.
 

• Get outside. Even though the instinct may be to hunker down, just a bit of time spent in daylight can help increase energy levels and improve mood. You can layer up and try a walk, or even jog or run. Even going for a drive, getting a cup of coffee, or meeting up with a friend can help reset your mood and activity level. 
• Move your body. Again, snuggling with Netflix may sound a lot more appealing. However, exercise doesn't have to take long, and joining a friend in an outdoor movement activity can boost positive effects with activity and social support. Or join an exercise class - knowing that others are there sweating with you can boost motivation. A body in motion stays in motion. 
• Eat high quality foods. When it's cold and dark, fast, fatty, and comfort foods become more alluring. Just make sure your food includes healthy components - dark, leafy greens, fruits and veggies across the color spectrum, nuts and seeds, whole grains. Omega 3 fatty acids have been shown to boost brain power. Healthy soups and stews can be made ahead and frozen for later use. Try to avoid alcohol over-use, as it is a depressant and can lead to more sluggishness. 
• Nourish your spirit and soul. Lots of small things are at our fingertips to do so. The trick is to add soothing, positive energy and take away draining energy. Spend time with a quality friend who adds positive energy to your life. Meditation, yoga, hot baths, nice candles, aromatic oils, and a good book can provide much needed nourishment that isolation and electronics cannot give. 
• Reach out to others in need. Stepping outside of ourselves and giving back helps draw attention to the bigger picture in life and away from internal negative rumination. Check in on a friend or smile at random strangers. Buy coffee for someone, or pick up volunteering if you can.
• Practice gratitude. 
• Ask for help. If it is difficult to get out of the winter blues or you believe you may have S.A.D., help is available from physicians, psychologists, counselors, and other healers. By working with a professional, you can determine how to best manage your concerns. 

I am a Houston psychologist. For more information about my practice, visit DrGortner.com.

Help! I Have Intense Emotions!

Feelings are like children:  You don't want them driving the car, but you don't want to stuff them in the trunk either. (Quote from the movie "Thanks for Sharing")

Most of us have been conditioned by our environment that having positive emotions means success, and having negative emotions means failure.  However, both positive and negative emotions are a normal and desirable part of life.  Like children, they can be unpredictable.  Just the same, they can be brutally honest and teach us about ourselves.  Unlike rational thought, the experience of feelings is often non-linear, it can feel like a spiral or circle, or an endless loop.  This can be a challenging experience. 

Some emotions can create an intense experience.  Feelings such as anger and fear can leave us with the perceived notion of feeling overwhelmed or out of control. When faced with such intense feelings, we may often feel compelled to stuff them away and supress them. We may have been taught not to listen to, show, or express our feelings.  Most of us believe we shouldn't have negative or challenging emotions or that if we allow ourselves to have them, we may lose control and something "terrible" might happen.  So when we are faced with a difficult situation in our life, we may feel upset or angry, and tell ourselves that we shouldn't be feeling this way.  Our habitual response may be to stuff those emotions in the trunk of our car.  But what happens? The stuffed away emotions start knocking, screaming, and expressing their discontent at being in the trunk.  So we try to block out the noise.  In real life, this manifests as numbing out: by staying busy and filling our lives with escapes, pursuing addictions and distractions such as overworking, substances, food, shopping, sex, getting in and out of relationships, or other impulsive behaviors.  This can give us the false illusion that the emotion has gone away.  This may work...temporarily.

What's the true "fix" for intense emotions?  Some musings and food for thought:
 

• There is no need for a "fix".  Emotions are merely experiences that are temporary.  Usually they can teach us some important insight about ourselves.  
• It's important to accept there is nothing wrong with having emotions: being afraid, angry, upset, surprised, disgusted, being happy, being excited.
• Try not to get caught up in what your emotions mean about other people, but rather what they mean about yourself.
• If you have a tendency to stuff your emotions in the trunk of your car, play with the notion of putting them in the back seat instead.  Check on them in the rearview mirror - acknowledge that they're there, talk to them every once in a while.  Maybe listen to what they have to say.
• Letting go of the success/failure duality of emotions opens up amazing freedom.  Emotions just "are", without being good or bad, until we tell ourselves a story about what they mean, could be, or should be.
• Don't be scared of emotions.  Imagine you are riding them like a wave.

This Holiday Season, Return To Simplicity

The holidays are a time when our inner self may be exposed to more vulnerability than usual.  Much time is focused on the external world – preparations, shopping, responding, caring for, tending to.  Lots of stimuli bombard us, and it’s not only the holiday consumer goods commercials and advertisements that now seem to be starting in October.  Our inner self is now working overtime responding to these stimuli.  There are both internal and external pressures to keep up with. 

So this creates a new layer of stress, or roughness, for our inner self.  Our inner self is our oldest friend, the most tender and vulnerable part of us.   Our inner self is our heart space.  The part that has endured hurts throughout our lifetime – fear, abandonment, unmet needs.   This is the part of us that can feel ravenous with emotional hunger as well as be walled off from potential hurts, all at the same time. 

The holidays are an interesting time.  Our inner self has two conflicting demands – responding to the many external pulls, which at the same time creates an increased internal need for love and protection. 

I’m advocating that at this time, you turn extra kind attention, loving care, and protection towards your inner self.  Like being your own mother responding to her upset (inner) child with care, patience, and compassion.  I may even dare to say that during this time, turn inward first before you turn outward. 

Listen to your inner self’s needs. 

Give the gift of self-compassion.

Sometimes it’s okay if the only thing you did today was breathe.

Trust the process. 

Consider embracing simplicity during the holiday season. For example, this may simply mean spending time with the people we love and who love us back. 

Keep calm and let go (perhaps of the things and circumstances that no longer serve you).
 

For more holiday coping advice, see:

Self-Care for The Holidays

Stay Sane During The Holidays

Staying Sane During The Holidays - Part II