Author Archives: Ronnie Siddique

What is Mental Health?

Foundations of Wellbeing
May is Mental Health Awareness Month, and I am frequently asked by interviewers and websites about what defines mental health.

I believe there are seven interrelated foundations that underlie mental health: Physical, Intellectual, Environmental, Vocational, Social, Emotional, and Spiritual health.

Physical Wellbeing
Move More. Eat Better.
This dimension of wellbeing focuses on practicing healthy daily habits. It is important for building strength, flexibility, and endurance. Many of us have a genetic loading for chronic health conditions, including pre-diabetes, high blood pressure, or cholesterol. Starting early with self-care makes a huge difference. When it comes to exercise, variety and individual preferences are key. The biggest variable: Consistency.

Intellectual Wellbeing
Boost your Brain.
An active and open mind (mental flexibility) leads to a life filled with passion and purpose. To engage in a variety of creative and stimulating activities is ideal, helping to keep your mind sharp and your brain healthy and happy. In fact, when a patient suffers a brain injury or trauma, I prescribe a regimen of word and strategy games, reading, art, trying new recipes, and other activities to stimulate our juices. You can also challenge your brain with a thought-provoking seminar or class, learning a new language, or engaging in interpersonal topical activities, such as joining a photography club or reading group.

Environmental Wellbeing
Love the Earth.
Help the planet and bring a sense of accomplishment and wellbeing to your own life. Have you asked how your daily habits can affect the world around you in a positive way? One environmentalist, my mother, Salma Siddique, I have worked with in this area, cultivates small personal and family habits that have a cumulative affect on our niches in this world; not wasting resources, recycling, sharing with neighbors and community all protect our planet and contribute to our collective mental health.

Be in Nature.
From going for a daily walk, to raising house plants as green babies, to spending time with companion animals, nature is good for our mental health.
Have a personal environment that resonates.

Whether it’s an apartment, house, garden, office, or even a single room, create a space that is soothing and rejuvenating.

Vocational Wellbeing
Live and Work with Purpose.
This aspect of wellbeing focuses on enriching your life and that of others by sharing your special gifts, skills, and talents. Whether through work, your craft, or volunteering, you can make a positive impact and reap the documented health benefits of adding purpose to your life.

Social Wellbeing
Connect with Others.
Personal connections contribute to a long and fulfilling life. When you nurture relationships with family and friends, you create healthy support networks that I call a scaffolding for good and bad times.

Sustain caring relationships.
Humans are social creatures, and having ongoing meaningful relationships is crucial for mental health. Be intentional about regularly FaceTiming,  texting, or Zooming with your close friends and family. You don’t even need to talk explicitly about personal problems. You can connect deeply on anything—from your week at work to a fantasy trip or home project you are planning. Research is unequivocal that a not-so-secret path to a long and healthy life is through human attachments.

Connect with Self.
You also have a relationship with yourself, your most important connection.Celebrate your self-image. Real confidence is being true to yourself and recognizing your strengths and vulnerabilities. Give yourself space for those moments and remember you’re a unique, multidimensional person. Self-image affects every aspect of well-being.

Spiritual Wellbeing
Nourish your Soul.
Is your mind at peace? A set of core beliefs or values that shape you and how you live your life often creates harmony. Personal prayer, meditation, volunteering for those in need all contribute to a positive mental health.

Emotional Wellbeing
Incorporate stress-free activities.
Practicing relaxing activities such as yoga, meditation, or Tai Chi can serve as powerful tools to diminish stress and regulate emotions.

Decrease screen time.
Unplug from work, social media, web surfing, and anything that may be distracting you from being centered.

Write.
From Journaling, to poetry and creative writing, to just keeping a list of wins and losses for the week, writing helps you understand and ventilate emotions.

Love.
Surround yourself with positive people who bring out the best in you, encourage you, believe in you, and occasionally scrape you off the floor when needed.

Be kind to others.
Volunteering and community service can be the most powerful feel-good actions.
Promote knowledge and safety.

Microaggressions, racism, financial hardship, vicarious trauma from images on social media and screens, and an inability to access resources can create a pervasive state of internal danger and emotional dysregulation.

ADHD IN ADULTS

High functioning ADHD can look like:

    • Feeling like you have great ideas, but are unable to organize them or act on them.
    • Hitting a wall or shutting down in the middle of the day, or after going for hours.
    • Feeling not good enough or an imposter.
    • Losing or misplacing things.
    • Difficulty prioritizing when faced with multiple tasks.
    • Mundane tasks are avoided or postponed.
    • Dreading facing deadlines and time constrained tasks.
    • Trouble focusing on the task at hand.
    • Procrastinating: difficulty starting tasks.
    • Difficulty ending tasks; feeling like you can go on and on.
    • Feeling restless and fidgety while working (leg jiggling, playing with objects on
    • your desk, moving in your chair).
    • Feeling behind. All the time.
    • Messy workspace, desk, car, purse, papers.
    • Exhaustion from trying to stay organized, hold it together, and keep up.

Also see these work and study tips.

The Daily You

Your relationship with yourself is the most defining factor in shaping the kind of life you live, especially in interactions with your friends, colleagues, work, and family.

Think of the people in your life that you love and respect. How do you treat them? Do you want to protect them when they are hurting? Do you listen to their dreams and goals? Do you tell them that you appreciate them and they are cherished?Do you believe in them and what they want to accomplish?

Chances are, you are kind to them, patient with their thoughts and ideas, fierce when they are in pain, and you forgive them when they make a mistake. You give them space, time, and opportunity; you make sure they have the room to grow because you love them enough to believe in the potential of their growth.

Now think of how you treat yourself.

Do you give yourself the love and respect that you might give your closest friends/loved ones?

Do you take care of your body, your mind, and your goals?

Here are ways that you could be showing your body and mind self-love in your everyday life:

  • Sleeping properly
  • Eating well. This includes meal prepping, trying delicious new foods, and sitting down to eat in a mindful way
  • Giving yourself time and space when you’re having a bad day
  • Exercising regularly
  • Engaging in physical touch, affection, cuddles, intimacy
  • Thanking yourself and those around you
  • Spending time in nature
  • Playing when you need it
  • Praying when you need it, or other spiritual practices
  • Avoiding vices and toxic influences
  • Reflecting and meditating. Meditation does not have to be seated. You can lie down, walk, move while focusing on your breath.
  • Saying no

I’m starting a weekly accounting with clients. What has worked to support you this week, what was not so great? The daily you, 24/7, with edits.
Also see: Self-Care is Often a Very Un-Beautiful Thing.

Life After Gaslighting

Gaslighting refers to when someone tries to overwrite your memories, experiences, or perceptions. Simultaneously, they may convince you that you are wrong if you attempt to question their “edited” version of reality. Over time, the individual being gaslighted starts doubting their own thoughts and memories. Most mental health professionals consider gaslighting to be a form of emotional abuse that’s particularly insidious.

Gaslighting can look like a friend or partner saying you are overreacting, exaggerating, or misunderstanding the situation.

It can be a parent telling a child that they are oversensitive or dramatic.

It can even happen in the context of social justice, with minimization or denial when an individual is upset about sexism, racism, and other forms of injustice.

Life After Gaslighting:
Release and express strong emotions.
Crying easily, feeling angry, doubting feelings of happiness are all common after an extended period of doubting or suppressing emotional expression, or being punished or even ridiculed for emotions.

Learn to See the Positive in Vulnerabilities
Often people end up feeling ashamed of their emotions after having been told they are wrong over and over again. Being vulnerable takes practice. Allowing yourself to be expressive in vulnerable ways can be tried out with trusted friends or professionals.

Allow Yourself to Make Mistakes
Gaslighting erodes your trust in yourself. When you’re constantly hearing that you’re doing something wrong, it’s only natural to begin to question whether you can do anything right. You might find yourself constantly apologizing. Being able to safely make mistakes without being criticized or mocked helps regain your trust in yourself. It also helps you see that you are human, and making a mistake is not a big deal.

Be Gentle With Yourself
Many people turn against themselves when they realize they’ve been gaslighted, blaming themselves for not recognizing or confronting it. Keep in mind that this kind of self-criticism is a common result of gaslighting. Try to let go of self-blame, and be compassionate with yourself.

Surround Yourself With Love
Spend as much time as you can with people who love and appreciate you. Talk with them about the doubts, insecurities, and fears that became a part of your life through the gaslighting relationship. Allow them to validate your reality as you let go of constant self-doubt. Let these connections nourish you.

Create a psychological first-aid kit
What are some healthy things you can do right now to soothe your hurt and treat yourself with TLC? What are the things that give you energy? Create a list of the activities and things that raise you up. I call this a “psychological first-aid kit.” When you are feeling low, turn to it, to practice some good self-care. Some psychological first-aid kits might include going for a walk, calling a trusted friend, painting or coloring, reading, watching a movie, cuddling a companion animal, and meditation.

Forget Closure
If you feel like you need closure to move on, you probably aren’t going to get it from the narcissist/gaslighter. When a “relationship post-mortem” discussion is not possible, the onus of the healing process falls on you. You will likely not hear an apology or explanation. In addition, gaslighters are adept at telling you not to talk to other people about what happened, so often there are very few people to bear witness about what you have experienced.

Reconnect
You may have become isolated from your friends and family. Gaslighters/narcissists work to distance you from others. Reach out to friends and family that are emotionally healthy. Make sure you ask them if they’re emotionally available so you don’t create a burden inadvertently. You’ll know they’re emotionally healthy because when you are around them you feel relatively calm, and most importantly, like you can be yourself without judgment or criticism.

Learn From Your Experience
Learn from your experience, but keep in mind that you may see everyone as a potential gaslighter for a while. The trauma of gaslighting can lead to being emotionally cautious and leery. Give yourself time to process and heal without having to plunge into new relationships.

Also see The Anxiety Toolkit.

Mother, as a Verb.

Many people had a parent in childhood and adolescence who couldn’t meet mental, emotional, or physical needs. Perhaps the parent was struggling to do the best they could with the limitations of society and personal circumstances, but fell short. Perhaps they had mental health challenges, medical problems, trauma, financial hardship, personal struggles, and lack of validation from society. 

Whatever the reason is, many people are left with relationship wounds from their interactions with primary caregivers.

Mother wounds can show up in the following ways:

  • Unrealistic expectations in relationships.
  • An inability to practice consistent self-care.
  • Emotionally care-taking others to the point of personal exhaustion and disappointment.
  • Unconscious self-sabotage in work and in love.
  • An inability to ask for and receive support.
  • Disordered eating – or other addictions or numbing coping mechanisms.
  • Allowing and accepting poor or abusive treatment from others.
  • Living out the unlived lives of our mothers and not being true to personal aspirations and dreams.
  • Shame, believing that something is fundamentally wrong with you, or that you’re not worthy of love.
  • Keeping yourself small – physically, emotionally, or mentally – for fear of stepping fully into your power.
  • Feeling relentlessly needy in your relationships.
  • Feeling resentful and bitter, and believing that others have it better.
  • Never feeling good enough no matter what you do.

Everyone needs mothering. Mothering is that nurturing process that helps someone grow. In addition to physical nourishment, including gentle touch, care, safety, and food, emotional nurturing consists of meeting a child’s emotional needs.

These include:

  • Love
  • Play
  • Respect
  • Encouragement
  • Understanding
  • Acceptance
  • Empathy
  • Comfort
  • Reliability
  • Guidance

As an adult, you still have these emotional needs.
Self-love and re-parenting means working on meeting them as a life long process.

Practices:
When you have uncomfortable feelings, literally put your hand on your chest, and say aloud, “You’re (or I’m) ____.” (e.g., angry, sad, afraid, lonely). This accepts and honors your feelings.

If you have difficulty identifying your feelings, pay attention to your inner dialogue. Notice your thoughts. Try to name your specific feelings. (“Upset” isn’t a specific feeling.) Do this several times a day to increase your feeling recognition. Putting words to emotions is validation.

Think or write about the feeling and what you need that will make you feel better. You need to sleep, take a time out, drink a hot beverage, eat a snack, go outside, take a nap, call a friend. Meeting needs is good parenting.

If you’re angry or anxious, practice yoga, stretching, meditation, or simple breathing exercises. Slowing your breath slows your brain and calms your nervous system. Exhale 10 times making a hissing (“sss”) sound with your tongue behind your teeth. Vocalizing is ideal for releasing anger.

Practice giving yourself nurturance: Write a supportive letter to yourself. Have a warm drink or eat some comforting soup. Wrap your body in a soft blanket.

Do something pleasurable, e.g., read a book or watch your favorite show, cuddle your companion animal, walk in nature, listen to music or dance, create something, cook something nourishing, or stroke/groom your skin. Pleasure releases chemicals in the brain that counterbalance pain, stress, and negative emotions. Discover what pleasures you.

Adults also need to play. This means doing something purposeless that fully engages you and is enjoyable for its own sake. The more active the better, i.e., play with your dog vs. walking them, make a yummy meal while listening to music, take some selfies (My essay: The Selfie and Mental Health, coming soon).  Play brings you into the pleasure of the moment.

Practice complimenting and encouraging yourself – especially when you don’t think you’re doing enough. Remind yourself of what you have done and allow yourself time to rest and rejuvenate.

Forgive yourself. Good parents don’t punish children for mistakes or constantly remind them of perceived failures. Instead, learn from mistakes and move forward.

Keep commitments to yourself as you would anyone else. When you don’t, you’re in effect abandoning yourself. How would you feel if your parent repeatedly broke promises to you? Love yourself by demonstrating that you’re important enough to keep commitments to yourself.

The point of re-mothering work is to have different experiences with yourself and with others to help you fill in any developmental gaps or unmet needs from childhood that are getting in your way as an adult and sabotaging your ability to fully engage with life.

Why Self-Compassion is more Important than Self-Esteem

Self-esteem is a positive evaluation of self and self-worth. While there is some overlap, self-compassion doesn’t require that we evaluate ourselves positively or that we see ourselves as “above average”. Instead, the positive emotions of self-compassion still kick in when self-esteem falls down; when we don’t meet our expectations, suffer a loss, fail in some way. It is a way of relating to yourself. This means that the sense of intrinsic self-worth inherent in self-compassion is highly stable. Self-compassion has been linked to higher resilience, better physical health, and increased life satisfaction.

External circumstances, skills, friendships, intimate relationships, even physical capabilities, may wax and wane. Self-compassion, as practice, is a constant. 

Also see The Neuropsychology of Self-Compassion.

Use cautious in a sentence

Where the Wild Things Are, Maurice Sendak

Please be careful, be safe. These words have become our default farewell, replacing have a nice day. How does being careful differ from being cautious? It’s a familiar question in my line of work. The difference between cautious and careful in my opinion is that cautious is an emotion, a fear based emotion mostly. Being careful is an ACTION; it is things you can do, like gathering data, getting additional input, studying experts, analyzing, checking your locks, wearing a mask.

Natural selection rewards the cautious. At the slightest hint of danger, most animals scurry for safety – only in human beings and the higher primates – does curiosity overcome caution to any great extent. (See Fight/Flight/Flow, Dr. H. Siddique, in press, 2021).

It’s not always that easy to uncover and address our fears. Obviously, I’m an advocate for good psychotherapy – for regular work with someone who can accompany us through our dark thoughts and help us get to the other side of many. At times, fear may cloud our vision. It clouds our judgement and can paralyze the very responsiveness we would need in a real emergency. None of us can really do much with fear – it’s there and feels stuck there. Sometimes it feels like something actually stuck in our throats or stomachs. We go around and around in this enclosed track of fear. There’s no forward movement or further understanding. We may feel frozen.

I frequently work with kids with being cautious (fear base) versus careful (action base). Being a kid is already a pretty scary and vulnerable position. Children are primed to pick up on and absorb fears of all kinds, from the darkness under the bed to frightening imaginings of someone entering their home at night. As adults, parents, and mental health professionals, we help our young folks distinguish between caution and carefulness. Quite often, I see kids who have a highly anxious parent, and their own baseline anxiety, not surprisingly, is much higher than their peers’. When your baseline is set higher, you are easily overloaded when additional stressors rear their heads.

In counseling/therapy, treatment for fearfulness or overcautiousness consists of not just relaxation strategies, but action oriented thoughts, self statements, rituals of safety and self soothing, and healthy self-care. Behaviors create new pathways that diminish existing fears.

(Picture credit, from “where the wild things are”, by Maurice Sendak, a primer in caution versus carefulness.I highly recommend it for children of all ages, five through 90.)

The Neuropsychology of Self Compassion: thoughts for 2021.

A growing body of research suggests that self-compassion is strongly associated with psychological health. One of the most consistent findings in the literature is that greater self-compassion is linked to less anxiety and depression (Neff, 2003; Pauley & McPherson, 2010).

There are physiological reasons underlying this association. Neuropsychological research has found that individuals trained therapeutically to increase feelings of self-compassion had reduced levels of the stress hormone cortisol. It also appeared to increase heart-rate variability, which is associated with a greater ability to self-soothe when stressed. In other studies, self-compassionate people have been found to worry less than those who lack self-compassion, are less perfectionistic, and tend to experience fewer negative emotions. However, they are also LESS likely to suppress unwanted thoughts and emotions and are more willing to acknowledge their negative emotions as valid and important.

For the purpose of this article, although I realize there is a wide range of writing and discussion on this topic, I define self compassion as having three primary components:

  • Self-kindness, or refraining from harsh criticism of the self.
  • Sense of connection to the world and others, or the fact that all people are imperfect and all people experience pain.
  • Mindfulness, or maintaining intentional awareness of experiences, even those that are painful, rather than either minimizing/ignoring or exaggerating their effect.

There is also evidence that intentionally cultivating self-compassion stimulates parts of the brain associated with generalized compassion. Using fMRI technology, neuropsychologists found that instructing individuals to be more self-compassionate was associated with neuronal activity similar to what occurs when feelings of empathy for others are evoked. This research would suggest that the tendency to respond to suffering with caring concern is a general process applied to both oneself and others, so that self-compassion is “contagious”, so to speak. From the perspective of psychology, building the capacity to hold suffering in compassionate awareness facilitates the ability to extend compassion to multiple targets: the self, others, and all sentient beings (see Sharon Salzburg, 1997)

Self compassion and mental health
Self-compassion is also often confused with or linked to self-esteem, but the two differ: While self-esteem focuses on favorable self-evaluation, particularly for achievements, self-compassion is a form of self-acceptance, even in the face of failure. This emotion represents a shift away from being the best toward simply being the person one is. A person who scores high on measures of self-compassion might accept failures. Self-compassion does not depend on either social comparisons or one’s sense of personal success; rather, recognition and acceptance of one’s flaws often leads to growth and personal development in a way that self-esteem does not. A lack of compassion for the self can play a role in mental health conditions, especially anxiety and depression.

How to increase self compassion
It may be helpful to frame self-criticism as a critique that might be given to a friend. If the words are too harsh for a loved one, then they are likely also too harsh for the self. In general, people tend to be more accepting of the flaws of others than they are of their own. I always ask patients who are speaking about themselves in self-deprecatory terms, would you speak to your friend or a loved one like that?

Mindfulness-based cognitive therapy, (MBCT), developed from Jon Kabat-Zinn’s mindfulness-based meditation, is meant to increase self-awareness and thus can positively influence levels of self-compassion. The goal of this therapy is for those in treatment to become increasingly able to see themselves separately from the negative thoughts and moods they might experience. In MBCT, the process of healing includes the interjection of positive thoughts in response to a negative mood, but not denying the negative feelings, so those who experience a sense of lowness after focusing on their mistakes and flaws can often come to accept themselves more readily as a whole person.

Clinical psychologist Dr. Kristin Neff developed a self-compassion scale to help people measure whether their own self-compassion is low, moderate, or high. She also developed several exercises that help enhance self-compassion, including writing a letter to oneself, from the point of view of a compassionate friend, every day for a week. Journaling or otherwise writing about personal imperfections and inadequacies can also help increase mindfulness, and when combined with changes in techniques of personal criticism, this practice can also positively influence the development of self-compassion.

Last, but far from least, a self-care routine is also essential, as the meeting of personal needs can increase ability and energy to effectively care for and support others. When personal wellness declines, negative feelings might often be directed toward the self, and this can also make it more difficult to feel compassion for others.

Also see: Put on Your Own Oxygen Mask First.

How to reset

“Add something new to the mix.” If you’ve ever been in my office, you’ve heard me say this.  It takes approximately 60 days to start to lay down new neural pathways, which come from consistent practice of a new behavior.

Growth involves changing behaviors—and in order to change a behavior, you have to change your thinking (or “rewire” your brain). Neuropsychologists find that habitual behavior is created by thinking patterns that create neural pathways and memories, which become the default basis for your behavior when you’re faced with a choice or decision. Trying to change that default thinking by “trying not to do it,” in effect just strengthens an undesired behavior. When you try NOT to think of something, you actually have to think about that thing in order to not think about it.

Change requires creating new neural pathways from NEW thinking.

Many people assume willpower is a character trait that you’re born with, or innately lack. I frequently work with teenagers and young adults. When they make supposedly bad decisions, I often hear parents say to their kids, ‘why did you do that, where was your willpower’?

But research suggests that it is more complex: It can be trained, but it also relies on mental resources, self care, and energy, and can become depleted if overused. Researcher and psychologist, Dr. Roy Baumeister, has spent years studying how people regulate emotions, resist temptation, break bad habits, and perform up to their potential; and why they often fail to do so. Among his conclusions: Each person’s supply of willpower is limited. And, as the ‘power’ aspect of willpower implies, it’s a form of energy. It gets depleted when you use it.

So new habits depend on the basic energy supply that a person needs for all other acts of daily self-control, problem-solving, and decision-making. In short, eating well, getting enough sleep, exercising, reading, writing, learning, trying new things, having a strong social group, and caring for others are the fuel that is required for change. I call this fuel the foundation. With it, you build new roads and pathways; infrastructure.

People often view resolutions or intentions as short-term goals to be achieved. So if they don’t quit that bad habit or lose that weight in a short period of time, they become demotivated and often quit trying. Change requires uploading a new program in your subconscious. It can include deceptively simple actions. Go for a walk. Engage with a buddy who has similar goals to keep each other accountable. Put greens on your grocery list. Finish that online course or certification. Clean out your closets. Edit your contacts.

Add. 

Also see Willpower: Rediscovering the Greatest Human Strength- August 28, 2012, by Roy F. Baumeister and John Tierney.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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