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EAT HEALTHY OPTIONS | MOVE KICKBOXING | RELATE : S R A L INNER CRITIC | DO JOURNALING | TRY LAUGHTER THERAPY REGU
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Contents spring2013
volume 01 | issue 03
FEATURES COVER STORY: Zahava Aarons Surviving Postnatal Depression Mary-Anne Swarts A Life Now Worth Living Mental Health Recovery A New Understanding Adult and Child ADHD Information and Inspiration
WIN!
Books, DVDs & Tickets For our fabulous giveaways, see pages 7, 13, 23, 32
E.L.S.K.E PHOTOGRAPHY
10 14 16 20 26 30 34 36 38
Spice Your Way to (Mental) Health The Medicinal Properties of Spices I’ve Gotta Feeling… How to Understand and Work with Your Emotions
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MOVE: Kickboxing Kick and Punch Your Way to Health DO: Journaling A Well-known Therapeutic Tool EAT: Healthy Options Roasted Vegetables with Chickpeas & Quinoa Coconut Bread
40 42 48
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RELATE: The Inner Critic Making Sense of the Negative Inner Voice TRY: Laughter Therapy The HA HA HA Phenomenon
J.K. Rowling Magic in Adversity
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IN EVERY ISSUE...
03 Editor’s Notes
08 8 Steps for Mental Wellness
04 Inbox
44 Inspiration
05 Ask the Expert
45 Subscribe
06 Newsdesk
47 Resources Spring2013 | 1
PUBLISHING EDITOR Jen Goy jen@thrivemag.co.za CREATIVE DIRECTOR & DESIGNER Angelique da Costa angelique@thrivemag.co.za COPY EDITOR: Anna Herrington PANEL OF EXPERTS Prof. Dan Stein BSc(Med), MBChB, FRCPC, PhD, DPhil Dr Judy Bentley MBChB, MMed(Psych), FCPsych(SA) Dr David Dennis MBChB, FCPsych(SA) Dr Neil Horn MBChB, FCPsych(UK) Dr John Parker MBBCH, FCPsych(SA) Dr Arien van der Merwe MBChB, FRSCH(London), MISMA(UK) Engelie Brand MSc(Med App Psych), MA(Clin Psych) Equivalence Bradley Drake MSc(Clin Psych) Zureida Garda MA(Clin Psych) Tebogo Makgabo MA(Clin Psych) Corrie Davidson MA(Social Work) Dr Rene Jeannes M.Tech Homeopathy Beatrice Rabkin BSc(Nutr Med), Dip.Pharm Shona Saayman BSc(OT) Honours Dr Jaci Schultz M.Tech Homeopathy Nurain Tisaker BSocSc(Social Work) Honours LIFE COACHES: Godfrey Madanhire, Elmarie Potgieter, Susan Roy ACC. PCD. ADVERTISING ENQUIRIES ads@thrivemag.co.za SUBSCRIPTION ENQUIRIES subs@thrivemag.co.za EDITORIAL ENQUIRIES info@thrivemag.co.za PRINTED BY Tandym Print RETOUCHING BY Colour Extreme COPYRIGHT Turquoise Swan Media Pty(Ltd). All rights reserved. Reproduction in whole or in part is prohibited without prior permission of the Editor.
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YOUR STORY
Have you suffered from mental illness at some point in your life? Are you willing to tell your story and inspire others? Email us on hello@thrivemag.co.za
Need expert advice? Why not ask our Panel of Experts Email hello@thrivemag.co.za
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PERSONAL STORIES All personal stories in Thrive are real. However, due to the stigma surrounding mental illness, most people wish to remain anonymous. If you would like to make contact, email stories@thrivemag.co.za. Your message will be forwarded to the person concerned.
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EAT HEALTHY OPTIONS | MOVE KICKBOXING | RELATE RS: INNER CRITIC | DO JOURNALING | TRY LAUGHTER THERAPY REGULA
ON THE COVER: Zahava Aarons PHOTOGRAPHY: Elske Kritzinger E.L.S.K.E Photography 082 927 7194 elskegallery.co.za 2 | Spring2013
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DISCLAIMER: The views and opinions expressed in this magazine are those of the contributors and not necessarily those of Thrive. Always consult a specialist before making any changes to your diet or medication.
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welcome volume 01 | issue 03
editor’s notes
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I’d love to hear from you! email hello@ thrivemag. co.za
he stigma attached to mental illness is pervasive and immeasurably destructive. It means that those with mental illness – and even their supporters – wish to keep it secret and, to do so, often refuse to get the help that they so desperately need. It means that mental health is always right at the bottom of the health budget priority list. It means that sufferers often judge themselves severely, permanently carrying around a pernicious burden of shame. Recent research has shown that those with mental illness are even stigmatized by healthcare professionals, often not being properly treated for other medical conditions. Yet, it is estimated that 1 in 4 people will experience some form of mental illness at some stage in their lives. And this proportion is rising. Moreover, mental illness kills. In South Africa, there are over 22 suicides and 220 suicide attempts every 24 hours, and 90% are a direct result of depression. It is no wonder that mental illness is becoming known as the silent medical emergency. Something needs to be done. Fast.
“MENTAL ILLNESS IS BECOMING KNOWN AS THE SILENT MEDICAL EMERGENCY.” Yes, we need advocacy. However, there are two other potentially world-changing prongs of attack. The first is education of the media. The second is for those with mental illness to “come out”, particularly those who have recovered or are living successfully alongside it. Let’s look at the media. There’s often blatant misrepresentation – factual,
sensationalist or both. However, perhaps even worse, is the subtle, often unconscious undermining which is achieved by the use of an inappropriate word or phrase – an undermining that can be difficult to pick up unless we pay careful attention. A little while ago, I came across an article in a mainstream South African magazine which really pushed my buttons. It was on bipolar disorder. The writer had clearly done her research, and the facts were accurate. All good. Until the sentence: “People with bipolar disorder are doomed to take medication for the rest of their lives”. Yes, having bipolar disorder generally does mean that. But “doomed”? Come on! If you have hypertension and need chronic meds, are you “doomed”? And what about a woman on the pill? Is she “doomed”? We would never say that. So why do we say it so easily for bipolar disorder (and any other chronic mental disorder)? I myself have bipolar disorder, and being labelled “doomed” makes me feel pitied, “less than” and disempowered. All this, due to only one word used unconsciously by someone who, more than likely, felt she was decreasing the stigma by writing a factually accurate article. So we have rather a large challenge on our hands. However, not so long ago we had similar challenges with regards to dark skin and sexual orientation and, although prejudice and stigma still exist, we have come a long way. Now it’s time for mental illness to take centre stage. If we delay, the consequences will be immense.
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HAVE YOU ENJOYED READING THRIVE? TELL US WHAT YOU THINK!
HELLO@THRIVEMAG.CO.ZA
Importance of Nutrition I am thrilled to have discovered Thrive magazine as I am on a quest to learn more about depression, the illness I have lived with for 16 years. Time and time again, I leave my appointments with mental health professionals feeling that my questions have gone unanswered. This is extremely frustrating. I recently visited a new psychiatrist in order to go back on medication (I had stopped taking it for a while as I had been trying to fall pregnant). It was a very disappointing experience and I left feeling worse than when I had arrived. In my experience, it seems that GPs and psychiatrists often only want to treat the symptoms, rather than trying to find the underlying cause. I wholeheartedly believe in the ability of correct nutrition to heal the body. I am a qualified dietician (although currently
DR NEIL HORN MBChB, FCPsych (UK) PG Dip (Cog Ther) Neil is a psychiatrist with a special interest in bipolar disorder, depression, anxiety and cognitive therapy. He trained in the UK and works at UCT, Valkenberg Hospital and in private practice. neil.horn@uct.ac.za health.uct.at.za 4 | Spring2013
not practising), however I am becoming increasingly interested in nutritional therapy. I am very excited to see you have a nutritional therapist on your Panel of Experts. Claudia Misselhorn, Johannesburg Yes, we at Thrive most definitely believe in the healing power of correct nutrition. It takes effort to change the way we eat, but the potential mental health benefits are enormous.
Many Thanks! I felt as if a light had been turned on when I started reading Thrive. It contains so much important and relevant information. Many thanks! I have an adult daughter with schizophrenia and OCD, who is under my care. It has been an extremely difficult journey for our whole family. I gave my magazine to my daughter’s boyfriend (I only lent it to him!). He was thrilled with it and now wants to give it to his Mom to read. I also want to lend my precious magazine to the psychiatric sister who
SHONA SAAYMAN BSc(OT)Honours Shona is an occupational therapist in private practice. She combines creativity, movement and other modalities in individual treatment, and facilitates weekly creative adult support groups. shonams@iafrica.co.za 83 357 5292
takes a group of schizophrenic sufferers for “coffee group” once a week. It looks like my copy of Thrive is going to prove useful to many people. Keep up the good work! Anonymous, Durban We hope that this issue of Thrive proves to be just as useful!
No Longer Ashamed! I have bipolar disorder type 1 and have struggled with the symptoms all my life, having been hospitalized many times. This year has been the worst one so far – I have been in four institutions. I am currently a day patient at a halfway house and it is here that I discovered Thrive magazine. It has really inspired me and I have finally clicked that I actually do need to take my pills in order to function in life, and that it is nothing to be ashamed of. Thank you. Tanya McCraig, Johannesburg It is wonderful to hear that you’re no longer ashamed of taking medication. We wish you all the best for your wellness journey.
GODFREY MADANHIRE BTech(Education) Godfrey is a life coach and motivational speaker. He is the driving force behind Dreamworld Promotions and, through his seminars, workshops and presentations has helped many people significantly change their lives. dreamworldpromotions.co.za
ELMARIE POTGIETER Elmarie is a certified life coach and NLP practitioner. She wrote the article Journaling on page 36. She has also developed comprehensive mood charts which are available for download at thrivemag.co.za elmarie@crus.co.za 072 777 3570
ASK THE EXPERT
“What’s the difference between a panic attack and anxiety?”
A
Do you have a question for our experts? Email hello@thrivemag.co.za
DR JUDY BENTLEY MBChB, MMed(Psych), FCPsych(SA) Judy is a psychiatrist in private practice in Cape Town. She is on Thrive’s Panel of Experts and wrote the article 8 Steps for Mental Wellness on page 8. claremont neuropsych.co.za drjudybentley@ gmail.com
nxiety acts as a signal which alerts us to potential danger. We tend to feel anxious when we start asking ourselves “what if” questions, for example: “What if I fail?”, “What if I don’t cope?”, “What if the car breaks down?”. Anxiety is different to fear, which we experience when there is an actual, known and present danger, and not just a potential danger. Both anxiety and fear are normal human emotions. Anxiety has an emotional component, a cognitive (thought) component and a physical component. The emotional component is the feeling of apprehension, a sense of things being wrong or going wrong, and a vague feeling of dread or even a sense of doom. The cognitive component involves distortion of thoughts, such as only noticing the worrying aspects of the environment that confirm the fear, and not seeing the aspects of the situation that could reassure us that there is, in fact, nothing wrong. When we are overly anxious, we struggle to concentrate and our memory is poor. Physical symptoms of anxiety include stomach upsets (”butterflies” and sometimes diarrhoea), dizziness, sweating, increased blood pressure, palpitations, restlessness, feeling faint, a racing pulse, tremors, tingling in the fingers, and needing to go to the toilet more often and more urgently. Anxiety becomes pathological (an illness) when it occurs in situations that most
people do not find anxiety-provoking, or when it is excessive, disabling or persistent. In generalized anxiety disorder, people feel continually and excessively anxious about normal daily concerns, so much so, that it interferes with their ability to function. On the other hand, panic attacks are episodic and happen suddenly, with no warning. They can occur as a result of exposure to a feared object (e.g., a person who has a phobia for dogs and experiences a panic attack when seeing a dog) or out of the blue (true panic disorder).
When having a panic attack, people experience overwhelming anxiety, fear and discomfort. The attack starts abruptly and reaches its maximum point within approximately ten minutes. It then slowly subsides. The feelings are often accompanied by a sense that they are going to die, or that they are going crazy. There are symptoms of arousal (sweating, palpitations, shaking or a dry mouth), symptoms involving the chest and abdomen (difficulty breathing, a choking feeling, chest pain or nausea), general symptoms (hot flushes, cold chills, numbness or tingling sensations) and symptoms involving mental state (dizziness, feeling faint, feeling that objects are unreal or that the person is not really present, fear of losing control or dying). Because of the intensity of these physical symptoms, people who are experiencing a panic attack often end up in the casualty ward at a hospital, being investigated for heart or breathing problems. Spring2013 | 5
This year the South African Depression and Anxiety Group (SADAG) will be focusing on depression in the elderly. To foster awareness, they will be giving a series of talks in retirement homes and frail care centres countrywide. For more info, contact SADAG 011 262 6396 admin@anxiety.org.za
volume 01 | issue 03
2 DESIGNS: Mal-adjusted or Nor-mal 2 STYLES: Mens relaxed fit tee & Womens fitted tee 3 COLOURS: Chocolate with mustard print. Black with grey print (men’s only). Mustard with chocolate print (women’s only) 5 SIZES: S, M, L, XL & XXL. For sale on Thrive’s website thrivemag.co.za/shop * All proceeds go to the Lentegeur Hospital Spring Project.
The Brain Basics article in Thrive’s Autumn 2013 issue mentioned that although a computer simulation of the brain is theoretically possible, it is most likely impractical. It seems that the European Union (EU) disagrees. Earlier this year, the Human Brain Project (HBP) was voted one of the first two EU Future and Emerging Technologies (FET) flagship projects, gaining €1 billion in funding. The HBP, based at the École Polytechnique Fédérale de Lausanne in Switzerland, is headed by Professor Henry Markram. Giant kudos go to the South African educational system – Prof. Markram is a born and bred South African, educated at the University of Cape Town. According the Prof. Markram, the HBP aims to “reconstruct the brain systematically, to piece the pieces together, derive the biological rules [and] test them”. The ultimate goal of the project is to reach a comprehensive understanding of how the brain works, with the possibility of finding cures for brain disorders ranging from “autism to Alzheimer’s”. The opinion of the scientific world on the achievability of this goal is divided. In an email published in Nature magazine, Kevin Martin, co-director of the Institute for Neuroinformatics in Zurich, acknowledges that passionate men such as Prof. Markram are needed to drive science forward, but goes on to wonder: “… what if they’re passionately wrong?”. Let’s hold thumbs that Prof. Markram is passionately right! humanbrainproject.eu Source – The Telegraph, UK 6 | Spring2013
ERIC MILLER
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In July, Mental Health Awareness Month, the SA Federation for Mental Health started a long-term, national awareness project on the need to upscale mental health services. As part of the campaign, people with psychiatric disabilities protested with placards and two hospital beds in central Cape Town. The participants were service users from Cape Mental Health’s Fountain House (a psychosocial rehabilitation day centre in Observatory – the only one of its kind in South Africa), as well as members of the Cape Consumer Advocacy Body (CCAB), a self-advocacy group for people with psychiatric disabilities, and staff from Cape Mental Health.
spring2013
BodyTalk is a holistic therapy that promotes the body’s ability to heal itself. BodyTalk is a noninvasive way to identify the root causes of your health issues. It allows your body to unblock the related energy pathways in the body so that it can more effectively heal itself. Dr John Veltheim, from the USA, the creator of BodyTalk, will be talking about and demonstrating this consciousness-based healthcare system at the Sports Science Institute in Cape Town on Tuesday 1 October from 7:30 to 9:30 p.m. Tickets cost R100. 3 sets of double For more info, see tickets up for grabs! bodytalksystem.com Email win@thrivemag. or contact Lee-Ann co.za by Tuesday 24 Connolly lee@thriveSeptember. za.com thrive-za.com
GIVEAWAY
volume 01 | issue 03
ALL EPISODES ARE AVAILABLE ON
The popular SABC 3 television series, I am Woman Leap of Faith, now in its second season, gets audiences thinking about leaping into the great unknown. Covering the life stories of South African women, the series creators ask the powerful and challenging question: “What does it mean to take a real risk, to stretch way beyond your comfort zone, to embrace chaos, and to welcome deep inner change?” Sometimes we do this by choice, and sometimes we have no choice, but always, we have to leap…
iamwomanseries.com INCLUDING: Sindiwe Magona (S1, episode 18) acclaimed writer, and depression survivor. Lynn Witten (S1, episode 22) sexual abuse survivor. Lindiwe Bardill (S2, episode 12) anorexia survivor. Jen Goy (S2, episode 8) Thrive’s publishing editor and bipolar disorder survivor.
by Dr Judy Bentley MBChB, MMed(Psych), FCPsych(SA)
GET WELL
3 KNOW YOUR ILLNESS
1 SEE A DOCTOR If you have symptoms that are starting to affect your daily life, it’s time to see a doctor. Your GP is qualified to treat milder mental illnesses. However, if you have an illness such as depression that is causing you to stay away from work, is affecting your relationships, or is recurrent, you need to ask for a referral to a psychiatrist who can give you a more accurate assessment and provide in-depth management. If necessary your GP or psychiatrist will be able to refer you to a therapist for additional treatment.
Knowledge is power! Get to know the symptoms, signs, and what you can expect from your illness. Briefly record what you are experiencing each day. This will keep track of your improvement, and will show early signs of your symptoms worsening. This information is also extremely helpful to your doctor in assessing your progress. Research your illness and learn about ways to get and stay mentally well. However, make sure that the information comes from a reputable source.
2 TAKE YOUR MEDS NEED INSPIRATION?
See Thrive’s Regular Sections: EAT, MOVE, DO, RELATE & TRY! 8 | Spring2013
If medication is prescribed, take it regularly. It is the only way to ensure that you get the response you want. If you have side effects, or notice anything unusual or undesirable while on the medication, speak to your doctor. Don’t just stop taking it. Stopping any medication suddenly can be dangerous or make you feel ill.
STAY WELL
5 MOVE Exercise has been proven to reduce stress and improve recovery from depression. Keep moving!
4 EAT Eat regular meals even if you have very little appetite. Little and often is good for you. Keep up your intake of fruit and veg. Try not to give in to the temptation to live off carbohydrate-laden pastries and sweets. Choose low GI foods. This regulates your blood sugar and improves the functioning of your brain. It is particularly important for people who experience a lot of anxiety. A little of what you fancy does you good - eat a square or two of dark chocolate daily. Omega-3s help to protect your brain. Eat oily fish at least three times a week and/or take a supplement.
Remember: Always be gentle with yourself. Accept where you are at and set ‘baby step’ goals. Aim for progress and not perfection.
6 DO Sleep! Ensure that you keep regular hours as much as possible. Go to bed and get up at the same time each day regardless of whether it is during the week or on a weekend. Explore your creativity! Your brain needs stimulation to keep healthy. Get outdoors and soak up as much light and sunshine as possible. Even better, exercise outdoors. Explore stress management and relaxation activities. Find what works for you and do it!
7 RELATE The most important relationship is with yourself. Take time to work on this. Being part of a community is good for your mental health. Improve your relationship skills, and nurture old and new friendships. Get involved in giving back to your community in a way that works for you. Don’t isolate yourself no matter how much you feel like retreating. Contact with friends and family gives perspective and energy. If possible, see a therapist regularly.
8 NURTURE YOURSELF You can’t give to others if you have nothing left to give. Take time out regularly to recharge your batteries. Spring2013 | 9
10 | Spring2013
E.L.S.K.E PHOTOGRAPHY
CLINICAL PSYCHOLOGIST, ZAHAVA AARONS, DREAMT OF THE JOYS OF MOTHERHOOD. HOWEVER, AFTER THE BIRTH OF HER FIRST CHILD, SAUL, SHE DEVELOPED SEVERE POSTNATAL DEPRESSION, AND EXPERIENCED A STARKLY DIFFERENT REALITY TO WHAT SHE HAD EXPECTED. How was your pregnancy?
Tell us about the birth.
I fell pregnant with Saul when I was 36. Although I had a history of some depression, I was in an extremely good space in my life at the time: my psychology practice was flourishing; I was happy in my marriage; I had a wonderful social life; and I was physically very fit. I needed fertility treatment, but it was relatively non-invasive with minimal hormonal intervention. I conceived fairly quickly and had an easy pregnancy. I loved every moment of it and couldn’t wait to be a mom! I planned to have a natural birth at home, supervised by a midwife, and most definitely without an epidural. In retrospect, I can’t believe that at my age, and with all the knowledge that I have as a psychologist, I could have been so naïve!
I went into labour two and a half weeks early. It was a Sunday morning and my husband wasn’t home. He had just started his architectural practice and needed to work all hours. I called the midwife, and she was with me within half an hour. The contractions started to come very quickly, but without the dilation necessary to give birth. After about four or five hours, I couldn’t take the pain anymore. My husband came home and he drove me to the hospital. The whole way there I was on all fours in the back of the car – screaming! At the hospital I was given an epidural which took the pain away, but I still didn’t dilate. After about five more hours of labour, the baby started to show signs of distress, and I needed to have an emergency caesarean. This operation was extremely traumatic for me. Saul was born and he was healthy, but as a result of everything I had experienced, I was completely depleted – physically and emotionally. Spring2013 | 11
What happened after the birth? I was fine for the first couple of days. When I came home, we had the bris (Jewish circumcision ritual), and the first sign that there was something wrong with me was when I battled to open the presents. I found them threatening. I would open one and think, “What is this?”. It all looked so complicated. My brain started to become very foggy and to work in strange ways. Everything seemed to happen in slow-motion. I felt dissociated and that I had become really stupid. I struggled with breastfeeding and developed very sore and engorged breasts. Saul wasn’t gaining weight properly, and I started to obsess about this. I became fearful that I couldn’t keep him alive and, about three weeks after the birth, I started to avoid being with him. However, I didn’t ever feel that I didn’t love him or that I wanted to hurt him. Rather, I was afraid that I couldn’t look after him properly.
I couldn’t eat and became emaciated. I thought that I was going to starve both of us to death. Basic tasks like changing a nappy and putting him in a car seat felt impossible. I couldn’t sleep. My husband didn’t understand what was happening to me. I was confused, terrified and continually agitated. It was a living hell. You would think that as I’m a psychologist I should have known what was wrong, but somehow I couldn’t apply my knowledge to my own life. However, I did know that my baby needed to have his needs met. I knew that he needed to be picked up when he cried and, when he was hungry, he needed to be fed. I knew that if I couldn’t do this, someone else had to. Luckily my mom was around, and she and my husband were able to step in. However, I felt overwhelmingly guilty and ashamed that I needed their help. I tormented myself with self-criticism and self-loathing. I felt defective. I thought: “What is wrong with me that I can’t do this thing that comes naturally to every other mother in the world?” Of course, it happens to many mothers but, at the time, I felt that I was the only one.
“IT IS CRUCIAL TO SHATTER THE ILLUSION THAT When were you diagnosed with postnatal depression? BECOMING A MOTHER IS A About five weeks after the birth, the penny finally dropped. One night, at about 3 a.m., I BASIC INSTINCT, AND shook my husband awake and said: “I postnatal depression and I need THEREFORE NATURAL AND EASY.” have to see a psychiatrist immediately!”. 12 | Spring2013
I saw the psychiatrist, was diagnosed and put on medication. I also saw a therapist who helped me to make practical decisions: I hired a night nurse and stopped breastfeeding. This enabled me to take sleeping pills and sleep for the first time in weeks. I was also able to take a sedative if necessary.
How was your recovery process? I was lucky to be diagnosed early on, as generally the earlier the diagnosis, the quicker the recovery. However, my postnatal depression proved to be resistant to medication. I would get better for a while and then fall ill again. It took a whole year to find a combination of medication that worked in a sustained fashion (my postnatal depression had actually triggered the development of bipolar disorder type 2, and I needed a mood stabilizer as well as an antidepressant). However, my real healing took much longer. I needed to work through my guilt and shame. I needed to learn to have compassion for myself and to forgive myself. The benefit of going through this process was that I learnt a lot about life and mothering. I came to see myself, and all mothers who have suffered from postnatal depression, as heroes who have undergone a horrendous ordeal, but have come through it successfully. I think that the whole experience – the trauma and the process of healing – has enabled me to truly thrive in my life, in a way that I couldn’t have done before.
What are your thoughts about the stigma? It was as I processed my guilt and shame that I started to think seriously about the stigma attached to postnatal depression. This stigma means that sufferers often don’t talk about their illness which results in them feeling isolated and thinking that they are the “only one”. The particularly difficult thing about postnatal depression is that society expects a new mother to be blissful, and if that is not the case, the mother experiences a tremendous sense of failure. This is the reason that women often won’t admit to suffering from postnatal depression. However, this “conspiracy of silence” is the root of the soul-destroying
shame, which compounds the illness immensely. It is crucial to shatter the illusion that becoming a mother is a basic instinct, and therefore natural and easy. I am passionate about speaking out about postnatal depression and sharing my experience. This passion led me to co-author a book, Recognising Postnatal Depression, with Paula Levin, and GP, Andy Taub-Da Costa, who both have suffered from severe postnatal depression. We have included ten personal stories, which I think is one of the most important aspects of the book. Women need to know that others have gone through what they are going through, and that they have survived.
WIN!
Tell us about your current project. At the beginning of this year, Akeso Clinics contacted me as they wanted to address the high incidence of postnatal depression in South Africa. They asked me to help them develop a specialized treatment programme. As a result, we are planning to create wards at their clinics where mothers with postnatal depression can be admitted together with their babies. Previously, a mother was always hospitalized alone, and the consequent separation from her baby tended to increase her immense guilt about being ill. As a result, many sufferers refused treatment that they desperately needed. It is also important for the healing process that the mother and the baby are together. This means that the mother is able to rest while her baby is taken care of. Later, she can be assisted with basic mothering tasks such as bathing and changing nappies, until she has the confidence to do them on her own.
Anything you’d like to add? If you are suffering from postnatal depression, have the courage to speak your truth. Be cautious about who you talk to – make sure it’s someone you can trust not to judge you – but speak! That is the way you’ll get help and move forward. Also, remaining silent keeps the stigma alive. If we can all speak out and help shatter this stigma (and that surrounding all mental illness), the world can only become a better place.
Recognising Postnatal Depression: A Handbook for Mothers (5 copies) Giving birth is a major life adjustment and rite of passage for all mothers. This book is for anyone who is struggling or has struggled on that journey, who may be grappling with confusion, anxiety, fear or anger. It offers hope, support and comfort, and a clear path out of what may feel like a bewildering or overwhelming situation. Email win@ thrivemag.co.za with your full name, phone number and title of the book. Spring2013 | 13
BARBRA COWLEY
A
fter the death of her mother, Mary-Anne Swarts, a domestic worker from Mitchells Plain, Cape Town, descended into the depths of depression. For a long time, her life didn’t seem worth living. However, with the right treatment, she recovered and now wants to help others by speaking out about her experiences.
Tell us your story. A year and a half ago, my mother passed away after a long illness. We were extremely close and my grief process was intense. However, instead of recovering, I became depressed, although at the time, I didn’t know that was what it was. I started battling to sleep and not wanting to get out of bed in the mornings. I felt continuously tired and my whole body hurt. I continually burst into tears and had to force myself to go to work. I tried to hide what was happening as I didn’t want to burden my husband and children. I’ve always been the strong one, the one who held the family together, and I felt guilty and ashamed for feeling the way I did. My family knew that something was wrong, but when they asked me, I would just say I was OK and walk away. I thought I could do it on my own, but things became worse and worse.
What made you get help?
“I FEEL THAT I HAVE COMPLETED A MARATHON ... I AM SO PROUD OF MYSELF AND AM NOW WEARING A GOLD MEDAL IN MY HEART!” 14 | Spring2013
I eventually couldn’t go on anymore. I broke down in front of my family who told me I needed to get help. None of us knew where I should go, but somehow I managed to get hold of a phone number. To this day, I don’t know who gave me the number, but it proved to be a lifesaver – literally. It was the number of the Lentegeur Day Clinic and I spoke to the sister in charge. I cried and cried as I told her my story, but she didn’t put the phone
down. She listened and, when I was finished, said that I needed to come into the clinic as soon as possible.
What happened at the clinic? I arrived at the clinic the next morning and was directed to the waiting area in the mental health section. However, I didn’t want to sit there. I felt that I didn’t belong with the “crazy” people and went to sit in another section. When the sister arrived, she took me to a private room and asked me many questions. She told me that I had had a breakdown and was suffering from depression. She then sent me to a doctor at the clinic, who prescribed an antidepressant and sleeping tablets. There was a six-month waiting list to see a psychologist, but the doctor said I couldn’t wait that long and managed to get me an emergency appointment.
Did you tell anyone in your community? I didn’t tell anyone. Only my husband and children knew about what I was going through. In my community, mental illness is a skande (Afrikaans for disgrace). People gossip about it and laugh at you. They label you and that label never goes away. It was hard enough being depressed but, on top of that, I had to worry about hiding it from people.
What happened after starting treatment? At first I didn’t want to take my medication, as that would confirm I was “crazy”, and I didn’t like to think of myself that way. I took the antidepressants on and off for quite a while, but eventually the doctor convinced me that, if I wanted to get well, I had to take them as prescribed. I was very nervous about seeing a psychologist and, in the beginning,
sat on the edge of my chair during our sessions. I wondered why she took notes, and she explained that it was necessary for my treatment to keep a record of our sessions, but that everything was confidential. I started seeing her weekly and, once I realized that she was really there to help me and that I could trust her, I relaxed. It was wonderful to be able to talk about everything that was on my mind. Her support enabled me to get through many difficult days. I was booked off work. However, as I work as a char, I don’t get paid if I don’t work, and I had to force myself to carry on. Nevertheless, I have one employer who was wonderful. She knew that there was something wrong, but she didn’t push me for answers and just let me be. She allowed me to do a half-day’s work if that was all I could manage, yet she still paid me for the whole day. I am immensely grateful for her understanding. Things became worse before they improved. A few weeks into my treatment, I saw my psychologist and broke down completely. She wanted to admit me to Lentegeur Hospital for two weeks so that I could get away from everything and rest. I didn’t want to go because, if I did, everyone would know, and I’d be the laughing stock of Mitchell’s Plain for being put in a “crazy” hospital. I pleaded with her. She said that if I did everything else that she asked me to do, she would let me stay at home. I promised that I would. It was an up and down process, but I gradually recovered. It’s now a year since my first visit to the clinic and, although my life is still not easy, there is now light where once there was none.
What was your darkest hour? This is the first time that I’m telling anyone about this: I tried to commit suicide. I felt that I couldn’t fight the
depression anymore. I knew that it would cause my family a lot of pain, but I reasoned that they would get over it. Even if it was the easy way out, I was convinced that it was the right thing to do. I had hoarded the sleeping tablets given to me by the clinic, and I started taking them. However, after taking about four or five tablets, something made me stop. I think that, at the end of the day, I couldn’t leave my children.
How do you feel now about your experience of depression? I feel that I have completed a marathon. It’s like I had a small chisel and needed to carve my way through a mountain. I didn’t think that I’d ever get there, but eventually I hit the last piece and I was through it. I am so proud of myself and am now wearing a gold medal in my heart!
What have you learnt? Depression is nothing to be ashamed about, and it’s much better to tell people about it than to keep it hidden. Even though some people may not understand, talking about it is the only way to get the support you need. Continually worrying about what people will think is no way to live. If there’s a next time, I’d get help as soon as possible, take my medication as prescribed and, if it was recommended, go into hospital.
Is there anything you’d like to add? I’d like to thank all the staff at the Lentegeur Day Clinic. They are so warm and friendly, and are always smiling. If I needed to cry, they were there with a hug and a piece of toilet paper to mop up my tears. I don’t know if I would have recovered without them. They are doing amazing work and providing a service second to none. Spring2013 | 15
By Dr John Parker
DR JOHN PARKER MBBCH, FCPsych(SA) John is a senior lecturer in the Department of Psychiatry & Mental Health at UCT and a specialist psychiatrist at Lentegeur Hospital. He is head of OPD and Outreach Services as well as the founder and project manager of the Lentegeur Spring Project. jsparker@ westerncape. gov.za 16 | Spring2013
D
r Elizabeth Baxter was diagnosed with schizoaffective disorder a few years after graduating from medical school. She was hospitalized several times and given a typically gloomy psychiatric prognosis – the most she could hope for career-wise would be to put “objects into boxes on an assembly line”. Despite this, she managed to complete her specialist training in psychiatry, and is now a successful psychiatrist in the United States, as well as a renowned speaker on mental health recovery experiences. She attributes her recovery to the support of family and friends, the encouragement she received from caregivers, together with her perseverance and spiritual growth. Her story may sound exceptional, but is in fact one that is becoming increasingly common. As a result, a radical new way of viewing mental illness has emerged, with important implications for those suffering from mental disorders as well as the way in which mental health care is provided. This new understanding, known as the “philosophy of recovery”, has developed into a worldwide movement, which is both reshaping mental health services and giving new hope to many who previously believed they were damaged beyond repair and doomed to life as second-class citizens.
WHAT DOES RECOVERY MEAN?
“Recovery is not an endpoint, but a journey.”
Recovery is traditionally understood as the absence of disease, or cure. Whilst this is appropriate if applied to certain short-lived conditions such as pneumonia or a broken leg, we may question how it applies to more enduring or chronic conditions such as high-blood pressure, an amputated limb or mental disorders. Another definition is needed. We are all aware of many successful businessmen and women with high blood pressure and some very famous Olympians with amputated limbs. Although, in the traditional sense, they can never recover from these chronic conditions, we don’t think of them as sick people or “cripples”. Yet, if a person has received a diagnosis of a mental disorder, our understanding and resultant attitude is often very different. This “sick and tobe-pitied” mentality has a powerful effect on how the patient is treated by healthcare providers. It also breeds a sense of hopelessness, which dramatically decreases the chance of the person ever getting better. If there is no hope, why bother even trying? Spring2013 | 17
Y R E V O C E R G N I MAK A REALITY
The philosophy of recovery views mental illness recovery as a personal process that can be aided by support services. Dr Norah Jacobson, a leading researcher on patient perspectives on recovery, has emphasized that four “internal conditions” need to be present for recovery to take place:
1
Hope that recovery is
possible, generating a frame of mind that allows this to occur. This makes it critical that “good news” stories about mental illness are shared so that others can believe it is possible to get better.
2 3
Understanding that
healing is different to cure, and that the emphasis is on the self rather than illness and control.
Empowerment as a
corrective for the sense of helplessness and dependency that comes with severe mental illness and prolonged contact with some of the less transformed mental health services.
4
Connection with society and knowledge of what the person’s roles are in it.
18 | Spring2013
For these conditions to exist, Marianne Farkas of Boston University’s Centre for Psychosocial Rehabilitation, has argued that mental health services need to promote four key values:
1 2
Person orientation:
seeing a patient as a whole person, rather than as simply someone with an illness.
Person involvement:
involving people who have experienced mental illness in the design, planning and delivery of mental health services.
3
Self-determination or self-choice:
understanding that patients need to decide for themselves what “better” means, set their own goals in this regard, make their own plans for how to achieve them, and take responsibility for the outcome of their decisions.
4
Hope: recognising the
tremendous harm that is done when services are provided in a negative, cynical environment, and the enormous healing benefits of a positive atmosphere.
However, long-term follow-up studies are increasingly showing that the vast majority of people with mental disorders can get better over an extended period of time, particularly when they receive the right kind of support. This applies to even the most severe of disorders, such as schizophrenia. Furthermore, from the perspective of the philosophy of recovery, recovery in the short term is also possible.
THE NEW UNDERSTANDING The new understanding of mental illness recovery begins with the realization that recovery is not an endpoint, but a journey. This journey begins with recognizing the existence of a mental health problem and the desire to set out on a path to healing. Accordingly, recovery is about accepting the reality of the illness, but also knowing that it is possible to have a satisfying life full of hope and meaning regardless of whether symptoms are present or not. Equally importantly, it is about realizing that recovery is about the whole self and not just the illness. As we all have our own way of seeing the world and our own ideas of what it means to live a positive, meaningful life, the definition of recovery is unique for each person. When we start thinking about recovery in this way, we realize that everyone is on this journey, as it is fundamentally the struggle to find happiness and meaning. We are empowered as we see that the line between normality and illness is, at best, an artificial one and not something we have to tolerate, as if some of us are less than human. This new understanding of recovery is well summarized in the 2004 consensus statement of the US Substance Abuse and Mental Health
Services Administration: “Mental health recovery is a journey of healing and transformation, enabling a person with mental health problems to live a meaningful life in a community of his or her choice, while striving to achieve his or her full potential.”
HISTORY OF THE RECOVERY MOVEMENT Three factors are credited with giving rise to the recovery movement: the development of the field of psychosocial rehabilitation (also known as psychiatric rehabilitation), growing public dissatisfaction with the existing psychiatric practices, and the disability rights movement.
giving more and more members of the public the courage to speak out. This was given further impetus by the disability rights movement where strong arguments were being made regarding social approaches to disability, including the view that whilst an individual may have an impairment (such as an anxiety disorder or needing a wheelchair), it was actually society that disabled them (through discrimination or by not having wheelchair ramps next to stairs). In 1988, Patricia Deegan, a clinical psychologist, set out one of the first definitions of personal recovery. She described it as “a process of
“The line between normality and illness is, at best, an artificial one and not something we have to tolerate, as if some of us are less than human.” Psychosocial rehabilitation is defined as the process of restoring community functioning and the wellbeing of an individual diagnosed with a mental disorder. This field primarily arose in response to the wave of hospital closures, which occurred in the USA and Europe in the 1970s and 1980s. Healthcare providers soon began to argue that the needs of patients who had been discharged from hospital after extremely long stays went far beyond the simple provision of medication, and involved the development of comprehensive support systems. At the same time, the voice of the mental health survivor and advocacy movements began to be heard,
recovering a new and valued sense of self and purpose that occurs in people with psychiatric disabilities, as they become active and responsible participants in their own rehabilitation project”. In the early 1990s, William Anthony, the head of Boston University’s Centre for Psychosocial Rehabilitation and a leading academic in the field, called for the philosophy of recovery to become the guiding vision of rehabilitation services. This was the beginning of what has now become a worldwide movement, and the new understanding of recovery has become a core philosophy underpinning mental health policy in many parts of the world.
RECOVERY IN SOUTH AFRICA This vision of recovery is critical for the further development of mental health services in South Africa where resources are poor and levels of public knowledge and concern are even worse. The recovery movement involves a wide range of role-players including patients, their friends and family, NGOs, as well as national and provincial government, all of whom need to pull together to make the necessary changes. Indeed, as awareness improves and stigma is challenged, it will become apparent that improved mental health is everyone’s business and achieving it involves the kind of empowerment and transformation that is the dream of our young democracy.
FURTHER READING Psychosis Fails to Block Psychiatrist’s Career Path. Psychiatric News, 2002, June, 37(2): 5 E. Kupersanin Recovery From Schizophrenia: With Views of Psychiatrists, Psychologists, and Others Diagnosed with this Disorder. Schizophrenia Bulletin. 2009, March, 35(2): 370–380 S.J. Frese, E.L. Knight, E. Saks The Vision of Recovery Today: What it is and What it Means for Services. World Psychiatry. 2007, June 6(2): 68–74 M. Farkas For convenient online links to these articles, visit thrivemag.co.za Spring2013 | 19
STOP FIDDLING & PAY ATTENTION!
By Janet Bytheway
A JANET BYTHEWAY MA (Clin Psych) Janet is a clinical psychologist and has been in private practice for 21 years. She is a co-founder of the Blaauwberg Therapy Centre, Cape Town, and has a special interest in working with families in distress. janetbytheway. co.za 021 557 6066 janet@janetby theway.co.za 20 | Spring2013
ttention deficit hyperactivity disorder (ADHD) is a condition that can significantly interfere with your ability to be productive and efficient. Your brain is constantly changing channels and bringing to mind all the possibilities out there, making it very hard to stay focused on a particular task. Although ADHD is more commonly associated with children, adults can also struggle with this debilitating condition. However, the general consensus is that ADHD starts in childhood and is not an adult-onset disorder. Therefore, if a person is diagnosed for the first time as an adult, it means that he or she has had it since childhood, but the condition has been previously undetected. It usually manifests before the age of seven. ADHD is defined as a long-standing pattern of difficulty in concentrating and/or hyperactive or impulsive behaviour. This behaviour is noticeably worse than that of peers, or children of a similar age. It negatively affects functioning in all areas of life, including work or schoolwork, and interpersonal relationships.
THE IMPORTANCE OF DIAGNOSIS Knowing that the condition is present is the beginning of being able to manage it. Many people don’t like the idea of a diagnosis or being labelled, but if you don’t know if you or your child have the disorder, nothing can be done about it. With the help of medication and other interventions, it’s possible to function more effectively and ultimately live a happier life. Nevertheless, there is a thin line between the diagnosis being used in a way that allows you or your child to get the support you need, and that of it acting as negative label. However, people with undiagnosed ADHD often are labelled anyway, albeit informally. Children are seen as “naughty”, “disruptive” or “lazy”, and adults are seen as “dreamers”, “slackers”, or “troublemakers”. Another benefit of a diagnosis is discovering that there is a reason why you or your child lack concentration, are hyperactive and/or impulsive. The diagnosis of ADHD moves the behaviour from a moral judgement to a treatable condition.
For a list of the symptoms of ADHD and the diagnostic criteria, see thrivemag.co.za
Work in small spurts rather than long hauls.
Break tasks down into smaller tasks. Make lists.
Get help where you need it, e.g., have a secretary or an accountant. Apply external limits to your impulses.
Get enough exercise to work off some of the noise inside.
Find someone to help keep you on track.
I Attention Deficit Hyperactivity Disorder Predominantly Inattentive Type
II Attention Deficit Hyperactivity Disorder Predominantly Hyperactive-Impulsive Type
III Attention Deficit Hyperactivity Disorder Combined TypeÂ
Many people are confused by the term ADHD as the child or adult may only display inattentive behaviour. This presentation used to be called ADD (Attention Deficit Disorder), but is now known as ADHD I.
Spring2013 | 21
GIVEAWAY WHAT IS NOT ADHD
Medihelp’s DVD Living with ADHD (3 copies) Accomplished young photographer, Daniël Naudé, explains how he has managed to harness the energy associated with ADHD to give him a competitive edge in pursuing his passion. Daniël’s story proves that the symptoms of ADHD, which may cause significant impairment in functioning, can be treated effectively. Email win@thrivemag. co.za with your full name, phone number and title of the DVD.
Many adults or children present with the symptoms of ADHD, but not all of them will be diagnosed with the condition. Before a diagnosis is made, it is very important that the person is thoroughly assessed to make sure that their behaviour is not caused by something else. In children, this may be hearing or eyesight problems, learning disabilities, high intelligence resulting in boredom, raised anxiety levels, and psychiatric conditions such as bipolar disorder or Tourette’s syndrome. In adults, symptoms may be caused by physical conditions such as a thyroid disorder and other psychiatric or psychological conditions that can present with poor concentration and agitation, e.g., anxiety, depression, substance abuse or post-traumatic stress.
CAUSES OF ADHD ADHD is a problem with brain wiring. There is a strong genetic component to its development, but factors such as smoking during pregnancy, birth complications, early exposure to toxins and pesticides, and head injuries (especially to the frontal lobe) have also been shown to play a role. It’s important to know that ADHD is not caused by emotional difficulties or the way a child is parented. ADHD can certainly be made
MY STORY I WAS DIAGNOSED WITH ADHD AS A VERY YOUNG CHILD AND WAS ON MEDICATION FOR MANY YEARS. However, my symptoms remained, making school life very difficult. I was easily distracted, battled to sit still and struggled with learning. I was often ridiculed by adults and told that I was stupid. When I left school, I decided I had had enough of being on medication and stopped taking it. However, I worked at developing skills to help me cope with everyday life. I have a job in retail and always double-check everything I do. I take things slowly and focus on customers by listening carefully to what they are saying and watching the blinking of their eyes. I am studying parttime and, when it’s exam time, I make a timetable and stick to it, even if it’s difficult. I reward myself when I achieve my goals. ADHD is part of who I am. It has been important for me to accept my disorder and to not use it as an excuse. Acceptance has meant that I have learnt to manage it, and I am now functioning well in my life. - VK To contact VK, email stories@thrivemag.co.za. See page 2 for more info.
better or worse by the parenting style, but this does not cause it.
WHAT CAN BE DONE? Once ADHD is diagnosed, a treatment plan can be developed. ADHD cannot be cured or “outgrown”, but a child may develop better coping strategies over time and therefore be able to manage the condition more effectively. Adults or children with ADHD respond best to a structured environment. Parents need to create a routine for the child’s daily activities. Adults with ADHD may need help with becoming organized. A child diagnosed with ADHD will generally do better at school if they sit on their own near the front of the class, rather than in the back row with rowdy children. There also are many easy and practical techniques that can be used to aid functioning. It is very important that those with ADHD (particularly children) are helped to understand that their condition is not a moral failure and is just something that needs to be managed. For instance, if a child has poor eyesight, they need to wear glasses and, similarly, if a child struggles with concentration, they need appropriate support. Medication can help a great deal too, but it is not the whole solution.
INCREASE IN INCIDENCE It is a concern that an increasing number of adults and children are being diagnosed with ADHD. There could be many reasons for this, the most important being that people are often not properly assessed before being diagnosed. Many children are insufficiently physically active: sometimes it is not safe for them to play outside, and houses and flats are small, often not having gardens for them to run around in. In addition, children are spending more time engaging with electronics: cell phones, iPads, Xboxes, Play Stations, computer games or television. As a result, their brains are being trained to react to fast-moving, colourful and loud stimuli, and a teacher standing in front of the class may no longer present an exciting Spring2013 | 23
enough stimulus to maintain some children’s attention. ADHD was previously considered to be a child’s condition and it has only been recently recognised that adults can suffer from its symptoms too.
GET HELP NOW! When ADHD goes undiagnosed, it can cause a person to be labelled in all manner of unhelpful ways. A thorough assessment can clarify whether or not it is present. If it is, much can be done for the person to be able to get on with their life without being held back by the condition’s debilitating symptoms. As Dr Edward Hallowell, author of the classic books on ADHD, Driven to Distraction, and who himself was diagnosed with the condition at age 50, says: “[With treatment], suddenly the radio station is tuned in, the windshield is clear, the sand storm has died down. And the child or adult, who had been such a problem, such a nudge, such a general pain in the neck to himself and everybody else, that person starts doing things he’d never been able to do before. He surprises everyone around him, and he surprises himself.”
FURTHER READING
drhallowell.com
Understanding ADHD: A Parent’s Guide to Attention Deficit Hyperactivity Disorder in Children - C. Green Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood - E. Hallowell & J. Ratey You Mean I’m Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults with Attention Deficit Disorder - K. Kelly & P. Ramundo
MY STORY ALTHOUGH MY ADHD SYMPTOMS HAVE BEEN PRESENT ALL MY LIFE, I WAS ONLY DIAGNOSED A FEW YEARS AGO, SOON AFTER I TURNED 40. The symptoms became a real problem after the birth of my first child. I struggled with housework, either battling to get going or spending far too long on a single task. I would often start with one thing and, on walking to a different part of the house, forget what I had been doing and start something else. I generally battled to concentrate and was very easily distracted. I was initially diagnosed with postnatal depression and spent three years trying different types of antidepressants. However, my symptoms didn’t improve. Eventually, I found information on adult ADHD on the internet and went to see a psychiatrist who specializes in the disorder. He diagnosed me with the condition as well as co-morbid depression and anxiety. It was an enormous relief to finally find out what was wrong and that it was not my fault. I take medication, which has helped immensely. I also use smartphone apps that help me to improve my concentration, and I follow a low GI diet. I stick to a daily schedule with alarm reminders, make sure I get enough sleep, and manage my stress levels by not taking on too much. - JM To contact JM, email stories@thrivemag.co.za See page 2 for more info.
“It’s like driving in the rain with bad windshield wipers. Everything is smudged and blurred and you’re speeding along, and it’s reeeeally frustrating not being able to see very well. Or it’s like listening to a radio station with a lot of static and you have to strain to hear what’s going on.” Edward M. Hallowell, MD on living with ADHD
DIET & ADHD...
“A balanced and healthy diet is the foundation of any therapy or treatment when it comes to ADHD. Healthy children feel better and therefore have the potential to respond to therapy and school in a more positive manner. Compared to adults, children have a higher risk of food allergies and food intolerances. These may exacerbate poor concentration and difficult behaviour patterns, and need to be treated.” – Katherine Megaw, Dietician 24 | Spring2013
“Research has shown that diet plays a role in ADHD. In 2008, the editor of the publication, American Academy of Pediatrics Grand Rounds, referring to a study that showed a link between ADHD and food additives, wrote, “… even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of children, admit we might have been wrong”. The difficulty is that we are all biochemically individual. Therefore, a specific diet may work wonderfully for one child, but not for another.” – Hannah Kaye, Nutritionist
By Beatrice Rabkin
26 | Spring2013
W
e all know that spices make food taste and smell great, therefore it’s no accident that the phrase “spice up”, meaning “add zing” to anything from a public speech to one’s sex life, has found its way into the English language. Another aspect to this spice metaphor (and far less commonly known) is that spices possess considerable (mental) health-giving properties. The medicinal properties of spices are due to the presence of phytochemicals. Although most foods contain phytochemicals, they are most plentiful in fresh and organic vegetables, fruits, herbs and spices. However, they are destroyed or removed by modern processing techniques and consequently are not present in sugar and other highly refined foods. Although phytochemicals may not be essential to sustaining life, they provide protection against chronic disease and are crucial to health.
Mental illness biology Recent scientific data indicates that inflammation plays an important role in mood disorders. It contributes to the breakdown of tryptophan (the precursor to serotonin), resulting in a serotonin deficiency; it interferes with neuronal signalling, (the transportation of messages along the nerves), increasing fear and anxiety; it speeds up the production of damaging free radicals; and it slows down the repair of damage to neurons (nerve cells). Inflammation may be caused by infection, bacterial or fungal overgrowth, a diet lacking in nutrients, an imbalance in omega-3 and omega-6 fatty acids, trauma, excess fat (especially fat around the middle), substance abuse, emotional stress and food intolerance. Therefore, the presence of any of these factors can contribute to the development of mood disorders. Oxidation and free radical production, without sufficient antioxidants around to “mop them up”, contributes to the ageing process and the development of chronic disease. However, several studies have specifically shown that
free radical damage to neurons in the brain enhances the development of schizophrenia, and there is no reason not to believe that this free radical damage contributes to the development of all mental disorders. Free radicals are the by-products of natural body processes, but production speeds up with exposure to environmental pollutants, smoking, diesel fumes, radiation and some foods. Antioxidants deactivate free radicals. Therefore, increasing the level of antioxidants in the body can be an effective therapeutic approach for alleviating the symptoms of schizophrenia and probably that of all chronic diseases.
Tumeric
DID YOU KNOW? To increase shelf life, many spices have been irradiated which significantly limits their medicinal properties. Look for spices which are labelled “nonirradiated”.
Turmeric is best known for its use in Indian curries. Its bright yellow colour is indicative of its antioxidant potential. Indeed, the active ingredient, curcumin, is one of nature’s most powerful healers and has been used as such since antiquity. Although it is a potent antioxidant, it is best known as an antiinflammatory, and both these properties make it useful in the prevention and treatment of neuro-psychiatric disorders. Curcumin also acts directly on neurotransmitters using the same mechanism as that of a group of pharmaceutical antidepressants called MAO inhibitors – it inhibits an enzyme which breaks down serotonin and, at higher doses, dopamine. However, the action of curcumin is far less potent than that of the pharmaceuticals.
Ginger Ginger is always a delicious addition to a wide variety of foods and infusions (teas). Like turmeric, it has been used for its healing properties for centuries and has significant, although not as potent, anti-inflammatory properties. It also acts as an antioxidant, therefore making it neuroprotective.
BEATRICE RABKIN BSc (Nutritional Medicine); Dip. Pharmacy Beatrice practices as a nutritional therapist and has worked in the public health sector as a pharmacist. beatrice rabkin. co.za 021 686 4280 beatrice@rabkin. co.za Spring2013 | 27
DID YOU KNOW?
Ginger assists in removing toxins from the body by promoting healthy sweating. As sweat contains germ-fighting properties, ginger also protects against infection – a cause of inflammation. Drinking an infusion of ginger before a meal stimulates saliva and gastric juices. This aids digestion and encourages the smooth passage of food through the gastrointestinal tract, thereby enhancing the absorption of important nutrients.
The simplest and most economical way to ingest spices is as an infusion (tea). For maximum benefit, use as many spices (and herbs) as Cinnamon Cinnamon improves blood sugar control and, possible.
accordingly, has the potential to limit the harmful effects of hypoglycaemia (low blood sugar). Hypoglycaemia is often associated with mood swings and anxiety. Cinnamon oil has some antifungal properties. Fungi such as Candida secrete acetaldehyde, which is known to penetrate the blood-brain barrier and therefore can adversely affect the body’s neurological systems. Sodium benzoate, which is produced in the body after consuming cinnamon, has antiinflammatory and neuroprotective effects. It is important to use cinnamon sticks that are tightly rolled. If the cinnamon looks like bark chips, it is actually cassia, the properties of which are somewhat different. Cinnamon is delicious sprinkled on oats or as an ingredient in smoothies. It enhances the flavour of baked or stewed fruit, and cinnamon sticks can also be added to curries, potjies and bredies.
FURTHER READING Nutrition and Mental Health: A Handbook. An Essential Guide to the Relationship between Diet and Mental Health. – M. Watts (ed) An Overview of Curcumin in Neurological Disorders. Indian J Pharm Sci. 2010 MarApr 72(2): 149-154 – S.K. Kulkarni & A. Dhir Psychological and neuroendocrinological effects of the odor of saffron(crocus sativus). The Free Library. June 2011 – H.Fukuri, K. Toyoshima & R. Komaki For convenient online links to these articles, and more recommended reading, visit thrivemag.co.za 28 | Spring2013
Saffron Saffron is another colourful spice with possible mood stabilizing effects. It is derived from the stigmas of the flower, saffron crocus, and has the reputation of being the world’s most expensive spice. However, a little goes a long way. Grown mainly in India, Iran, Spain, Greece and Italy, it is probably best known in curry, paella, bouillabaisse and risotto. It was used traditionally in Persian medicine to “lift the mood” and, indeed, there is recent evidence that twenty minutes of smelling saffron can significantly lower stress and anxiety levels. Smell it, and then cook with it!
Fennel seeds Fennel’s unique combination of antioxidant, anti-inflammatory and mild blood sugar stabilizing effects, makes it beneficial for mental health. Fennel also stimulates the secretion of digestive juices, aiding effective nutrient absorption. Although all parts of the fennel plant are edible and have nutritional benefits, it is the essential oil, anathole, which is concentrated in the seeds, that is responsible for fennel’s antiinflammatory effects. Fennel seeds can be crushed and used in curries, soups, casseroles and many other dishes. They can also be infused in hot water, either on their own or as a herbal tea mixture, generating an extremely pleasant aroma and providing immediate digestive benefits on drinking.
In short... There are many spices and each has numerous health-giving properties. However, using the spices in foods and teas is unlikely to have any significant effect on disease in the short-term, but long-term use, in combination with a nutrient-dense diet, can certainly help prevent disease.
clinically clinically proven natural provenmedicines natural medicines
By Zureida Garda
WE LIVE IN A SOCIETY THAT VALUES THE INTELLECT ABOVE ALL ELSE. CONSEQUENTLY, WE LIKE TO MAKE SENSE OF THE WORLD USING RATIONAL AND LOGICAL CRITERIA. HOWEVER, EMOTIONS OR FEELINGS DON’T LEND THEMSELVES TO THE NEAT CATEGORIZATION OF RATIONALITY AND, AS A RESULT, ARE A CONFUSING AREA FOR MOST OF US.
W
e have often learned to ignore our feelings when making decisions. We are all familiar with the phrases “don’t be so emotional”, “don’t take it personally” and “don’t let your emotions cloud your judgement”. Yet, all of us experience a myriad of emotions daily which, more often than not, influence our actions. Some of these actions may even be inappropriate. For example, if we are angry and repress or deny it, we can become walking time bombs, where the smallest trigger is able to set us off, such as someone cutting us
30 | Spring2013
off in traffic or saying the wrong thing. The repressed anger can no longer be contained, and it bursts out, maybe even accompanied by violence. We also like to divide our emotional experiences into those that are “good” and those that are “bad”. Feelings such as happiness, joy or pleasure are regarded as “good”, whereas anger, jealousy or sadness are seen as “bad” or even dangerous. These are social and cultural stereotypes which we have come to accept over time. As a result, most of us feel guilty for having “bad” emotions and spend our lives repressing, denying or avoiding them. However, despite using the best logic
and the utmost willpower, emotions do not disappear, and at some stage we are forced to deal with them. But what if we stopped trying to repress or deny our “bad” emotions and learnt to make friends with them? What if, instead of excluding our emotions when making decisions, we used them in conjunction with our intellect?
MAKING FRIENDS WITH EMOTIONS To make friends with our emotions, we first need to stop judging them as “good” or “bad”. We need to see them as simply responses to internal or external triggers – in other words, normal reactions to our life experiences.
“When we stop resisting our emotions and let them “flow”, their power over us lessens, and we are able to manage them more effectively.”
ZUREIDA GARDA MA (Clin Psych) Zureida is a well-being consultant based in Johannesburg. She assists clients in exploring emotional blockages, drawing on her psychological training and using tools such as hypnotherapy, EFT and mindfulness. ztgarda@gmail. com 082 322 7073
We need to realize that it is social and cultural biases that lead us to judge feelings as “positive” or “negative”, and this judgement causes us to try to not to feel the “negative” ones. In her book, The Language of Emotions, Karla McLaren talks about allowing our emotions to flow like water. If we were to dam up a swiftly-flowing river without having a pressure-release mechanism, the pressure of the water behind the dam wall would build up until the dam burst. Similarly, when we “dam up” the “flow” of our “negative” emotions such as sadness or anger, pressure builds up inside us until these emotions come out in extreme and uncontrolled ways,
for example, by inappropriately yelling at people or bursting into tears. When we stop resisting our emotions and let them “flow”, their power over us lessens, and we are able to manage them more effectively. It is essential to learn this skill of “feeling what you feel”. We need to recognise when we are having an emotional reaction, identify what the emotion is and give it space to flow without judgement or resistance – in other words, just let it “be”. By doing so, we insert a space between the emotional trigger and our reaction. If we do not resist feeling the emotion, its intensity eases, and we can then decide on our best course of action.
Through this process, we also learn to develop our personal emotional language. Emotions are often given broad labels such as “anger” or “fear”, but there are many layers or nuances within these labels. For instance, “anger” can mean anything from mild irritation to frustration to a towering rage. It can be helpful to rate our emotions on a scale of one to ten. If we use anger as an example, mild irritation may rate as a one, frustration a five, and rage a ten. As we pay more attention to all the emotions we experience, we learn to understand the subtleties of our individual reactions. By doing so, we become more self-aware and our interpersonal relationships improve. Spring2013 | 31
PROCESSINNSG EMOTIO
1 2
Acknowledge and accept what you are feeling. Don’t resist it. Don’t judge it.
If it is an intense or extreme emotion, go to a private space such as your bathroom, bedroom or car. Allow yourself to fully feel the emotion. Scream or cry if possible.
3
If you are angry, it helps to do something physical to get the angry energy out of your body. Punch a pillow, jump up and down or run as fast as you can on the spot until your muscles feel tired. The intensity of the emotion will ease as you physically work it out of your body.
4
Another helpful technique is “free writing”. This is a form of venting whereby you pour whatever it is you are feeling onto the page without worrying about punctuation, spelling, grammar or proper sentences. It is best to handwrite as it then also serves as a physical release. As you write you will begin to feel the intensity of the emotion easing, and you will start to feel calmer. It does not matter how many pages you need to write until this happens – you will know when you have written enough.
5
Once you have done the above (and only then!), you are ready to decide how to act. Giving yourself the space to process your emotions enables you to choose the best or most helpful course of action, instead of merely reacting in a kneejerk fashion.
* If, despite trying these techniques, you experience extreme emotions that feel uncontrollable or if you have experienced trauma of any kind, please contact a mental healthcare practitioner to assist you. 32 | Spring2013
INTEGRATING EMOTIONS & INTELLECT Once we have processed our emotions, we can bring the intellect back into the equation. Using both our feelings and intellect enables us to make the best decision for ourselves in any given moment. We have all been in a situation when we have needed to make a choice
think about your future boss, you have a sense of dread and, every time you lean towards the more logical decision, this feeling becomes stronger. If you gave equal weight to your logical and emotional responses, you would be able to make a decision that took both into account and would make you happier.
“Emotions are essentially energies moving through us in order to teach us more about ourselves.” and have relied exclusively on our intellectual faculties. This helps us to make the most logical decision. However, afterwards we may feel uncomfortable with it. For example, you may wish to change jobs and receive two job offers with comparable salaries and benefits. Company A is close to where you live. However, when you meet your future boss, you take an instant and inexplicable dislike towards him or her. Company B is 20 minutes further away, but you really like the environment and feel excited and enthusiastic about working there. You may rationalize that many people do not like their boss, and that you don’t have to like someone in order to work with them. You may think it makes the most sense to choose Company A, as you will save on petrol costs and be able to leave home later in the mornings. However, whenever you
Of course, decision-making is generally more complex than this example. We need to practise paying attention to both our intellect and emotions in order for this to become automatic. It is helpful to start with small daily decisions such as what we would like to eat or which clothes we would like to wear. Gradually we will become better at knowing our emotional reactions and will be able to use this technique when making bigger decisions. Emotions are essentially energies moving through us in order to teach us more about ourselves. The more we learn not to be afraid of our emotions and allow them to help us know ourselves better, the more at peace we will become. With greater selfunderstanding, we are able to live more authentically and will ultimately be happier.
The Language of Emotions Karla McClaren (3 copies)
GIVEAWAY
A breakthrough guide toward a new and empowering relationship with our feeling states. As a practical lexicon for working with a full spectrum of emotions, the book explores the latest insights about emotion from psychology and neurology, and how to apply them in real life. Email win@thrivemag.co.za with your full name, phone number and title of the book.
By Nadia Dossa
A
physical activity needs to be thoroughly enjoyable and leave you looking forward to the next time, rather than relieved that it’s over and doesn’t need to be repeated for a few days. There’s no hope of maintaining a fitness programme if it involves buckets of self-coaxing to get going before you even raise your heart rate. Options need to be explored until you find an activity that inspires your passion. Perhaps kickboxing will fit the bill.
WHAT IS KICKBOXING? Kickboxing is a mixture of eastern and western combat sports. It takes the best from each and combines them into a unique hybrid fighting system. There are various styles. However, kickboxing is generally practised in a ring where combatants use kicks, punches, elbow strikes and knee strikes to overpower their opponent. 34 | Spring2013
Kickboxing classes
(or similar) are offered at specialized gyms, as well as Virgin Active and Planet Fitness nationwide.
CARDIO-KICKBOXING Combat sport certainly isn’t for everyone, but if you would like to release pent up stress and tension without actually hitting anyone, a derivative of kickboxing called cardiokickboxing could be for you. Cardiokickboxing participants are trained in the same way as professional kickboxers except that there is no physical contact. However, you still get to kick and punch! Specific kickboxing techniques are taught on punching bags and using various other pieces of equipment such as focus mitts, kick pads and skipping ropes. No one gets hurt but everyone has fun! Classes are structured to be effective in achieving health and fitness goals. Exercise programmes contain routines that are sequenced specifically to target various body parts so that an overall workout is obtained. Some exercises
focus on strengthening the core muscles and make use of light weights to supplement body weight.
BENEFITS The benefits of exercise extend from physical to emotional and mental health. Thanks to the release of endorphins, there is the feel-good factor. A good session of training will refresh and renew you, providing energy rather than depleting it. Mental clutter tends to dissipate leading to a clearer state of mind, with thoughts more likely to move in a positive direction. As is the case with all martial arts, kickboxing and cardio-kickboxing require disciplined concentration and focus resulting in increased mental strength as well as physical strength. This holds obvious benefits for all areas of your life. Self-confidence is improved and regular participants
find they are better able to “stand their ground”. Gaining external strength often translates into feeling stronger internally. Schalk Labuschagne, a third degree black belt holder and national champion, says that kickboxing ultimately teaches you to “respect everyone and fear no one”. Sometimes the battles in our minds can overwhelm us. We know we’re fighting but we can’t always see what it is that we’re fighting. Kickboxing or cardio-kickboxing is a way to bring the invisible fight of the mind into the physical realm where we can punch and kick at whatever is bothering us. Frustrations are released leading to a sense of calm. We can only know what we might enjoy in life if we try new things. If nothing else, a good session of kickboxing or cardio-kickboxing will shut away the stresses of the world for a while and be a bit of fun!
MY STORY My kickboxing journey began when I was admitted to a clinic a few years ago. I have bipolar disorder type 1 and I was going through a particularly tough time as the end of a long-term relationship was looming. All the symptoms of my illness came rushing back with a vengeance and, once again, I started self-harming. This has been my way of dealing with negative emotions since a young age. However, an encounter in the clinic helped me to find an alternative. In psychiatric clinics, there are many different kinds of people and personality clashes are inevitable. During this visit, there was one patient who liked to stir up trouble. One night, I became the target for her bullying. My usual reaction to such an incident would have been to selfharm and, as a result, fall into a spiralling vortex of mixed emotions. However, when entering a psychiatric clinic all possible
self-harm implements, such as mirrors, scissors and tweezers are removed. Not being able to support the weight of my tormented feelings with its usual crutch, I had to find another way. I remembered seeing a punching bag in the gym at the clinic. I had never punched anything before, but was desperate. I started tentatively, but was soon using my full strength to punch and kick all the anguish out of my system. However, it became more than that. The exercise made me feel great! It felt like I had sweated all my physical and mental toxins out in one go. I felt refreshed and my mind was crystal clear. In this way I discovered a passion I didn’t know I had. As soon as I left the clinic, I found a club in my area that offers cardio-kickboxing and kickboxing. I started classes and enjoy myself immensely. As I push myself, the endorphins rushing through my
body create a euphoric experience. Even better is the sense of accomplishment I feel after each class, especially as I see my technique improve. Also, doing the exercise in a class setting has enabled me to meet other people with the same passion, helping me to become less of a recluse. Even when things seem to be at their lowest, I still manage to go to kickboxing and cardio-kickboxing, and the effort is well worth it. The sport has helped me in so many ways. It can be so easy to slip and fall into deepening darkness, but kickboxing helps to keep me stable. We all need to find that one thing for which we can always drag ourselves out of the house, no matter how we may be feeling. I discovered my thing accidentally and have never looked back. Email stories@thrivemag.co.za See page 2 for more info. Spring2013 | 35
K
eeping a journal is a wellknown therapeutic tool. Yes, it may be writing, but we’re not talking about producing a novel, poem or short story with sights set on publishing. We’re talking about taking up a pen, or tapping at a keyboard, and writing down whatever words come to mind – words for no one’s eyes but our own (and certainly not for those of a grammar and spelling Nazi!). You don’t need to be an experienced writer. You only need a little time and the willingness to try something new, and the relief, excitement and joy that journaling offers can be yours.
BENEFITS Journaling is a useful wellnessenhancing activity to incorporate into your life on an on-going basis. However, it may be especially helpful in difficult times when you feel 36 | Spring2013
By Elmarie Potgieter shattered or bowed down by life. It can help glue your broken pieces together. It can help smooth you down and pull you up, until you’re standing straight and tall once again. Journaling can help you make sense of things. It can help you to recall events that may have altered your relationships or how you see yourself. It can help you uncover what has brought you to the present moment. It can help you acknowledge what you have gone through and validate how it may have affected you. Journaling enables you to access your true feelings – feelings that may have been long buried. Writing about these feelings helps you to deeply experience and digest them, giving you new perspective and promoting emotional healing. Writing also assists with noticing and cultivating positive feelings; perhaps peace and hope, or even pride and satisfaction at filling a page or two with words on a tough day.
GETTING STARTED Don’t wait for the inspiration to come. It may never arrive. The best is just to sit down and start writing. All you have to do is begin. Write one word, one sentence, and the rest will follow. Before you know it, you may have filled a page (or even two or three), but a paragraph is quite OK. Writing has the ability to transport you to another state of mind, and sometimes you may be surprised to find that you have completely lost track of time. Your mind may play tricks on you, saying you are too busy and don’t have time for another activity. In truth, we can all carve ten minutes out of our days. And just that amount of writing time can be extremely useful and have a huge impact on our lives.
JOURNALING WHEN DEPRESSED In the pit of depression, everything can look dark and gloomy. If you
“Journaling can help smooth you down and pull you up, until you’re standing straight and tall once again.” haven’t journaled before, you will probably doubt that you can do it and question if it will help. Try to trust that it can and will. At the very least, you have nothing to lose by giving it a bash. Try to write with your depression and not against it. Write about what you are actually feeling, rather than what you wish or think you should be feeling.
FREE WRITING As you journal, make sure you’re moving forward rather than staying stuck. If you find yourself endlessly pondering on the same old problem in the same old way, have a go at free writing. This may help you think of new options and possibilities. Free writing involves choosing a topic or using a writing prompt (e.g., a question, a quotation, a poem), and writing continuously for a chosen period of time. It’s writing without thinking as a “stream of consciousness”, reflecting on both your life and the world in general. It’s important not to take journaling too seriously. It’s not another chore in our lives (although it may seem like that to start with). Rather, it’s a form of release and a way to express ourselves. It’s something that can lift our mood and perhaps add a ray of light to our darkest days.
FURTHER READING Writing through the Darkness: Easing your Depression with Paper and Pen E.M. Schaefer
MY STORY JOURNALING HAS BEEN A PART OF MY LIFE FOR THE PAST 20 YEARS. I started the practice as a component of my spiritual journey, recording on a daily basis where I was spiritually and emotionally. As a result, when I became depressed five years ago, I had a wonderful tool to help me through my most trying hours. My depression occurred so suddenly that I didn’t know what had hit me. I thought I had contracted malaria as I was living in a malariaendemic area at that time, but the test was negative. I then assumed that I was just tired and needed to take a break. However, as soon as I started to rest, I crashed completely and was diagnosed six weeks later with depression due to burnout. Unfortunately, I was resistant to medication and, instead of getting better, my depression deepened. Eventually, my GP referred me to
a psychiatrist, and after a hospital admission and numerous medication changes, I managed to stabilize my mood. During this time, my journal was my closest companion – my truest friend who was always by my side. I was often desperate to express myself, but unable to confide in anyone. However, in my journal I could write about my worst pain and biggest anxieties. When things felt the most hopeless, journaling gave me the courage to face another day. – Elmarie Potgieter Elmarie is a life coach based in Johannesburg and is on Thrive’s Panel of Experts. See page 5.
Journaling helps us become more conscious of our thoughts and therefore better able to choose our actions. Emotions are often processed at an unconscious level. Journaling helps bring these emotions to consciousness, allowing us to process and integrate them, and consequently lessening their power over us. Journaling can be a place to vent and get whatever it is that is bothering us off our chests. It clears out our “mental trash”, making space for creative processes.
Angela Hough-Maxwell Psychologist, Cape Town Spring2013 | 37
Roasted Vegetables with Chickpeas & Quinoa Recipe: Beatrice Rabkin | Photo: Dawn Jorgensen
RICH IN ANTIOXIDANTS
LOW GI/GL
INGREDIENTS 2 medium eggplants 2 large red or yellow peppers 2 medium onions 2 heads of garlic 6 medium zucchini (courgettes) 1 cup cauliflower florets 2 medium tomatoes olive oil a few large sprigs of rosemary 3/4 cup quinoa, cooked 400g tin of chickpeas mixed lettuce leaves olive oil and balsamic vinegar for salad dressing 38 | Spring2013
METHOD
Heat oven to 180째C. HEALTHY Cut all vegetables into chucks of about the same size. OPTION Put all vegetables in a large bowl. Sprinkle with a generous amount of olive oil and toss. Serves: 4 Place vegetables in a large roasting pan. Cut garlic heads in half, widthwise. Brush garlic heads with olive oil. Place garlic heads and sprigs of rosemary on top of the vegetables in the roasting pan. Roast for about 1 hour or until soft. Mix the cooked quinoa and the chickpeas into the vegetables in the roasting pan. In a large salad bowl, toss salad leaves with dressing. The roasted vegetables can be added to the salad and tossed in with the dressing, or they can be placed on top of the salad in individual bowls. Drizzle with olive oil. Quinoa can be substituted with brown rice or millet.
Coconut Bread Recipe: Beatrice Rabkin | Photo: Dawn Jorgensen
GLUTEN FREE
LOW GI/GL
INGREDIENTS 3 cups ground coconut 1 cup coarsely ground nuts or seeds or both 1/2 cup olive or coconut oil 4 eggs 1 tsp baking soda
METHOD Mix all ingredients together. Place in a small bread tin. Bake at 180째C for about 30 minutes.
HEALTHY OPTION Makes: 1 loaf
Spring2013 | 39
By Nurain Tisaker
WE ALL KNOW THAT VOICE INSIDE OUR HEAD THAT KEEPS TELLING US WE ARE NOT GOOD ENOUGH (ATTRACTIVE ENOUGH, SMART ENOUGH, CREATIVE ENOUGH & THE LIST GOES ON...). SAY HELLO TO THE INNER CRITIC!
T
he Inner Critic is the part of our psyche that loves to judge and condemn the way we think, feel or behave. Everyone has one, although the strength of its voice varies from person to person. It also tends to be louder or softer depending on how we are feeling about ourselves and our circumstances at a particular time. The Inner Critic may blame and compare. It may set high, perfectionistic and unattainable standards of achievement which set us up for failure from the word go, and trap us in a vicious cycle of self-reproach. We may know it as the voice of our eating disorder, addiction, depression or anxiety. It may call us names such as “stupid”, “weak”, “crazy”, “useless”, “fatty” or “worthless” and lead us to believe that they are true. Our failures tend to be magnified or exaggerated, while our successes and strengths are undermined. Over time, the Inner Critic can break down and weaken our self-esteem with drastic consequences for our mental wellness. Some people are aware of being self-critical, either all the time or in specific circumstances. However, other people struggle to distinguish the Inner Critic’s harsh denigration from a healthier, more rational voice. Instead, the Inner Critic’s voice is regarded as authoritative and truthful.
40 | Spring2013
The origin of the Inner Critic Throughout childhood, parents, teachers and other caregivers teach us values and behaviours that are regarded as acceptable by our culture and religion, and society in general. These “acceptable” messages may be communicated directly, for example, telling a child that she needs to leave the house in clean clothes. Others are communicated indirectly, such as when a child is punished or rejected for being “naughty” or “bad”. Over time, these messages are internalised, giving birth to the Inner Critic. This Inner Critic enabled you to survive in your family and culture. It developed as a way to prevent disapproval from others and therefore helped you avoid feelings of pain, shame or guilt. In other words, it kept you emotionally “safe”. For instance, if, as a child, your family expected you to behave in a considerate and self-sacrificing way towards others all the time and continually reinforced this message, you may have developed an Inner Critic which, every time you perceive yourself as behaving selfishly or inconsiderately, reminds you that this is not the “correct” way to behave, and condemns you for it. This will lead to feelings of discomfort when doing things for yourself, and may prevent you from taking appropriate care of your emotional and physical needs. Effectively, the Inner Critic remembers an adult figure from your childhood reprimanding you for behaving selfishly and, in order to protect you from his or her disapproval (which may be painful to hear and experience), informs you of the most “appropriate” way to behave. As adults, the thoughts and expectations of our Inner Critic may unconsciously create self-fulfilling prophecies. For example, you may think and believe that you do not deserve to be loved, as it was the message you received as a child. This can result in behaviour that makes it difficult for others to love you, reinforcing the “I’m not loveable” message. Unfortunately, the messages of the Inner Critic are generally
believed because of the Inner Critic’s strong association with adult figures who we trusted and respected in our childhood.
“THE FIRST STEP IN REDUCING THE POWER OF THE INNER CRITIC IS TO ACKNOWLEDGE ITS EXISTENCE.” Loosening the Inner Critic’s grip The first step in reducing the power of the Inner Critic is to acknowledge its existence, and then to observe it and learn to identify its belittling beliefs and thought patterns. By doing this, we effectively separate ourselves from the Inner Critic and will then find it easier to access a more rational and, inevitably, more positive voice. Ideally, the Inner Critic becomes a character with whom we have a conscious dialogue in which our healthier, more supportive self presents evidence to dispute the Inner Critic’s negative claims. It is important to gain an understanding of how our Inner Critic works and why it does what it does. Therapy is often useful here. Until we make sense of our Inner Critic, we will tend to believe everything it says and remain its victim. It is also good to keep in mind that much of what the Inner Critic says is actually intended to be helpful and self-protective. This will enable us to develop empathy for it even as it criticizes us, which also helps to loosen its hold. Self-acceptance is a very important part of this process. Acknowledging and learning to accept all parts of ourselves, including characteristics we are not too comfortable with, empowers our positive and self-nurturing voice, helping to lower the volume of our Inner Critic’s voice.
NURAIN TISAKER BSocSci(Social Work) Honours Nurain is a clinical social worker in private practice. She is a specialist in the fields of addiction, eating disorders, mood and anxiety disorders. 073 825 8372 nurain.tisaker@ gmail.com
Next Issue: Working with your Inner Critic
Spring2013 | 41
T
he infection is spread by human contact and its symptoms manifest instantly. Mass infection can occur within a few seconds.
SYMPTOMS: Vocal utterances ranging from giggles and chuckles, to roars, howls, hoots and uncontrollable shrieks of glee. Gasping for breath and redness of face. Relaxation of muscles. Dramatic improvement in mood. Increase in self-esteem and selfconfidence. “…ONCE YOU Easing of fears and FIND LAUGHTER, removing of worries. NO MATTER HOW PAINFUL YOUR Increase in SITUATION MIGHT attractiveness of BE, YOU CAN SURVIVE IT.” personality. – BILL COSBY Enhancement of quality of relationships.
BRONWYN KILROE Otherwise known as Cape Town’s Laughing Lady, Bronwyn is a certified laughter coach, trained by Dr M. Kataria, the founder of laughter yoga. She facilitates SUPER FUN Laughter Sessions which are ideal for corporate wellness programmes, teambuilding events and year-end functions. laughter sessions.com 083 383 0173 laughtersessions@ telkomsa.net 42 | Spring2013
By Bronwen Kilroe
THE LAUGHTER INFECTION (ALSO KNOWN AS THE HA HA HA PHENOMENON) IS HIGHLY CONTAGIOUS AND CAN BE CONTRACTED BY ANYONE, ANYTIME, ANYWHERE! BE CAREFUL: YOU COULD EASILY BE NEXT!
The Laughter Epidemic has been sweeping the globe and is rapidly becoming a pandemic. It has infected people in more than 65 countries including Australia, Japan, India, Germany, the USA and the UK. Popular trends such as Laughter Competitions, Laughter Parties and Laughter-cize (a new weight-loss craze), as well as the Man with the Most Contagious Laugh in the World, have featured on The Oprah Winfrey Show and news channels around the world including BBC, ABC and CNN. The largest Laughter Epidemic Session to date was in the year 2000 in Copenhagen, Denmark, with 10 000 people participating. This event is recorded in the Guinness World Records. And now, finally, the Laughter Epidemic has reached South Africa!
LAUGHTER: THE BEST MEDICINE? We all know the saying “laughter is the best medicine”, but what does this
TIPS FORG
CULTIVATIN LAUGHTER
Watch a funny movie Go to a comedy club Share a good joke or a funny story with friends Play with your pet Play with children Do fun activities such as karaoke or tenpin bowling Do something silly everyday! actually mean? Research has shown that when we start laughing, it is as if we take a key and unlock a pharmacy that resides in our brains. This pharmacy starts producing endorphins. These “happy chemicals” are known for their feel-good effect and therefore, a daily dose of laughter is the perfect prescription to take you from sad to glad! Endorphins are also the body’s natural painkillers. Norman Cousins, in his best-selling book, Anatomy of an Illness, published in 1979, describes how he used laughter to recover from a devastating illness. He noticed that after a heavy bout of laughter, he could have two pain-free hours of sleep. Research has backed up this claim. Stress is known to be a major contributing factor to many health problems, including depression, cardiovascular disease, diabetes, cancer, infertility, insomnia, asthma – the list goes on and on. Laughter has been shown to decrease the stress hormones, adrenaline and cortisol, thereby making it the body’s inbuilt stress-coping mechanism. Laughter strengthens the immune system, controls hypertension, improves oxygenation and circulation, and promotes muscle relaxation. It also provides a workout for the heart – a kind of “internal jogging”. Dr William Fry of Stanford University, and a
leading researcher into the benefits of laughter, is of the opinion that one minute of hearty laughter is equivalent to ten minutes on a rowing machine.
LAUGHTER AS THERAPY In 1995, Dr Madan Kataria, a physician from Mumbai, India, developed a technique known as laughter therapy to capitalize on the health benefits of laughter. Laughter therapy consists of laughing exercises (simple tensionreleasing exercises) combined with breathing techniques and clapping. The therapy is based on the concept that anyone can laugh for no reason at all. There is no need to hear a joke or watch a comedy show to be able to do so. There is also no need to be feeling good and no need to have a sense of humour. Laughter therapy teaches the skill of laughing “without intellect”, and that it is possible to “fake it, till you make it”. The body cannot distinguish between fake laughter and real laughter. Therefore, every time a person laughs, whether it’s genuine or not, the “happy chemicals” are released into the blood stream. Laughter therapy sessions are done in a group because laughter is contagious, with the fake laughter rapidly turning into genuine fits of giggles and chuckles. People all around the world are using laughter therapy as a powerful tool to improve vitality and wellbeing, alleviate aches and pains, and reduce stress levels. Laughter therapy is also quickly gaining credibility as an effective means of treating depression and anxiety. Indeed, it improves mood so quickly, that it has been described as the “Happiness Shock Treatment”! If you can approach all situations you encounter with laughter, you will literally laugh your way to health, happiness and success. So get your Ha Ha Ha going, join in the Laughter Epidemic and JUST LAUGH!
LAUGHTER THERAPY EXERCISE DUE TO THE CONTAGIOUS NATURE OF LAUGHTER, A LAUGHTER THERAPY SESSION IS USUALLY DONE IN A GROUP. HOWEVER, IF YOU WOULD LIKE TO GET YOUR HA HA HA GOING ON YOUR OWN OR WITH A FRIEND, TRY THIS EXERCISE:
1 2 3
Stand with your feet hip-width apart, shoulders back and arms gently resting at your sides.
Take a deep breath in through your nose, filling your lungs with air. Follow this with a long breath out, expelling all the air. Take another deep breath in, and this time laugh out loud to: “Ha ha ha ha ha ha…” for about 5 seconds or until all the air is expelled from your lungs.
4 5 6
Take another deep breath in, and now laugh out loud to: “Hee hee hee hee hee hee...”.
Take another deep breath in, and now laugh out loud to: “Ho ho ho ho ho ho ho.”. For variation, you can also laugh out to a mixture of: “Ha ha, hee hee, ho ho...”.
FURTHER READING Laugh for No Reason – Dr M. Kataria Anatomy of an Illness: As Perceived by the Patient – N. Cousins Laughter The Best Medicine: The Healing Powers of Happiness, Humour and Joy – R. Holden Spring2013 | 43
Inspiration
“The soul would have no rainbow if the eyes didn’t have tears.” African Proverb
44 | Spring2013
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Your best friend feels worthless and is in a sad mood that does not go away – how can you help? Your daughter is cutting herself – how can you help?
Mental Health First Aid training program enables you to help your family, friends, or colleagues who are at risk of developing a mental illness or in a mental health crisis.
You will learn to assist them by applying a five step action plan for mental health first aid. By doing so you will contribute to: • Preserve life where a person may be a danger to themselves and / or others. • Prevent a mental health problem from developing into a serious state. • Provide comfort to a person suffering from a mental illness. • Recognise a mental health problem or crisis. • Promote recovery of mental health. • Maintain a balanced life. • Reduce family distress. • Reduce stigma.
To learn more about Mental Health First Aid go to www.mhfasa.co.za or send a message to info@mhfasa.co.za Training program accredited with 16 CPD points by the Health Professional Council of South Africa.
Resources & Useful Info. “because knowing where to get help is the first step to recovery…”
HELP-LINES
SADAG Suicide Crisis Line 0800 567 567 SMS 31393 8am-8pm Pharmadynamics Police and Trauma Line 0800 20 50 26 8am-8pm AstraZeneca Bipolar Line 0800 70 80 90 8am-8pm Sanofi Aventis Sleep Line 0800 753 379 8am-8pm SADAG Mental Health Line 011 262 6396 8am-8pm
Department of Social Development Substance Abuse Line 0800 12 13 14 SMS 32312 24hr helpline Dr Reddy’s Help Line 0800 21 22 23 8am-8pm Lifeline lifeline.org.za National 0861 322 322 AIDS 0800 012 322 Stop Gender Violence 0800 150 150
Are you finding it hard to cope with everyday life? You could be suffering from depression.
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Go to mySupport.co.za for support and understanding.
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FREE COUNSELLING Lifeline lifeline.org.za FAMSA famsa.org.za 67 Visagie Street, Monte Vista, 7460, South Africa Tel: +27 21 558 7252 | Fax: +27 21 558 7425 | Mobile: +27 82 584 9834
www.cognitive-behaviour-therapy.co.za
SUPPORT GROUPS Contact SADAG for groups in your area 011 262 6396
INFORMATION ON MENTAL ILLNESS sadag.org health24.com psychcentral.com nami.org
ONLINE FORUMS bipolarsa.org.za psychcentral.com nami.org Spring2013 | 47
By Lara Lane
“
We must try not to sink beneath our anguish, Harry, but battle on.” – Albus Dumbledore, Harry Potter and the Half-Blood Prince. This advice given to the world’s most famous wizard may ring as a hollow platitude to those not familiar with the life story of J.K. Rowling, author of the spectacularly successful Harry Potter series. However, to those who do know a bit about the personal past of one of the world’s richest self-made women, each similar sentiment uttered by characters in the stories, resonates with profound wisdom. Joanne Rowling has fought her very own battle – that against severe clinical depression. This depression was probably due to a combination of her unfortunate life circumstances and sensitive psychological make-up. An unhappy childhood gave way to a failed marriage and a life of poverty as a single mother in a tiny flat in Edinburgh. It was then that thoughts of suicide started to plague this now iconic figure. For Rowling, the writing of Harry Potter constituted a form of psychological selfhealing – an exercise that was at once therapeutic and escapist. Through the novels, she resolved many of her own
48 | Spring2013
childhood issues, even giving Harry a family at the conclusion of the series. However, it was not only the writing that helped Rowling get back on her feet. She eventually decided to seek help and committed herself to an intensive period of cognitive behavioural therapy (CBT). This provided a solid platform from which she could pursue her creative outlet. Cognitive behavioural therapy is designed to help patients control their negative thoughts and typically involves a series of sessions with a therapist. The technique is recommended for depression, anxiety, bulimia and posttraumatic stress disorder. Although Rowling describes her initial depression as “a numbness, a coldness and an inability to believe you will feel happy again”, her commitment to CBT and the pursuit of her creative passions finally lifted her out of her negative mental state. “Harry Potter gave me back self-respect. Harry gave me a job to do that I loved more than anything else,” she said. “It was an amazing thing that happened.” At the pinnacle of the success of the Harry Potter books, when almost overnight she became a celebrity with her face recognized world-wide, Rowling experienced a second bout of depression
and went back into therapy to learn to cope with the pressures of this fame. Rowling is the UK’s best-selling author of all time and almost single-handedly responsible for the creation of a billion dollar industry. However, Rowling has decided not to forget the role that her suffering played in the development of her personal and professional life. At most opportunities, she speaks out about her struggle, categorically dismissing the stigma that is so often attached to mental illness. “What’s to be ashamed of? I went through a really rough time and I am quite proud that I got out of that.”
Rowling’s latest novel, The Casual Vacancy, explores the realities of obsessive-compulsive disorder (OCD) in a refreshingly serious and enlightened manner. Although approximately one in every 50 people will suffer from some form of OCD in his or her lifetime, this debilitating disorder is often made light of, and its symptoms seen as due to superstition or an obsessive tendency for order. Inspired in part by her own experience of the disorder in her teens, Rowling uses the novel to explore how people with obsessive-compulsive disorder develop rituals to deal with the upsetting thoughts they’re having. These rituals are an attempt to regain a sense of control. However, they provide little relief as they don’t address the deeper issues. J.K. Rowling stands as an icon of inspiration to everyone who has ever suffered from a form of mental illness. Not because of her immense talent or success, but because of the single decision she made, one dreary evening in a flat in Edinburgh, to seek help and turn her life around. As the all-knowing Dumbledore says in Harry Potter and the Chamber of Secrets, “It is our choices that show what we truly are, far more than our abilities”.
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