Indifference: Meh. Shrug.

Indifference, blah. meh. shrug: words that don’t inspire confidence, or energy or much of anything, really. Yet, somehow, indifference does not seem to get discussed much. Interestingly, people don’t seem to get alarmed by indifference, when it is one of the biggest red flags that something is wrong: with a life, a relationship, a team, or a business. Perhaps that means indifference just reinforces itself? Can you be indifferent if you are speaking up about being indifferent?

I once heard indifference described as “absence of fire”. I like that because indifference does not glow, it just exists, kind of like a lump. When you are indifferent about someone or something, you cannot be moving forward, and you may not even be moving backward, more like standing still or running in place, which exhausts you but gets you nowhere.

Indifference is a true opposite. Many people argue that hate is the opposite of love or that anger is the opposite of happy. But really those emotions are all the same, they all involve feeling strongly about something. Anger and hate are not marked by absence of fire. Indifference the most obvious, yet most overlooked marker of a lack of love.

Think about romantic relationships. When partners become indifferent, they tend to start living side-by-side parallel lives. Existing under one roof, taking care of housekeeping, raising children (if there are any), but not really caring about the other person. Indifference takes the friendship and humanness out of a relationship and replaces it with a series of anonymous business transactions.

In business relationships, indifference stops the flow of ideas and information. The business becomes about existing, maintaining the status quo, avoiding fights, instead of one of growth, change and continued profitability. With indifference, you cling to what you already have instead of trying to create something new.

Nobel Peace Prize Winner and Holocaust Survivor Elie Wiesel once gave a speech about indifference at the close of the 20th century. He said that indifference was “more dangerous than anger. Anger can at times be creative. One writes a great poem, a great symphony, one does something special for the sake of humanity because one is angry at the injustice that one witnesses. But indifference is never creative. Even hatred at times may elicit a response. You fight it. You denounce it. You disarm it. Indifference elicits no response. Indifference is not a response…therefore it’s always a friend of the enemy.”

Indifference is a killer. It kills relationships, can kill people (when we turn a blind eye to violence and suffering), kills businesses, and slowly but surely kills individuals who succumb to chronic health problems brought on by stress and unhappiness, every single day.

So why is more attention not paid to indifference? I think because indifference is so insidious and silent, it is easy to accept. Indifference doesn’t show up unannounced one day, wreaking havoc and destruction, like a wildfire or tornado. Indifference seeps in on a daily basis. Have you ever told yourself, “this is the way it has to be” or “I have to stay here, the economy sucks and at least I get benefits” or “I have no choice, breaking up/divorce is so expensive”? If you have, you can bet you are caught in the loop of indifference.

A key piece of breaking out of indifference involves changing your story. We all have unproductive parts of our stories and we are the only people with the power to change those stories. As I’ve written previously, you get to decide what gets told and how it gets told and what it means.

Even though changing your story takes thoughtful consideration and time, there are some smaller things you can do to shake up your routine which will likely put some cracks in your indifference. Where in your life are things rote? Food? Try some new food. Commute? Change your route. Always listen to music? Go to a museum and look at visual art. Or go to a live concert if you tend not to see bands or listen to music. Changing your patterns will begin to change your thinking and set you on the road to changing your story.

Author, speaker and wine expert, Gary Vaynerchuk, who can be described as pretty much anything but indifferent, says, “how we cultivate our relationships is often the greatest determinant of the type of life we get to live.”

Is there a place in your life where you are feeling indifferent that could use some rewriting? Where can you add more life to your life?

Jackie Dotson is a psychotherapist, writer, speaker, consultant. She currently runs a private practice in Sacramento where she specializes in helping small business owners get past the obstacles that keep them from business success. Jackie is the co-host of the weekly podcast, “The Powder Keg of Awesome” and is the Sacramento Small Business Examiner, for Examiner.com

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

Change: Like it or Not It Ain’t Going Anywhere

I am in the process of shifting the focus of my practice from general therapy/counseling to working with businesses. This change is coming after years of my being absolutely fascinated with the workings of business and entrepreneurialism. When I started studying the subject on a whim about seven years ago, I had no idea just how much I was going to love it. My personal library has way more business books than psychology books (being that I finished grad school in the previous century, I’ve long since sold off my schoolbooks).

Does this mean I am sorry that I spent years studying history, journalism, psychology and clinical social work? Hell no! I find they are all fit together and I use my skills constantly. My background as a therapist fits so well into studying how organizations behave. I am especially interested in studying how people and organizations adapt to change.

Another reason why I have no regrets is because, as we are seeing, there really aren’t linear careers anymore (which is fine by me because I like change). Once upon a time, in my profession, your options were limited to starting out as an in-the-trenches clinician, then “moving up” to a supervisor and/or director one day. In other words, very step-by-step, linear stuff. To some degree this is still the case in a lot of places (for now). However, with the world flattening and the economy and job market spinning all over the place, it’s not good if these are the only skills you have in your back pocket.

A fascinating article was recently published in Fast Company magazine called “This is Generation Flux” . The article is about chaos and crisis in the business world, how the two are now a constant presence instead of just hitting us every decade or so. The article also profiles people it considers to be the embodiment of “Generation Flux” and defines generation flux as: “a mind-set that embraces instability, that tolerates–and even enjoys–recalibrating careers, business models, and assumptions. Not everyone will join Generation Flux, but to be successful, businesses and individuals will have to work at it.” Okay, okay, perhaps the reason why the piece resonated so strongly with me is because that definition describes me to a T.

As I was reading this piece, my mind kept shifting back and forth to experiences I had in my own career as well my own work with clients about acknowledging, adapting and embracing change. I consider myself one of the lucky ones. I love change. Nothing gets me more excited than learning new ways of doing things and going to new places. So seeing the world-as-we-know-it go into complete upheaval gets me into the zone, instead of running for cover.

How do you react to change?

There are several ways humans react to change. I frequently write about our “lizard brain” and how it’s wired to fear change. Our “lizard brain” has the singular goal of keeping us safe from danger, so it interprets any kind of change as potential danger. So, stepping out and doing new (scary) things can feel very daunting. So, not surprisingly, many people (and industries) react to change with a combination of fear, denial and resistance. At the turn of the century, we all saw how the recording industry reacted to the advent of digital music. In this century, we can all see how the recording industry never really recovered, in large part, due to its reactionary, punitive reaction to the new technology.

Fear, denial and resistance lead straight to looking to the past and trying to recreate it, because we perceive the past as being a “simpler” time. For example, many of us perceive high school as being a simpler time, yet I bet no one perceived it as such while going through it! The Generation Flux article touches on this tendency to embrace nostalgia.

Embracing nostalgia is not a good life strategy. We’ve all been at networking events, conferences and trade shows where the topic of conversation is focused on loss and “the way things used to be”. I lose all of my energy and interest when I get trapped in these kinds of conversations. Looking back, although it provides the illusion of comfort, is really not the way to move forward. Being comfortable is not going to get you where you need to go.

Flexibility is your friend. It’s overplayed at this point, but Charles Darwin’s quote about it’s not the strongest who survive, but the most adaptable, says it best. In sports, the athletes who can stay on their toes and in the moment are usually the ones who win games. The same goes for business.

In addition to being flexible, learning how to operate without a map or a manual is also extremely helpful. Because markets are changing so quickly these days, there is no time for a map or a manual or the tests and surveys we relied so heavily on in the past. In your business or industry you are probably finding that you have to reinvent from scratch almost constantly. If you can do this: awesome, that’s a gigantic chunk of the battle. If not, don’t worry, all humans possess the innate ability to work well on the fly, it’s just a skill you have to develop.

So that’s what I’ve decided to do. Since I love change and I love business, I decided to use that to create something new. I am now helping business owners and professionals learn how to navigate change and use it to make better businesses. I know how the uncertainty and upheaval can make people insecure and I can help you build your skills. If the constant change is causing you and your business partners to have the same arguments over and over, I can help with that too.

Jackie Dotson is the founder of Jackie Dotson, LCSW in Sacramento, CA, as well as the co-host of The Powder Keg of Awesome Podcast.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

It’s a New Year, what’s your Story?

Bet you probably already know it, but it’s a whole New Year! So, in the spirit of January 2012, I could go all New Year’s Resolutions on you. But since you all know me by now, you know that I just won’t do that, it’s not my style.

New Years Resolution talk bores me. I’m sure you are seeing lots of it on Facebook and Twitter these days. It bores me because I know that “resolutions” don’t stick (except in extreme “results not typical” type cases). Since I never make traditional resolutions for myself, I never really put too much thought into why beyond my basic knowing that a simple calendar change is not enough to sustain motivation for behavior change. Then, a few days ago, I was reading Daniel Pink’s blog and he was reviewing a new book called “the Willpower Instinct”.

In this book, the author points out that most behavior change fails because people make the erroneous assumption that they will make different decisions tomorrow than they make today. We have all done this in one form or another: “I’ll start my diet on Monday” or “I’ll go to the gym tomorrow”. Problem is when tomorrow comes, we make the same choices. I’d never heard it articulated that way before. I like it and can’t wait to read this book.

I have another New Year’s pet peeve: pretending that the old year didn’t happen once the New Year starts. You hear this a lot when people talk about “clean slates” and “fresh starts”. Yes, a new year can be viewed as such (think about it, the concept of a new year can be viewed in any number of ways). But in leaving the old behind (and I am a huge fan of letting go of the past), it’s crucial to remember the lessons learned in the previous year.

This past week, I spoke about this on my weekly podcast. Some years are awesome. Some years are neutral. Some years suck. The one thing all years have in common are the lessons each year delivers. I hear a lot of people saying that 2011 was a very tough year, (I know it was certainly not a favorite year in my life), so if this is the case for you, spend some time reflecting on what you learned from that. Learning from things helps you if that thing comes up again (which you know it will).

Figuring out what you’ve learned from 2011 will help you set your story around it. From time to time you will hear me talk about the concept of story. Stories are our creation of reality. What we tell ourselves about what happened gives what happened meaning. Our stories are our realities. One of my favorite books is “The Power of Story” by Jim Loehr. The entire book is about how we create stories and how we can rewrite our stories when they don’t help us. The best part about our stories is they can be re-written at any time. You don’t have to wait for January 1st, you can begin anytime.

Loehr describes story as “those tales we create and tell ourselves and others, which form the only reality we will ever know in this life”. He argues that since your life is the most important story you can tell, it’s imperative that you get the story “right.”

So how are you going to tell the story of 2011? If horrible things happened to you, what story will you tell yourself and others about what happened? If great things happened, again, what’s the story? Do you see yourself as “lucky”, “unlucky”, “cursed”, “blessed”, “hardworking”, “lazy”? It’s important that you know because how you see yourself and your story will determine how the story plays out in the future.

So I’d like to conclude by borrowing a question from Loehr’s book. He asks “in which important areas of my life is it clear that I cannot achieve my goals with the story I’ve got?” Answering this question honestly will show you what to work on and how to create a story that will take you where you want to go.

Jackie Dotson is the founder of Jackie Dotson, LCSW in Sacramento, CA, as well as the co-host of The Powder Keg of Awesome Podcast.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

Surviving A Slowdown

In your industry, you will find there are times of the year when things get really busy and times when things slow to a crawl, a slow maddening crawl. In my industry, business slows to a crawl in November and December. It happens every year, I can practically set my watch to it, so generally speaking, I can plan around it. However, this year, for a myriad of reasons, dealing with the holiday slowdown has been the most challenging. So a wise friend of mine said, “that’s what you need to write about.”

As all of us in business know, when it slows down, it sucks. Yes, there is something to be said about having the downtime to plan and take some time off, and I will talk more about that another time. But when things get slow, the resistance and the internal “chatter” that can throw anyone off on a good day, just seems to get louder. You may find yourself questioning your “usefulness” to the world. Inertia kicks in. Scientifically speaking, inertia is the resistance of any physical object to a change in its state of motion or rest, or the tendency of an object to resist any change in its motion. When you slow down, your momentum disappears and it gets that much harder to kick back into gear. You know you are under the influence of inertia when you find you have twice the amount of free time that you normally do, yet you seem to get less than half as much done. Inertia sucks up your motivation.

What do you do when things get slow? For starters, don’t panic. When we panic, we end up spinning our wheels and engaging in acts of desperation that don’t serve our businesses in the long-run (Why else do you think Groupon was so popular in 2011? Groupon preys on desperate merchants. I predict it will disappear in 2012). If it’s a time of year when it’s typically quiet, know that the slow down is time-limited and things will pick up soon. Catch up on your favorite Christmas movies and take the dog for longer walks. Do your long-term planning for 2012. Purge your office of old paper, make room for the new.

If you find yourself in a slowdown at a time that is normally not slow, the same rule applies: don’t panic. Revisit your business and marketing plans. What worked in the past, may not be working now. If this is the case, it can be tempting to cry “no fair”, but in reality, business changes are coming more rapidly and more frequently (just ask the television advertising industry). Having the ability to adapt readily is the best skill you can have.

Next, make sure you are surrounding yourself with “yay-sayers”. Another friend shared a brilliant blog post on this very subject just yesterday. I linked to the post because it says what I would say: you’ll never prove your naysayers wrong because naysaying is how they roll. Naysayers are in the business of naysaying, so nothing can be done to change them. It’s amazing how much time and energy we waste trying to prove other people wrong.

Just let them go and focus on “proving your yay-sayers right.” A big part of being successful is realizing and accepting that no one ever builds anything significant alone. So, now is also a good time to let go of the Horatio Alger myths and embrace your yay-sayers.

It has been a challenging year for many of us, one of my most challenging yet. This was the year I got to strip everything down to the basics. I was finally able to let go of what was familiar, yet stifling in my career. Learning to sit with uncertainty, and the fear that comes with actually getting something that you want (that scares you as much as it delights you) were two of the biggest lessons of 2011. There is a great deal of clarity that comes with stripping things down to their basics, and although I can’t say I am sad to leave 2011 behind, I will always be grateful for the lessons that came from getting this clarity.

In 2011, partly by serendipity, partly by being surrounded by great yay-sayers, partly from finally getting out of a comfortable rut, I discovered that I get the biggest charge out of helping people with their business problems: getting business partners to stop fighting, helping individuals get past the blocking beliefs that keep them from taking their business to the next level. I love the dynamics of business and I wholeheartedly believe that small business and startups are the very thing that will take this country out of its current economic stall. This process of discovery was quite painful at times but I am now so excited to be a part of the action and finally be doing what I really love to do!

Stay tuned for a complete update and overhaul of jackiedotson.com in the coming days. 2012 will see a continuation of the Powder Keg of Awesome podcast, as well as this blog.

In 2012, what business problems do you need help with? What do you want to create next year?

Jackie Dotson is the founder of Jackie Dotson, LCSW in Sacramento, CA, as well as the co-host of The Powder Keg of Awesome Podcast.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

December Down Low

I’ve been quiet around here the past couple of weeks, but not because I’ve stopped having anything to say (you know me better than that by now!)

Traditionally this is the time of year when everyone in the psychology/self-help/personal growth field gives their boring and tired tips on how to “cope” and “survive” the holiday season. I don’t do this (nor do I tend to use words like “cope” and “survive” but that’s a whole other post.)

You are all adults. You know by now, better than anyone, that there are some aspects of the holiday season that are fun and exciting and other parts that are downright maddening. The holidays are basically the same every year, there should really be no surprises left by the time you reach legal voting age. You know that relatives who are difficult and argumentative 11 months out of the year are NOT going to become pleasant and charming come December. And you also know, since you’ve been to this rodeo before, what you need to do to maximize your enjoyment and minimize your stress (I’m guessing that going to the mall in the evening on December 23rd won’t do anything to minimize your stress level, unless you happen to own the mall). You do NOT need me to regurgitate boring “tips” such as “stick to a budget” and “eat before you go to a party.”

So in this holiday season, if you eat too much, drink too much, spend too much or too little, dress your pets in silly outfits, SO BE IT. If you find yourself leaning more on your vices this month, SO BE IT. Feeling bad about it is just a waste of time, so be mindful and enjoy indulging in excess. I know I will.

All of that said, I use this time of year (a very slow season in my profession, despite the wholly untrue urban legend that the suicide rate goes up during the holidays) to gear up and retool for the coming year. I’ve been making tons of changes to my business and website and have been spending virtually every waking moment of the past 3-4 weeks on this big change. Stay tuned!

I am also moving my office. I was planning on moving early next year, but due to forces outside of my control, I found myself in need of new digs on the second week in December. Next week I will be moving to bigger, shinier digs only six blocks away from my old office.

So there you have it. Merry Christmas, Happy Chanukah, Happy Winter Solstice and Happy New Year. See you in 2012!

Part 4: Making the Shift…

In parts 1-3 of this series, I explored the road that led me through and away from the traditional medical model of mental health care. I explained, in writing, for the first time, the things I saw that led me to question the conventional wisdom of psychiatry, perhaps in an effort to close this particular chapter of my career.

As I shifted away from seeing life problems as mental disorders, I spent more time looking at what made successful people “go” in the world and I came to the following conclusions as to what are key elements in helping you live a life relatively free of pain and suffering.

Being happy and stable requires a pretty strong foundation. Without a strong foundation, we tend to get blown around very easily by the crap life throws our way. These are three key components that go into having a solid foundation:

1)Having a purpose in life. Of the people I’ve met who are both successful in life and simultaneously happy with their success (there is a distinction), all seemed to have one thing in common: a purpose in life. In Napoleon Hill’s classic works, including “Master Key to Riches” and “the Magic Ladder to Success”, (written in the 1930s), he writes entire chapters on “having definiteness of purpose” and notes that living without a purpose is akin to being a ship without a rudder. Without purpose, life can feel meaningless or pointless, which is a recipe for acquiring an illness or disorder to give your life some meaning. Doing nothing is always a recipe for entropy. Nature endorses action. If you have something and do not use it, it atrophies, much like the muscles in a broken leg when it’s in a cast. Hill wisely points out as well that only you can decide what your “purpose” is, that adopting someone else’s purpose is a sure way to fail.

What is your purpose?

2)Having grounded relationships. Humans are social creatures that historically have always lived in tribes of some form or another. Even though some of us are introverted and others are extroverted, we all need relationships. Those who claim they do not need relationships are just making a vain effort to protect themselves from getting hurt. But it’s not enough to just have superficial contacts with people in proximity or live by your Facebook friend count or number of Twitter followers. The key is in having grounded relationships, whether they’re “online or “offline” (yes I believe online relationships “count”), ones that exist without the high drama that should exist only in soap operas. Making drama, also known as “crazymaking” is a form of resistance and avoidance.

Are there areas in your life where you are just making drama to avoid dealing with what’s really going on?

3)Recognizing that daily living is both cyclical and rhythmic. The downside to living in an open-all-night world is it can be hard to know when to switch off. We tend to jump from activity to activity without stopping to take a real break. Looking back to well over 100 years ago, we didn’t have electricity, so we were forced to hunker down and go to sleep when it got dark out. Nature has far fewer methods of forcing us to rest now. Sadly for many people, getting sick and crashing is pretty much the only way nature can still make it’s point that we are not machines.

The constant push to keep going and do more, more, more, leads us to make lousy choices from moment to moment. By lousy choices, I mean things like: skipping out on sleep, grabbing fast food frequently because it’s fast and easy, relying on caffeine to keep going and then switching to booze in an effort to calm down. It’s one thing to do this stuff occasionally, but in the long run, it contributes to major physical and emotional breakdowns. When we cannot see or feel the consequences in the now, there tends to not be any incentive to not do what harms you.

Sustainable energy does not come out of a can. In order to make effective use of energy, we need to expend it and renew it in a regular fashion. You can’t work 14 hours a day every day and expect to keep up that pace without crashing. It is much more efficient to work for a while and rest for a while than crash to the point where you have to sleep 12 hours straight just to achieve minimal recovery. It’s one thing to sprint. Sprinting can be fun, and in business it’s sometimes necessary. Sprinting is also addictive, because it can make you feel like you have a purpose. However, moving frenetically through life is not actually a purpose, it is the illusion of purpose. This is why it is important to play and rest as hard as you work. Taking time to renew, unplug and experience fun helps foster creativity and, you guessed it, grounded relationships.

When I am trying to learn something new or improve upon something, I am a big fan of getting back to basics, keeping it simple. When I became interested in learning more about the habits I was seeing in successful people, I began to review what is referred to as “success literature”. I’ve literally read hundreds of books over the past decade. But, since I am not a fan of “new agey” literature or “pop psychology,” I made a point to go right back to the earliest sources of success literature. I am continually floored by how relevant Napoleon Hill’s work is to modern living and how, by following the practical advice given in his books, you can avoid most of the malaise, anxiety, angst and depression that is so prevalent in today’s world. His principles worked for people like Andrew Carnegie and Henry Ford! There is no way I could ignore guidance that worked well for so many of our great thinkers and leaders.

So through this very long, informative journey, I now see that there is a way to make progress and improvement in your life and world without resorting to mediocre tactics and systems that are really designed to keep you stuck in your status quo (so that you keep coming back for more groups, more refills, more made-up labels).

Author Steven Pressfield calls this the difference between being an amateur and “going pro”. So I ask, would you rather be a person with a purpose, making things go in the world or one who gets meaning through being sick and stuck?

Jackie Dotson is the founder of Jackie Dotson, LCSW in Sacramento, CA, as well as the co-host of The Powder Keg of Awesome Podcast.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

Leaving the Medical Model: Part 3

In parts 1 and 2 of this series, I examined the relationship between the medical model of mental health care and the pharmaceutical companies, highlighting how the demand for medication, driven by direct to consumer advertising of medication, influences the committees who write the manual of mental disorders. There is incentive to create more disorders so more medication can be sold to treat these disorders. It forms a very symbiotic relationship. The drug companies need the doctors in clinics and hospitals to prescribe the medication, and the hospitals and clinics need patients to demand the services.

This removes the incentive for the patients/clients/consumers to actually get better and stay better. When someone’s problems and symptoms resolve, in theory there is no more need for medication, hospitalization or outpatient visits, which begs the question, how, then does the industry generate repeat business?

Several years ago, while working in an outpatient program, I started to wonder why, in spite of more advanced treatment and the so-called “better” and more varied medications, the number of people seeking services and the number of people taking medication was increasing at a rapid rate. As I mentioned in Part 2, according to the CDC, rates of antidepressant use have increased an astounding 400% in just 15 years.”

A study released by Stony Brook University evaluated hospitalization rates from 1996-2007. “The data showed that hospitalization rates increased the most for children ages 5-12, going from 155 per 100,000 children in 1996 to 283 per 100,000 children in 2007. Among teens, the rate increased from 683 to 969 per 100,000. Among adults, the rate increased from 921 to 995 per 100,000. By contrast, the rate declined among the elderly, going from 977 to 807 per 100,000.” This increase happened during a time when the number of available psychiatric beds actually declined as well as lengths of stay.

Any number of reasons can be attributed to this increase, including, but not limited to: the belief that there is less stigma attached to asking for help; the bad economy causing increases in stress levels; a belief that taking psychiatric medications has the unintended effect of exacerbating the symptoms they are designed to treat (e.g.: anti-depressants have been documented to cause suicidal behavior as well as the “manic” episodes seen in bipolar disorder); the belief that problems of daily life are now seen as mental disorders and are being diverted to the mental health care system to address. I think all of these examples are contributing to the increase in hospitalizations, in some form.

I have major reservations with the notion of psychiatric hospitalization, except in very extreme cases where someone is posing a serious risk to themselves or others. I found, through working in an outpatient setting (where most patients came from the hospital) that people often come to identify with being a “patient” after spending a few days in such a facility. The danger in this is, instead of seeing themselves as someone going through a difficult time and needing help, they come to identify themselves as being a sick person. I’ve talked with parents who complained that their teenagers, after a hospitalization, learned new destructive behaviors (such as self-mutilation) from being in the hospital, and also learned to get their needs met from acting out of control and setting up a cycle of re-hospitalization.

In the back of my mind, I could not stop thinking that there had to be a better way to approach the very real problems people today face, without turning them into lifelong patients. I did not like working in outpatient programs, where patients would come through, spend a couple of weeks, supposedly learning new skills and behaviors, only to cycle back a few months later, not applying the new knowledge. This was not how I wanted to spend my career. I knew shifting the focus away from that of the concept of having a disorder would be a key component.

Ironically, it was from spending time in my career away from the psychiatric system of care, that I was able to more clearly see what helped people function well in the world and ways that I could be helpful to others who were going through hard times without having to “medicalize” their problems.

About five years ago, I started to become active in the local business community through several organizations. I met a lot of people, made many new friends and colleagues. I noticed I was meeting a lot of people who were doing really well in their personal and professional lives (and also some people here and there who were not doing so well). So I set out to both see what made these people tick and how I could incorporate this knowledge in my work with my clients. I learned a lot of great stuff, which I will explore in greater detail in part four.

In Part Four, I will look at ways of labeling and perceiving life problems; habits happier people have; and ways to deal with the problems that you come across every day that won’t require you to be in long-term treatment.

Jackie Dotson is the founder of Jackie Dotson, LCSW in Sacramento, CA, as well as the co-host of The Powder Keg of Awesome Podcast.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

Leaving Behind the Medical Model: Part 2

In part one of this series, I wrote about the medical model of mental health treatment. I was trained in this model and I do not think it is truly effective for dealing with the very real problems people face today. Anxiety and depression have been defined and marketed as mental disorders instead of human reactions to very real problems. This does a huge disservice to people who want to learn to cope better with their problems but do not want to be labeled or made a lifelong patient of mental health services.

Over the past several years, I’ve seen many people’s lives turned completely upside down by severe stressors. The unemployment rate is high right now. The foreclosure rate on homes remains high. People who are employed find they are dealing with having to work longer hours for less pay and in more volatile working conditions as employers continually try to get more productivity out of fewer workers. Many people live with the stress of knowing they could be laid off at any moment.

When faced with these problems, it is normal for humans to feel sad and cry, have trouble sleeping, be angry and anxious. We do not need to “medicalize” these problems in order to be of service. I believe it is possible to help people without making their stressors into mental “disorders.”

For six years, I worked as a crisis clinician in emergency rooms, seeing patients with psychiatric emergencies (suicidal overdoses, psychotic episodes, depression, anxiety attacks). I was an independent contractor, which meant I was not an employee of and had no financial ties to any psychiatric hospitals, so I was under no pressure or demand to send patients to a particular facility if they needed hospitalization.

One evening, I was called to see a woman who came in with her chief complaint being “my meds aren’t working.” (a common presenting complaint in the ER). I sat down to talk to her and I learned that she recently lost her job and left her abusive husband. She had no place to live and was staying temporarily with various friends. She complained that her husband was making threats against her and she feared for her safety. She said she was anxious and crying all the time and unable to sleep, drinking more alcohol than usual.

I told her, “you just told me you have no place to live, no source of income, and you feel unsafe because your ex-husband is threatening you. It’s not surprising you are not sleeping, anxious and crying, because nothing in your world is safe right now.” She looked at me, started to cry and said, “I never thought of it that way before.”

Together we worked on some basic plans to increase her level of safety and it turns out she had more social support than she initially realized which is not unusual because it can be very difficult to see your options when you are hitting bottom. She did not need to be hospitalized. Not every human problem needs a psychiatric solution.

Even though this happened years ago, I remember this woman vividly because this assessment caused things to really hit home for me: we’ve trained ourselves rely on the medical model and believe that medication can make everything better, without having to change behaviors or undesirable situations.

This phenomenon is not limited to the realm of psychiatry. You see this with medical illnesses as well. I’ve met several people who told me “I can eat as much meat as I want to because I take cholesterol-lowering medication.” In other words, it’s easier to just take the pills than make conscious choices about your diet.

I recognize that not all medication is “bad” and that is not the argument I am, trying to make. There are a lot of medications out there that save lives and improve lives. I understand that many people take psychiatric medication and find it helpful. In these circumstances, if the action you take works well and helps you get better, why not keep doing it? I would also be willing to guess that if the medication is helping, you are probably also doing other things in life (such as exercise, getting enough sleep, avoiding bad relationships) that are helping you feel better as well.

When figuring out how to best get help, I think doing a cost-benefit analysis (potential benefits vs side effects) is essential and I also think that too many people reach for the medication as a first option, thinking it will be a panacea, without doing anything to change the habits that are contributing to their problems. As a clinician, I find this extremely frustrating and I recognize that the medical model of treatment often reinforces this way of thinking and approaching problems.

According to a recent article in Psychiatric Times, “a new CDC study based on a large survey of the general population reveals the following alarming results: Rates of antidepressant use continue to escalate, a remarkable 11% of the general population now takes an antidepressant. Antidepressants are now the third most prescribed class of medications in the US- and are first in the 18-44 age group. Rates of antidepressant use have increased an astounding 400% in just 15 years.”

The article goes on to look at the role pharmaceutical advertising, “loose prescribing” and what the author calls “the medicalization of normality”, plays in this dramatic increase. I like the description, “medicalization of normality” because, as I mentioned earlier where problems are turned into disorders, medication can be sold to “treat” these disorders.

We are bombarded with pharmaceutical advertising in magazines and on TV. As a result, clients have come to expect to be given a pill whenever they go to a doctor with a problem because they’ve seen it on TV. Clients will often demand to be given a specific medication because they saw the ad on television and thus claim to “know” it is the right course of action because they saw “the butterfly” or the “sad pill under the cloud”.

As a therapist and a consumer, I object to this practice because it suggest we just throw pills at a problem instead of asking the patient and medical professional address the real reasons causing the problem. This takes longer and requires more work, which is why people reach for the quick fix. I also object to it because it causes people to demand medication that may not be appropriate for them in the first place which puts pressure on their doctors.

I have a tremendous deal of criticism and frustration towards the pharmaceutical industry for their aggressive and misleading marketing tactics. I do not believe drug advertising should be allowed on television and in print. In fact, the United States is only one of just two nations in the entire world that allow direct-to-consumer drug advertising (New Zealand is the other). Psychiatric medication is very profitable for the drug companies, so they are aggressive in their campaigns to sell more of it.

In his book, the War of Art, author Steven Pressfield talks about his days as an advertising copywriter. When he worked at ad agencies, they were told by drug companies to “invent a disease and we will sell the cure.” He makes the argument that a lot of so-called diseases (especially the “checklist” based diseases that have no definitive scientific test) are really just marketing ploys created by advertising agencies.

In Part 3, I will look at how being labeled with a disorder and as a patient can keep people stuck and how the system does not benefit from it’s patients getting better. I also look at alternative options for those who want help, but don’t want to be a lifelong patient in the mental health care system.

Jackie Dotson is the founder of Jackie Dotson, LCSW in Sacramento, CA, as well as the co-host of The Powder Keg of Awesome Podcast.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

Leaving Behind the “Medical Model”: Part I

Recently, a few people have asked me how I came to break with the traditional medical model of therapy, so I decided to write a series of blog posts on how I came to my conclusions because it has taken me many years to arrive at these conclusions. First, a bit of background: I’ve been working as a therapist since 1999 and in the mental health field since 1996, over 15 years now. Through my schooling and post-graduate experience I was trained in the so-called “medical model” of treatment. I worked in outpatient clinics, day treatment programs and hospitals where the medical model was, and still is, the gold standard of mental health treatment.

The problem is, the medical model of treatment never made sense to me because I felt it “medicalized” common problems and made patients out of people instead of helping people resolve their problems. I understand and support the need for intensive and supportive community treatment models for severely disabled patients. But setting aside this small percentage of the population, I do not think the medical model works well for most problems. So it’s not surprising that even though I was always good at what I did, I never really felt comfortable with how I was asked to do it.

How is the medical model of mental health treatment set up anyway?

Generally speaking, in most outpatient settings, it works like this: first you set up an “intake” appointment with either a psychiatrist or therapist or in some places, with both.

At the intake appointment, the therapist or psychiatrist will ask you a lot of pointed questions about your “symptoms”. In the medical model, the goal is not to get to know you as a whole person with a complex set of issues. Rather, the goal is to reduce your concerns to a list of neatly categorized symptoms. If you have “enough” symptoms that match the checklists, then, congratulations, you’ve been diagnosed with a “mental disorder”, one that is conveniently listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders).

The doctor will then likely offer you a prescription or two for medication to address your symptoms and the therapist will offer you therapy to “work on your issues.” Some clinics will enroll you in “classes” to teach you about your disorder. That’s a broad description of how intake works.

Let’s say for example you’ve lost a loved one and you’re having a hard time getting back on your feet and need some help learning how to get used to living without this person. You may be having trouble sleeping or find yourself isolating from friends. If your “symptoms” match the ones on the checklist, you get labeled with a mental disorder, instead of acknowledging that you are going through a very painful, but common life stress. (I, for one, do not believe that grief is a mental disorder). If you do not have “enough” symptoms, then they will tell you that you do not “meet criteria” and thus do not qualify for help in their particular setting because insurance will not pay for treatment if there is no DSM diagnosis. In a nutshell: no diagnosis, no treatment (unless you are paying out of pocket).

The symptom checklists in the DSM IV that clinicians use to make diagnoses are just that, checklists. There are no scientific tests to prove their validity; they are simply checklists of commonly observed symptoms, symptoms that are made up by and voted on by the committees that work on the DSM.

To give you an example of a symptom checklist, I use, as an example, what I consider to be the most laughable “disorder” in the DSM: “Oppositional Defiant Disorder”, a diagnosis commonly given to adolescents. The DSM defines it as a “pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, where 4 or more of the following symptoms are present”:

“1) Often loses temper 
(2) often argues with adults 
(3) often actively defies or refuses to comply with adults’ requests or rules 
(4) often deliberately annoys people 
(5) often blames others for his or her mistakes or misbehavior 
(6) is often touchy or easily annoyed by others 
(7) is often angry and resentful 
(8) is often spiteful or vindictive”

Yes, that describes pretty much every child or teenager at one time or another. I know I met all of these “criteria” during my teen years. This is a checklist, there is no scientific test to prove this is actual “illness” but a DSM committee decided that it is. If the DSM says an illness is an illness, then it must be an illness, right? Wrong.

The DSM once considered homosexuality to be a mental disorder, and it was listed in the manual, with its very own symptom checklist much like the one above. Caving to social pressures, the DSM committee removed homosexuality from the DSM in 1973, replacing it with another illness called “ego-dystonic homosexuality” which was eventually removed from the manual in 1987. It seems pretty ludicrous today.

The DSM is subjective, vague and, has been dead wrong in the past about what they believed to be “illnesses”. It is also written and edited by doctors, many of who have financial ties to the pharmaceutical industry. I no longer use the DSM in my practice for these reasons.

A study published in 2006, by Tufts University, concluded that of the 170 panel members who created the DSM-IV, 95 (56%) had one or more financial ties to pharmaceutical companies. 100% of the members who worked on the mood disorder panel (depression, bipolar) and schizophrenia/psychosis panel had financial ties to drug companies.

In doing my research, I also learned that the FDA will not approve a drug to treat a mental illness unless the condition is listed in the DSM. In the first DSM, published in 1952, there were 106 defined mental disorders. In the latest edition, the DSM-IV, published in 1994, there were 297 mental disorders. It is not surprising that the number has increased so dramatically, as they need to invent disorders with each revision, in order keep up with the new medications.

The next edition, the DSM-5, is scheduled for publication in May 2013. At this time it is unclear how many disorders will be included. However, there will be a new diagnosis for children, “Disruptive Mood Dysregulation Disorder”, known in layman’s terms as a “temper tantrum”. Yes, the powers that be have officially made a normal developmental part of being a child into a mental disorder.

We now know when something is officially christened a “disorder” then the drug companies have permission to create, market and sell medication to treat it. See how that works?

In part two of this series, I will address how drug company marketing and advertising influences mainstream psychiatry as well as how “medicalizing” the very real stressors people face today does not help them resolve their problems.

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.

Enjoy the Silence

(Today’s apologies go directly to Depeche Mode)

I was involved in a discussion this morning with some great folks in my business development group. I really love this group because the business topics we riff on are not the run of the mill “10 ways to generate customers” types of topics. In our meetings, we get real and explore topics you don’t normally get to discuss in your average business or networking meeting.

Today we talked about having a “fear of free time”, of not knowing what to do with yourself during gaps and lulls in your day when things get quiet. Most of us treat silence as a vacuum that needs filling, after all, nature abhors a vacuum, right?

What happens during those silent times that scares the crap out of you so much? Silence gives us space to think about things, which can be very intimidating. During quiet times, we tend to start thinking about things we don’t want to think about, maybe hurts from the past or situations in the present that we need to confront but wish we could ignore. Sometimes silence gets us thinking about what we really want in life, which is incredibly frightening to most people, as counterintuitive as that may seem. It’s frightening because there focusing on what you really want to do and have is admitting to yourself that you are not “there” yet and the gap between what you have and what you want can be intimidating.

Silence also gives resistance more of a chance to speak up. Although resistance seems to shout loudly over any activity, it gets big during quiet times. As I’ve written about before, we tend to quell resistance by creating drama and busywork, just like how we quell silence with noise and busyness.

Culture also plays a big role in our need to fill the voids. Being busy, having a full schedule, being on the go is seen as honorable and is rewarded in work environments. Taking downtime, napping, meditating, daydreaming is seen as a form of laziness, which is unfortunate because those are some of the best places that energy and ideas come from.

Right now, take 15 seconds. Stop reading. Mute your music. Close your eyes and just sit there. Okay, what was that like? Uncomfortable? What did your head use to fill the space? Chatter? A mental to-do list, perhaps? The voice that shoulds? Was it easy or hard to sit there? Take note of what came up.

If you are used to always filling the free space in your life with noise and activity, it is going to be very difficult at first learning how to tolerate it. You may only be able to take a few seconds or minutes here or there. That’s okay. There is no right or wrong way to teach yourself how to dial down a bit. Putting pressure on yourself to “do it right” will just make things worse.

You may be asking, why do I want to subject myself to this if it’s so damn uncomfortable? What’s in it for me?

Being able to tolerate silence and downtime is a killer skill to have in your pocket. For one, it keeps you more level-headed. Have you ever been in a tense discussion where all of a sudden neither party is talking? It’s during that period of dead air that you’re more likely to blurt out anything in order to fill the empty space. This could cause you to lose power in a business negotiation or disclose something about yourself that you were not quite ready to say. In short, being able to tolerate the silence can go a long way in protecting your personal power.

Silence spurs creativity. Ideas do materialize out of thin air, but not typically when you are going a mile a minute, doing anything and everything to stay busy. Getting quiet gives dormant ideas and insights a chance to rise up.

Tolerating silence, dare I say it, builds maturity. We’ve established that, during downtime, we often start thinking about things we’d prefer to avoid. Being able to look at that stuff and begin to take action on it takes a lot of courage. Being able to feel uncomfortable, scared and even panicky, without rushing to stop it helps you grow. In fact you will not grow until you face the uncomfortable, so any action you take to build this mental muscle will serve you.

So, in summary, being able to tolerate silence will go a long way in helping you make stuff go in your life. I find this a bit ironic, because “type A” people who love to make stuff go in the world typically struggle the most with this.

What are some of your beliefs and attitudes towards things like free time, dead silence, and “downtime”? Would it be possible for you to re-examine some of these attitudes so you can use silence to help you get more from your life?

Engage with Jackie on Twitter: @jackiedotson or on Facebook: www.facebook.com/Jackie.Dotson.LCSW.