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Learning From The Loss Of Robin Williams

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Ron Henry/Flickr/Creative Commons

By Leona Kashersky, Psy.D.

When I learned of the tragic death of Robin Williams two weeks ago, tears came to my eyes.

I valued his mind and contribution to the arts and humanity, as did so many in the world who share in the loss of this beloved comedian, who took his own life on August 11, 2014.

Not only did I feel an emptiness at the thought of never seeing another new Williams’ masterpiece, but knowing that so many looked up to him, I feared that his end could inspire those who are struggling with suicidal thoughts to follow his example.

Recent studies have shown that when a mentor, parent, loved one, or admired celebrity commits suicide, communities can become vulnerable to more tragic loss of the same kind.

As such, I’d like to speak to Williams’ specific situation, and address some general suicide risk factors in hopes that education could help us to grieve and prevent further harm.

O’ Captain, My Captain: Robin Williams’ Struggle

It is well documented that Williams had a long battle with substance use, and mental health professionals have hypothesized that he also suffered from bipolar disorder.

In early July, he checked himself into rehab, though news reports stated that he did not technically relapse. This readmission into rehab was right after his new sitcom The Crazy Ones was canceled after only one season. Whether or not Williams actually relapsed or was preventing a relapse, it is important to recognize that he was proactive in addressing his need for help.

Further, Williams had just started a new medication to treat his newly diagnosed Parkinson’s disease; his medication did come with warnings related to depression and suicidal ideation.

Risk Factors, Warning Signs & Intervention

Though we don’t know the complete details of Williams’ personal life, there were risk factors present in Williams’ history and current life situation that indicate that he was vulnerable to suicide.

Most suicides occur within three months following the treatment of a major depression, as the patient’s energy increases and before negative and destructive thoughts decrease. This leaves individuals in the initial phases of treatment at risk to follow through on suicidal thoughts. Moreover, even individuals who have a drug, alcohol, or eating disorder in full remission can be 10 percent more likely to complete suicide and are at higher risk. Professional monitoring is needed in the form of regularly scheduled counseling to teach healthy coping skills for managing stress.

In addition, patients starting some new medications that are not related to mental health treatment can be at risk of developing depressed and self-destructive thoughts. When patients are warned of the side effects, they don’t always remember the warning was given when the thoughts start to intrude. Often, patients are caught off guard and can be at greater risk of harmful behaviors.

Most people who contemplate suicide do not want to die, but rather feel disconnected from others and are likely experiencing difficulty thinking creatively about how to solve life’s challenges.

Here are some more general risk factors and warning signs that can help you identify and help those considering suicide:

Risk Factors

  • Mood changes or depression
  • Peer and/or family conflict
  • Perfectionism/overachievement
  • Poor coping skills
  • School or work failure
  • Drug or alcohol use


Warning Signs

  • Withdrawal from friends and family
  • Recent break up
  • Running away
  • Talking about suicide (even if it sounds like a joke)
  • Dramatic changes (for the worse) in personality and/or appearance


9 Initial Interventions for First Responders to Suicide: 

  • Be patient and nonjudgmental
  • Treat the problem seriously
  • Do not try to talk the person out of it
  • Do not be afraid to ask direct questions about suicide
  • Communicate your concern and support
  • Offer yourself as a caring listener until professional help can be arranged
  • Try to evaluate the seriousness of the risk presented in order to make the appropriate referrals to mental health professionals and emergency services (i.e. 911)
  • Do not swear to secrecy. Contact someone who can help if the individual will not get help personally
  • Do not leave the person alone if you feel the threat of self-harm is immediate


Ted Eytan / Flickr / Creative Commons

At the “Mrs. Doubtfire” House, 2640 Steiner Street, San Francisco, CA, USA. Ted Eytan / Flickr / Creative Commons

 

Community’s Role in Suicide Prevention

As community members interested in preventing suicide, we must work together to identify, reach out, show compassion, and educate people who are or who know someone that may be at risk.

As a larger community, we can support individuals in developing a spiritual practice that fosters community inclusion and engages individuals in altruistic projects that inspire them to help others or the environment. Programs that build a sense of mastery and inspire a sense of community inclusion rather than alienation are known to be effective in preventing suicide.

In addition, community can support centers that provide organized outings for cultural enrichment, specialized training, education, sexual counseling, crisis intervention, and health care.

We can find a Healing Pathway!

Healing Pathways offers its condolences to everyone who loved Robin Williams dearly. We hope that we can all grieve together as a community and teach each other how to move through pain and sadness with compassion for each other and ourselves.

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The Compassion Door: 5 Steps to more LOVE!

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love-lines

By Leona Kashersky, Psy.D.

For the last year I have deepened my study and practice of compassion, using embodiment practices to integrate  “Lovingkindness” or “Metta” into my daily life and physical being.  My personal experience mirrors what research in the fields of transpersonal and mindfulness psychology is saying about the overall health benefits of the practice. This practice actually enhances immune  function, cardiovascular health, glucose regulation, and even improves social skills!

Metta can be loosely defined as love and compassion for the self and others. Researchers are learning that practicing lovingkindness or metta has objective and observable emotional, physical, social benefits. Donald Rothberg, whose work spans over 30 years as a leading teacher and writer on transpersonal psychology, meditation, and socially engaged spiritual practice, wrote “The Engaged Spiritual Life: A Buddhist Approach to Transforming Ourselves and the World.” Both Donald Rothberg and Barbra Fredrickson have been influential in conducting and participating in research to establish evidence for the health benefits of meditation, self-love, and compassion in modern society.  Fredrickson teaches what she calls “micro-moments of love” or  “positivity resonance” in scientific lingo and in everyday language. As Fredrickson points out, compassion generates loveand love feels good! Start with yourself, and it will naturally radiate out to others near and far.

In my most recent experiences with meditation on love, compassion, and kindness I have used Metta mantras such as “rest in an awakened heart”, “safe and free from harm”, “the body supports the practice”, “surrounded by love and kindness”, in combination with movement. The pairing of movement, breath, mantra, and human connection help to assist in the integration of the compassion practice into the entire mind, body, and spirit.  Movement can include yoga, walking, and dance, including 5 Rhythms; Included are a couple of links to local favorites! The practice of movement meditation has assisted in my personal journey to embody the practice of loving kindness.

The following  techniques reduce burnout and increases positive emotion and LOVE on many different levels in the lives’ of individual people, families, and communities.  A brief and concise description of how the mantras are used are outlined below:

for HP Blog

Step 1:

Cultivate self-compassion: First, focus on the easiest person to grow compassion towards, the self. This is done by not merely reciting words or phrases, but by allowing one’s self to feel the meaning of the phrase or words during the meditation.

  1. I rest with an awakened heart
  2. May I be safe and free from harm
  3. May my body support my practice
  4. May I be surrounded by love and kindness

Step 2:

Cultivate compassion for a ‘dear one’, someone you love dearly. This may be your child, your parent, or a romantic partner, or even a pet!  This is the second easiest form of compassion to grow. As you concentrate on the meaning or feelings of phrases or words, picture the face of the dear one; allow yourself to really experience the face of this dear one. Then slowly use  following mantras. One meditation session may only focus on one of the phrases for each of these steps.

  1. May you rest with an awakened heart
  2. May you be safe and free from harm
  3. May your body support your practice
  4. May you be surrounded by love and kindness

Step 3:

Cultivate compassion for a ‘neutral person’. This neutral person can be someone you see at Starbucks every weekday morning; however you don’t really know them. You don’t usually talk or say hello, you may just see each other in passing. You have no strong feelings towards them, neither positive or negative. Allow yourself to really imagine them in your presence, see their face in your mind’s eye. Begin the following mantras for them.

  1. May you rest with an awakened heart
  2. May you be safe and free from harm
  3. May your body support your practice
  4. May you be surrounded by love and kindness

Step 4:

Cultivate compassion for a ‘difficult person’, someone you find challenging to feel compassion for at the moment.  The difficult person can be someone  close to you, or a someone you’ve never met, such as a political leader. Sometimes the ‘difficult person’ and the ‘dear one’ can be the same person depending on how you feel at the time. Really allow yourself to feel the presence of the difficult person before using the following mantras.

  1. May you rest with an awakened heart
  2. May you be safe and free from harm
  3. May your body support your practice
  4. May you be surrounded by love and kindness

Step 5:

Cultivating compassion for all beings is a meditation focusing on humans, plants, animals, and the entire living planet. We continue to use the four focused mantras or phrases to do this with the following.

  1. May all beings rest with an awakened heart
  2. May all beings be safe and free from harm
  3. May all beings be free from pain and suffering
  4. May all beings be surrounded by love and kindness

 

References: 

Cultivating self-care and compassion in psychological therapists in training: the experience of practicing loving-kindness meditation. Training and Education in Professional Psychology, Vol 7(4), Nov 2013, 267-277 Boellinghaus, Inga; Jones, FergalW.; Hutton, Jane
Effect of Kindness-Based Meditation on Health and well-Being: A Systematic Review and Meta-Analysis. Galante, Julieta; Galante, Ignacio; Bekkers, Marie-jet; Gallacher, John Journal of Consulting and Clinical Psychology, Jun 30, 2014, No Pagination Specified.

The nondiscriminating heart: Lovingkindness meditation training decreases implicit intergroup bias. Journal of Experimental Psychology: General, Vol 143(3), Jun 2014, 1306-1313 Kang, Yoona; Gray, Jeremy R.; Dovidio, John F.

Self-compassion: Conceptualizations, correlations, and interventions. Barnard, Laura K.; Curry, John F. Review of General Psychology, Vol 15(4), Dec 2011, 289-303.

Effects of intranasal oxytocin on ‘compassion focused imagery’.  Rockliff, Helen; Karl Anke; McEwan, Kirsten; Gilbert, Jean; Matos, Marcela; Gilbert, Paul Emotion, Vol 66(8), Nov 2011, 1388-1396

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Tonglen: A Buddhist Meditation Practice

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photo by Emily Roesly

Positive visualizing creates the reality you want!                                                (Photo by Emily Roesly, via morguefile)

by Nicolina M. Cahouette, M.A., M.F.T.I #77972

The Meditative Breath Practice of Tonglen involves visualizing a person who you believe is in pain or has caused you pain.  Contrary to our habit of avoiding pain, Tonglen invites us to breath in the pain we are perceiving.  Our bodies become “conversion machines”, and we use our out breath to release the pain, extending a frequency of love toward the person we are trying to help or forgive.

Pema Chodron explains how this simple act, rooted in awareness, broadens our understanding connectedness and human suffering, because we reinforce the reality of an empathetic connection as we visualize while breathing in.

According to The Tibetan Book of the Dead by Sogyal Rinpoche, Tonglen is effective in negating the restricting and sometimes detrimental influence of our ego because it  opens our hearts to those around us and encourages us to help others  without losing ourselves in their personal dramas. We are compassionate observers, and teachers who are also learning how the people around us are effected by their own suffering (1993, p.195).

Visualization is a powerful part of this practice, and it has a number of cognitive benefits. Continually visualizing scenes which evoke positive emotional states reinforces the production of neurotransmitters in the brain associated with positive emotional states. Further, it encourages the pruning of synaptic relationships that are counterproductive.

Tonglen Breathing Exercise SANYO DIGITAL CAMERA

It is important to be in a quiet comfortable place where you can assume a comfortable posture.  Remember, comfortable for your body! You can sit on a cushion, on the floor, or on a chair.  Choose what is best for you. As this is a breath awareness exercise, it can be helpful to place your hand on your stomach to increase awareness of your diaphragm moving in and out with each breath.

While inhaling, visualize the pain associated with what you are trying to release around a specific person. Any confrontations or experiences that were especially salient to you will be a good fit for this exercise.

While exhaling, visualize having a positive healing experience with this person, that love is flowing from you, to the subject of your practice. This practice is a process of thought transmutation that encourages emotional healing around a person or experience.

A good rule of thumb when adopting any meditation practice is to accept that you may find it difficult to focus while you are experiencing the miscellaneous thought traffic that will drift in and out of your meditation time. Also, if you are a novice meditator, keep it brief at first. Start with 10 minute increments once daily until you can sit with ease, then increase the time in 5 or 10 minute intervals until you find what amount of time gives you the maximum ease and benefit.  Want some help?  Try this guided version with Dr. Miles Neale 

Rinpoche, S. (1993). The Tibetan Book of Living and Dying. (p. 195).

NY:Harper Collins.

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Coming Home: Grief Healing through Art

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Transformation by Fire: Each year the Burning Man Festival culminates with the burning of a temple which participants have filled with symbols of love, life and loss that they are ready to let the fire transform. (Photo (c) Tristan Savatier – www.loupiote.com -used by permission)

by Nicolina Cahouette, M.A., MFTI

Human relationships are profoundly changing experiences. They are euphoric in their infancy, and can take us to the darkest lows when they fall apart. Remember the Daryll Hall song “Every time you go away, you take a piece of me with you” popularized by Paul Young?   When an important relationship ends or changes, we experience a loss that can be emotionally akin to the death of a love one.   Therapists often hear that people feel lost or incomplete when a relationship transforms or ends.  This is a normal stage of the grief process and the duration of this stage can vary from person to person.

As Barbara Ganim discusses in her work, artistic expression is another experience that profoundly alters the human landscape.  Art connects us experientially through our senses, which is similar to what occurs in important relationships. Art has the power to emotionally transport us through the past. All of our senses are engaged through artistic expression. When we lose time in a project, performance, or exhibit, we are actively connected with our emotional system, experiencing a sort of time travel that takes us through the many sensory levels of processing and integrating the experience in different ways. This process allows us to see beyond the primary filter of pain we may use to describe an event and understand that many emotional components are part of the equation, thereby releasing the ideology that the event or a relationship ending was “only painful”.

The value of losing one’s self in time creatively is eloquently outlined in Mihaly Csikszentmihalyi’s book on Flow Psychology. Csikszentmihalyi describes how creative process or Flow increases human happiness. The following exercise is an artistic journey that calls back that piece of you that went with the other person when the relationship ended.

The Coming Home Exercise

This activity is inspired by Gestalt therapy, an experiential approach “fathered” by Fritz Perls.  You’re going to make a collage of the relationship experience.  This powerful piece will culminate with a representation of you taking back your energy. The materials are entirely up to you: The only requirement is that the elements of the project should be powerful reminders of the relationship’s emotional impact on you. The elements could be a picture of your favorite place, food, or unique mannerisms that you shared only with that person. The  piece should include a representation of you calling that lost piece of yourself back to you. Let that image or description resonate with you on an emotional level. For example, a strong calling back image could be hands reaching out and pulling towards you. How you decide to visually represent the act is up to your creative discretion.

Once the project is finished, display it prominently where you will see it during the grieving process. As time goes on, you may notice it less and less. When you feel you are ready, you may choose to do a letting go exercise where you burn the piece, bury it, or let it flow down a river. You may also choose to put it away or if positive feelings are experienced by looking at it, leave it where it is. The power of this exercise opens the mind’s experience to the fact that more than one emotion can exist in the same space when recalling an experience. This expands our ability to assimilate information from the experiences and primary relationships in our lives.

Healing Pathways offers our condolences to those affected by the Isla Vista tragedy this week in Santa Barbara.

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Teens and Depression: What You Should Know.

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Depression is on the rise amongst teens and effective treatment options remain daunting. Depression affects approximately 6% of female teenagers and about 4.6% of male teens. Young people who suffer from depression also suffer from functional impairment (poor academic performance or poor self-care), higher suicide (or suicide attempt) rates, and higher rates of depression in their adulthood. A new study dampens expectations of successful depression treatment for teenagers — finding that depression returns in most teens that undergo treatment.

John Curry, Ph.D. of the Duke University Medical Center and colleagues found that 46.6% of teenagers treated for depression using three different (short-term) treatment interventions including medication, cognitive behavioral therapy, and a combination of the two are expected to experience a recurrence of depression.

Dr. Curry and his colleagues also discovered that teens who experienced a combination of depression with anxiety disorder were 61.9% more likely to have clinical levels of symptom recurrence. These teens also had higher rates of suicidal thoughts and behaviors, alerting all of us that anxiously depressed young people are at greater suicide risk.

The study also found that teens who received no treatment or short-term treatment were more likely to have a relapse of depression after a two year period. The results of this research impress upon parents and practitioners, a need to include recurrence prevention in the discharge planning for these young people. Prevention efforts would include symptom/medication monitoring and cognitive behavioral booster sessions beyond an 18-week maintenance period.

If you are a teenager suffering from depression, talk to your parents or a trusted adult. They can help you find the help you need to get through this difficult time. If you are a parent concerned about your child, seek professional help if symptoms persist beyond two weeks or if you have any reason to believe your child is considering suicide.

If you live in the Sacramento area you can contact Dr. Leona Kashersky at (916) 595-7233 or email her at lkashersky@live.com

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