Social Anxiety Disorder

Sweaty palms, rapid heartbeat, dry mouth...these are typical things most of us are familiar with in situations where we feel nervous about something.    But what if you feel this way all the time?  What if you are so anxious in social settings that you have panic attacks or avoid situations completely because you are terrified of being embarrassed, being criticized, or offending other people in some way?   What if these fears prevent you from accomplishing important goals and dreams?    

When social anxiety has a significant impact on your relationships or career and educational goals, then its likely you may be suffering from Social Anxiety Disorder.   Yes, its a real thing and it goes way beyond the average experience of "social butterflies".   

Below are the features of Social Anxiety Disorder (aka Social Phobia) according to the DSM-V (that giant book of officially recognized mental disorders) in short form:

A)  Experiencing intense anxiety about one or more social situations when there's a possibility of scrutiny from other people (e.g. meeting someone new, eating in front of others, asking for directions).  
B) The person is afraid of behaving in a way that could be embarrassing which he or she believes will result in being negatively evaluated (e.g. humiliated, rejected).   
C) The situation causes intense fear and anxiety.   This is not the kind of fear or anxiety about, say, giving a speech or performing in front of an audience when you normally don't have to.   This level is more on the debilitating end of fear/anxiety spectrum.
D) You endure the intense fear and anxiety "to just get through" a situation or avoid it completely.
E) These intense emotions are out of proportion to the actual perceived threat.   
F)  The fears or avoidance keep coming back and last at least 6 months.   
G)  The fears or avoidance cause "clinically significant" distress and interfere with your ability to cope well in either your job, school, or relationships.
H)  The fears or avoidance are not a result of substance abuse or medication.
I) The fears or avoidance are not a result of another mental disorder (e.g. autism, body dysmorphic disorder).
J) The fears or avoidance are not related a medical condition (e.g. obesity, disfigurement, Parkinson's disease).

The main things to keep in mind here are that these fears and avoidance behaviors are having a seriously negative impact on a person's life AND they are out of proportion to any actual threat.  In other words, if someone is being bullied or abused then fear and avoidance are to be expected.    

Also, Social Anxiety Disorder almost always begins before a person reaches adulthood.   

The good news is that you don't have to stay stuck and forever inhibited by this disorder.   Cognitive Behavioral Therapy - as well as Exposure Therapy - has proved through research to be effective in helping people deal with their social anxiety successfully and achieve things that seemed out of reach before.   

How Do We Wisely Use the Past?

There is one thing every person has in common - we cannot change our past.   Many people feel shadowed by their unhappy past and try hard to minimize it, justify it, use it as an excuse for poor choices, or repress it completely.    Others have had blessing upon blessing and are well-equipped to handle life's challenges.   

People who fall into the latter group, no matter how kind life has been, still do not escape unscathed.   Everyone has hurts and pains to some degree, right?    Disappointments, grudges, regrets, grief, failures, heartbreaks, guilt, feeling misjudged, etc.    When someone uses phrases like "raw deal", "hard luck", "tough break", "hot water", "Catch-22" and so forth we can relate since we have "been there" emotionally and psychologically.    

So are the injuries of the past an enemy that keeps us enslaved or can we regain lost ground and come out - not necessarily completely uninjured - but more resilient, more perceptive, and a lot wiser?  

Timothy Keller offers the following prayer, "Lord, you are the ultimate teacher of wisdom.  You sat with your disciples and taught them in parables.  Now help me learn wisdom from my experience."

Proverbs 4:25-26 advises, "Let your eyes look straight ahead; fix your gaze directly before you.  Give careful thought to the paths for your feet and be steadfast in all your ways." 

Although we cannot forget the past completely, it is unwise to stay "stuck" in it.   Feelings of resentment and lack of forgiveness are understandable at times, but we must let go of the safety rails (e.g. self-sufficiency, substance abuse, control issues) and surrender to God.  Safety rails may feel safe out of their familiarity; however, they are not really safe and never lead us to a place of security.   

God will take us down a path toward healing and discernment when we let go.  That emotional energy has to go somewhere and since we cannot change history we can only move forward.   The hurt needs a legitimate outlet that is future-focused and filled with hope.  In turn, we can become empowered to turn the "bad" of the past into a force for good toward others and a source of growth for ourselves.    

What safety rails are you hanging onto?   

















Source:  God's Wisdom for Navigating Life by Timothy Keller

The Opiate Crisis

64,070.   That's the number of drug overdose deaths in the US in 2016 according to the CDC, which is a record high.  More than 20,000 of these deaths involved synthetic opioids.  

Below is a breakdown of morphine and is relatives:

Morphine - A naturally occurring opiate found in plants like the opium poppy.   Morphine was discovered in the early 1800s.  Morphine is used in creating synthetic painkillers.

Heroine - A chemist created heroine using morphine in the 1870s. 

Prescription opioids - These are prescription painkillers like oxycodone (Percocet, Oxycontin), hydrocodone (Vicodin), hydromorphone (Dilaudid) etc.

Fentanyl - Also a synthetic opioid used for treating severe pain; its hundreds of times stronger than morphine.

Carfentanil - Related to fentanyl except its thought to be thousands times stronger than morphine.  

Fentanyl is now a huge part of the overdose crisis.   Its legally prescribed but in recent years its become a street drug and often manufactured illegally.   Its a lucrative business.  According to this cnn.com article, "...you can buy about a kilogram of black-market fentanyl or a derivative online for about $8,000. That can be used to cut 1 million pills, and on the street, those pills can bring in a total of $20 million to $30 million."   

Even scarier than fentanyl is carfentanil.  This is a drug used to tranquilize elephants.  Its 10,000 times stronger than morphine.   A tiny amount can kill a person.  

Tragically, people buying heroin on the street don't realize that they're using something laced with fentanyl or even carfentanil.    Hence, this contributes to a spike in overdose deaths.   One bright spot is the use of a drug called naloxone, which instantly kicks opioids out of the brain's opioid receptors and saves lives - if help arrives in time.    

Now for the personal side of this problem.   Watch this video of this woman telling her story to CNN.    What stands out to me the most about her is her utter lack of pretense and absolute sincerity in warning people to stay far away from heroin.    It is heartbreaking to see.   Her story is shared by so many others.   And its not just the story of people living on the edges of society - its a story found behind many doors, in every social class and every community.  

Data obtained from CDC.gov

Bipolar I and Bipolar II Disorders

Bipolar Disorder is a commonly misunderstood, and misdiagnosed, mental health disorder.  According to the National Alliance on Mental Health, about 2.6% of the US population has been diagnosed with Bipolar Disorder.   It is often difficult to diagnose due to its symptoms overlapping with the effects of substance abuse, certain medications, and other mental health diagnoses (e.g. ADHD, schizophrenia).   Additionally, there are four types of BD:  Bipolar I, Bipolar II, Cyclothymia, and Bipolar Unspecified.   

This post will focus on the first two types.      

According to the DSM-V, this is the breakdown on Bipolar I and Bipolar II criteria, categorized by letter.   

Bipolar I

Bipolar I is characterized by manic symptoms of abnormally elevated/energized mood or irritability that must last at least one week nearly every day (A).  For a person experiencing elevated/hyper mood to meet full criteria for Bipolar I, they must meet three of these seven symptoms (B):  

grandiosity (unrealistic beliefs about oneself)

less need for sleep without feeling tired

an unusual level of talkativeness for the person’s personality

high distractibility

flight of ideas (random, racing thoughts)

increased goal-directed activity (e.g. excessive planning, sexual promiscuity) or purposeless agitation

impulsive behaviors (e.g. spending, high risk sexual behaviors)

If a person’s mood is more irritable than elevated/energized, four of the above criteria must be met.  

Additionally, the manic episode must cause significant social or occupational dysfunction OR psychotic symptoms are present OR hospitalization is required to prevent harm to self or others.   (C)

These symptoms must not be caused by the effects of a substance, medication, or medical condition (D).   

Although common with Bipolar I, a major depressive episode is not required to be diagnosed with Bipolar I.   

Bipolar II

Bipolar II is similar but characterized by a hypomanic episode (See below for criteria).   Also criteria for at least one major depressive episode must been met (A).   

The person has never had a manic episode (B).

The hypomanic episode and the major depressive episode are not better explained by another disorder (e.g. schizophrenia, other psychotic disorder, delusional disorder) (C).

Depression and/or alternating moods between depressed mood and hypomania cause significant distress (not severe) in the person's life socially and/or occupationally (D).  

Criteria for a hypomanic episode:  

A hypomanic episode must last at least 4 days and the person's mood must be abnormally elevated or irritable nearly all day, every day (A). 

The category B requirements are the same as listed above for manic episode (B).  

The changes must be out of character for the individual (C).  

The changes must be noticeable to others (D).  

The effect of a hypomanic episode on a person socially or occupationally is not severe and there is no psychosis or need for hospitalization (E).   

The episode is not caused by use of a substance or another medical condition (F).  

Major Depressive Episode

A major depressive episode must occur during a 2 week period of time.   Five of the following symptoms must be present during this period (A):

Depressed mood most of the day, nearly every day (this can be a feeling of emptiness or hopelessness).

Significant decrease in activities or interests 

Weight loss or gain due to appetite change

Insomnia or sleeping too much

Physical agitation or retardation

Loss of energy/fatigue

A feeling of worthlessness or excessive guilt

Decreased ability to make decisions or concentrate

Recurring thoughts of death or suicidal ideation (without a specific plan)

Additionally, these symptoms must have a significantly negative affect on a person socially, occupationally, or in any other major area of a person’s life (B).  

These symptoms must not be caused by another medical condition or by the effects of a substance (C).  

Bipolar diagnoses become more complicated when severity, various features such as onset, and other types disorders in this category are factored in, but these are the basics and I hope its helpful. 

Sources:  

NAMI. (n.d.). Retrieved November 14, 2017, from https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder

American Psychiatric Association. (2013). Diagnostic and 

     statistical manual of mental disorders (5th ed.). Washington, DC: 

     Author.

Holiday Mania

I love this time of year.   From pumpkins through the Christmas rush this season provides so many fun ways to make new memories and take comfort in traditions.    But I've noticed a trend in recent years that borders on commercial mania.    The fall stuff is now out in August, Halloween stuff in September, and by the time the kids break out their costumes, the pumpkins are passe.   On Oct 31st, a local grocery store was already promoting snowman decor - the fall stuff being relegated to the discount aisle. 

What is this merry go round of holiday madness?    Obviously marketers are out to maximize their profits but they wouldn't bother if we weren't willing to jump right in and buy seasonal things way out sync with the actual seasons. 

We live in an age when there have never been so many ways to be distracted and the demands for our attention have never been so, well, demanding.   I think the holiday madness reflects a deeper issue in our culture.    With so much distraction and demand, we are at risk of losing out completely on the gift of slowing down and savoring the present.   If you think about it in practical terms, the present is all we have at any given moment.    We can only grow and learn in the present.   The message from the barrage of holiday decor is essentially this - the present is not satisfying enough so we have to keep rushing toward the next "big" thing to be.....what exactly?  happy? satisfied?

Counseling is helpful for a long list of reasons, but I believe part of its effectiveness is that a person chooses to spend an hour in a quiet, comfortable environment exploring deeper issues and reflecting on the things that truly matter to him or her.    God wants us to slow down and take stock of our own hearts and minds so we can grow and know Him better, but we cannot do that unless we are very deliberate about it.   We can embrace the holiday rush in a healthy way but it is essential for our spiritual, emotional, and mental health to carve out these "spaces" for ourselves.  Otherwise, we will just remain swept up in the chaotic flow of distraction and demand. 

Where Character Grows

I want my children to have character when they are grown - the kind that requires grit and guts and might set them apart if it comes down to it.   Yes, I want them to be able to stand alone if they must.   I'll hazard a guess that most parents want their children to be like this.  

It's a lovely thought.   But integrity of this kind costs something.   How I wish I could just give it to them, but I know I can't.    And that is where I stumble and waver at heart. Character doesn't come easy; it comes mostly through trials and tribulations.    Yes, "trial and tribulation" sounds Old Testament-y.   I doubt they'll face the threat of stoning or be carried off by foreign invaders.    No, there are lesser trials and these will be enough.  

Most likely, they will face the following things that will hurt:  being misjudged, being treated unfairly, not receiving credit when it's due, guilt, rejection, loneliness, subtle snobbery, blatant snobbery, discouragement, temptation, failure, disappointment, embarrassment, etc.   Basically, the universal stuff of life.   Some of it will come to them from forces outside of their control and inevitably some from their own choices.      

As a mom, it's is hard to accept that I cannot protect them from this type of pain.  But I can prepare them.   That's all I can do.   Pray and prepare.   I will do those things with all my heart.   Then my role will change and they will go out own their own.  

My hope is that they will have discernment and humility to push through these things. Courage to face pain head on when necessary.   How they navigate the real world is where their own character will grow.  

Perseverance, character, and hope.  Romans 5:3-4

Thirst

The Samaritan woman at the well was bewildered that a Jewish man was speaking to her, asking her for a drink.   

Jesus answered her, “If you knew the gift of God, and who it is that is saying to you, ‘Give me a drink,’ you would have asked him, and he would have given you living water.” The woman said to him, “Sir, you have nothing to draw water with, and the well is deep. Where do you get that living water? Are you greater than our father Jacob? He gave us the well and drank from it himself, as did his sons and his livestock.” Jesus said to her, “Everyone who drinks of this water will be thirsty again, but whoever drinks of the water that I will give him will never be thirsty again. The water that I will give him will become in him a spring of water welling up to eternal life.”  

Never thirst.

Thirst for what?   For the feeling of significance, the feeling of being safe, the feeling of belonging?  We will have feelings of longing for these things at times.  We are designed to long for them. 

But Jesus isn't talking about feelings.   He is not saying we will never feel insignificant in a certain situation, unsafe in a dangerous place, or lonely and wanting companionship. 

Feelings are temporary and sometimes not to be trusted.   This deep thirst must be quenched by more than just emotional satisfaction from our circumstances.

   

"Living" is a grammatically present progressive, implying that it does not stop and start or just end - like feelings do.    If we base our lives on efforts to secure emotional satisfaction, we come to a dead end.   We will strive, manipulate, and eventually exhaust ourselves.  

Timothy Keller, one of my favorite authors, puts it this way in his book Encounters with Jesus:

Everybody has got to live for something, but Jesus is arguing that, if he is not that thing, it will fail you.  First, it will enslave you.  Whatever that thing is, you will tell yourself that you have to have it or there is no tomorrow.  That means that if anything threatens it, you will becomes inordinately scared; if anyone blocks it, you will become inordinately angry; and if  you fail to achieve it, you will never be able to forgive yourself.  But second, if you do achieve it, it will fail to deliver the fulfillment you expected.

The first step to finding living water is to realize that we have a deeper longing, a thirst of the soul that can only be satisfied by the supernatural - never the earthly.   Its a state of being - of being "athirst".   

Jesus uses this word again in Revelation 21 when speaking to John in a vision:  "And he said unto me, It is done. I am Alpha and Omega, the beginning and the end. I will give unto him that is athirst of the fountain of the water of life freely."

What a relief that we do not have to, and cannot if we try, find a way to satisfy the deepest needs of our soul.