We all have a friend or family member who just can’t seem to get out from under their accumulation of stuff. Their garage, guest bedroom and basement are packed, and you can’t see the top of the kitchen table. But when does “cluttered” become “hoarded?” We have all seen the sensationalized TV depictions of filthy homes that need to be condemned. But is that what hoarding really looks like?  And why can’t those folks just throw it all out?

Today’s guest explains myths surrounding hoarding, treatment strategies and why we all might be at risk.


Guest information for ‘Clutter and Hoarding’ Podcast Episode

Elaine Birchall, MSW is the director of Birchall Consulting and the founder of the Canadian National Hoarding Coalition. A hoarding behavior specialist and clutter coach, Elaine provides training, consultations, and counseling to people and organizations across the US and Canada.




About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Clutter and HoardingEpisode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in everyday plain language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of The Psych Central Podcast. Calling into the show today, we have Elaine Birchall, who is a social worker and hoarding specialist and also the co-author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding from Johns Hopkins University Press. Elaine, welcome to the show.

Elaine Birchall: Thank you for inviting me, Gabe.

Gabe Howard: Oh, it is quite our pleasure. Hoarding, it seems like it is everywhere, I think, in 2019 because of all the media coverage, all of the television shows. There’s just a lot more understood about hoarding today than there was 20 years ago. But I imagine that a lot of this information is incorrect. So starting right off. Can you tell us what the general population doesn’t understand about hoarding that they think they do?

Elaine Birchall: Well, the general population, I think believes that hoarding is necessarily a dirty, chaotic mess, and that’s not true. Hoarding has three criteria, Gabe. And unless each of those three criteria are met, whatever you’re looking at, at that point in time anyway, isn’t necessarily a hoarding situation.

Gabe Howard: What are the criteria?

Elaine Birchall: The first is there is an excessive accumulation. What most people would call an excess of accumulation. And I’d say a failure to resolve that proportionately. Now, that does not mean one thing in and one thing out. What it means is that fundamentally inside yourself, you either don’t have or you have a broken check and balance system that tells you when things are starting to get out of hand so that you can do it when it’s a smaller job, which is easier, obviously. The second is that some or all of the living spaces — now that can be your home, your office, your car, your back yard, your garage, it can be anywhere where you live — those spaces can’t be used for their intended purpose. You can still do the functions in your home, but you are not doing them in the spaces where they were intended to be done. That’s important because you probably don’t have the tools to do those jobs and you’re probably adding to the clutter by leaving things lying around rather than put it away when you’ve got that kind of disruption. The third criteria is somebody is upset, distress, or impairment in functioning. You’re still living there, but now you’re adapting. You’re stepping over things. You’re moving things off of a chair so that somebody has a place to sit. You stop inviting people home because you’re embarrassed about the condition. So half of your social, most of your social life, happens outside your home. Now, there’s one key thing about that stress or impairment in functioning, doesn’t mean, Gabe, that those people have to be distressed right now. You have to tick that box if people who need to know, if they knew the truth about the condition of the property, would have cause to be concerned. That’s your neighbor, who is at increased risk, that’s your family members, your pets, the fire department, children’s services, animal control, by-laws, property standards, if you’re in a multi-unit dwelling. So you can see how hoarding is not an individual problem that happens in isolation.

Gabe Howard: I really appreciate you sharing that because, of course, one of the things that I’ve learned is while my family members may hang on to things longer than I do, they don’t meet any of that criteria. They can still use their kitchen as a kitchen. They can still use their living room as a living room. And they invite people over all the time. So it shows, at least from my perspective, that I see hoarding as hanging on to stuff that I don’t like when in actuality it’s causing this… I don’t want to use the word trauma, but maybe it’s causing distress in their lives? Is that accurate?

Elaine Birchall: Yes, it does cause distress, sometimes because the individual themselves realizes this is not a good situation for me or for if you have a family, your family sometimes is in distress. So, Gabe, it’s also or more about I just wish people would get off my back. I don’t think there’s anything wrong with this. I think I have the right to live the way I want to live. Well, that’s true. But up to a point, everything has limits. When you create a hazard for yourself, no matter how big or how small that hazard is, you are probably also creating a hazard, certainly in hoarding situations. It will go on to create a public health and safety hazard as well, because to hoarding is a compulsion. It’s a compulsive disorder.

Gabe Howard: Is there a relationship among hoarding versus cluttering versus collecting vs. hanging on to things? Maybe longer than the average. Is it all part and parcel of the same thing? Or is it just completely separate and I’m barking up the wrong tree?

Elaine Birchall: Not necessarily. So hoarding is, though, to some even a minimal degree, those three criteria got ticked. That’s hoarding. All right. What we don’t know, however, is every single person who hoards has told me that they started out with clutter, but every person who has clutter is not necessarily going to go on to develop hoarding disorder. The difficulty is that at the inception, at the early, early stages of hoarding, it’s hard to tell whether that’s just clutter or whether you are really headed down a path you probably don’t want to go down. I want people to think more about that compulsion, that driving need to have things or acquire things or get the deal or all of those triggers that the people at the other end of the spectrum of hoarding look back and go, “Boy, that was a telling sign. I wish I wish I’d known back then that was a dangerous sign.”

Gabe Howard: Is it possible for somebody to be a hoarder and be super organized, clutter-free? I mean, it seems like it would be right because of your three criteria, but it doesn’t sound right like how can you be clean and organized and also a hoarder? They seem mutually exclusive, but I suspect they’re not.

Elaine Birchall: No. No, they’re not exclusive. Some of the people that I work with are extremely high functioning. Not all my clients, but I have had a number of lawyers. I have had a number of physicians. I’ve even had some practicing psychiatrists who get caught up in that sense of being overwhelmed at work. They are high functioning. They are organized. In this other area of their life, not so much. But I’ve also had people who are just average people, and they are meticulously clean and tidy. They are also very well organized. It’s about the excess of accumulation, though, Gabe. It doesn’t matter how tidy or how neat or how organized you are, if you have an excess of accumulation, then you have a problem. All right. Because we have relationships with our things, each of the things that we make important enough to keep. We form a relationship with those things. So it’s not just a matter of, oh, you have this, that and the other and you don’t really need it. If you start to engage in that logic internally where you can’t decide, no, you don’t need six toasters, but you cannot decide which of the four or five you should let go of and what to do about them. That becomes a problem.

Gabe Howard: As you’re talking about letting things go, I’m reminded of the television shows, the sensational houses that are just filled to the brim where they just do this massive clean out. Just get rid of so much stuff. And one of the things that they talk about on those shows is what’s going to prevent the person from just filling the house back up? Of just reacquiring everything?

Elaine Birchall: Absolutely, I’m happy you asked that question. Unless there is an immediate threat to safety and life, if at all possible, avoid the extreme cleanup. Now, there are occasions when a situation has gone on too long. It is too intensely deteriorated and a cleanup does need to be done. But they always cause additional damage and trauma. Sometimes, however, for the safety of the individual and the community, it has to happen. That is a real pity. That’s why I’m so happy to be on your podcast, helping people understand the sooner you identify it, the smaller the problems, the less distress. If you have the opportunity, if you have the choice, it’s the regular steady progression with the person. Not to get them to get rid of things. That’s not the point. Come at it the other way to help that person. But don’t tell them what the answer is. Only they know the answer of what’s important. Help them find the things that mean the most to them. Because we do have relationships with our things. I’m going to liken it to I guess a metaphor would be your best friend. If you find your best friends among that clutter, it’s going to be much easier for you to identify the other things that are just hangers on. They got caught up in the clutter and in the chaos and the piles. When unimportant is mixed with really important in a pile, the whole pile, whether specific items are of absolutely no importance to you or not, that whole pile feels as important as the most important thing that you believe is in that pile. That’s why slow and steady wins the race. And you are 100 percent correct, Gabe. You do an intensive clean up like that, and the moment that door shuts, it starts again. Because if nothing changes, nothing changes.

Gabe Howard: Can you describe some of the barriers to letting go of things? Why are people so fascinated with hanging on to multiple toasters, multiple televisions, just multiple numbers of the exact same thing?

Elaine Birchall: So quite often, Gabe, it’s about having, not using and people who are in this mental situation of hoarding disorder, they acquire things because things soothe them. We all need ways to soothe ourselves. And these individuals have lost track of the ability to self-soothe. They also believe that increasing number of things are important or valuable. Sometimes it’s just the process of decision making. It’s extremely difficult, particularly when you’re as overwhelmed as these folks are to make decisions that you can live with. And if you just get rid of things and some people do that, they try to remedy the situation just by pell-mell, getting rid of things. What happens is you create a void in yourself and then you fill that void and generally you fill it with things.

Gabe Howard: We’ll be right back after this message from our sponsor.

Announcer: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: And we’re back speaking with Elaine Birchall, co-author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding. One of the common tropes on the television shows is that hoarding is related to grief and loss. Is that true? And if so, why?

Elaine Birchall: It can be, but hoarding is a lot more than trauma or grief and loss. Anything in the human experience that makes you vulnerable and creates a state of mentally being overwhelmed. There are three paths basically to hoarding. One is genetics. All right? We do know that, depends on the study, anywhere from 50 to 84 percent of individuals who hoard have a first degree family relative who hoard, that’s mother, father, sister, brother who hoards. We know that there are 4 chromosomes with markers in common. Now, we don’t know enough about that for it to be predictive, but that we know about after the fact with studies. The second path is that if you have a high risk co-morbid factor, that’s another condition. It could be a mental health condition or it could be a physical condition. And there’s a whole list of them. And they’re well known. That if you have that co-morbid… bipolar is one, ADHD, another is social anxiety, OCD. There’s quite a long list. It puts you at a higher risk for also developing hoarding disorder. The important thing about that, Gabe, is that if you get the OCD straightened up and you’re managing it better, or bipolar or ADHD, it’s not going to make much of an impact on the hoarding disorder. It might make you, however, more available to do the unique work you need to do to resolve the hoarding. And the third path is particularly scary because I believe most of us aren’t immune from this, and that is that if you are not the most organized individual, you’re kind of chronically disorganized. You know, every so often take the phone off the hook and lock the door and you spend the weekend getting things back to the way you want them to be. But that happens repetitively. Then they become vulnerable. You have a loss, you have a trauma, you have a health crisis. You lose a job, someone dies, your pet dies, there’s some disruption. You become vulnerable. You are at a higher risk of also at that point, starting to developing hoarding disorder. And that third one I think most of us are vulnerable to hoarding.

Gabe Howard: During the research for this show, I looked over your web site and read the book, etc. and one of the things that I was surprised that came up was online shopping addiction. I wouldn’t think that hoarding and online shopping would go hand in hand, but they do. Can you talk about that for a moment? Because you identify three factors that make people vulnerable to online shopping addiction that I was just fascinated by.

Elaine Birchall: Absolutely. There’s a thing about online shopping is there’s no shame, there’s no, I’m going with a basket and I’m filling the basket and paying for the basket. I’m taking all those things home. And then I have to physically bring them back the next day because I couldn’t afford them. Online shopping, I just hit items one at a time. Generally, when I’m alone or I’m feeling vulnerable or I’m feeling something that’s not positive. And it’s so easy. It’s so accessible. And all I have to do is return it anonymously. But it’s a little like playing at the slots. You know how that turnover of serotonin and dopamine when you find the right thing. You know, you’re on certain sites where you win the auction or it’s the last item. And get a deal.

Gabe Howard: It’s exciting.

Elaine Birchall: That’s like crack cocaine to some people.

Gabe Howard: Wow.

Elaine Birchall: I’ve had people literally, this is not an exaggeration by the slightest bit, I’ve had people who, when they give me a tour of their home, have a double garage full of unopened shopping channel boxes. So clearly it wasn’t for these folks, and probably for many others, it wasn’t about what’s in the box. It was about the excitement of the arrival, the achievement of acquisition

Gabe Howard: Wow.

Elaine Birchall: And it also causes you go bankrupt.

Gabe Howard: This has just been absolutely fascinating, and I really appreciate you helping me and our listeners understand what hoarding is, because, again, the media has done a really good job of convincing us that it’s just one very specific thing. And that sort of leads me to my final question. Is hoarding disorder curable? Is there hope?

Elaine Birchall: Yes, there is hope. That’s why I do this, yes there is hope. It depends on how early the onset occurred, how long you’ve been doing it and how many other, I’m going to call them balls in the air, you’re trying to keep going. I met a woman yesterday, for instance. And even though it’s not the worst situation as far as accumulation, her life is legitimately so complicated, you know, disabled children, health issues, untreated trauma and abuse, social anxiety. There’s a list that it’s going to take quite a while.

Gabe Howard: When we talk about getting better and recovering from hoarding, what are realistic goals for people?

Elaine Birchall: Every single person, if they are willing to do the mental work, right? Because if the head and the thinking doesn’t change, if you don’t change your relationship to your things, your hands can’t help you. So every single person is capable of learning to manage at a minimum with the right resources. Right? And many people, many people the later the onset. So it didn’t start in childhood. It hasn’t gone on 50 years untreated. Later the onset, the more you reach out, when you identify the clutter isn’t working for you anymore. You realize how overwhelmed you are. We showed at that point, you can turn this around. But if you have the vulnerability towards it. Like being on a diet, Gabe, you have to understand where your triggers are and you have to learn how to either avoid them or manage them, or when you trip and fall, reach out again sooner and get back, recover what you’ve lost.

Gabe Howard: And just to boil this down to a timeframe. Is it reasonable to think that you’re going to have this under control in a couple of weeks, a couple of months, or is this a long term kind of commitment?

Elaine Birchall: Depends on the person and it depends on how long they’ve been doing the behaviors that have created the hoarding environment. I’ve had people who needed six sessions and they got the concepts. They had quite an issue with clutter and it was hoarding disorder, but they got it and they worked together. It was a couple. They worked together and they’ve made significant improvements. I’ve had other people that required a year and a half. A very, very few people, generally, those people who began hoarding at a very young age, you know, ten, eleven, twelve, thirteen in that pre-teen and got no help for it. And now they’re 50 or 60. And in addition, they have another co-morbid factor. Maybe OCD, maybe a touch of Asperger’s, other issues. Depression, bipolar, those cyclical disorders that you really have to manage. They didn’t get any help with any of that. They didn’t even know that that was part of their reality. Those people are probably going to need very long term. But the interval between changes. You’re not with them every week. Now, maybe you’re with them every month now maybe you’re with them every three months. I had a woman one time. Really interesting. It was the first time this ever happened. And I’d worked with her for about maybe eight or nine months. And she was doing really well. And I said, you know what? Let’s revisit whether you need to continue seeing me now. What do you think? And she said, well, I think I can manage on my own now, but I want to see you once a year. And I thought to myself, once a year? What good is that going to do? But I learned something. And she said, I want to see you once a year mainly because every day when I make decisions, I will know that in a year I’m going to be seeing you, and I want to use you as my own personal accountability. The people do use the skills you teach them and they do really unique things with them to help themselves. Those people make it.

Gabe Howard: Elaine, thank you so much. This has been very illuminating. And I think it will help people understand exactly what hoarding is, what it isn’t, and really add just an incredible amount of knowledge to a misunderstood disorder. So thank you for being on the show. Where can folks find you, your web site, and where can they buy Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding?

Elaine Birchall: So go to my Web site http://hoarding.ca/. I’ve got all kinds of free resources on there under the resource tab. There’s a quiz there. Are you a hoarder in the making? Now, I’ve developed that quiz specifically around the risk factors and the criteria. Go and take my quiz and identify, am I at the point that really I need help now? Because if you have a few of them, you have a compounded risk that might be expressing a vulnerability to go on and go way over the line. Once you’re over the line, Gabe, you’re overwhelmed,all right? Like you can’t move in a straight line. It’s extremely and becomes more extremely difficult to make the decisions you’re going to have to to resolve this. You can get Conquer the Clutter on Amazon.com, in Barnes & Noble bookstores; if you’re in Canada, you can get it in Indigo’s Chapters. You can go on my website. You can order it from Johns Hopkins University Press directly. Thank you, Gabe, for the opportunity. It’s really great to get a positive message out there that puts things more in a true perspective.

Gabe Howard: You’re very welcome and thank you for being on the show. And to our listeners, do you want to interact with the show on Facebook? It’s really easy. All you have to do is join our Facebook group and you can do that by going to PsychCentral.com/FBshow. And remember, we live or die by reviews. Wherever you downloaded this podcast, give us as many stars as you feel appropriate and use your words. Tell people why they should listen. And while you’re at it, share us on social media. Email a friend and tell your colleagues. We don’t have a million dollar advertising budget, so our listeners are our best chance to gain following. And remember, if you’d like to get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply visit BetterHelp.com/PsychCentral. We will see everybody next week.

Announcer: You’ve been listening to the Psych Central Podcast. Previous episodes can be found at PsychCentral.com/show or on your favorite podcast player. To learn more about our host, Gabe Howard, please visit his website at GabeHoward.com. PsychCentral.com is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, PsychCentral.com offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com. If you have feedback about the show, please email show@PsychCentral.com. Thank you for listening and please share widely.

Go to Source
Date: 23rd October 2019 at 20:39
Author: Psychcentral – psychology – The Psych Central Podcast

According to a recently-published interview with John Torous, MD, MBI, Director of the Digital Psychiatry Division at the Department of Psychiatry at Beth Israel Deaconess Medical Center, there are seven great evidenced-based mental health apps you should consider. Evidence-based means they’ve met the minimum requirements by the U.S. Food and Drug Administration (FDA) or have at least one randomized clinical research study that supports their use and effectiveness.

The recommendation for these evidence-based mental health apps comes in an interview with Dr. Torous found in the Oct. 2019 issue of The Carlat Psychiatry Report (subscribe here), a professional publication targeted toward physicians and psychiatrists. In that interview, Dr. Torous warns:

“Patients are starting to use health apps and they may not be telling you, which can be a problem because most of the apps that are available are poorly designed and lack research support. So you want to consider privacy, evidence, and ease of use. Some of the better-studied apps are coming out as prescription only products that are approved by the FDA as digital therapeutics.”

I couldn’t agree more. Just because an app appears in the App Store or on Google Play doesn’t mean it’s been vetted in any manner whatsoever as being safe and effective for the condition or concern it targets. Most mental health apps are surprisingly not designed in conjunction with a mental health expert — it may be written by some guy who took a single psychology course in college. Because of that lack of expertise, some apps give just plain bad advice, such as suggesting using alcohol to relieve stress or negative feelings.

This is also a good time to remind you of the amazing PsyberGuide, an objective non-profit project that reviews the strength of the scientific research support for mental health apps, and describes the therapeutic interventions that an app provides.



Although only available for Android devices (sorry iPhone users), this suite of 13 individual apps from Northwestern University. New users should begin with the IntelliCare Hub app, which helps manage the various apps available, depending upon each person’s unique mental health needs.

The apps are supposed by NIH-funded research, and are based upon the foundation of cognitive behavioral therapy (CBT). Apps range from Worry Knot (for anxiety), Boost Me (for stress and depression), and My Mantra (find your inspiring words), to Aspire (what is your aspiration?), Daily Feats (recognize your daily achievements) and Thought Challenger (challenge negative thoughts).

Free download.

Download now: https://intellicare.cbits.northwestern.edu/ or on Google Play

Review this app on the PsyberGuide guide.



Breathe2Relax comes from the National Center for Telehealth & Technology and is an app focused on teaching a person how to successfully do deep breathing exercises. These exercises have been proven in research to help reduce stress. The app describes itself as a “stress management tool which provides detailed information on the effects of stress on the body and instructions and practice exercises to help users learn the stress management skill called diaphragmatic breathing.Breathing exercises have been documented to decrease the body’s ‘fight-or-flight’ (stress) response, and help with mood stabilization, anger control, and anxiety management. Breathe2Relax can be used as a stand-alone stress reduction tool, or can be used in tandem with clinical care directed by a healthcare worker.”

Free download.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.

cbti coach

CBT-i Coach

Grapple with insomnia or sleep problems? CBT-i Coach is for anyone with insomnia or would like to improve their sleep regimen and habits. “The app will guide you through the process of learning about sleep, developing positive sleep routines, and improving your sleep environment. It provides a structured program that teaches strategies proven to improve sleep and help alleviate symptoms of insomnia.”

CBT-i Coach was a collaborative effort between VA’s National Center for PTSD, Stanford School of Medicine, and the U.S. Department of Defense’s National Center for Telehealth and Technology. It’s a free app.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.


Stop, Breathe & Think

You’ve heard of mindfulness. But you want some help and guidance to learn how to do it and incorporate it into your daily routine. There are a multitude of mindfulness apps in the app stores, but this is one of the best ones available. Free for basic use, but you can subscribe ($9.95/month) for additional features.

According to the app developers and supporting research, the app allows you to reduce your anxiety and stress, learn to breathe more mindfully, improve your sleep habits, daily check-ins, and track your moods over time. Check out iMindfulness and Mindfulness Daily for other apps in this space.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.

Wellness Tracker

DBSA Wellness Tracker

The Depression and Bipolar Support Alliance (DBSA) publishes this app allows you to track “your emotional, mental, and physical health. The tracker reports give you an at-a-glance summary of your health trends. This can help you better recognize potential health problems and mood triggers in your daily life, as well as help you better partner with your clinician on treatment plans.”

Sorry Android users, only for iOS devices. Free to download.

Download now: iOS App Store

Review this app on the PsyberGuide guide.

Virtual Hope Box

Virtual Hope Box

The Virtual Hope Box app, according to PsyberGuide, “is a multi-media coping skill app designed for individuals struggling with depression (particularly military service members). The four main features of Virtual Hope Box include sections for distraction, inspiration, relaxation, and coping skill options. The distraction techniques include games that require focus, like Sudoku and word puzzles.

“The relaxation techniques offer a variety of guided and self-controlled meditation exercises. The coping techniques offer suggestions for activities that reduce stress. The inspiration section offers brief quotes to improve mood and motivation.

“The app can be used in collaboration with a mental health provider through the ‘coping cards’ feature, which can be programmed to address specific problem areas. The relaxation tools can also be used with a clinical professional or other meditation partner, if desired.”

Free to download, the app was created by the National Center for Telehealth & Technology.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.



Need a medication reminder app? Medisafe is one of the better and easier ones to use.

This app, created by Medisafe Inc., offers a clean and simple interface for managing your drug reminders, and allows you to share reports with others, such as your prescription provider or a family member. Also offers integration with GoodRx, a discount drug provider, and has a plethora of reminder options (including when it’s time for refills).

Free to download and use with basic features; advanced features available for $4.99/month subscription.

Download now: iOS App Store or Google Play


Go to Source
Date: 23rd October 2019 at 20:39
Author: Psychcentral – psychology – John M. Grohol, Psy.D.

The word “schizophrenia” tends to conjure ideas of dramatic imagery: hallucinations, delusions, insane asylums in the general public’s mind. Most people don’t think of the boring parts that consume many with schizophrenia, like lacking the motivation to get out of bed, to make friends…

Host Rachel Star Withers, a diagnosed schizophrenic, and co-host Gabe Howard discuss avolition and ways to help motivate loved ones in this episode of Inside Schizophrenia. Family Counselor Ms. Breen joins to share ways to sort through dilemmas. And Rachel does an experiment on her own to address her lack of motivation in being social. 

Highlights from “Motivation in Schizophrenia” Episode

[00:52] The Boring Parts of Schizophrenia

[04:00] Do People with Schizophrenia Want to Get Better?

[06:23] Avolition- lacking the ability to initiate

[09:40] Why is my Loved One Ignoring Me?

[14:00] Social Anxiety vs Avolition

[15:40] What is the Treatment?

[17:00] How Friends and Family can Help

[25:20] Rachel’s Pre-Planning

[28:20] Interview with Guest Family Therapist Ms. Debbie Breen

[37:17] Lacking the Choice

[38:00] Rachel’s Experiment

[43:10] Do Something

[45:45] Rachel’s Closing Remarks

About Our Guest

Headshot of Mr. Breen

Ms. Breen is the principal therapist and owner of South Charlotte Family Counseling in Matthews, North Carolina.

At South Charlotte Family Counseling, we value truth, simplicity, and peace of mind, trusting these qualities to aid our clients in sorting through the dilemmas and distress that brings them into a counseling setting. Together, we identify core issues, set goals, and establish time frames for completion.


Computer Generated Transcript for “Working With Schizophrenia” Episode

Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.

Rachel : You’re listening to Inside Schizophrenia. I’m Rachel Star Withers here with my co-host, Gabe Howard. Gabe, today, we’re talking about motivation in schizophrenia. You know, when people hear schizophrenia, they’re always like, “Oh my God. Hallucinations, killers, murderers.” Like, they think really dramatic stuff. And yes, I do hallucinate a lot. Unfortunately, most of time it’s really boring stuff like I’m seeing something wrong, like my cup of water is distorted and I’m like, what am I looking at?

Gabe: And of course, the whole thing about violence killing all of that. That is what people think about. And it’s so sad because like almost never happens. You should listen to our violence episode. If you haven’t already.

Rachel : Oh, absolutely. Yes. I meant just the general population when they hear the word I’m sorry not to. That’s just like you have a stereotype.

Gabe: Yeah,

Rachel : Yeah.

Gabe: They think that you’re lazy or violent. That’s really that’s what they think. Like, oh, you have schizophrenia. You must be lazy, violent. And definitely you’re causing your family and friends to suffer.

Rachel : Yep. Why aren’t you in a locked up in a mental hospital? Why aren’t you homeless? I’m shocked you can like make whole sentences.

Gabe: And we’re here to dispel all of those myths and the myth that we’re working on today. As you said, is the whole motivation issue, because there’s a big difference between being not motivated to climb a mountain, and not motivated to get out of bed, which is not uncommon for people like yourself.

Rachel : Yes. The biggest thing I struggle with across the board, my schizophrenia has always been the negative symptoms, the depression, the stuff that keeps me down. I struggled with my whole life and to look at me from the outside, you would see I’ve done so many projects, TV shows, radio, podcasts. But I’ve just done so many things across the board that they’re like, “Dude, Rachel, like you’re always up to something.” What people don’t see, though, are the days that I can’t get out of bed. The days that I wear like my pajamas all day. And I can’t tell you what time it is. I realize I forgot to eat that day. I haven’t taken a shower. And, you know, it’s like mentally, I’m gone. I have to set up my medication specifically morning and night, like I set it up once a week, labeled because I forget. Sometimes I just don’t want to do things. It’s like just I don’t know. It’s like a hole in my head. Does that make any sense, Gabe?

Gabe: It does it makes a lot of sense and we know that that is an unfortunate outcome or a symptom of schizophrenia. It’s a symptom of a lot of mental illnesses, not being able to get out of bed, not being able to be organized, to get stuff done, etc. Do you think that sometimes it becomes sort of when you’re well and you’re doing all the things that you need to do? They sort of forget about that when you spend all day in bed or you don’t shower for three days, which compounds the problem. So rather than looking at oh, my loved one is symptomatic, they’re thinking to themselves, Oh, she’s always lazy.

Rachel : Yes, unfortunately, yes, especially when I get stuck in it for like a few months where I’m just a slug. You’re not sure how to explain it and I’m just mentally out of it. It’s like there’s nobody home in my head and just doing the smallest thing, like getting up and taking a shower and washing my hair is like a feat. It’s just a feat in itself. But it’s overwhelming. And sometimes I feel like it’s overwhelming to try and get up and like walk across the room to my desk to take my pills, which are sitting there with water. But it’s just strange. Some days like, yeah, I won’t take my meds until 5 p.m., unfortunately, because I just laid in bed and kind of a delusional state.

Gabe: Let’s touch on that for a moment. There’s two things that have become abundantly clear in what you just said. You didn’t take your medication. I think there’s a lot of talk about people with schizophrenia and not taking their medication. But the second thing that you said is that you want to. You want to take your medication. You just can’t get up the motivation to move from your bed to, in your case, across the room to your desk. And not everybody is as fortunate to have their pills across the room. You know, sometimes it can be across town, it could be a pharmacy, it could be just whatever. Can you touch on that for a moment? Cause I really do think that it feeds into the idea that people with schizophrenia aren’t trying to get better vs. One of the symptoms of schizophrenia is motivation issues.

Rachel : And it’s hard to explain, but it’s like I know what I need to do, which is get up out of bed, walk across the room, just take your medication. Those like few steps just become overwhelming. And it’s like all I can do to like mentally get myself moving, you know, be like big things, little things, as you said, my medication across the room. I’m not going to lie. The other week, I was out of one of my medications for a week because it was sitting at Wal-Mart and I just needed to go and pick it up. But the idea of getting in my car, driving 30 minutes there, I just couldn’t do it. Thankfully, my mom eventually was like, hey, do you need me to do anything? And I was like, if you happen to be going that way, I do have something I need picked up. And she was like, oh, my God, Rachel, you should have said something, but I didn’t even. Like I could have asked my parents at any point and I didn’t. And I can’t really tell you why I didn’t. It was just there was like a hole in my head there where I just couldn’t seem to get myself to do that, to ask.

Gabe: Motivation is difficult for a lot of people. It’s not just the hallmark of people with schizophrenia. There’s lots of people that could be more motivated. I think that that’s just that’s just a fact that we need to accept. But the motivation that you’re talking about is very basic, right? You’re not motivated to ask for help. You’re not motivated to respond to a question. You’re not motivated to participate in your own care. Are these things that are universal for people with schizophrenia?

Rachel : Yes. And it’s almost weird because I think to the outside world motivation. That’s a great word. That makes sense. The actual as far as schizophrenia and other mental disorders is there’s a term called avolition that is a symptom of different ones. From schizophrenia, it can go into bipolar, different types of personality disorders. But it’s a decrease in motivation to pretty much you lack the ability to initiate things like I kind of just said a minute ago, it’s like there’s a whole there’s some reason that you can’t do this thing even though you want to. Like, for instance, some just normal ones you might notice in your friends and family would be like paying bills. For the reason this person hasn’t paid a bill. Thankfully now that’s why all my stuff is automatic. It’s for actually that exact reason.

Gabe: Because you realized it and you were able to work out that. That’s a coping mechanism that you have been able to to work out for yourself. And again, I think that it’s important that people hear you want to. It’s not a lack of desire. You’re not, because I know that a lot of times people with schizophrenia, they don’t want to get well. They’re not trying. They’re happy with the way things are. And that’s not true. That’s what avolition is. Let’s really nail down avolition vs. laziness. Let’s really talk about the difference. It’s not lack of desire. It’s lack of ability.

Rachel : Yes. To fully understand how it’s different from laziness. Laziness is just as I don’t care, I don’t want to do it. I’m just gonna chill. Whereas avolition is more, I know what I need to do. I want to do it. There’s some thing holding me back from being able to do this thing. And it’s like a mental hole in your head of something is stopping me and making this incredibly difficult.

Gabe: And there’s tons of goods examples, you know, failing to show up for a scheduled a vendor meeting, failing to deal with everyday responsibilities with your family. Ignoring the phone ringing and that’s like a really like a really simple one, right? The phone goes, ring, ring. You say hello. That doesn’t seem all that hard, but it can be monumental.

Rachel : Yes, I am terrible about that with even texts, emails. Unfortunately, sometimes I will let emails like pile up for three months knowing like they’re there. I’ve read them, but I just can’t seem to get the energy up to reply. And then when I reply, you’ll be like, Rachel, you literally wrote one sentence. I’m like, I know, but that was I don’t know why. I just had to wait for a good day that I could sit there and bam, bam, bam. I don’t know. And even like text messages, someone will say, hey, do you want to hang out? And fortunately, a lot of times like that just seems overwhelming to me. And I want friends. I want to hang out. I want to make connections. Then the opportunity comes up and I’m like, I don’t know. Oh, you know, that just it’s overwhelming. The idea that I have to get up, get dressed, go somewhere, act a certain way. I don’t know.

Gabe: And I know that a lot of people feel that you’re ignoring them on purpose. I mean, this was a real human to human relationship thing. This transcends one person having schizophrenia. I know that if I text my wife and she does not respond back, I think, oh, why? Why is she ignoring me? This has nothing to do with mental illness. I just I feel like I want my wife to take a moment out of her day and acknowledge the thing that I texted. So the person on the other end, the person who texted or called isn’t getting a response. They tend to see what is happening from that perspective. Why is my friend loved one family member not responding to me? And they believe that it’s almost malicious. But that’s not what’s happening from your perspective. From your perspective. There’s this giant mountain that is answering a text message and you can’t climb it.

Rachel : I see it. I have the tools around me, but I can’t. It’s like my mind. I can’t figure out how to use those tools to climate.

Gabe: And this is specifically a negative symptom

Rachel : Mm hmm,

Gabe: Of schizophrenia? Correct?

Rachel : Yes. So for all of my people out there, in case you didn’t know, negative means lacking. So something that is lacking out what you would call the normal person. And then if you hear positive symptoms. Positive symptoms would be something added to a “normal” person. So like most people don’t have hallucinations, that would be added to. Most people have motivation to get up and brush their teeth. If you don’t, that would be negative. You’re lacking it.

Gabe: So to be clear, you’re not saying that because you have schizophrenia, you can never be lazy. People with schizophrenia absolutely, unequivocally can be lazy.

Rachel : Oh, absolutely, yeah, I can. Many days be lazy. So just because someone doesn’t want to do something. If you are a friend or loved one watching this, you’re gonna have to kinda don’t just let everything slide. Even my like my dad knows that at a certain time, if he hasn’t seen me up and moving around, he needs to step in and help push me. Because honestly, he’s not sure if I’m just being super lazy or there’s something wrong with me.

Gabe: I like how you put that. He needs to help. You didn’t say my father orders me to go for a walk or my friend demands that I do X or tells me that it’s for my own good. He helps you because he’s not sure. So he keeps an open mind. So other examples of avolition versus laziness are.

Rachel : So if I have to go into Wal-Mart and pick up my prescriptions like I did the other week, I know I have to do it. Laziness is ugh, I just don’t want to drive over there and I don’t want to stand in line. Oh, my goodness. I’m going to have to like talk to people. Avolition is OK, I need to do this. I know I need to do this, but there’s something I just can’t seem. It’s overwhelming. The task itself has become overwhelming of me having to put on clothing that would be appropriate to walk outside in. I have to get in my car. I have to drive 30 minutes there. I’ve had situations where like the idea of walking into a store is overwhelming because I know how bright it’s going to be. I know there’s gonna be people everywhere. There’s a lot of sounds and it’s just overwhelming. And I can’t get out of my car and go inside and I can’t really say why. It’s not like I’m scared. It’s just it’s too much. You know, I could easily do it the next day, but there’s something that it all becomes hard for me. It’s like there’s just this this wall that says you can’t go any further. Even though I want to. And with things like that, it takes me having a good day to be able to go and do certain things certain days like you like, whoa, you got so much done, Rachel..

Rachel : Yeah. On good days, I’m like, choo choo choo choo choo. I like it. So I do all the work I can possibly in prep because I never know when it’s gonna go the other way. So it’s one reason I set out all my pills for the week. I set out all the clothing I’m gonna wear for the week. One of the hardest things for me is when I do go to my part time job where I work, I have to look really nice and trying to put together an outfit. Sometimes I can’t do it. And you’re like, Rachel, just these pants and a shirt and you know, but I can’t. It’s like there’s I just can’t. I’ll have the hardest time putting on clothes because I can’t focus. So what I do is I lay them out ahead of time. So I go, OK. I already set these two together. Just put them on. Don’t worry. Just put them on. That’s a little bit of personal-ness about me, what I struggle with. But listeners, I would like to know something about you. Please take a brief three minute survey so we can better understand our audience. If you’ll go to PsychCentral.com/survey19 and fill that out for us. That would be awesome.

Gabe: The goal is to learn about you so that we can make the best possible show for you and you’ll be entered into a drawing to win one hundred dollars from Amazon (void where prohibited). So we really appreciate it. I have a specific question, though. Is this like fear? Are you afraid to answer the phone or you just don’t have the ability to do it? And other things that kind of pop up in my head or like social anxiety or just it’s kind of what it sounds like. But is it different from that?

Rachel : Yes, it’s different. You can totally have social anxiety and have schizophrenia. I mean, I’ve had times where I went to a party. I don’t do well around people. I don’t know. And I was so nervous that I couldn’t get out of the car. And I was just I was terrified of what was going to happen. Avolition and lack of motivation is not that I’m not scared of anything. I can walk in there, you know, and I’m not like gonna like burst into tears.

Gabe: When it comes to avolition, you’re not scared of anything. Whereas with social anxiety, you are scared. But the end result is the same. You don’t do it.

Rachel : Yes, there’s some reason I can’t, you know? It’s not just the reason it’s oh, I’m terrified. I’m shaking. Avolition is just there’s a whole missing and I don’t know what to do. And usually I don’t make it to the party and sit in my car. It’s I don’t even get to the point of wearing clothing to go there. For some reason, with me, clothing is a big issue. And I know it is with other types of people that have certain mental disorders have told me that, too. And if you are a friend or loved one, it sounds silly, but that can really help some people. It’s just being like, hey, you look really good in this outfit. When someone gives me a compliment about an outfit, I like mentally go, okay, these go together really well. I’m going to put this in my lineup for next week. It’s just bizarre, but it’s almost that confirmation I needed to, OK, check. That’s one outfit I have down for next week.

Gabe: Let’s talk about how we can help motivate people with schizophrenia. How people with schizophrenia can get the support that they need and feel more motivated. What’s the treatment for this? Because I don’t think anybody wants to walk away and believe, oh, well, this is a symptom of schizophrenia. Nothing can be done. This is your life now. And that’s certainly not what we’re saying.

Rachel : The treatment is cognitive behavioral therapy. Getting therapy to help you figure out how to get over these holes. The other thing is medication management. And I wish I could be like, oh, there’s a special pill you can take and you’ll be fine as if you’ve been taking medication for any amount of time. You know that it’s not true. It’s an ongoing process and sometimes trying different medication. And there really isn’t a set motivation pill.

Gabe: And it’s really important to understand that this is an excellent example of where medication and psychotherapy really do go hand in hand.

Rachel : And it’s amazing if you’re able to find a place where you can have the therapy and it’s connected with whoever is your psychiatrist doing the medication. That’s one thing is I was lucky to get a counselor recently who is at the same center as the person I see who does the medication. So I’ll be able to talk to her. And she’s like, you know, Rachel, I’ve been hearing a lot of such and such. Are you having issues with your depression? Maybe I should put a note in your chart and next time you might want to bring that up. So that that’s actually worked out really good for me as far as a lot of my management is having those two people, someone who knows me. You know, on a more personal level of me share again therapy and working with me to be able to kind of tell the other one. So very cool if you’re able to set that up kind of situation.

Gabe: Let’s talk about what our loved ones, our friends and family can do to help us deal with lack of motivation.

Rachel : Communicate. Talk to us. Don’t like aggressively push. Don’t holler. Don’t get mad. It’s like we said earlier. Yes, someone with schizophrenia can totally be lazy. OK. So you know it could totally be being lazy on some things, but kind of ask some questions, see if you’re able to start understanding the difference and what it is. So communicate. So if you see, OK, I’m having trouble. I have not taken a shower all week. This needs to change like for a lot of reasons. Just general health reasons. Talk to that person. Figure out where the breakdown is. OK. What is keeping them from doing this task? See if you can help and see. Again, these are little things. So if you know I’m not taking my medication, there’s something going on. Step in like my mom had to with me. OK. I’m going to go and get it. And she said, I’ll go and get it. If you’re able to step in and figure out where is this person having the issue? If it’s bill paying. OK. Sit down and be like, look, let’s get this setup on automatic or let’s have you write out all of your appointments and I’ll put them in my phone also so I can send you a reminder. I can swing by and say, hey, don’t forget, you know, just little things. It doesn’t have to be you take over this person’s life and drag them out of bed and put them in the shower and scrub them. Okay. Just talk to us and figure out where’s this person having an issue?

Gabe: So what you’re basically saying is don’t force them to do it and do it for them, help them do it. But why can’t we just do it? Why shouldn’t we just drag you out of bed and scrub you to use your analogy, why doesn’t that work?

Rachel : Because that person with schizophrenia, and I’m talking about myself, too. You have to be able to do things for yourself and to the loved ones out there if you’re doing that thing for them. You’re not necessarily helping. OK. You’re just kind of taking over my life. And everyone knows, I’ve had my parents interviewed and stuff. And I’ve always told them that the minute they refer to themselves as a caretaker, I’m moving out. I will go live in my car because I don’t like that analogy that somebody has to do everything for me. OK. I’m not a little baby.

Gabe: Because you want to be proud.

Rachel : Yes. And while, unfortunately, there are a lot of things that I can’t do, I can’t work a normal 9 to 5, 40 hour week job. I’ve had to make a lot of adjustments because I can’t do that. I can’t live alone. I get weird. But there’s a difference between that and having someone just take over my life and be like, okay, well, you live with me now. I’m gonna you know, you’re paying rent to me and I’m gonna take care of you. And it’s like you become a parent to them. And no, you’re gonna have someone with schizophrenia really start to resent you, honestly.

Gabe: So you believe that a partnership works better because you’ve described in your own situation that if your parents who love you very much and out of love just took over your life and forced you to do everything you would resent them. That would be traumatizing for you. But more importantly, you’ve said that it wouldn’t work. You specifically said that you would run away. Do you think you would be better if you ran away? Because your current situation of discussing it, being partners, figuring out what you need help with and what you don’t need help with seems to be working extraordinarily well. This this has been working for years.

Rachel : And I have run away a few times. I mean, no, I’ve lived. That’s how we know this works, is that I have lived by myself and had to look around and realize I hadn’t left the house in days. I had gotten off the floor in days. I’d been in the same spot laying on the floor out of it. And yeah, I could not live alone. Did I need someone to come in and do everything for me and feed me and that? No. I did, however, definitely need help at that moment. I needed to be around people because I wasn’t doing anything like on my own. I just kind of like mentally shut off. But at what point I was able to realize, okay, this is not good. I need help. And I called my dad and I said, listen, this is what’s happening. I don’t know what to do. And I moved back in pretty much that next day. And it was great. They didn’t have to do that much to help me because just them being around was able to, just them being around. My dad kind of always checking that I was eating, you know, and knowing that she hasn’t gotten out of bed in the past eight hours and him coming and bringing me food. Or usually it’s, Rachel, I made you lunch, come up here. Making me walk all the way up the steps. So many steps. You know, it it seems like a little thing, but sometimes it was huge and that was monumental. But it got me moving. Not him, like sitting there spoon feeding me soup.

Gabe: I know you use words like he made me, but he’s not actually making you, right? He’s encouraging and asking. Like you said, he. He made lunch and came down and banged on the door. And I suppose what I’m really trying to say is that you have developed an excellent partnership with your family so that they know what you need help with, what you don’t need help with, when they need to step in. And I think here is the key. You all have figured out when they don’t need to step in. And I think that’s really the missing piece for a lot of families out there. They don’t know when to back off. They know when to step forward, but they don’t know when to step backward.

Rachel : And on that note, just because you said banging on the door, one thing that I found and just throwing it out, I’m not saying it will work for everyone. My door’s almost never closed. I always want it open because I can’t live alone in general. I seclude myself off and it’s the same thing with my room. I don’t close my door unless I’m changing my clothes and then it’s back open again. On that note, my parents also just don’t wander in my room as I am a grown woman. But they walk up to the door and like, Hey, Rachel, you know. But for me, that’s important because it lets them check on me without really disturbing me. They’ll just kind of pop their heads in and be like, OK, she’s fine. And it gives me more of a link that if they’re walking by, it helps me be like, hey, what are you doing? And my mom will be like, oh, I’m going out. And I’m like, can I come? I need some stuff from Harris Teeter or from the grocery store and I’ll kind of go with her where I probably wouldn’t have done that before. And that’s exactly what happened yesterday. I really been at a grocery store like a week. And I just kind of hadn’t gotten any. And I really wanted to, but I just I hadn’t. And she she was going to the grocery store. Can I just come along?

Gabe: And the way this really ties into motivation, and I think that’s important, is if you’ve done some preplanning ahead of time, like leaving your door open, setting general guidelines for eating, and these have become sort of house rules. It’s not authoritarian, it’s not caretaker or caregiver. It’s just the rules of the house. And no matter where you live, there’s rules of the house. You know, husbands and wives have general house rules, roommates have house rules. Dorms have house rules. That’s what you’ve established. And it’s a lot less about you being a person living with schizophrenia and much more about keeping everybody in the house healthy and safe.

Rachel : Yes. Mm hmm.

Gabe: So preplanning is also more motivational issues. Expectations are set when everybody as well.

Rachel : Yes.

Gabe: So preplanning is also more motivational issues. Expectations are set when everybody as well.

Rachel : Yes.

Gabe: We will be right back after this message from our sponsor.

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Gabe: And we are back discussing motivation in schizophrenia.

Rachel: One other thing is that I know my big issues, okay. The clothing I talked about. Another one is eating. So I have a lot of protein bars. I always have protein bars. When they’re on sale, I’ll buy like a case. So, so many protein bars because I know a lot of times, I can’t make it up the steps, to the kitchen, but I’ll have that protein bar by my bed. So. OK. OK. At least I eat something. To take my pills, I have to have some kind of food in me. So that’s another reason it gets caught on the pills thing is that, well, I haven’t eaten and I have to go eat before I take my pills and everything just spirals. When it comes to hygiene, I actually read this on a schizophrenia forum and someone said that on the days when they couldn’t get out of bed and shower, they had the little, like you would wipe a baby with, those little wipes. And I was like, that’s so smart. And I went out and got them that day. And yes, some days, that’s what I use, you know.

Gabe: I really like these examples because on one hand, the cynic in me says, oh, you didn’t eat a healthy meal, you didn’t get out of bed and you didn’t take a shower. But that’s not the level that we’re playing on, right?

Rachel : Go with this. Isn’t that. Yeah. I did that thing, but I did something. I did something moving me towards it. All right. That might not have been like what anyone else would’ve done if the goal was to take a shower. I didn’t quite get there, but I did something towards that. I took care of the problem in a way that I could as opposed to just doing nothing.

Gabe: And that’s empowering because previously you had done nothing. So we really have to reward small successes with this illness. We just have to because it’s not ideal. That’s why it’s an illness.

Rachel : Correct. I mean, the protein bars thing, you know? No, I don’t want to be someone who’s like, well, all I had to eat in the past week as protein bars. I’m going to be incredibly, you know, for one sick, because ugh. I also buy really cheap ones, so they taste terrible. But I did something. I’m not just laying there like wasting away. Two or three days of that, we’re having another problem. But usually my parents have noticed that there’s something going on. We haven’t seen Rachel in the kitchen or at all. And they know when to step in, but they don’t have to worry about me just completely not eating or something. They don’t have to worry. I even have like mouthwash for days that I don’t even think I can, like, mentally handle brushing my teeth, which again, like right now that sounds silly to say, Rachel, you can’t brush your teeth like I even have a sonic toothbrush. Like you really just gotta stick it in your mouth and your whole mouth vibrates it loose. But then some days I’m like, I just can’t. And being able to just take a swig of mouthwash, that’s something.

Gabe: Rachel, you had the good fortune to speak to Debbie Breen, who is a therapist who specializes in counseling people to help them set goals and achieve those goals. She’s sort of an expert on motivation, correct?

Rachel : Yes. Yes.

Gabe: All right, well, let’s hear it.

Rachel Star Withers: We’re here speaking with licensed professional counselor Debbie Breen. So thank you so much for being here with us today.

Debbie Breen: You’re welcome. Glad to be here.

Rachel Star Withers: And I think all of us in life, we’re going to have times when we don’t have motivation to do something. When it comes to people, you know, with severe schizophrenia, depression and other type of serious mental disorders, what do you see that, motivation wise, we struggle with the most?

Debbie Breen: Our feeling of a lack of motivation is a signal that something is not right. We’re not in congruence with our value system or something that’s important to us and/or we haven’t resolved past pain.  So think of it like this, our feelings are like the instruments on our car dash. They’re not good or bad. They just tell me what the current status is. If I’m almost on empty, it’s I’m assuming you don’t want red. If my engine’s not functioning, I’m going to see that red light flicker. And that just helps me to act. So what we learn is what I’m thinking about is a perception that it’s not the totality of a story or thought. Most of us can’t do this alone. But when we seek professional help, we learn about cognitive behavior and how we are created. We learn to realize, wow, my thoughts are skewed. I am on this habit or passive way of thinking that is negative. It’s like I’m playing a rerun of only the negative things that have occurred. But then that becomes my reality.

Rachel Star Withers: And what about when it comes to working where we’re talking like the issue of like getting out of bed to go to work or just you’re upset with pretty much having to go, period? Like you don’t like what you do in general or just not have the motivation to get up and like pursue work?

Debbie Breen: One of the first signs of maybe depression beginning is how hard is it to get out of bed? And you can have a range from a little bit hit snooze to. I really can’t get out of bed. That behavior is telling me that where the thinking is that I’m feeling depressed. I don’t see a reason to get up. I’m not making a difference. I’m not motivated to go do something or create something. There’s a deficit my life. And I’m being passive with how I’m handling it. And it’s not getting better or going away. So hopefully you’ll get to that point or someone in your life can help you say, wow, I’m saying this and we need to make some changes. I have to be open to trying it another way, learning how to do it another way, maybe shifting medication. But as I move toward that action of trying to solve it, I’m doing something active, which then gives me motivation and hope that life can be different. If I just can’t get up and get out of bed, then we need to find help, we need to find support. We need to find professional help because that tells us our body is just it’s not working and it’s going to take more than self effort because that’s not working. We need someone to walk with us. There may need to be medication management. We need to learn these skills. And again, that’s a choice. The motivation is I don’t like what I’m experiencing right now, and I need to choose to do something different.

Rachel Star Withers: Well, on that note, what you just said about support, that’s perfect. But a lot of times people when we’re in those states have just that kind of deep depression, an episode, schizophrenia, it we don’t see that. What would friends, family, what can they do when you see someone like that who doesn’t realize how bad they are?

Debbie Breen: And that’s a tough thing because if you’re an adult, if you’re over 18, that person’s gotta want to get help. And that’s where it’s difficult as a family, when we can’t make someone get help. But we see them suffering and then we’re hurting with them because we love them. But there’s gotta be a choice with that individual wanting to take the steps. First thing is just we want to be present. Whether it’s mental health, or we could even say, let’s say loss or death, talking is not what’s needed. We need someone just to be present. Quiet. Accept that this is what I’m feeling and thinking. It’s not a fun place to be, but it’s part of life. It’s scary being in that place and feeling like you’re alone. So having someone just there is huge while we’re working through this. The second thing that person can do is they can validate that feeling by saying, you know what, I don’t understand, but I know what it’s like to feel like I don’t care. Like there might not be hope. We’ve all had that. And we’re reminding that person you’re not the first person to go through it. You won’t be the last. This is part of our human condition. And just validate and not judge it. After some time has passed, and I know that’s relative, what we want to do is we want to pull them from the feelings state, which is where they’re drowning in to thinking. We’re just too far on this side and we need to bring some cognition that we need to start changing those thoughts from all negative to what can you do? What is important to you right now? What do you need? So if someone is feeling, what’s the point, hopeless. Then they’re communicating to me that they want to have a desire for purpose. They want to have meaning, but they’re not seeing it in the current moment. So we start with what’s important to you or what do you value? Let’s say if it’s your pet, well, we want you to focus on your pet. I want you to show acts of kindness. Pet him, walk him. I want you to think about your pet and taking care of your pet. Your pet counts on you. Now I’m bringing back into their cognition a positive thought of an important relationship and that is that pet needs them and they do have purpose. I just want them to start thinking about what they can do, which helps put in perspective this imbalance that’s going on. And give room for them to choose. To make things different may take time. Everything is a season, but I need to want to reach out to that resource and then start to participate.

Rachel Star Withers: Debbie, so if there’s someone listening right now who is struggling with motivation, whether it’s something really small or like a major life event, they’re just having a hard time accepting and moving forward. Do you have any advice that you want to leave with them?

Debbie Breen: I understand where they’re coming from. You live long enough, and I’m older in years, and you see things, and you go through things and life is hard. To go through that alone is very difficult. We really need, again, our support, our friends. We need a sense of community who can just be there with us and help care. And then vice versa, when we are out of that, we are then there for them. And there’s a lot of security in that. There’s something about feeling alone, which is where we feel when it’s dark. That’s frightening. It’s easy to want to quit, your brain’s saying it’s always going to be hard. It’s never going to get better. And that’s not the truth. So, that’s a tough place to be. The message is you will get through it, but we have to be active in that. We have to take those steps and it feels really hard.

Rachel Star Withers: Debbie, where can our listeners find you?

Debbie Breen: Our practice is Charlotte Family Counseling, and we’re located in Matthews and in downtown Charlotte, North Carolina. And our website is www.CharlotteFamilyCounseling.com.

Rachel Star Withers: Well, thank you very much, Debbie. It was wonderful speaking with you today and hearing about your advice for us.

Gabe: Rachel, that was really cool. I’m glad that she agreed to be interviewed by you.

Rachel : I really like how she stressed that it was a choice, regardless of how I feel, what’s going on. Choose to do something. Pick something and just focus on it and do it. Kind of what she said with the choice thing. It made me start thinking that if you switch out motivation for the word choice, it really changes a lot in your thinking. So if you’re like, man, I lack the motivation to get out of bed. It becomes I like the choice to get out of bed. And I’m like, well, no, I can get out of bed. You know, I would actually think, well, no, of course I can do it. And it just made me start like thinking. As I mentioned earlier in the episode, one of the biggest things I struggle with motivation is social interaction. I want friends and I know as a human I should have friends. That is a healthy thing people do is interact with other people. And yet I’m so bad at replying to texts and actually talking and making those friendships. A lot have fallen by the wayside. And not because I’m being rude in my mind. But I just, I didn’t follow up. I didn’t stay connected with those people. So I did a little experiment and decided that, OK. My issue is that I lack motivation. What’s something I can do? Something small that is going to help me with that? So I decided to give five people different compliments. Something about me that I would probably think in my head and said, I’m going to actually say it out loud.

Rachel : And, you know, that’s like all original. That’s pretty little. No, I’m going to have to interact with five people that I probably wouldn’t have said anything. But I did. I got all five people. I talked to one of my co-workers who always dresses amazing. His hair is amazing and he’s just incredible. I’m just like, Michael, you always look so amazing. And he got so happy. He’s like, Rachel, it’s so sweet of you say that, you know. And we talked a little bit about fashion. This other girl at my work, she came in with her hair bright blue. This is a very interesting place I work at. I know it already sounds exciting, but I was like, you know, your hair just really I don’t know. It makes me smile. Like it was like Smurf color blue, as she said. Oh, thank you. You know. That’s a pretty big change, like, yeah, that’s an incredibly huge change. But it was just cute, though, like it actually looked cute on her. I don’t think it would look cute on me. I saw this girl who had like a full tattoo sleeve, which I’ve always wanted. I’m nowhere near close to that. But I want to. When I see it on women, I think that, I just don’t know, it looks so cool to me. And I told her that. Of course, whenever you tell someone like their tattoo looks cool, they immediately are going to tell you the backstory. I got this, like, okay. So I heard how she got her next 20 tattoos on her arm. One of my acting students, they’ve come so far. And after classes, I said, Hey, hang back a minute. I just want you know, I’m really proud of you because that today was the best you’ve done in the past 20 weeks. That blew my mind. That is a completely different person. This dude just completely lit up. And then on my way home, I ran out of people. I was at the gas station and the lady across from me at the pump, she had these really cool like cat eye glasses. They would look ridiculous on me, but they looked so cool on her. And I just told her, I was like, you look so neat with those glasses, like eye catching and like she looks like this edgy, cool person. And she just smiled and was like, thank you. I just got them. And doing my little experiment, did it fix all of my problems? No. But my issue was that I’m having trouble with being social. And those five conversations are way more than I would have had if I hadn’t pushed myself to do that. While five seems like a lot every day because some days I don’t leave my house like I don’t have to. So, you know, I decided, though, regardless, every day, Gabe, from now on, I’m going to give at least two compliments to people. And so we’ll start with you for today. Gabe, you are a wonderful host and co-host and interviewer. I’m always impressed by your speaking skills. You’re very clear. And I think that you do an awesome job of like breaking ideas down. So that is my compliment for you, Gabe.

Gabe: Thank you, Rachel. I really appreciate that. And what I liked about your story and you may not have even realized it. You pointed out like what you were thinking. I think you kind of showed your hand a little bit because you were like, I saw these glasses and I thought they were cool, but they would never look good on me. And, you know, I saw the tattoo sleeve and I want one, but but I’m nowhere near there and I’m never going to get around to it. The pessimism, the lack of motivation, the whatever words you want to use, it came through in your own storytelling and yet you overcame it. Instead of sitting with the negative thing and doing nothing, which by your own admission, was your trend. You took the negative and turned it into a positive. Will you do that every time? No, of course not. As you said, to solve all the world’s problems? No, of course not. But it helped. I mean, now that you’re doing it twice a day, obviously you’ve felt that you’ve got a lot of benefit from it. Yes.

Rachel : Oh, absolutely. And it wasn’t. And that’s one thing I was giving the backstories. I didn’t want you to think, Oh, she’s just go around making up stuff to say. Those were thoughts I had. I just, you know, normally would think them. And like, I should tell Michael that I always love how he dresses. He just looks incredible. Just stepped off the runway. And I’m like, what have you done today? And he’s like, oh, I just decided to come here, just woke up. And I’m like, he did so good. But there are things that I think inside, and when I actually said these things, you know, it’s kind of cool to see someone light up. Just like, we all like getting compliments, you know? Yeah, that was a little interaction we had. And all those people were like, I made them happy enough to smile, which made me smile. And I’m like, go, Rachel, you connected.

Gabe: That is that is awesome, Rachel. And I think that everybody should try this experiment. Give one compliment a day. Give two compliments a week or find out what you can do that is seemingly small and insignificant and see what kind of results that you get.

Rachel : Figure out what is something small? And at least do something.

Gabe: I understand what you’re saying about switching motivation and choice, but in my year, what I hear is like, that’s great for normal people. That’s great for people who have, you know, typical problems with motivations. I kind of want to play a little devil’s advocate for a moment and say, well, wait a minute. Do people with schizophrenia have the choice to get out of bed? I mean, can they really just will themselves forward? I think that a lot of people are going to hear this and think, oh, wow, this is the advice of, oh, you should just do yoga and your schizophrenia will be fine.

Rachel : Very good question. With that, I think, no, it’s more changing the thought because whatever is overwhelming, changing it. Social interaction feels overwhelming. What is something that I can break it and make it easier? OK. Getting out of bed and brushing my teeth today seems overwhelming, but, OK, let me break this down. What can I do? Well, I can start by getting towards the end of the bed, standing up, grabbing the mouthwash. Just what can I do? I might not be able make it all the way in there. What is something? And like narrowing down, I get to Wal-Mart and suddenly it seems overwhelming to go inside. I’m sitting there with like, what do I do? All right. What can I do? Sometimes, you know, I can just get out in the parking lot and just doing that motion. I’ll slowly go inside. Sometimes I wear my glasses inside. I don’t know why. It makes me feel like, I feel invisible. You know, I’m not. But I feel that way. Wear like a really low, low hat. And I’m kind of like in my own world. And other days, it’s like, you know, I’ll have to go home. But instead of not doing anything, I’m going to text my mom. Can you help me get my medication? Can you help me do this thing as opposed to just keeping it to myself? Like actually opening up and thinking, what can someone else help me with?

Gabe: I think it’s important to understand that coping skills have a place right. You know, obviously, if you are in the middle of severe hallucinations or if you’re in crisis or if you are very, very delusional, then the help that you need isn’t utilizing a coping mechanism. You need more help then this could provide. So these are skills that you should use it when you’re maybe in the middle of the spectrum. It’s really hard to sort of discuss when these skills will work, but it is a tool to put in your toolbox that you can use when appropriate.

Rachel : And let me always be clear to everyone. I actually am on medication for my schizophrenia and depression. I have been for many years. So I always want to put that out there that no, I didn’t just naturally, yes, use these coping mechanisms and everything was OK. And Rachel got to like skip through the field, happy. I am on quite a few medications which have to be tweaked very often.

Gabe: It’s important to understand, of course, that we need many tools, right? You know, the best painter in the world doesn’t have one paintbrush. But for some reason, when it comes to discussions surrounding schizophrenia, everybody’s looking for that one thing. We want one thing and that will make everything better. This is a discussion about one area lack of motivation. We do have to have this general assumption that other areas of the disease are in a good place,

Rachel : Correct. Yeah.

Gabe: Because obviously, if they’re not, motivation is not your primary concern.

Rachel : Mm hmm. No on days I’m out of my head sometimes I mean it, though, like when I’m hallucinating it, I don’t need to go. It has nothing to it. Rachel needs to get the car and go get her her medication. Rachel’s like in another world. So that’s not the same thing as like what I’m talking about today. The big issue there is I need to deal with kind of the crisis. I mean, not worry so much about my lack of motivation. Hey, listeners, we want to get to know you better. So please take a brief 3 minute survey so we can better understand you. Who’s listening to this? Go to PsychCentral.com/survey19 to complete it now. So everyone who completes the survey will automatically be entered into a drawing for a free one hundred dollar amazon.com gift card (void where prohibited). So Gabe, I assume I can apply, right? I can take the survey?

Gabe: I think that both of us are exempt from both filling out the survey and winning the gift card.

Rachel : Oh.

Gabe: So that just increases your odds and we really want to do this so that we know you better and can make the best show possible. So check it out over on PsychCentral.com/survey19.

Rachel : And as always, thank you for listening to our podcast, Inside Schizophrenia. Please share this podcast, like it, subscribe, comment. And share it seriously with your loved ones. Whoever you know that you’re probably listening to this podcast for a specific reason. Share it with that person that you’re worried about or that you’re trying to help. Or if you’re that person, share it with maybe your people around you so they can understand better. Thank you so much for listening, guys. And we’ll see you next month for another episode of Inside Schizophrenia.

Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.

Go to Source
Date: 20th October 2019 at 23:39
Author: Psychcentral – psychology – Rachel Star Withers

Are you always in control and always perfectly put together? Are you professionally successful, a great friend, and always showing a happy face to the world?  But what about on the inside? Is there something in the background or in the past that you don’t talk about?  Do you feel disconnected, like no one knows the “real” you? Deep down do you just know something is wrong? Well, you might have “perfectly hidden depression.”

Today Gabe speaks with Dr. Margaret Rutherford who has done extensive work on the relationship between perfectionism and depression.  Dr. Rutherford tells us how childhood trauma can lead to the development of coping mechanisms that don’t serve us as adults and how those behaviors might be masking depression. Then she shares how to challenge those beliefs and show ourselves the same compassion we would give to anyone else.


Guest information for ‘Hidden Depression’ Podcast Episode

Dr. Margaret Rutherford, a clinical psychologist, has practiced for twenty-six years in Fayetteville, Arkansas. Earning the 2009 Arkansas Private Practitioner of the Year award for her volunteer work at a local free health clinic, she began blogging and podcasting in 2012 to destigmatize mental illness and educate the public about therapy and treatment. With a compassionate and common-sense style, her work can be found at https://DrMargaretRutherford.com, as well as HuffPost, Psych Central, Psychology Today, The Mighty, the Gottman Blog and others. She hosts a weekly podcast, SelfWork with Dr. Margaret Rutherford. And her new book, Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression, will be published by New Harbinger in November 2019.

About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Hidden DepressionEpisode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in everyday plain language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome, everyone, to this week’s episode of the Psych Central Podcast. Calling in to the show today we have Dr. Margaret Rutherford, a clinical psychologist who has practiced for 26 years in Fayetteville, Arkansas. She’s the author of a new book, Perfectly Hidden Depression: How to Break Free from the Perfectionism that Masks Your Depression. Margaret, welcome to the show.

Dr. Margaret Rutherford: Thank you very much. I’m more than delighted to be here. This is a subject I’ve been passionate about for over 5 years, so any time I get to talk about it, I’m delighted.

Gabe Howard: Well, that’s wonderful. Now you have been a therapist, as we established, for well over twenty five years. How did you come up with the term perfectly hidden depression and why do you decide to write a book about it?

Dr. Margaret Rutherford: Well, I actually was sitting down to write a blog post one day. I had been blogging for, I don’t know, a couple of years by that. And I thought about several people that I had seen and I just sort of thought well, they are perfectly hidden. They don’t talk about their depression, they’re not open about their depression. But if I say, gosh, could you be aware that there’s something in the background that you’ll tell me a bad story or a painful story and there’s a smile on your face, but you’re not crying about it. So there was this problem between someone talking about something traumatic and yet not having any kind of painful emotion that was connected with it.

Gabe Howard: I know that a lot of times people think that depression is supposed to look a certain way. Whenever we see pictures of depression, it’s always somebody with their hands on their head or they are crying or dark storm clouds. But that’s not really the reality. There’s a lot of people who suffer from depression that upon visual inspection look perfectly fine.

Dr. Margaret Rutherford: Yes. And you know, in the literature that’s often called high-functioning depression or smiling depression. These are people who really know that they are depressed, that they have even the classic symptoms of depression, like it’s hard to get out of bed or they’re not as enjoying as many activities that they had in the past or something like that, or they even know when they get home from the office, here comes this negative energy or with this tendency to want to withdraw. Perfectly hidden depressed people can look like that. They can be aware on one level that they are depressed. The difference is there’s also a huge group of them that really don’t actually know they’re depressed. They have been hiding for so long. They have been pushing away trauma or painful emotions. Maybe they weren’t even allowed to talk about pain when they were children. There are all kinds of situations that can foster a perfectly hidden depression. And so this process is so automatic that they’re not really sure anymore. They know maybe their gut is telling them something’s wrong with this little tiny voice inside of them says, you know, this isn’t right. You should be happier. You should be actually more fulfilled. But they try not to listen that voice, because, of course, their major focus is on looking like they have the perfect looking life.

Gabe Howard: I know that when I was depressed, I thought that it was some sort of moral failing and, you know, my parents would say things to me like, well, what do you have to be upset about? Why? Why aren’t you happy? You have more than others. You know, I grew up in the era where we heard about, you know, starving children in other countries all the time when we didn’t want to eat dinner. So there was just always this comparison. And that made me, as a young adult, believe, well, yeah, since I don’t have a reason to be depressed, I must not be depressed. Is that what you’re trying to highlight and discuss with, you know, your work, your research, and in your book?

Dr. Margaret Rutherford: That’s certainly one of the traits. There are 10 commonly shared traits of perfectly hidden depression, Gabe. And one of them is an emphasis on counting your blessings to the point where you don’t even see that some blessings have vulnerabilities or problems attached to them. For example, I have a successful practice in Fayetteville, Arkansas. I’m very proud of that. I’ve worked hard for that. I’m very honored by that. But sometimes I get tired and we all have… Maybe you’re a great beauty or you’re wealthy and you wonder, are people attracted to me because I’m beautiful or because I’m wealthy? Let’s say someone has four children and they love having a big family. But then when it comes down to carting children to four different things or or having four different sets of homework or just buying clothes for four kids. There are some hardships that come along with blessings. And when you are trying to, well, what you said you were told as a child you don’t have anything to complain about. Then you were told, don’t talk about vulnerability, don’t talk about pain. It’s unseemly. You’re not being grateful. And I think that that sets up this dynamic where you shame yourself for not being grateful enough. Perfectly hidden depressed people, and even perfectionists in general, that perfectionism is often fueled by shame. Where you do you have to do your very best, because if you don’t, there are all kinds of shameful consequences for that. And you are completely self-critical and not counting their blessings is one of those criticisms.

Gabe Howard: Has research demonstrated a relationship between perfectionism and depression?

Dr. Margaret Rutherford: Yes, perfectionism actually started being written about, I don’t want to go into too much history, but back in the 1930s. It began getting some attention as a psychological problem. And there are some researchers now that are actually finding some correlation and a strong correlation between perfectionism and suicide. When I think about some of my own patients thinking, OK, what are the threads that might define or identify these people? What are the things that they spend a lot of time thinking about or doing? And I came up with 10 of them. Some I’ve already mentioned like being highly perfectionistic with a lot of shame, having an excessive sense of responsibility. These are people who have their hands up in the air all the time. They stay in their head. They tend to be very rational people. They detach from pain by being analytical. They worry a lot and they need a lot of control over themselves and their environment. They can easily focus on tasks because what they do is how they feel valuable. This is the kind of person that if they go to a party and they’re not given a role to do, they’re very uncomfortable. They really don’t know.

Dr. Margaret Rutherford: So they’ll start picking up plates. They’ll assign themselves some role because that’s where they’re most comfortable. Again, I’ve said this already. They don’t allow people into their own inner world, but they really sincerely focus on the well-being of others. They mean it’s not made up. It’s not fake. They discount personal hurt or sorrow. And they have hardly any self-compassion. They believe strongly in counting your blessings. We all often talk about that. They actually may enjoy success professionally, in fact, but they don’t know how to be emotionally intimate in their relationships. So their relationships are often very troubled. And the last one is something a little different. A lot of times these folks will show up in your office or just in life with a panic disorder or an eating disorder and obsessive compulsive disorder or an addiction. And when you think about that, the thread of all those disorders is the fact that they’re all about control. So they may have some accompanying diagnostically accurate mental health issues. And those are important to address. But the important fact about them for me, with perfectly hidden depression is the fact that those diagnoses reflect a problem with control.

Gabe Howard: Is there a way that a person can recognize this in themselves, if I’m somebody listening and I’m listening to what you said, or are there some cues or questions that I can ask myself so that I know if I’m falling under this?

Dr. Margaret Rutherford: That’s a great question, Gabe. You know, one of the people said to me, in fact, many people said to me, “When I saw the term perfectly hidden depression, I knew you had figured something out about me. Yes, I’m perfect looking. But yes, I have known something was wrong for a long time. And I am lonely and I’m despairing. No one knows me. And I have these thoughts of hurting myself that I don’t share with anybody.” I mean, I think you could recognize yourself in those 10 commonly shared traits. Probably the only one I hope that got confusing a little bit was the one talking about the other diagnoses that could accompany it. But I think even if you’re one of that huge group that I talked about a few minutes ago, that really this has become so automatic or unconscious that they don’t quite realize what they’re doing. They would never tell you that they were, depressed, however. What the people I interviewed told me is what they are very clear about is that they’re getting lonelier and lonelier. It’s getting harder and harder to maintain that mask. You’re feeling more and more pressured at work or at church or wherever you put your energies.

Dr. Margaret Rutherford: Because once you accomplish something, you have this sense of now that’s my “I have to top that.” And then the next one is I have to top that and I have to top that. The pressure is incredible. We know on a gut level and they know on a gut level if it’s them or you know what, if it’s you that something is amiss. And when you go back to your childhood and you think, how could I have learned this? You figure out, well, I was screamed at because I was told I would be no good. And so I decided to look perfect all the time or I took care of everybody in my family because my dad was an alcoholic and I never got to talk about anything bad for me. So, you know, guess what? I’m living my life as an adult that way. Or you were the star of your family where your mother or your dad or both said, “Gosh, you’re so talented. We don’t have to worry about you. You are great. You’re so successful.” And so you took it on like, oh, this is the way I get attention. I have to be this in order to be loved.

Gabe Howard: And these are examples of all the things that causes somebody to want to look perfect or appear perfect or be perfect?

Dr. Margaret Rutherford: Yes, exactly. There are several different causes. There are many roads to Rome, do you say? There are many ways to or paths that lead you to creating this: sexual abuse, neglect, just bad parenting and especially growing up in families where if you were crying or sad or angry or just wanted to voice your own opinion, that was not allowed. You adopted this drive, this strategy, for lack of a better word. I think it’s a good word, in fact, this strategy, to I just can’t let anybody in to my own vulnerabilities. It’s not allowed. I’m shamed for it. So then you shame yourself for it. Many of us have a childhood strategy that we came up with given the family we were born into. And that strategy helped us survive that family. Maybe you were smothered and you learned, you know, I’ve got to sometimes be more independent because I will get smothered if I don’t. We all have different ways we handled our parents’ vulnerabilities. What happens as an adult is often that strategy is no longer working. But we’re still using it. And so a perfectionist may have learned in their childhoods that they needed to create a perfect looking life in order to handle whatever was going on in the family. But then you come into adult life and looking perfect is something you’re still doing, but it’s gradually going to erode and sabotage your own joy and fulfillment in life.

Gabe Howard: We’ll be right back after this message from our sponsor.

Announcer: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: And we’re back with Dr. Margaret Rutherford. So what can somebody do if they identify with perfectly hidden depression? Is there an end? Can they get better? What’s the solution?

Dr. Margaret Rutherford: You know, I thought this book was… I was going to describe something. And I sent my book proposal in to all the publishing houses and that’s what it was. New Harbinger got back to me and said, no, no, no, no, no. If you want to describe it, fine, you need to do that. But you also need a treatment strategy.

Gabe Howard: Wow.

Dr. Margaret Rutherford: And so. Oh, goodness. And so what I did was I came up with a model that I use with almost every patient. They don’t have to be perfectionists. It’s a general model of what I do with therapy. And the model is you have to be conscious. Consciousness is the first stage. You have to be committed. So consciousness, commitment and with perfectionists, there are a lot of hurdles to commitment. A lot of them. Then you have to confront beliefs that you learned in childhood. This is really sort of cognitive behavioral work where you go back and you look at what you learn. You should, ought, must, have to, always do. And you begin to question those beliefs. Some of them are great, but which ones are causing a problem? And you look back on all that with an objective eye as much as you can, and then begin to think what beliefs do I want to live through? What beliefs do I want to live by now? The fourth stage is connection. And this is one of the toughest for perfectionists because we’re going to go back and do a trauma timeline about their childhoods.

Dr. Margaret Rutherford: What that means is you go back at year 1, 2, 3, 7, 9, 11, whatever years you think are important. And you talk about the positive things that happened, but you also let yourself write down the painful things that happened. And as you do that, you want to go back with self-compassion. What would you do with anybody else? Now, of course, all of that is about really rediscovering or discovering a new way of being for you. The last part is the part that’s about change. Changing your behavior. If I’ve learned one thing as a therapist, I’ve learned you get a lot of insights. Insight is wonderful; insight is great; insight helps you see things. It helps put the puzzle pieces together. But where you get your hope is in behavior change. What’s it like to act on these new beliefs? What’s it like to confront something that you’re sabotaging yourself with? What’s it like to feel emotions that you have suppressed for so long? It’s probably pretty frightening, actually. And so you want to start putting those things into your own life and into your behavior. And that’s where you’re going to get your hope.

Gabe Howard: I’m fascinated by this idea that something that individuals did not know was a problem is able to change their life in such a dramatic fashion. What kind of feedback are you getting from people who have utilized these methods? How are their lives improving by embracing this?

Dr. Margaret Rutherford: That’s a great question. I will tell you, and I promise you, I’m not being dramatic, just this year I’ve had two people have said to me, I wouldn’t be alive right now if I had not done this work. They actually were so miserable that they had those thoughts and they were so afraid they were going to act on them that that’s why they came into my practice. So I don’t think that’s true of everybody. But what I have heard is that, for example, one woman came, a young woman came into my office and she said there’s something about that term, “perfectly hidden depression” that I’m drawn to, and I’m not sure why. Well, come to find out. There was a lot of trauma in her lifetime that she had never talked about with anybody, didn’t even see it as trauma. When I used the term trauma, she started laughing. Oh, that’s not traumatic. And her father had hit her so violently when she was a young child that she’d had surgeries on her face.

Gabe Howard: Wow.

Dr. Margaret Rutherford: She didn’t consider that traumatic. So you’re trying to wake people up to the idea that what they have considered well, that was just my life or again, they have discounted it of what their reaction would be to someone else telling them that had happened in their lives, they would be horrified. And so you’re inviting people to get in touch with feelings. Another example, and this is gonna be about sexual abuse. So please listen carefully if you have any history of that. But a woman came in who had had a college sexual relationship, a boyfriend, that she had been with him for years, and he had been sexually abusive to her. When she first brought it up, she said, “You know, maybe this is important, maybe it’s not. But, you know, I should probably tell you about this relationship in college.” Yeah. I mean, it was very important in the way she was living her present life. So often these people just want you to confirm was this trauma, was this more difficult than I thought?

Gabe Howard: It’s obviously interesting to think about what we see as trauma and other people versus what we think about as traumatizing for ourselves. The examples that you used. I’m like, oh yeah, that that’s absolutely traumatic. But maybe you don’t recognize that in yourself. Is this what you’re noticing? Could there be perfectly hidden trauma? I mean, does all of this sort of go hand in hand?

Dr. Margaret Rutherford: Huh, that’s an interesting kind of thought, isn’t it? Yes. I mean, I think we are in a culture often that tells us to buck up. Don’t call it a problem. You know, you’re whining. Quit it. It’s selfish to think about that. In fact, it’s one of the funny, not funny but ironic examples. Years ago, you know, I had 7 or 8 patients a day typically, and sometimes I run real tight between sessions and one person had gone and the other person who came in, I don’t know, a minute after her sat exactly where she had sat on the sofa so she could feel the warmth of the body, warmth from the sofa that was still holding that warmth from the other person. And she looked at me and she said, you know, all of a sudden I get this feeling that I bet that person’s problems are a lot more important than mine. I feel silly being here. And I looked at her and I said, so you felt warmth on the sofa and somehow you jumped to the idea and the belief that you’re not important. Why you’re here isn’t important. So help me understand that. Amazing to me how many people have things in their life that they have very courageously gotten through. And I admire their courage.

Dr. Margaret Rutherford: I admire their resilience. It’s when resilience is on steroids that I have the problem. Don’t sweat the small stuff. OK, fine. Don’t sweat the small stuff, but sweat the big stuff and call it big. Berne Brown, of course, has written incredibly and presented incredibly about shame and vulnerability. One of her tenets is that you could only get to courage through vulnerability. She said a man stood up in the audience because people kind of going in, well, you know, maybe. But courage is courage. Courage is a lack of fear. And the soldier stood up, he had had three stints in Iraq. He’d been shot at. I mean, he’d seen people die and he looked at her and said, you are so right. I was afraid over there. And I had to recognize that fear and that vulnerability before I could get to my courage. Rudy Giuliani said it after 9/11. And I’m not going to say it as eloquently as he did. But he said something like, I thought I knew the definition of courage before 9/11, and that was the absence of fear. I found out that I’m wrong. Courage is feeling your fear and going forward. Recognizing vulnerability, admitting vulnerability, revealing vulnerability. And that way you can work your way toward true courage.

Gabe Howard: Dr. Rutherford, I completely agree and I’ve learned a lot and of course, getting to the end of our show, obviously we can find the book on Amazon. What is your Web site? I know that you write for PsychCentral.com. So obviously you can check out Dr. Margaret Rutherford there. Where can folks find you if they want to learn more?

Dr. Margaret Rutherford: Sure. My Web site has the creative name of DrMargaretRutherford.com.

Gabe Howard: I love it.

Dr. Margaret Rutherford: And I’ve been blogging there for seven years. I do have a tag. You know, if you click on the tag, it will take you to all my posts on perfectly hidden depression. I also have a podcast that I’ve been doing for three years now. It’s called Self Work with Dr. Margaret Rutherford. And that’s on i-Tunes, on Stitcher, SoundCloud. It’s now on Spotify and I Heart Radio. So I really love the podcast. I can go more in depth with topics on the podcast than I can through blog posts. You know, I can spend 20-25 minutes talking about something where, you know, a blog post maybe has maybe a thousand words. I’ve got a Facebook page, I’m on Instagram, Pinterest, it’s all under Dr. Margaret Rutherford or Pinterest is Doctor Slash Margaret, I think. I would love to have your listeners join me. And the book does come out November 1. I’m thrilled that New Harbinger is publishing it. It is a much better book because they were involved because I’ve never written anything. I never thought I would write anything. And they have made it really, I think, a very readable book. I include lots of stories of these people I interviewed as well as my own patients, of course, anonymously. So I hope you’ll join me there.

Gabe Howard: Thank you so much, Dr. Rutherford. My final question before we hop on out of here is did you have personal reasons for writing this book?

Dr. Margaret Rutherford: Yes, I did. I wouldn’t call myself perfectly hidden and depressed. But certainly, my mother was. She ended taking anxiety medications in her thirties that developed into a prescription drug addiction and actually sabotaged a great deal of her life in the last decade or two of her life. But my mother was extremely perfectionistic. I can remember the dining room table being set for a party and we couldn’t go in there for a week. I remember that party would occur and my mother would ask me, was the food any good? Because she would always look for people who needed her help or her conversation because they might be uncomfortable. She got up at 4:00 in the morning so no one would see her without her makeup and her high heels and hose. I mean, that’s maybe being Southern and being a 1950s housewife, but a lot of it was her perfectionism. So I saw how miserable it made her. And I also adopted a great deal of her perfectionistic standards until I became a therapist. And I began working my own way through those and realizing that those were actually my mother’s vulnerabilities speaking to me and I no longer wanted to live my life like that. So people have said to me, your mother would be so proud of you for talking about yourself on the Internet. And I said, no. My mother would think it was terrible. So I don’t want people to live in that same prison that my mother lived in. And I hope that it will be helpful to those who want to get out.

Gabe Howard: Well, thank you so very much for everything that you do for our community. Thank you for everything that you do for PsychCentral.com. And thank you for being on today’s show. We really, really appreciated having you.

Dr. Margaret Rutherford: The thanks is mine, and the gratitude is mine, Gabe. Thank you very much for asking me and everyone have a wonderful day. And if you are hiding, please, if you can, get the e-book if you don’t want to buy it for real. There’s also an e-book and an audio book is coming.

Gabe Howard: Very cool. And remember, everybody, if you want to interact with the show on Facebook, all you have to do is go over to PsychCentral.com/FBshow. And don’t forget to review our show on whatever podcast player you found us on. Do me a favor, tell a friend to share us on social media. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentralWe’ll see everybody next week.

Announcer: You’ve been listening to the Psych Central Podcast. Previous episodes can be found at PsychCentral.com/show or on your favorite podcast player. To learn more about our host, Gabe Howard, please visit his website at GabeHoward.com. PsychCentral.com is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, PsychCentral.com offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com. If you have feedback about the show, please email show@PsychCentral.com. Thank you for listening and please share widely.


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Date: 15th October 2019 at 18:11
Author: Psychcentral – psychology – The Psych Central Podcast