How to deal with Psychological Problems that Occur in Combination
Life is a very untidy business. And therapy is a gritty, often very messy process to boot. Psychological problems very seldom occur in isolation. Far more often mental health issues manifest themselves in a combination of complex, interconnected and interdependent ways. And never more so than in the context of anxiety and depression. These two increasingly prevalent psychological problems are so metaphorically and literally joined at the hip that they are often referred to as “the terrible twins”. However, twins though they might be, this dreadful twosome are far from identical. They need to be treated in very specific and dramatically different ways. For example, no matter how much it feels like you might, you can’t actually die from anxiety. On the other hand, in stark contrast, depression can be deadly. An estimated 121 million people suffer from depression world-wide. Severe depression is responsible for some 850,000 deaths by suicide every year. While the path descending into depression is different for everybody, there are many broad overarching similarities. (I except those for whose depression is primarily attributable to biochemistry.) For most of us, the journey begins with a crisis. Crisis causes anxiety. Anxiety leads to depression. Depression leads to self-medication. Self-medication leads to addiction. Addiction leads to more mood disorders, interpersonal problems and once again to anxiety. Anxiety leads to eating disorders and thence once again to depression. And so, the potentially deadly circle dance goes around ever downward and deeper into the dark and dangerous realm of serious mental illness.
The professional practitioner’s go-to reference for accurate diagnosis is the venerable The Diagnostic And Statistical Manual of Mental Disorders, a variant of which was first published in 1952. DSM has long attempted to organise subjects like personality disorders into convenient clusters.
I accept that this attempt to simplify things is both necessary and laudable, but I can tell you first hand drawing from my 30 years of personal hands-on experience in the clinical trenches that life is never quite as clear cut, simple or tidy. Not in the case of personality disorders nor in that of many more common psychological disorders. The propensity for issues to occur together makes them harder to diagnose and to treat. The medical term for all this is comorbidity. I promise not to descend into “Doctor Speak” or medico mumbo jumbo. That won’t be necessary because my point is a profoundly simple one. It’s what we call a “no-brainer”:
Anxiety and depression are closely interrelated. It follows therefore, that the depressed person can learn from the experience and treatment of the anxious person and vice versa. What’s more, both can learn by thinking critically about the crisis that may have led both of them there in the first place. And so on and so on.
I am not a theatre buff or a Shakespeare tragic by any stretch of the imagination but I have been known to quote Claudius when he laments, “When sorrows come, they come not single spies, but in battalions.” Hamlet Act IV, Scene V (And yes I had to look that up. The act and scene I mean. Claudius’ words are forever etched on my temporal lobe if you trust the most recent evidence of where the functions of memory are carried out by the brain.)
Comorbidity, the co-occurrence of two or more psychological disorders within an individual, is a complex and common phenomenon in the field of mental health. However, it is one with which Metaphorical Therapy can offer significant help not least because the System focusses on a wide array of common problems through the same revealing lens; that of the Keystone Principles of Mental Health.
The legendary golfer Gary Player said, “The harder I practice the luckier I get.” It is a universal truth that the more you practice the better you get. Another no-brainer. However don’t let yourself fall into the trap of repetitively practicing just one thing. It’s better than nothing. But only just. Witness boxers and martial artists endlessly practicing combinations that can be applied to a multiplicity of different combat scenarios. In short: If one move is all you have, you are at a significantly greater risk of receiving an ass-kicking in the ring or on the street.
In summary then: The propensity of problems to occur together is not the exception but the norm in the realm of mental health. Research demonstrates that people diagnosed with one psychological disorder are at a significantly increased risk of developing additional conditions. This phenomenon poses unique challenges for both individuals and mental health professionals. Many psychological disorders share common risk factors, such as genetic predisposition, childhood adversity, or environmental stressors. But it is important to note that coping strategies can also often span more than one just one problem. For example; knowing when to ask for help is important in the context of all, and very nearly almost every mental health issue you care to imagine. In a nutshell then: The co-occurrence of psychological problems has profound implications for affected individuals, treatment providers and society as a whole.
So knowing all this what can you do?
The best way to answer this question by using the specific MindMovie treatment modules in the Metaphorical Therapy smartphone app and tracing the bones of a simplified journey through the various immersive modules.
Imagine this:
You are experiencing problems with Anxiety and panic attacks so you listen to the Storm of Anxiety and Dr Whittington’s accompanying tracks a couple of times and you find yourself feeling better and coping more effectively than you were.
You think, “Excellent! Job done!”
And you are quite wrong. (Or at best only partially right.)
As a paid subscriber by listening to only the one module that you think applies your problem you are denying yourself many more valuable benefits and survival skills that are there ripe for the taking. For example:
- By listening to Holding the Fort – Managing Crisis you come to better understand how your anxiety got started in the first place and become far less likely to fall into the same trap for a second time.
- By undertaking the arduous character-building journey through The Long Harsh Personal Winter of Depression you can use the resonance and perceived relevance of the story to ascertain exactly where you are on your personal journey and recognise early on, the warning signs that you might be at risk of sinking into the dangerous gorge of depression.
- By delving into the incredible immersive experience of The Wildfire of Addiction you can clearly grasp the clear and present danger of collapsing into the flames of addiction and thus side step the legion of more serious problems that come with falling into that common and tragically crowded pitfall.
The best thing about all this is just how easy Metaphorical Therapy makes things for you. It’s not work. Not even close. It’s more like sitting back to watch your favourite movie or listening to a few of your favourite songs. You will be hard-pressed to come up with a reason not to do it.
Remember the more you practice the better you get. This is nothing more than a profoundly simple human truth. The Metaphorical Therapy app is much like moisturiser. The more you put it on, the deeper it sinks in.
The power of the pre-mortem: “Am I Okay?”
In the midst of our busy lives we all too often neglect the importance of checking in on those around us in order to ask a simple question with important and far-reaching consequences: “Are you okay?”
I think there is a more important question: “Am I Ok?” It is critically important that you take control of and responsibility for your own mental health. One of my favourite and most frequently used metaphors is that of driving to a destination versus being driven there as a passenger. With your hands on the wheel, you will remember how you got there. If you are a passenger, you may still get lost even after making the same journey many times.
Post-mortem versus Pre-Mortem.
You are more than likely quite familiar with the term post-mortem (the examination of a deceased person by an Anatomical or Forensic Pathologist to ascertain the cause of death). As a professional practitioner devoted to improving a lot of the living, you will hardly be surprised to learn that I regard that as being too little too late! I much prefer the idea and practice of what I like to call a pre-mortem. Simply put: A pre-mortem can do much to postpone your post-mortem.
And that is where the simple question, “Am I Okay?” will take you.
However, be warned; a thorough pre-mortem can be quite painful. Even though they are simple, the questions can be challenging. Taking action to change toxic behaviour is even harder. Some of the questions are obviously relevant to physical health and others to your state of mental well-being. Here is an example of some of the questions you should ask yourself:
- Did I take a shower today?
Personal hygiene is crucial to mental and physical wellness. Washing your body is a great way to rinse out your head.
- Have I eaten anything healthy in the past few hours?
Fresh fruit or vegetables in particular.
- Have I had any water to drink in the past hour?
Adequate hydration is vital to your health on a multiplicity of levels.
- Did I get enough sleep last night?
A well-rested body and mind improves health dramatically. Stick to a schedule and get the rest you need.
- Have I been for a walk in the past 24 hours?
Walking outdoors for at least 20 minutes will boost your energy.
- Is it daytime? Did I make my bed? Am I dressed?
The time-honoured Latin phrase carpe diem (seize the day) has echoed down the centuries for good reason. You’ll be happier and more productive if you get ready every day. No matter how hard it seems, grab the day by the horns!
- Is it nighttime? Am I struggling to fall asleep?
Put away your phone, close your eyes, be still, and count your breaths. Like all things, healthy restful sleep comes with practice.
- Have there been any changes to medication I might be taking?
If you are more irritable or anxious than usual it might be because you’re on a new medication (or alternatively it may be a sign that you need medication). As always it is best to consult your doctor.
- Do I feel unattractive?
Before you negatively judge your looks, get cleaned up and dressed. Make an effort. Put your best foot forward. Taking care of yourself will boost your self-esteem.
- Did I do something fun today?
Read, exercise, listen to music, dance. Whatever your notion of fun is, find time to do it.
- Have I hugged someone recently?
Physical contact is critically important to a healthy body and mind. Hug your family, friends, or pets every chance you get.
- Have I given someone a compliment in the past 24 hours?
Helping boost others self-esteem increases your own. It’s that simple.
- Have I shared how I am feeling today?
Talking about your feelings, regardless of whether they are positive or negative, gives you a sense of control. It is a powerful antidote to the feelings of powerlessness that often feed depression.
- Am I focused on the future or dwelling the past?
Focus on the future because you can influence, change and shape it. The past is an abstraction of the mind that you cannot change!
- Do I have something to look forward to?
Having something to look forward to makes our problems seem much smaller.
- Do I feel unproductive?
Start with a single, simple task: Make your bed. Do the laundry. Wash the dishes. You’ll be amazed at how much of a sense of control the little things can give you.
- Have I had to make a big decision lately?
Your body and mind react naturally to change. Practice self-awareness and cut yourself some slack when you are facing tumultuous change.
- Have I exhausted myself lately?
This can be physically, socially, emotionally, or intellectually. Like batteries, your mind and body need time to recharge.
- How long has it been since I felt bad about myself?
Be self-aware. Tell that cruel relentless unremitting inner critic to shut up.
- Have you talked to a counsellor?
Talking to a professional is not a weakness. It is common sense. Take time to find a counsellor who suits you and reach out to them in times of need.
As human beings, we thrive on connection and social interaction. By asking someone if they are okay, we convey our genuine interest and concern for their well-being. This simple act opens the door for honest and open communication, allowing individuals to share their struggles, fears, and challenges. By actively listening and providing support, we strengthen our relationships and build a sense of trust and understanding with others. When we take the time to ask “Are you okay?” we demonstrate that we are willing to be there for one another, fostering a sense of community and compassion.
The Three-legged Stool of Happiness:
Someone to love. Something to do. Something to look forward to.
I am a great advocate of keeping things simple. I believe that the metaphorical stool of happiness has three legs:
- Someone to love.
- Something to do.
- Something to look forward to
Ask yourself about these three things often. With these factors in mind, having asked yourself, “Am I Okay?” and having conducted your own pre-mortem, you will be in a far better position to ask others if they’re okay and to be genuinely helpful. Furthermore, you will be in a far better position to help them, not only to understand the complexities of their own unique circumstances but also what actions they can take to aid their pursuit of happiness and mental wellbeing. If you have read this far, I am willing to bet my metaphorically bottom dollar that you will increasingly find yourself able to answer to the question, “Am I ok?” in the positive.
About the author
Dr. Mark Whittington and Gaby Bush
Dr. Mark Whittington is a graduate of the distinguished Otago Medical School, and has more than 30 years’ experience working at the clinical coalface as a Consultant Psychiatrist.
Gaby Bush is a creative director, writer ,ex-patient, corporate refugee, and survivor of severe PTSD. Gaby is living proof of how well the Metaphorical Therapy System works in the real world.
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