My piece, “Some Simple Steps for the Stressed-Out: Psychiatrist Offers Simple Steps for Coping with Uncertainty,” on dealing with stress from the economic downturn, appeared on the front page of the Washington Post Health Section today.
A middle-aged, working-class woman recently came to my medical office complaining that her back had “seized up.” Her husband had lost both his jobs and was feeling quite disheartened; not long after, her blood pressure had “jumped though the ceiling” and she began sleeping poorly.
Another patient came to see me suffering from crippling anxiety attacks. He had lost the better part of his considerable fortune in the economic collapse. Now he was waking in the middle of each night feeling his chest crushed, unable to breathe, half fearing and half wishing he would die.
I have been practicing psychiatry for 40 years, but I’ve never seen this much stress and worry about economic well-being and the future. There is a sense that the ground is no longer solid, that a system we all thought would sustain us no longer works as we were told it would. In the past, when patients reported job-related stress, it was from unfulfilling work and the anxiety of making choices. “Should I stay in this job that I can’t stand and keep feeling so unhappy?” they would say. Now, I hear about unmeetable mortgages, months without work, fears of ending life in a low-paying, entry-level job. “What went wrong?” my patients say. “What could I have done?” “How can I manage?”
In this uncertain time, symptoms of chronic illnesses — hypertension, back pain, diabetes — that were controlled or dormant are erupting. Low-level depression, whose hallmarks are feelings of helplessness and hopelessness, is endemic.
Large numbers of people across the country are trying to quiet their apprehension with drugs or drink, or have turned to antidepressants, anti-anxiety medications and sleeping pills. But after decades working not only in Washington but also with war-traumatized populations overseas, I’ve found there are simple strategies for helping people cope that are easy to learn, practice at home and, in these stressful times, free.
1.Begin a simple meditation practice. Loss — of jobs or economic security, as well as of a beloved person — is perhaps the greatest and most common of stressors, and the most frequent cause of anxiety and depression. Slow, deep breathing — in through the nose, out through the mouth, with the belly relaxed and soft, and the eyes closed — is a sure “evidence-based” antidote to the stress response that uncertainty provokes. Practicing this “soft belly” technique several times a day for several minutes each time quiets the “fight-or-flight” response that makes people anxious and agitated, and brings us what cardiologist Herbert Benson famously called “the relaxation response.” Financial advisers, child-care workers and soldiers back from a second tour in Iraq with whom I’ve worked have all found, in this simple practice, a source of calm.
2.Move your body. With the possible exception of talking with a sympathetic, skilled human being, physical exercise may be the single best therapy for depression. It’s very good for anxiety as well. Exercise has been shown in animal studies to increase cells in the hippocampus, a region of the brain concerned with memory and emotion, which can be depleted by significant psychological trauma (and financial stress is one of the most significant traumas) or chronic depression. Exercise increases mood-enhancing neurotransmitters in our brains, and decreases the levels of stress hormones that exacerbate chronic illness.
It may not be easy to get moving when you’re feeling defeated, but every step you take, literally as well as figuratively, will encourage you to take the next one. Make sure you do something physical that you enjoy or once did enjoy. Aerobics or yoga classes may feel overwhelming or too expensive. Don’t worry: Dancing at home by yourself works just as well, and so does walking. Exercise is often the first item on my prescription pad.
3.Reach out to others. Human connection — to family, friends, co-workers in the same boat — is an antidote to the sense of aimlessness and isolation that may come from job loss or unexpected economic insecurity. Social connection also helps prevent the chronic illness that can often follow prolonged stress. I see the healing power of group membership every day in mind-body skills groups that colleagues and I organize, when a group member, demoralized and humiliated by job loss, realizes he or she is not the only one. Acknowledging and sharing (but not indulging) this sense of grief and pain is a remarkable source of strength for many people.
4.Find someone who will listen and help you take a realistic look at your situation. When the middle-aged woman with the “seized-up” back came to see me, we discussed her finances as well as her feelings. Although her husband had lost his jobs, her own job, in the health-care industry, was still secure. She and her husband would have to give up some of the “little luxuries” to which they’d been accustomed, but it was clear they could still manage. She needed to relax (using the soft-belly technique), recognize what she could and couldn’t do, give her husband a fair share of the household chores while he looked for another job, and generally unburden her mind, body and spirit. This simple exploratory conversation — and a subsequent heart-to-heart with her husband — allowed her to turn aside the cascade of anxious emotions. Her body began to repair itself.
5.Let your imagination help you find healing — and new meaning and purpose. The wealthy man who came to see me last winter paralyzed by anxiety attacks after losing much of his fortune was able to put his own trauma in perspective by using his imagination.
Though he still was, by most standards, wealthy, his sense of himself as a wise, sure-footed investor had been shattered. He did soft belly breathing to relax and began to cut out and copy pictures from magazines that seemed to him somehow hopeful. He spent days, he told me, copying a photo of a man his age, a grandfather apparently, standing with his arm around a young boy on the verge of the hole where the World Trade Center had been. “The tragedy in the picture is so much greater than my own,” he said, “and I realized that what’s really important is the connection between this man and boy, the hope for the future. I drew it, and I really started looking for this connection in my own life — a connection with meaning now, not money.”
Other patients find relief and assistance from imagining themselves in a safe place and consulting their inner “wise guide” to help them find peace, direction and meaning. This may seem kind of strange at first, but it’s an ancient process used in many indigenous cultures and is actually pretty easy.
First, after breathing deeply and relaxing, imagine someplace safe and comfortable, one you know or one that just arises at the moment in your imagination. As you sit there, you allow your “guide” to appear. Accept whatever image appears — a wise old man or woman, a relative, a figure from scripture or literature, or even an animal. Mentally introduce yourself, and ask this guide a question about what’s troubling you, and then “listen” to the response that comes into your mind. Let the dialogue with you and this guide continue. Often helpful guidance will emerge from your own intuitive understanding.
6.Speak and act on your own behalf. Sometimes this produces rapid and even material benefits: One patient, a financial analyst, talked to her colleague about impending cutbacks; they forestalled a layoff by offering their supervisor a job-share alternative. Often speaking up for yourself produces valuable information and greater peace of mind and clarity: An anxious nanny finally asked her employer, who was herself experiencing a significant decrease in income, if her own job was secure and discovered it was; an IT consultant, asking his boss for a straightforward response, discovered his job was likely to be eliminated and began the search for another job, early, unsurprised and still employed.
There are two common denominators to these six strategies for dealing with and healing from financial setbacks and the unnerving feeling that the ground has shifted. All of them remind us, in times when the economy has made us feel powerless, that there are things we can do to help ourselves. And none of them costs money.
You can read the original article here.
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Thanks for reading, and I hope the techniques in the article will be useful to you and to everyone in these difficult times.
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I said that I would write more about our work in Israel and Gaza, but the work-and trying to find funding so that we can continue it-is taking up so much time (joyous, exciting time, to be sure) that I haven’t been able to write.
Still, I thought I would send along this very brief summary that I forwarded to our US Mind-Body Medicine faculty.
Just a couple of words from Gaza City: overwhelming, amazing, touching. That’s three words.
We (Jim, Amy, Afrim, Yusuf, Dan and Lee-Ann) had a great visit with our Israeli faculty. They are doing many interesting and exciting projects including groups that combine mind-body skills and Jewish spirituality, joint Israeli Jewish and Arab groups, and many groups for traumatized children and adults in Sderot. In fact, we made a visit to Sderot and had a chance to talk with teachers who are using mind-body skills in wonderfully creative ways with children in the SCIENCE AND RELIGION SCHOOL. The kids have experienced shelling on and off for eight years and are having all kinds of problems with concentration, bed-wetting and anger.
Naftali who heads up our Israeli program, is on the track of a major initiative in the South which will build on the work that he and his team have already done. We are working together on developing cooperative relationships and future funding.
Thanks to Danny Grossman, a friend to whom Aaron and Debbie Kaplan introduced us some years ago, (with able assists from Naftali and Smadar who handle the administrative work in Israel), we were all able to get into Gaza. It took a couple of extra days for Afrim and Yusuf, but Naftali and Tami and Ayelet from our Israeli faculty kept their spirits high while they waited. Once in Gaza, we began with visits with grieving families. There are whole sections of Gaza that have been completely destroyed and many thousands of people who are without homes. “I am very small,” one ten year old girl told us, “but the tent the 20 of us are staying in is even smaller.”
We went on for a day of meetings with our Gaza faculty. The next day, we had more site visits including one to Dr. Izzeldin Abuelaish, whose three daughters were killed. He’s an amazing man, an OBGYN who works in Israel as well as Gaza and through some miracle of wisdom and compassion, has managed to transform his suffering into a visionary project for the education of girls in Gaza-“not just so they will think, but so they will think freely”-and a mission to promote greater Israeli-Palestinian understanding.
We’re now about to start the 4th day of our PTP. Our Gaza faculty, which Jamil heads up, is doing virtually all the lectures and leading all the groups and our international team is consulting/supervising. The Gaza group is doing an absolutely wonderful job. They are so open-hearted and skillful-I’d say over the last 18 months, they’ve each lead anywhere between 6 and 20 groups and it shows.
Participants (there are over 140 of them) are speaking of issues that they have never before discussed and beginning to solve problems that have troubled them for years-not to mention finding practical ways to ease their high levels of anxiety and deal with nightmares, flashbacks, etc. All of them-faculty and participants-are so eager to learn and to share what they are learning. They are an inspiration to all of us.
There is much more to tell and I will when I have more time. For now, I send all of you my love as well as my gratitude for being with us on this and many other adventures.