Tuesday, November 6, 2012

Living with a Disability part 3

I talked some in the last post about the unwanted gift that we receive when we have a disability. The gift is that we can see the world from a very different perspective. Having been born with what many might consider a minor disability, the absence of a left hand, I still am aware that I look at things around disability in a very different way than more “able-bodied” friends. First of all, I was aware growing up that adults may be more uncomfortable than children with a disability. Children just seem to be curious. The questions about how I was different and why I was different. But it was more difficult for me to deal with the same questions from older children or adults. Their questions bothered me. At times I felt ashamed. Obviously, I shouldn’t have, since I had nothing to do with having one hand. As an adult and as a psychologist, I am aware that the way we deal with young children about difference has a lot to do with the attitudes and behaviors that they eventually develop around people who are different. It often starts with attempts by adults to hush young children and keep them from asking questions so that they will be polite and not rude. The message that we convey when we do this with our children is that there is something wrong about the difference that shouldn’t be talked about. There is something wrong with the person who has the difference, and if we talk about it, it will embarrass the person. Children are also often taught to feel sorry for the “disabled person” and to thank God that they are not like them. It doesn’t take long to understand why they develop the attitudes and behaviors that they eventually exhibit as older children and adults. This early training as a child contributes to many adults feeling uncomfortable around people with physical difference and encourages adults to avoid interactions or close relationships with persons with a disability. I've often felt over the years that many people did not really want to get to know me very well because of the physical difference and that many adults kept me in a category separate from the one they placed themselves in. Unfortunately, this behavior only increases their distance from people who are different and encourages segregation and discrimination. Lack of integration contributes to a lack of understanding and awareness which contributes to accessible bathrooms not really being accessible, to ramps being too steep and therefore dangerous and not accessible, etc. On the other end of the continuum, this uneasiness can lead to systematic efforts to extinguish difference. As a disabled person, I am aware that the Nazis came for those with physical differences and disabilities before they came for the Jews or the Gypsies. I am still waiting for someone to erect a monument to the million-plus physically different folks who perished in the Holocaust. Dealing with other people’s attitudes and stuff about physical difference, my physical difference, always seemed to me to be the most unfair thing about being a person with a disability. Learning how to tie your shoes with one hand is hard enough. But I think I finally realized over the years that to deal very well with my own stuff, my anger, shame, etc., with my physical difference requires that I deal with other people’s curiosity and uneasiness about it. Obviously, much easier said than done. Ron Breazeale via Psychology Today

Living with a Disability Part 2

So what constitutes a disability? Having been born without a left hand, I remember that it took me a number of years to feel that it was okay to be just as angry over that as was the individual who had lost the use of his legs through a car accident. Relatively speaking, my loss was less than his, but my anger was often no less intense. So to answer the question - What constitutes a disability? - is a relative matter. Obviously, being born or acquiring a disability can, to say the least, have a major impact on your life.It can shape or reshape the way in which you look at yourself and the way in which you relate to others. Managing a disability is a time-consuming process. It often places you in a dependent role with others. It is, by definition, frustrating. It can limit your life in many ways. It can close doors. But as they say, it can also open new ones. One of the new ones is the ability to see things from a very different perspective. In considering my own experience with what many might consider a minor disability, the absence of a left hand, I have sometimes struggled with a question of ‘where do I fit?’ I am clearly not able-bodied. No, the military agreed and didn’t send me to Vietnam. Of course, I really do not understand what it would be like to have two hands. The world is set up for people who have two hands. Everything from tying your shoes to opening most containers assumes that you have good use of both hands. But what am I complaining about? I can walk upstairs, I can drive a car, etc. And so the debate has always gone. Inside of me, at least. But I do know that I share a lot in common with other people who have a disability. I certainly feel the same about many issues. For example, I know that I am different and a minority in most settings. I was the only kid in my hometown with one hand. Like most persons with a disability, I have been questioned all my life as to why I'm different. Although I've gotten more comfortable with this over the years, I’ve never quite gotten used to it. As a child, I used to avoid these questions and looks by hiding my difference, e.g., putting my deformed hand into my left pocket. We’ll talk more in the next post about this unwanted gift that we receive with a disability. Looking at things from a different perspective. Ron Breazeale via Psychology Today

Living with a Disability

As we all know, life has no shortage of personal challenges and disasters, some relatively small, such as a minor accident, some major, such as a serious illness or disability. As we have discussed in this blog, resilience is the ability to manage adversity in your life, to bounce back. It is not a trait. It is not inherited. Research shows that it is a set of skills and attitudes that create mental toughness. These skills and attitudes can be learned and applied. Just as we have learned that reinforcing a bridge may make it stronger and less likely to be washed away by a flood, we know that reinforcing an individual’s coping skills, their resilience, can make it less likely that they will be overwhelmed, washed away, in the same flood. Acquiring a disability could very much feel like being caught in a flood. A flood of emotions, a flood of changes, a new life in many ways for you and those close to you. The landscape that is left afterwards may appear just as desolate as one that has been ravaged by a hurricane. Those who cope well with disability, who bounce back, quickly learn the skills and the attitudes that we are talking about. They end up knowing more about resilience than the average person. We have used persons with a disability to teach these skills and attitudes of resilience to more “able-bodied” individuals. The Maine Resilience Program was developed by persons with a disability and provides assistance to others in the community, including first responders, in helping them to develop and maintain these skills and attitudes. In this blog and the next, I will talk more about disability and resilience. I developed a program a number of years ago that focuses on the skills and the abilities required to live with a disability. The title of the publication was Living with a Disability: An Owner’s Manual. My goal then and now is to provide the information, skills and resources that are needed to succeed. The program doesn’t offer answers. But it does offer a process that I think can be effective. Living with a Disability, like other publications that have been written about disability, is similar to a driver’s manual. It doesn’t matter what kind of a car or van you drive, there are simply some general rules and principles that apply. To learn and refine the skills of resilience, you must practice them. Living with a Disability provides basic information about a variety of issues and problems that you will face as a person with a disability. You need to become an expert on your disability. If you use Living with a Disability or another publication similar to it as a resource, you will need to reread and discuss with family, friends and healthcare providers the information that it provides. And most of all, you will need to find ways to practice the skills and attitudes in your life on a daily basis. We have also been developing a serious game called “Bounce Back” which allows a person to practice these skills and attitudes. I will talk more about that in later posts. If you would like to learn more about the publication, Living with a Disability or to purchase a copy, you may do this by going to: abilitycoach.com. In the next post, I will talk more about what constitutes a disability and about my own experience of having a disability. Ron Breazeale via Psychology Today

"Positive Reframing" as optimistic thinking

(Guest Blogger Talya Steinberg, Psy.D) Optimistic thinking is a resiliency skill that helps people to overcome adversity and reach life goals. Remember the old metaphor “Is the glass is half-full or half-empty?” This is a perfect example of how the same event can be looked at in a positive or negative light. Positive reframing means trying to reconsider things in a positive light, and it is a powerful way to transform your thinking. Here’s an example of positive reframing that I really love. A woman was new to a large company and was trying very hard to make a good impression on her coworkers. One day, responding to a widely sent email, she accidentally attached a personal document about her financial difficulties instead of the intended form. Realizing the mistake to her chagrin, she quickly sent out a new email with the message “…Well at least it wasn’t a love letter ;)” Her coworkers got a kick out of her response, and an event that could have caused her to look unprofessional actually improved her coworkers’ opinions of her. Positive reframing does not change the situation, but it can certainly reduce damage and put things into a healthier perspective. Therapists use it frequently as a technique to restructure cognitions. When done skillfully with humor, it can be a wonderful tension de-fuser. Try it and see how a well-placed positive reframe can make a difference in a difficult situation. Dr. Talya Steinberg received her doctorate in Clinical Psychology in 2011 and is completing her postdoctoral training in Portland, Maine. She endorses positive psychology principles and teaches resiliency skills with Dr. Breazeale.

Smoking Yourself to Death

I have a number of clients who continue to smoke. Over the years, I have seen patients give up smoking over and over again. I certainly believe the research that says nicotine is an extremely addictive drug in the category with such drugs as cocaine. A number of my clients have given up smoking in response to developing medical conditions related to their “habit.” One client, however, that I have worked with for many years who has a chronic mental illness has, in the last few years, developed chronic obstructive pulmonary disease and has had a number of hospitalizations. He has been told by me and by his physicians that the next time he develops pneumonia and enters the hospital, he may not leave. But does such a “scare ‘em” approach really raise their awareness of the need for change since, if you believe in the stages of change, consciousness raising is one of the processes that you need to use to move people from precontemplation, not thinking about making a change into contemplation, actually thinking about and weighing the pros and the cons of changing. This effort on my part and the part of other medical providers seems to have made my client more fearful regarding the possibility of dying and more willing to “cut down” and to at least consider stopping. But he is not the third stage of change. He has not made a decision to stop, although he is more concerned and there is more dissonance which he is aware of between engaging in behavior (smoking) that may end his life and wanting to live. It would therefore seem that “working” the dissonance is a process of change that myself and the other medical providers seeing him should continue to emphasize. Until he makes the decision to stop, we will continue to provide empathy, offer support and point out that once he makes the decision, there are a number of things that can be provided for him to help him implement the decision, such as “the patch,” medications, group support, etc. We will also continue helping organize his life better and make only commitments that he can follow through with. But we cannot make the commitment for him. Unfortunately, for this person, like for many chronic smokers, smoking may be one of the few really pleasurable activities that they engage in on a daily basis. Helping him to find other activities that give him pleasure may help him to finally make the commitment that he needs to stop. As of this date, unfortunately, he continues to smoke. Ron Breazeale via Psychology Today

Out of Tragedy, a Good Life

As a woman who has accomplished such prestige and power in her career, United States Senator Olympia Stone is worthy of great veneration. However, to learn about the adversities that she has overcome to get there makes her story all the more inspiring. In her recent column in The New York Times, Ms. Snow recounted how her immigrant parents died before she was 10 years old and she was raised by her aunt who struggled on her own to support Ms. Snow and her five cousins. Well-acquainted with the virtues of hard work through hardships, Ms. Snow dreamed of making her way up the ranks into Washington one day and improving the lives of others. She majored in political science, married a man in the Maine House of Representatives, and worked in local politics in Maine. Her life was going well, albeit different from her original dreams of going to Washington, when tragedy struck again. At the young age of 26 her husband was killed unexpectedly in a car accident. Ms. Snow’s story is a testament to how some people now only cope with adversity, but actually find meaning and purpose through it. According to Ms. Snow, she realized early on that it was her choice whether to become overwhelmed by tragedies or learn from them, and she knew that by having choice, she had power. She viewed setbacks as temporary, not permanent, and had an enduring sense of faith. Finally, she had family and strong social support. In the midst of her emotional turmoil as she grieved her husband’s death, Ms. Snow’s friends and political leaders began to urge her to run in the special election for his seat. She recounted in her column that such a perilous personal juncture could have been the end of her, but she realized that this was an opportunity for her to make something positive out of a tragedy. She ran for the election and won, and the rest is history. Ms. Snow faced a number of losses and hardships in her life, but through them had the courage and the faith to carry on toward her dreams. She reminds us of an important lesson: it is not a question of whether you will encounter difficulties in your life; it’s really a question of how you confront them. (Olympia J. Snowe is a Republican Senator from Maine. Referenced from The Portland Daily Sun, June 9, 2012.) Bio Note: Dr. Talya Steinberg received her doctorate in Clinical Psychology in 2011 and is completing her postdoctoral training in Portland, Maine. She endorses positive psychology principles and teaches resiliency skills with Dr. Breazeale. Ron Breazeale via Psychology Today

Healthy Behaviors Strengthen Willpower

I'm sure it is not news to anyone that we are in the midst of a public health crisis in this country. And the major culprit in that health crisis is the failure of the American people to engage in a consistent fashion in healthy behaviors. Poor diet and lack of regular exercise have created the health crisis. The percentage of Americans who are overweight and obese has skyrocketed and with that an epidemic of cardiovascular problems and other disorders which, in large part, are preventable. The adversity that we are facing many would say is self-induced. So what role does willpower play in all of this? Research would support the idea that limited willpower is a primary roadblock to maintaining a healthy weight. This is especially true with children, with some of the research from the University of Pennsylvania suggesting that children with better self-control were less likely to become overweight as they transitioned to adolescence. As we have discussed in previous blogs, the role of willpower depletion may also play a major role here. We live in a society that tempts us many times each day with food and drink. We often end up in situations where we have unlimited choices about what to eat or drink. As in the previous blog, money and financial resources play a role. Fresh produce costs more than those in a can of junk food. So one might expect that by the end of the day, after being tempted repeatedly, our willpower may be sagging. The extra helping of lasagna or a dessert after dinner may look very attractive. Some research has suggested that willpower depletion may be even more important than bad moods in contributing to our overeating and other bad choices we make regarding food. As indicated in a previous blog (4/12/12), our beliefs and our attitudes may buffer us to some degree from the effects of willpower depletion. If we believe strongly in the concept of self-control and the importance of maintaining a strict diet, perhaps because we might die prematurely if we do not, we may be more likely to be less affected by willpower depletion. So what can be done with the knowledge that we have gained regarding willpower depletion and the issue of overeating and obesity? Overeating behaviors are certainly complex, with numerous psychological and neurological underpinnings. Many believe that stressing self-control and personal choice will stigmatize people with weight problems and make it unlikely that they will be motivated to lose weight. And, indeed, it is the environment that we live in that constantly bombards us with ads for fast food and relatively cheap processed meals. And we are bombarded with these messages 24 hours a day, 7 days a week. Willpower depletion appears to also play a role in the abuse of other substances, such as tobacco, alcohol and illicit drugs. In one study, social drinkers who exercised self-control in a lab setting went on to drink more alcohol in a supposed “taste test” than subjects who didn’t previously dip into their willpower pool. Other studies have supported these findings. Exercising willpower in one setting may undermine our ability to resist temptation in another, perhaps unrelated area of our life. These issues are complex, and as the old saying goes, “More research is needed.” But at this point, it appears clear that willpower plays a role in overeating and our inability to stick with a diet. Willpower depletion caused by an environment in which we are constantly tempted may be the major villain in this story. It is also clear that learning the skills and the attitudes of self-control at an early age may help us in later years to make better choices regarding exercise, diet and the abuse of substances. For more information on willpower and the studies that were discussed in this blog, go to the American Psychological Association. “What You Need to Know about Willpower, the Psychological Science of Self-control,” written by Kirsten Weir, www.apahelpcenter.org. Ron Breazeale via Psychology Today

Drug Addiction

I'm sure we are all aware of the problem that our society faces because of drug addiction. In New England, and specifically in Maine, addiction to prescription medications is a major problem. If you accept the Stages of Change Model and apply it to drug addiction, whether it be nicotine, as we discussed in a previous blog, or oxycodone, motivating the addict to make a decision to change their behavior is key. Motivational interventions have changed over the years. In the old days, the primary mode of intervention with drug addicts was often confrontation. Today it is more collaborative rather than confrontational and often begins with the current concerns of the individual addict and evaluation of their readiness for change. Connecting the motivational intervention to the core values of the individual requires that you understand what those core values are. Being ready, willing and able to change requires personal strength and self-control. As DiClementi pointed out in a recent workshop I attended, this may be what people mean when they talk about the strength of character and willpower. As I have pointed out in previous blogs, self-control is not a limitless resource and must be conserved. It can be increased and strengthened by exercise of self-control, but these gains need time to be consolidated. Working with someone with an addiction problem requires considerable patience. Offering empathy, hope and support is just as essential with someone abusing prescription drug as it is with someone attempting to stop smoking. Working the dissonance between the life a person is leading and the life the person would like to lead is also now an important part of motivating change in the addict. It is also important to consider the situational resources and problems that a person brings to the table. This obviously involves looking carefully at the interpersonal resources and support that they have and the problem relationships in which they are engaged. Families can facilitate recovery or be a major hindrance in the recovery process. This is also true for what people think and believe. Understanding what people have learned about themselves and the world and who they learned that from, e.g., who their role models are and have been, is another part of the process of helping people to recover from an addiction that may one day kill them. Considering the context in which they are trying to make the change is just as important as understanding the stage they are at in this change process. Persons with a strong addiction do not change because they want to, but because they are motivated to want to. For those of you who are working with individuals who are attempting to change or for those of you who are attempting to make changes in your life, whether it is giving up an addiction or a really bad habit, I would encourage you to take a look at Changepowr! by Meg Selig. This book was recently published and received very good reviews by James Prochaska, one of the authors of the Stages of Change Model, and others, myself included. It looks in some detail at the stages and processes of change and provides specific activities and exercises that make the processes of change much more understandable and easier to apply. Ron Breazeale via Psychology Today