Book Review: The Skeleton Cupboard

I am a big advocate of discussing mental health in the open -- it is something that has or will touch all of us in our lifetimes. And the sooner we can get rid of the shame associated with it the better, and more healthy, we will all be.

For a long time I flirted with the idea of becoming a psychologist, but now I'm pretty sure it's not the career for me. However, as I am absolutely drawn to reading and writing about psychology, I couldn't resist buying Tanya Byron's book The Skeleton Cupboard: The Making of a Clinical Psychologist.

At first I didn't realize it wasn't a memoir -- it is, in fact, fiction, based on Byron's 25 years of work in clinical psychology. The characters are inspired by her experience, but not actually based on real-life cases, which would risk the principle essential to her profession of confidence. This actually annoyed me at first and made me wonder how good it could actually be, but I should have had more faith in Byron (I have been a big fan of Byron's since the series she did with Claudia Winkleman on BBC Three called The House of Tiny Tearaways, where Byron was the therapist for families with children with behavioral problems. These types of shows are like catnip to me.)  

It would seem that the part of the book written in memoir is the perspective of her training as a therapist. Her time was split between her formal training at University College London and her series of six-month placements with supervision. And this is what is so interesting about the book: while telling the stories of her patients she also speaks about her own feelings and struggles around defining not only the mental health of her patients, but her own. 

Through narrative, Byron makes the point that it is not often clear where sanity ends and insanity begins. From my own experience, and from observing those around me, I would agree with Byron's conclusion in the epilogue, that some of us are just lucky enough to manage the challenges life presents, either through nurture, with supportive families and networks, or through nature, with less of a predisposition to mental health vulnerability. I also believe that the influence of these normalizing factors may change over time, and certain situations may result in those with no mental health issues in the past, suddenly finding themselves on the brink.  

As she puts it:

I'd forgotten how anxious I was, how arrogant I could be and how naive. I often had no more clarity of thought than the people I was meant to be treating. I owe a huge debt to them for providing me an opportunity to become a skilled practitioner and perhaps, a better person. 

I suppose some may find the book a tough read as even though the stories she tells are fictional, they are based on her clinical work. And certainly from what we know from reading the newspapers, the situations are believable, and very harrowing. But I think there's great hope in the telling of stories like these, in making all of us feel that we are not alone in our struggles as humans and through connection, there is some hope for healing.

For more book recommendations and links to all my book reviews, check out my resources page.

0

Book Review: The Now Habit

Run -- do not walk -- to the nearest book shop or visit your favourite online retailer and buy this book. You will never look back.

In recent weeks (perhaps months) I've been stuck in a real procrastination rut. One could argue that I'm too hard on myself (true) but I'm also sick and tired of feeling bad that I'm not accomplishing the things I want to get done. I've made the decision that either got to find a way to do them or just forget them and enjoy my life. I refuse to be caught in a constant stress cycle of wanting to do things, but not being able, and then feeling disappointed in myself.

So thank goodness I picked up The Now Habit by Neil Fiore, PhD. Compared to the last book I read on procrastination -- The Procrastination Equation -- this book gives the reader some really specific and novel ways to tackle procrastination. I read this book last week and although I do tend to get a little excited about new self-help books, I honestly feel like a different woman. In the last few days not only have I done much more work than usual but it also has been accompanied by far less stress. Perhaps I was ready for a solution (which always helps) but still, I can't see how reading this book could be a bad thing for anyone.

According to Fiore, there are three major fears that block action and create procrastination: the terror of being overwhelmed, the fear of failure and the fear of not finishing.

As he so aptly puts it, this is what a typical procrastinator thinks:

"I have to finish something important and do it perfectly while enduring long periods of isolation from the people and things I love."

Procrastination is a coping mechanism. Putting off something you are dreading is a reprieve from these feelings -- albeit a temporary one. It just creates more dread, terror and fear as the deadline fast approaches.

Fiore explains that people who procrastinate need to change their thinking about work. Those who are likely to procrastinate have often been told from an early age that life and work are hard and things won't be easy.

For example:

"You have a lot more work to do before you can rest on your laurels; you'd better get used to things getting tough because adulthood is even worse than childhood; and while you're out having fun, some catastrophe is lurking around the corner, waiting to surprise you."

Sound familiar? Even if we haven't been told this specifically by our parents, there are other ways to pick up these types of messages: school, work, religion, our bosses, the media and the IRS (or your government equivalent). The reason these types of messages are so stressful is that they invoke feelings of "I have to" or "I should" and mean that your brain has to not only muster the energy needed to do the dreaded task but also provide the energy needed to resist threats to the integrity of the self.

Fiore's book spells out new ways to speak to yourself and ways to change your thinking. It's a clear and easy method to follow and even if you don't believe what you're saying at first, over time the brain should experience some rewiring.

But Fiore also offers a novel way to get started on projects. He explains how to break things down into manageable chunks (which we are probably all familiar with), but also gives a concrete method for getting started while at the same time alleviating the pressure to do things 'right' from the get go. He calls it the 'unschedule' and it's brilliant. I won't give it all away -- also it sounds a little silly unless you read it all the way through and actually try it out (but it's an exercise that's really worth doing).

I can't recommend this book enough. Not only has it given me hope for completing my projects, it has also taken me a step closer to being kind to myself without sacrificing meaningful work, creativity or leisure time. Go buy this book. You can thank me later.

 Related Posts:

• Making Peace With Red Tape
• Ten Bags Of Clothes
• Book Review: The Procrastination Equation

0

Friday Find: Joy In Just One New Year's Resolution?

This year I'm going to make just one New Year's resolution. I don't think making a laundry list of everything you want to change and feeling overwhelmed really gets you anywhere – besides, so many of things I am trying to work on (writing, de-cluttering, post-injury exercise, becoming a morning person) I'm already attempting (some more successfully than others) on a daily basis.

I'm not the only one thinking in this direction. I've read a certain number of blog posts recently about having a one-word theme for resolutions, most recently Gretchen Rubin's (of The Happiness Project) article in the Huffington Post on choosing a theme for 2011.

Also, it got me thinking... could a New Year's resolution be something more fun? It doesn't have to be about trying to be more perfect and eliminating what we perceive as our shortcomings. I'm starting to think more along the lines of mapping out something I'd really like to do, that I'd regret not enjoying during my lifetime. Perhaps New Year's resolutions can be more about joy and less about drudgery.

So what's my one New Year's resolution? Music.

I've written before a little about how music has fallen by the wayside a bit for me over the years. Although I generally know what's going on in the pop world, at least, sometimes I feel like my music collection is a frozen relic from my college years (which actually is no longer very recent). Much of my life is word-based. From writing for both work and fun, to watching movies, plays and TV programs, I am incredibly verbally focused, and I think I need a break from that.

I enjoy music. And listening to music uses a different side of the brain. Language uses the left side of our brain while music and art are centered in our right. Which means that while listening to music, the overactive reasoning side of my brain can have a little rest. Which is good for everyone around me too.

It's a good time for me to get back into knowing what's going on in music – we need to decide on all the music elements of the wedding over the next few months, from the ceremony to the DJ's play list. And one of these days, I'm going to get back to playing the piano. Although maybe that's reserved for next year's resolution.

Happy New Year!

Related Posts:

• Tir Na Nog
• Jekyll And Hyde 

0

Uncertainty

We live in constant uncertainty. But yet we convince ourselves that isn't true. And perhaps it's our greatest defence mechanism.

I remember once knowing that someone was going to break up with me. He gave me a pretty good indication by writing a letter… but then I had to wait two days before I saw him to find out for sure (I'm not bitter – I understand there's just no nice way to break up with someone). But having an early indication was torture. It was so much worse than just knowing it was going to be over, because there was still that bit of uncertainty. I remember cleaning the flat frantically thinking: at least if he breaks up with me I'll have a clean flat!

There's a fair bit of commentary out there on the link between uncertainty and unhappiness. This Economist blog post shows how humans don't behave rationally when there's substantial uncertainty in their environments.

But what is it about uncertainty that bothers us?

Daniel Gilbert, who is a professor at Harvard University and author of Stumbling on Happiness, wrote in a blog post for the New York Times about this phenomenon. He cited a few instances of research where knowing about something negative was much better than not knowing.

For example, research at the University of British Columbia showed that people who learned they had a very high likelihood of developing the neurodegenerative disorder known as Huntington's disease were happier a year later than those in the study who did not learn what their risk of developing the disease was.

Gilbert says in his post:

Why would we prefer to know the worst than to suspect it? Because when we get bad news we weep for a while, and then get busy making the best of it. We change our behavior, we change our attitudes. We raise our consciousness and lower our standards. We find our bootstraps and tug. But we can’t come to terms with circumstances whose terms we don’t yet know. An uncertain future leaves us stranded in an unhappy present with nothing to do but wait.

I agree, and my own theory is that it's as if our brains are better geared towards solving definite problems than dealing with unknowns. When we don't exactly know what the problem is, or will actually be, it's as if the brain heads off to work and searches to locate it, spinning round in circles like a tire when a car is up on blocks.

And it's very hard to stop. The brain can often act a little like a runaway train, getting faster and more out-of-control. But I think that the best way to regard terrible uncertainty is the way we deal with the rest of the constant uncertainty in our life, including the ultimate one – death – by just not thinking about it.

Am I crazy for saying this? When you're facing very bad uncertainty: the results of a scary medical test, the possible end of a relationship, potential job loss or a missing person – how do you not think about it? The brain is racing and it wants to solve the problem, but guess what, it can't.

Obviously I'm not telling anyone not to do proactive actions about uncertain situations when they can do something. But there are so many situations where all you can do is wait. And it's really hard not to think about something when you're in distress – but we've all had experiences of doing this successfully. Something funny happens and suddenly the worry is gone for a moment. Where did it go? If we can try to extend these time periods, by focusing on the present moment and realizing that there's nothing we can actually do, we can help ourselves and the others around us.

The problem with not being able to deal well with uncertainty is that it's always with us. Sometimes it's worse than other times, but essentially, having a successful coping mechanism for dealing with uncertainty is something that lasts, frankly, for a lifetime.

0

Tir Na Nog

Tir Na Nog is the Irish mythological land of youth and beauty where sickness and death are remarkably absent. This past weekend Future Hub and I decided to check out our local Tir Na Nog pub, where Saturday nights feature a live Irish band performance.

I have to say, the name of the pub is quite apropos. In the outskirts of London, close to a large Sainsbury's and other modern (and somewhat depressing) inventions, sits an authentic Irish pub. It's decorated with not only wobbly wooden tables and candles stuck in wine jugs but also a cast iron cooking stove, a French horn hung from the ceiling and other knick-knacks dotted around, making the place seem cozy and generous. I was seated next to a lamp that looked like it was fashioned after the Old Woman Who Lived in a Shoe nursery rhyme.

The band sat around a large table on one side of the pub, looking relaxed and contented. Everyone else was listening with similar happy looks, tapping their feet in time to the music or nodding their heads.

Music has, at different times in my life, played a big role. When I was a kid my Dad played trombone in a jazz band and some of my earliest memories of music are of going to see him play (his big claim to fame is that Vanessa Williams once sang with the band). I sang in the church choir (and in various strange children's musicals) as a kid and played the piano for 12 years. Although I wasn't really allowed to go to concerts in high school, I went to every concert in college I could go to, even if I didn't even know the band's music. In college (and even my 20s) I felt I had more time to do these things, to know what was going on more in the music world. And I suppose to just sit around and listen to music.

But it's gone by the wayside over the years. Recently I've been trying to see more live music again. It's such a good antidote to my life, which is always about words. Whether it's writing for work or fun, or seeing films, TV shows, reading magazines, newspapers or books for my book club. There's a lot of verbalization.

But Saturday, listening to music sent a wash of peacefulness over me and my brain cleared out more than usual (although I'm sure the gin and tonic didn't hurt). It was so nice just to sit there and be.

I think it's important to do activities that take you out of your main areas of focus (as long as you still enjoy them!). I felt the same way when we went to see the film Gainsbourg – A glimpse at the life of French singer Serge Gainsbourg – the other week. The film was not very script-focused, it was more visual (which makes sense as the screenwriter is also a graphic novelist) and musical – and allowed me to just get lost in the sounds and visuals.

It makes sense scientifically that I would feel different – language uses the left side of our brain while music and art are centered in our right. Which means the overactive reasoning side of my brain could have a little rest. Just sit down and put your feet up, left brain, take a load off. Tir Na Nog did just what it said on the tin, it gave me a little glimpse of life and pleasurable pursuits coming together in the same place. Not bad for the price of a few drinks.

0

The Great Estrogen Debate

If you're a woman, and also a pre-menopausal woman, there's something you should keep an eye on – estrogen (or oestrogen for you Brits out there). If you're in your 20s or 30s you might be thinking about other things, but keep it in the back of your mind. It's an evolving situation and the implications of what you decide when the time comes might be very big.

Hormone Replacement Therapy (HRT) – taking estrogen to ease some of the unpleasant symptoms of menopause – has been pretty controversial. There was a famous study, back in 2002, called the Women's Health Initiative (WHI), that dramatically was called off three years early because the study concluded that it was too dangerous. The research was a multi-year study, comparing estrogen hormone replacement therapy with a placebo. The women in the study taking estrogen were experiencing more heart trouble than the ones on the placebo and their risk of stroke, blood clots and breast cancer increased dramatically.

Thing is, although most doctors stopped prescribing HRT for their patients at this time, there were some women for whom the estrogen was a lifeline. One such woman is Cynthia Gorney, who recently wrote a New York Times Magazine article about HRT, and who suffered violent mood swings and depressive thoughts when she stopped taking estrogen in the early stages of menopause. (I know you're thinking – does Taron read anything other than the New York Times? Apparently not. But it's really good journalism!)

But what current research is starting to show is that it's when women take HRT that is really relevant. Gorney started taking estrogen when her menopause was beginning, but the average age of the women in the WHI study was 63, and the average time period between their menopause (technically defined as the last mensus) and the start of taking the trial medication was 13.4 years. There are a few other differences as well, including differences in the way the estrogen used in the WHI study was manufactured. It's really too lengthy and complicated to go into in this blog post, but if you want the details or would like to read the whole darn article, click here.

But I'll boil it down for you. The WHI study essentially told all of us women that we should not take HRT well after menopause has technically happened – the study proved that it can increase your risk of stroke, blood clots and breast cancer. But what it hasn't told us is whether HRT is actually not harmful if you do it early enough, and if, in fact, it can be beneficial, particularly for people who experience very severe symptoms.

One study that is looking at this is the Kronos Early Estrogen Prevention Study (KEEPS). It is following more than 600 women and comparing a group that has been post-menopausal for an average of 15 years and has been on estradiol or on a placebo with a second, younger group that is an average of three years post-menopausal. There are lots of other studies on the go as well, including those looking at the effects of estrogen on depression and dementia.

The implications of what these studies could show us are grand, as there are many theories out there that say taking estrogen at the early stages of menopause could help women to retain higher cognitive abilities and may even prevent Alzheimer's, as well as avoid some of the less-palatable side effects of menopause.

Scientists already know that estrogen improves and protects the brain when it is added to healthy tissue, making new cells grow and increasing what's called "plasticity" – or the brain's ability to change. It builds up the density and number of dendritic spines, which are the barbs that stick out along the long tails of brain cells and hook up with other neurons to transmit information. Interestingly enough, the thinning of those spines is a classic sign of Alzheimer's.

But when cells are sick or dying – even due to the natural ageing process – estrogen has the opposite effect. Which explains why it was likely to be so harmful to many of the women in the WHI study. This is one of my more serious blogs – but serious implications, my friends. One to definitely keep on eye on as research develops and we get older.

2

Baby 19

If there's a way, there's a worry. I wouldn't say I am paralyzed by worry, in fact, it's almost the opposite – I am an extreme worrier, but I do things anyway. But that doesn't mean it's easy.

Here's how I would explain it. No matter how well things are going in my life (and I've been very lucky) I have this low-lying nagging sense that there's something I should be worried about. It's like that horrible feeling that you left the oven on at home. And I often feel like arguing with my brain about it. "Listen brain, why do you insist on thinking there's always something bad right around the corner? Just because that person didn't return your email/phone call/letter doesn't mean it has anything to do with you. Why is it always about you anyway? Can you just relax and enjoy yourself a little?"

So if there's a worry gene, I've definitely got it. Which is why I was incredibly intrigued by an article I read some time ago and forwarded to every anxiety-prone person I know. It details a longitudinal study by a psychology professor at Harvard, Jerome Kagan, to examine whether or not there are people who are predisposed to be anxious. In infancy the participants in the study were observed to see if they were "high-reactors" – essentially whether they freaked out or not when exposed to something new.

The first 18 babies in the study were cool as cucumbers, but Baby 19 became incredibly distressed when she was exposed to new sounds, voices, toys and smells. And the oldest high-reactive subjects in this study, and other studies of the same sort (like Baby 19), are now in their 20s. The article states that "for many of them, no matter how much they manage to avoid looking anxious to an outsider, fears still rattle in their skulls at 3 o’clock in the morning. They remain anxious just below the surface, their subconscious brains still twitchy, still hyper vigilant, still unable to shift attention away from perceived threats that aren’t really there."

This sounded particularly familiar to me. Which got me thinking, was I like Baby 19? I'm sure it would be hard to accurately collect data on whether or not as an infant I freaked out when exposed to new things. In hindsight, people's memories are often very subjective. But there was an incident when I was five years old in kindergarten class. I totally freaked out about a class trip to an ice cream shop. It was a Carvel store (for those New York State readers) and it was one I had been to numerous times with my parents. I remember it distinctly – I was absolutely terrified about going. But I still can't verbalize why. Ice cream really isn't the scariest thing. They had to call my Mom to come get me, but luckily my kindergarten class was actually on the college campus where she was a professor and she knew my teacher pretty well.

Sounds pretty Baby 19-ish to me. As an adult I've dealt with my anxiety in other ways. In fact, I moved countries about eight years ago and despite feeling terrified (and hating it for about the first year) I did it anyway. The article talks about how some people are able to actually harness this nervous energy. I wouldn't say this is true all the time for me – often I find it unharness-able (probably not a word) and something I'd rather not cope with. This is particularly true if I have a lot of free time, which is probably why I make sure I'm pretty busy (which creates other problems). And when I'm busy I like to do things that keep my brain active – to distract it from worrying. Interestingly enough, although some anxious people might find socializing anxiety-inducing, I find it just the opposite. I get to focus on someone else and get outside of my own head.

But the one thing I appreciated most from the article was the fact that it said that maybe this excessive worrying wasn't actually my fault – perhaps I'm pre-disposed. Which was a bit of a relief. Because there's nothing worse than trying not to worry and others around you telling you to chillax, like you mean to be this way. Sometimes it's not that simple.

The article is from the New York Times Magazine, so it's super long, but if you have any interest in the area, or suspect you may be a Baby 19, click here to read it.

2