Is self-care indulgent?

     Time and time again I was asked by many of my clients whether it is selfish to engage in self-care. Are we not supposed to focus on others in our lives before we focus on ourselves? Maybe we need to leave a task of caring for ourselves to our family and friends? Maybe we do not deserve to be cared for at all?

      So, let us look at all of those questions and really contemplate the issue. I have struggled with those questions a lot myself on both personal and professional levels. I am going to share my current perspective on it.

     What is self-care? There are many definitions out there. For example, here is the part of the World Health Organization’s definition: “"Self Care in health refers to the activities individuals, families and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health.”  When mental health professionals talk about self-care, they may refer to the basic ability of an individual to take care of the daily tasks of living, such as grooming and feeding self. When I use the word “self-care”, I refer to the individual’s ability to fully recognize their physical, emotional, social, and spiritual needs and to take full responsibility on him/herself for meeting those needs. So, in my mind anyone, including myself, deserves to be taken care of. However, in my mind it is also my responsibility to identify my needs and find ways of meeting them that do not interfere with other people’s lives and well-being. This is where it gets sticky for me. So, when I take time out of my evening to go to a yoga class, does it interfere with my daughter’s well-being? I could be staying home cooking for her, talking to her, helping her with her homework, right?

     This is what I found through my personal and clinical experiences. When an individual has self-care as their last priority or not a priority at all, they tend to feel stressed a lot and unable to manage their stress. They also accumulate resentment towards those they are taking care of. Throughout the years of making choices to put others first, folks tend to develop their own physical and mental health issues that often get ignored, because “there is no time” and because “it is selfish”. So, in my office I often see someone, who has been selfless and focused on pleasing others, and is very unhappy with his/her life and struggling with mental and physical health. In addition, family and friends of those individuals often develop a belief that it is this person’s job to take care of them and, as a result, stop taking care of themselves relying on their “caretaker” to make their food, medical appointments, and remind them of important events. 

     Often, “caretakers” cite religion or culture to justify what they are doing in their lives. After all, did not Jesus teach us to be selfless and focused on charity and serving others? Buddha and Mohammed supposedly did the same. I am no religious scholar, but I have some basic knowledge of the history of religion. Let’s look at some interesting verses from the sacred texts and quotes I have found.  I will start with the Bible. In  1 Corinthians 6:19-20, we read: “Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body” and in 1 Corinthians 3:16: “Do you not know that you are God's temple and that God's Spirit dwells in you?” If you are a God’s temple and God’s spirit dwells in you, do you think God would like you to neglect your body and spirit or would he like you to take the best care possible of yourself?

    In Islam there is also focus on taking good care of oneself and one’s body and very specific guidelines provided in Quran for doing that. I have found widely cited quote “the Prophet said: 'Be keen to do what is beneficial to you'.  Dr. Shahid Athar in his article “Health Guidelines From Quran And Sunnah” writes:

In summary, our healthy body is a gift from God. We are the trustees. We should not misuse it, nor provide wrong raw products for the factory and we should keep superb maintenance of this delicate and sensitive machine, in order to enjoy it. It is the container of our soul.

     In Buddhism there is a lot of focus on love and compassion. Here is what Thich Nhat Hanh, a beloved Buddhist monk and writer says on the topic:

 Love is the capacity to take care, to protect, to nourish. If you are not capable of generating that kind of energy toward yourself- if you are not capable of taking care of yourself, of nourishing yourself, of protecting yourself- it is very difficult to take care of another person. In the Buddhist teaching, it's clear that to love oneself is the foundation of the love of other people. Love is a practice. Love is truly a practice. [Shambhala Sun March 2006 ].

One of the core Buddhist practices is Metta, or Loving-Kindness meditation, which focuses on generating love and compassion for oneself and then extending it to others.

     What about modern American culture? Well, there is a lot of focus on consuming, indulging, and having. However, this has nothing to do with self-care. Self-care is about health and well-being. Self-indulgence is about being disconnected from oneself and others. I will focus more on this topic in the next post. Many of us also like talking about being selfish and no one likes to be labeled as one. Now let’s think together. When your partner or a friend or a colleague labels you as “selfish”, because you don’t want to give them more, are they being selfless?

     So, I asked earlier in this post, “when I take time out of my evening to go to a yoga class, does it interfere with my daughter’s well-being?” Having tried both, going to a class and staying home instead of going, today my response to this question is “No”. When I go to a yoga class in the evening, I spend time focusing on my body, mind, and spirit in a very positive way. I come back home fully nourished and happy. I am glad to see my daughter and talk to her. I am available without resentment to take care of her needs. I am also modeling for her how to take good care of herself and her health, as well as giving her permission to do the same. In my mind, the world just got a happy person, who is spreading positive energy around. And, everyone wins.

     Please, post your comments. I am especially interested in knowing whether you think of self-care as an indulgence and why.

Moving on by Celebrating Survival

Moving on by Celebrating Survival

     In all human cultures important events, such as births, weddings, deaths are marked by special celebrations and rituals. They help us acknowledge an event, its impact, and transition to the next stage of our lives. We also have holidays that mark different seasons, such as Thanksgiving or religious events, such as Christmas. Those celebrations are embedded in a specific culture and each member of the culture knows particular rituals and ways to celebrate particular event. We can modify what our culture has to offer, but we have a template and basic knowledge of what to do. For example, when it comes to a wedding in the US, all people have a basic idea of a wedding ceremony held in a sacred or important place involving a bride in a beautiful white dress, a groom – also dressed up, wedding party, guests, reception with food and music afterwards and so forth.

     Well, a traumatic event is all bit as important as a birth or a wedding. It transforms a person and his/her life forever and often marks a transition from a naïve and innocent individual to someone, who experienced very grim and dark side of human existence. Some people experience a number of traumatic events in their lives, each one is as important as the following one. Unfortunately, many human cultures, including American culture, leave people to their own devices, when it comes to dealing with trauma. Moreover wounded individuals often feel isolated and rejected, and their injuries are rarely acknowledged. Definitely, nothing about it is celebrated.

     One important aspect of trauma is that our psyche often gets stuck there, because it is overwhelmed during the traumatic event and unable to process it. So, often years after the end of sexual abuse, the survivor still feels unsafe and unstable and has difficulty thriving. The same applies to other types of traumas, such as combat, terrorism, assault, natural disaster and so forth.

     How can we help our psyche understand that traumatic event is over? How can we help ourselves move on? The answer maybe counterintuitive… By celebrating the end of trauma and the fact that we survived it! Since we don’t have any templates for how to conduct a celebration like that, there is a lot of freedom to create a celebratory event that fits your personality, life circumstances, values, type of trauma, etc.

     For those, who feel lost and would like some ideas to start from, below is a non-exhaustive list of celebratory possibilities:

·       Create a collage of survival and healing. Share it with those close to you.

·       Throw a party with survival theme. It can be focused on you or it can be focused on all guests surviving difficult and painful events in their lives. Have people share what they appreciate about survival and what they are celebrating.

·       Cook your favorite foods. Invite close friends and/or family to dinner. Share with them what you survived and when and how you are different today because of it.

·       Plan a get-away retreat focused on you taking good care of yourself, because you survived. Include activities and places that you enjoy in your itinerary. Maybe it’s camping, or fishing, or hanging out on a beach, or getting massage, or hiking, or a yoga class, or getting pedicure, or reading a great book, or having tea on a porch? Whatever it is, as long as it feeds your mind, body, and soul in a healthy, non-destructive way, it has a place on your celebration list.

·       Create a ritual including elements of your spiritual tradition(s), such as prayer, meditation, lighting candles, chanting, singing and other practices. Perform ritual alone or share it with significant people.

·       Create a scrap book focusing on differences between your life post-trauma and life during trauma.

NOTE TO THOSE WHO DON'T FEEL LIKE CELEBRATING 

           I understand that you may not feel like celebrating at all. In fact you may feel like life is not worth living given what happened, or you may be grieving losses, or you maybe plotting revenge. The idea of celebration may seem ridiculous to you in the context of your current life. In this case, I invite you to acknowledge that the trauma is over in any way you can, in any way that feels authentic to you. Sometimes journaling about it helps, Writing a simple sentence like "Accident happened on May 25, 1985. Today is June 27, 2012. The accident is OVER" and then looking at it on a daily basis may prove beneficial.

Please, share your own celebratory ideas or ways in which you celebrated/acknowledged your survival below.

Want to heal from trauma? Sign-up for a yoga class.

   What does yoga have to do with healing from trauma? Actually, a lot, according to both ancient texts and contemporary research.

     Yoga is an ancient holistic practice that originated in India more than 4,000 years ago. It includes ethics, meditation, breathing, movement, diet and other approaches for keeping body healthy and mind sane to help the seeker achieve spiritual enlightenment. In our days in the West, yoga mostly covers physical exercises, some breathing techniques and some meditation. Many people think of the folks practicing yoga as “flexible pretzels” and feel intimidated by the idea of a class. But yoga class does not have to be scary or challenging. There are many types of yoga, such as subtle, gentle, restorative, or yin that people with any fitness level can practice.

     Trauma affects individuals on all levels: physical, emotional, spiritual, and social. It also has profound effects on the functioning and even structure of our brains. According to a number of researchers (Ogden et al., 2006; van der Kolk, 2006), during traumatic events our cortex and frontal lobes get overloaded and shut down, while brain stem and amygdala carry on and get hyperactivated, which results in person’s inability to process trauma verbally and cognitively, as well as increased arousal and anxiety. 
     Talk therapy, which is often used, to address consequences of trauma has pretty serious limitations given aforementioned effects of trauma on brain. However, yoga, which is a holistic approach, has an ability to effect change on the level of brain stem and amygdala. Research shows that regular practice of yoga leads to decrease in anxiety, improved mood, increased ability to self-regulate, and restoration of biological rhythms (Brown & Gerbarg, 2009; Spinazzola et al., 2011).

     In my own experience of using yoga in the group treatment of trauma survivors, the regular practice is associated with increased sense of safety, ability to change state from depressed and anxious to more joyful and calm, enjoyment of being in one’s own body, and decreased level of anxiety and stress.

     There are many ways to start and develop your own yoga practice. Attending yoga classes is the easiest way to go. However, if you don’t have a yoga studio or GYM with yoga classes, you may want to purchase a yoga DVD. Below are some of the places and items that I recommend. Of course, you are welcome to do your own research. There are a lot of options available in our days.

     If you live in Knoxville, TN or surrounding area, check out my yoga classes at http://www.dr-irina.com/Wellnessclasses.en.html. There is a wonderful yoga studio, Glowing Body, in the Old City with multiple yoga classes every day of the week: http://www.glowingbody.net/. Aspen Health and Healing Center offers yoga classes in Oak Ridge: http://www.aspenhealthnow.com/ . If you live outside of Knoxville area, check out yoga journal directory for teachers & studios in your area: http://www.yogajournal.com/directory/.

     Here are some of the good yoga DVDs:

·       Yoga for beginners & stress relief: http://www.amazon.com/Beginners-Stress-Relief-Essential-Inflexible/dp/B001HAO8NM/ref=sr_1_1?ie=UTF8&qid=1339380511&sr=8-1&keywords=yoga+DVD

·       Yoga for depression with Amy Weintraub: http://www.amazon.com/LifeForce-Yoga-Beat-Blues-Level/dp/B000MMMWMU/ref=sr_1_6?s=movies-tv&ie=UTF8&qid=1339380770&sr=1-6&keywords=yoga+DVD+depression+anxiety

·       Viniyoga for anxiety with Gary Kraftsow: http://www.amazon.com/Viniyoga-Therapy-Beginners-Advanced-Kraftsow/dp/B005JJ0EL2/ref=sr_1_3?s=movies-tv&ie=UTF8&qid=1339380770&sr=1-3&keywords=yoga+DVD+depression+anxiety

     If you think that you cannot practice yoga, I suggest you watch the following video for inspiration and motivation: http://www.youtube.com/watch?v=bIXOo8D9Qsc – Arthur’s Transformation – Never give up. It features a man with both physical and psychological trauma, who used a power of yoga to help himself heal.

Coping with intense feelings

     Many trauma survivors struggle, when it comes to regulating their emotions.  If you find yourself feeling down, angry, afraid, sad and so forth "out-of-the-blue" and/or often, you may have this problem too. Even though it feels awful and scary, when you fall in "the black hole" of an intense negative feeling, and you may even think in the moment that it will never go away, there are a few simple steps that you can try to help yourself cope with those episodes.
     1. Acknowledge and accept the feeling that you are experiencing in the moment, no matter how "shitty" it is.Just say to yourself: "There is a feeling of anger (or any other feeling you experience in the moment) right now and it is OK".
     2. Choose a way to cope with you feeling. Any of the suggestions below can be used for this purpose, as well as other techniques you read about or learned in your own therapy.
       Riding the Wave. Imagine that you are in the middle of an ocean and there is a wave coming your way. If you try to fight it, you will most likely get drowned. However, if you let yourself lay on your back and relax, it will carry you, you can also choose to ride this wave if you are a surfer, or go with it in any other way that your imagination suggests. The idea is to imagine that you are riding a wave of an intense feeling instead of fighting it. And, when the wave washes over you, the feeling will go away.
     Soothing yourself. Focus on soothing yourself. There are many constructive ways in which it can be done. Here are a few ideas: wrap yourself up in a warm blanket, listen to calming music, take a bath with aroma oils or bubbles, look at the pictures of the people who love you, remind yourself that you are a wonderful person and that things will be OK, do self-massage, hug a stuffed animal, play with a pet, and so forth. The trick is to find what is soothing for you, and go with it.
     Exercising. Physical exercise can often help release the negative feeling. If you are angry, running or intense aerobic exercise may be a good choice. If you are sad or afraid, something like yoga, tai chi, or qui qong may fit more. Any form of exercise can be helpful, so choose what fits for you, whether it's walking, swimming, dancing, or something else.
    Expressing your feelings on paper.  Use journaling to express how you feel. People are sometimes hesitant to write down their thoughts and feelings out of the concern that someone else may read it. You do not have to store what you wrote. You may choose to shred, tear to pieces or burn that piece of paper. Sometimes folks connect to drawing and painting more. If you are one of them, by all means use your paints, markers, pastels, pencils, etc. to express your feeling. The goal is not to create a piece of art, but rather express what is going on inside.
     Distracting yourself. Use movies, music, puzzles, games, chatting with someone, books, math problems or anything else that you can focus on other than your intense feeling.
     Communicating with others. Let those, who you trust, around you know that you are struggling. Ask them for what you need and be specific. For example, "I am feeling really angry right now. It has nothing to do with you. I need to.... go for a 20 min run (take a shower, spend10 min alone, etc.) to cool down" or "I am feeling really sad right now. I am not sure why. I would like a hug and to talk to you for a few minutes."
     3. Be patient with yourself and your emotions. They come and go. They DO NOT MEAN anything about you as a person. IT'S OK TO FEEL THE WAY you feel. And remember, this feeling will pass, maybe not as quickly as you would like, but it will go away. You can speed up the process by being patient and abstaining from self-criticism.    
      Now that you know the steps, create a specific coping plan using suggestions above, as well as your own and others' ideas. Work on the plan, when you feel good. Write this plan down on a note card and carry it with you. This way when an intense feeling suddenly hits you, all you need to remember is pulling the card out and following the steps on it.
     Also, remember that there are a number of things that people often do, when feeling emotional intensity that ARE NOT HELPFUL. SO, stay away from using alcohol or recreational drugs, self-harm and self-destructive behaviors (e.g., cutting or being promiscuous), addictive behaviors (e.g., watching porn or gambling), aggressive behaviors towards others, self-criticism, and making important life decisions. Those may seem as good ideas in the moment, but almost always come with negative consequences in the long run.