Category Archives: General

12 Facts About Depression and South Asian Mental Health

South Asia is a broad region that includes close to 2 billion people. Encompassing India, Pakistan, Bangladesh, Nepal, Afghanistan, Sri Lanka, Bhutan, and the Maldives, South Asia is huge.

South Asia is a suicide-dense area but with only a handful of peer-reviewed studies assessing the relationship between depression and suicidal behavior.

South Asia represents approximately one-quarter (over 23%) of the global population. Depression affects close to 90 million people in South Asia. The World Health Organization (WHO) estimates that almost one-third of people suffering from clinical depression worldwide live in South Asia, making the region home to a large majority of the world’s depressed.

Suicide is a global public health issue (World Health Organization, 2021). WHO estimated that suicide isthe fourth-leading cause of death worldwide among 15–30- year-olds. It is the result of a complex interaction between several risk factors which may include biological, personal, social, psychological, cultural, and environmental factors, but psychiatric disorders are one of the most crucial risk factors (WHO, 2014; Arafat and Kabir, 2017). Depression numbers are probably underreported in South Asian communities because of years of stigma about mental disorders.

About 90% of people who die by suicide experience some form of psychiatric illness. Among psychiatric disorders, clinical depression is the most common risk factor for suicides.

Mental illness is taboo in many South Asian communities. Discussing mental health in South Asia has yet to be socially normalized. South Asian religious and cultural influences often do not consider mental health a medical issue, referring to it as shameful and even a “superstitious belief.”

A 2010 study by the mental health campaign Time to Change (www. found that South Asians rarely discuss mental health because of the risk the subject poses to their reputation, family, and status.

South Asian languages do not have a word for depression. There is dukkha (universal suffering); pagal (derogatory word, crazy); and shikasta (broken). Many South Asians are unable to express the specific condition of depression in their language. As a result, they often downplay it as part of “life’s ups and downs.” This language limitation and difficulty describing symptoms also makes diagnoses and treatment difficult.

Depression is a major contributor to other global health problems. Medical experts have found a correlation between the symptoms of depression and the perpetuation of chronic illness, such as cardiovascular disease. Depression exacerbates other health conditions.

Postpartum depression in South Asian women is often undiagnosed and unrecognized. The gender of the baby, domestic violence, secrecy, and poverty are all factors that put new mothers at a higher risk for postpartum depression. The stigma surrounding mental health prevents new mothers from receiving mental health care or support during after pregnancy.

Bangladesh, Sri Lanka, and Indonesia are three countries who have recently emphasized mental health as a “top priority” in public health. In 2021, WHO lauded their work and the important step it takes towards normalizing and treating depression and mental illness, as illness.

Non-government organizations (NGOs) have had a positive impact on mental health care. In countries where the government is not willing or able to make mental health a priority, NGOs are providing crucial support to people suffering from mental health issues. NGOs in South Asia have expanded their community-based programs and are providing specialized mental health services. For example, in the Maldives, a number of NGOs are offering rehabilitation, life-skills training, educationsl information, and resilience-building to citizens. These efforts have begun to increase the access South Asians have to mental health care with decreased stigma.

Mental disorders are bad for work and family life. People with major depression struggle to take care of their family, complete self-care tasks, pay bills, and be productive in the work place. Although poverty rates in South Asia are declining, the region accounted for nearly half of the world’s “multidimensionally poor” in 2017. Providing mental health care to South Asians may be a major step in helping to eradicate poverty within the region.

According to the World Bank, strong mental health is a contributing factor to not only the wealth of nations but to increased quality of living and productivity for families and individuals.

Read more about this:  South Asian Mental Health

***Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room.
988 Suicide & Crisis Lifeline
Call or text 988; Llame al 988 (para ayuda en español)
Use Lifeline Chat on the web.
The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Call or text 988 to connect with a trained crisis counselor.
New: If you are worried about a friend’s social media updates, you can contact safety teams at the social media company. They will reach out to connect the person with the help they need.

Dogs and Stress

We’ve known for a while that dogs can be trained to sniff out seizures, infections, diabetes, extremely elevated blood pressure, and sometimes even cancer. Therapy dogs and service dogs can be trained to help people with movement and balance problems, panic attacks, PTSD, cognitive fogginess, (including getting up and going in the morning), poor attention and concentration, and executive functioning and memory loss.

A series of recent studies indicated that dogs are also responsive to the release of cortisol and adrenaline in humans, using their exceptional sense of smell, the human stress hormones. If you have a dog that is very attentive, or at least stays near you when you are not feeling well or having a bad day, they are not only showing the affection and loyalty they have for you, they FEEL you.

One patient who has a rigorous job with deadlines throughout the week reported that she can be sitting tensely in her home office and will look up to see her dog staring at her. Instead of sleeping, he monitors her. When she’s not doing well, suddenly, her dog will start panting I have heard this phenomenon from dozens of patients.

Dogs can smell your stress. And they know something is wrong.
Also read: Mindfulness in Fur.

On Coupling

Below is a portion of a couples’ questionnaire that I send people who are coming in for relationship counseling. Sometimes it’s to address moving in together, getting engaged/married, becoming parents, or even breaking up in an honorable fashion: the next step questions.

I love working with couples. There is a magic that happens when individuals decide to share their lives. It’s also hard work.

Usually, when I start working with a couple, I ask questions that are streamlined for their specific situation. This questionnaire is extremely baseline; I work with couples who are in different combinations and permutations of relationship; there is no formula.

Here are some of my questionnaire items to possibly discuss with your partner.

Children related questions

  • At this point in the relationship, you may already know the overall “will we or won’t we” as regards to raising a family. But digging a bit deeper into the topic can be a beneficial exercise, since it can reveal areas you might want to work through.
  • How many children do we want to have, and what’s our ideal timeline? Will we adopt?
  • Do we want to hire a babysitter or nanny? Will our children go to day care? Or will one of us stay home?
  • If yes to a parent staying home, how long before we return to work?
  • Will our children attend public or private schools? How important is this to each of us, and why?
  • How do we hope to parent our children? What are the values that we find most important as parents in raising children?
  • What will we do if our parenting styles or values conflict?
  • What role will our extended family play in our parenting?
  • How will we speak to our family members who may favor a different parenting style from what we hope to implement?
  • What will we do if one of our children/child has special needs or is diagnosed with learning or behavioral concerns?

Religion and faith related questions

  • Whether you’re devout, undecided, or somewhere in-between, religion and spirituality are typically a tough topic for couples to discuss on their own. You may also have your own faith based counseling that you would like to engage.
  • Secular couples counseling provides the opportunity to voice your desires and concerns by asking questions like:
  • How important is religion / faith to each of us?
  • How much influence do we want religion to play in our lives and our children’s lives?
  • Which religion will be taught and celebrated in the home or could different religions be celebrated?
  • Will we celebrate religious holidays? If so, to what extent? What will those holidays look like?
  • What are our core spiritual values as individuals and as a couple, and how do we see ourselves upholding them?
  • How can we handle any conflicts between our individual values?
  • What happens with our extended family situations if our religious values are not commensurate with theirs?

Money related questions

  • For many, living together/marriage marks the point at which income and finances may become a shared responsibility.  But it’s not always as easy as opening a joint bank account and calling it a day; you may also need to discuss the nitty gritties of the “f” word… finances:
  • How much do each of us expect to contribute to the household?
  • How much of our income will we spend on our own personal hobbies or interests?
  • How much of how income do each of us envision saving
  • Should we have a monthly budget? How will we set it and stick to it?
  • Do we want to combine our finances completely or keep some accounts separate?
  • How much debt do we have, and how much money do we have saved?
  • What will we do if we have an emergency expense or an unexpected loss of income?
  • How much do we plan to spend on shared interests, like vacations? If we plan to spend some of our money on a vacation, what type of vacation do each of us enjoy?
  • What is the importance of earning money to each of us?
  • How much is expected from each of us in terms of earning money for the family?
  • What happens when we have significant discrepancies in income?
  • What are the emotional reactions we have around money, earning, spending, saving?

Work and career questions

  • One person’s long hours is another person’s normal. Make sure you and your partner are on the same page about career expectations.
  • How much will each of us work?
  • Do we expect or want to make any significant career changes in the future?
  • How will we balance careers and childcare if we have children?
  • How can we support each other in our career goals?
  • How much sacrifice is each of us willing to endure for the other person’s career goals and the pursuit of success? What if one of us becomes unemployed or under employed?
  • What happens if one of us wants to pursue future goals that require time and any commitments such as advanced degrees?
  • How many hours per week does each person expect the other will be away from home (or working at home) in order to pursue career goals?
  • How will we negotiate future ambitions and endeavors, such as one of us wanting to start a business or go into self-employment
  • Questions related to where you want to settle, in the short and long-term. Whether you both want to move, or put down roots where you are, it’s great to touch base now.
  • Where do we want to settle down? Will we want to live in the city or in the suburbs?
  • What is our shared vision of the future? Are there any significant differences?

Sex related questions

  • It’s a tricky topic, but crucial to be honest about. After all, who better to discuss sex with than your partner? NOT talking about sex can become a habit that makes it harder to communicate in the bedroom.
  • How important is sex to each of us?
  • How much sex do each of us envision having every week?
  • How will we handle any problems in the bedroom down the line?
  • How is our current sex life going? Do either of us have any unmet sexual desires?
  • Are we monogamous in the longterm? What will we do if either of us is interested in changing our relationship model in the future?
  • What other forms of intimacy and romance are important to us?
  • Do we make time to be together as a couple or do our other responsibilities take over?
  • Are we able to talk about sex, from preferences to complaints?

Social lives questions

  • Every relationship needs a healthy balance between friends, family, career, self-time, and each other – what does yours look like?
  • How much socializing is important to each of us? How much time do we want to spend with each of our friends and family?
  • How important is maintaining friendships outside the marriage to each of us and to what extent should our attention and shared resources be devoted to these (e.g. weekend bachelor and bachelorette parties, girls’ night out, weddings, showers, visiting out of town friends, etc.)?
  • How close are each of us to our immediate and extended family members? How much time do each of us expect to spend with our families (alone and with one another)?
  • How comfortable do you feel about your partner having friends of the opposite gender?
  • What are the rules around social media and having online friendships with opposite gender connections?
  • How do we feel about time spent away from family that is spent with friends, individually and as a couple?
  • Do we have friends that we share, individual friends, or both? What happens if we don’t like our partners’ friends?

Vacations and holiday related questions

  • How do each of us envision spending our weekends? Where do we want to spend them?
  • How will time off, and holidays, be spent?
  • How much of our vacation time will be devoted to visiting family versus traveling together as a couple or family?
  • Do we have a bucket list of places that we both want to explore?
  • How much time and expenditure do we want to spend on holidays?

Conflict resolution and decision making questions

  • How do we resolve conflicts?
  • What communication style works well for us, and where do we struggle?
  • How can we effectively express difficult emotions like anger and sadness?
  • How will we make major life decisions together?
  • Where can we turn for support if we disagree about a big decision in the future?

Household responsibility questions

  • How do we divide up household duties?
  • Do we have any particular challenges around sharing a household?
  • Which tasks will (or does) each partner handle?

Personal history questions

  • What are our plans for combining our different backgrounds, whether racial, ethnic, cultural, socio-economic, or otherwise?
  • Do we expect any conflicts related to our different backgrounds?
  • How might we plan to resolve those potential conflicts?
  • How do we handle medical and mental health issues?
  • How do we feel about the health of each other and how to best be supportive If your partner is under the weather?
  • What happens if one or the other becomes physically or mentally disabled?

Also read Healing in Relationships: Imago Therapy for Communication.


Happy Doctors Day to all my friends, family, and colleagues. I’m so proud of all the work that you do and how difficult it is.

We are having a huge doctor shortage in this country which is getting worse, day by day. It takes me weeks and endless phone calls to find a primary care referral for my neuropsychology patients. All my experienced physicians are completely full and they work a lot. Doctors are not there ‘for the money.’ The amount of education, work, stress, hours, and student loans is immense.

I want to mention three superhero doctors in my life who influenced me as a child and young adult:

My uncle, Dr. Paul Fischer, is based in Augusta, GA, and has practiced family medicine for over 35 years. His first practice was a solo rural one in Weeping Water, Nebraska, where he worked with many indigenous American patients, with deep compassion and gentleness. He moved from there to the Medical College of Georgia where he was a professor of Family Medicine, considered to be the less glamorous sibling of the medical practices. While there, he published a controversial article in JAMA showing that children as young as 4 years old, routinely recognize “Old Joe” the Camel cigarette cartoon character. Smoking was commonplace in preteens and teens and highly addictive. His research led to a long legal battle with the tobacco industry. Let’s just say that they don’t play nice. Thanks to him, cartoon characters and cigarettes are no longer friends.

My uncle Dr. Teepu Siddique is the foremost scientist and neurologist in the world helping ALS patients. His team at Duke Medical Center was nominated for the Nobel prize in medicine, giving some hope to families affected by this terrible disease. I have to add that he gave me my first medical research job, and I can still run DNA in a centrifuge in my sleep.

He and his collaborators, including my friend, Dr. Alan Roses (RIP) kind of adopted me. We went out to many lunches at red lobster and talked about neurogenetics (I wasn’t joking when I said I’m a science geek). His team discovered the first known cause of ALS, linking mutations in the SOD1 gene to the disease, and developed the first models for ALS and ALS/dementia, now used by investigators all over the world. Over the years, Dr. Siddique’s research has pioneered additional causes and signatures for both familial and sporadic forms of the disease and paved the way for targeted treatments.

I saw my friend’s father pass away from ALS, and I am so grateful for advances in this area. Dr. Siddique is a professor in Feinberg’s Ken & Ruth Davee Department of Neurology, as well as the Departments of Cell and Developmental Biology and Pathology, Northwestern U.

My paternal aunt, Dr. Asma Qureshi Fischer, perfected pediatric ultrasound, a noninvasive neural-imaging procedure to detect severe neurological disorders in infants. She patiently allowed me to work in her office and participate in hospital rounds over several summers. If you are ever planning on having children, I would not recommend hanging out in obstetrics wards.

Most certainly, my family and many mentors and friends helped me fall in love with science and neuropsychology. We are complete nerds combined with an aching desire to heal.

Thank you to all the doctors out there.
We need you.

Ireland and India: on connection

In the center of the Irish county seat, Sligo, sits a statue of Rabindranath Tagore, gifted in 2015, commemorating the Nobel prize winning National Poet of India. In a country with only 50,000 citizens of South Asian descent, Tagore shared a connection with William Butler Yeats, the poetic voice of Ireland. Both poets were interested in the relationship of poetry, music, spirituality, the struggles of everyday life, connection, and anti-imperialism. They followed each other’s work, and finally met in London.

Across continents, their works served as moments of identity shared between the Colonized. I call it ‘Partition poetry.’ Notably, both poets won the Nobel prize, 10 years apart, Tagore in 1913 and Yeats a decade later, in 1923. Although far from ideal, as by default Ireland was both a colonizer and the colonized, their fascination with the work of the other is striking. And inspiring.

I ranted to the knave and fool,
But outgrew that school,
Fit audience found, but cannot rule my fanatic heart.
-Remorse for Intemperate Speech
(William Butler Yeats, 1931)

Freedom from fear is the freedom.
I claim for you!
Freedom from the insult of dwelling in a puppets’ world,
Where movements are started through brainless thoughts repeated through mindless habits.
(Rabindranath Tagore, 1913)

Beannachtai na Feile Padraig.

On Hyperfocus

People with ADHD have difficulty focusing. But many can also hyperfocus on things they’re very interested in. Parents come to me and say my kid can play Fortnite for eight hours, why can’t they focus on the three regular chores they have to do in a week?

The idea of hyperfocus can be confusing. How can a person who has trouble focusing on most things lose themselves in a video game, movie, series, sport, or craft project for hours? It might look like that person doesn’t really struggle with attention.

Hyperfocus is a common but sometimes confusing symptom of ADHD, is the ability to zero in intensely on an interesting project or activity for hours at a time. It is the opposite of distractibility, and it is common among both children and adults with attention deficit hyperactivity disorder.

But actually having good focus requires two opposing elements. People need to be able to pay attention even if something isn’t that interesting. Many things are not interesting. And that is reality. Why do I have to sit through this meeting, take this class, work with this team, read this book, do such and such? Why the heck am I taking algebra or physics?

Secondly, they need to be able to not pay attention to something interesting, or something that’s bothering them (the biggest distractions are anxiety or sadness), when they need to focus on doing what they’re doing because it’s more interesting than what they’re being asked to do. Un-focusing and focusing. One of my clients reported that it’s like being in a tunnel, you only see one thing. Both good and bad.

The neuropsychology of hyperfocus.

Like distractibility, hyperfocus results from abnormally low levels of dopamine, a neurotransmitter that is particularly active in the brain’s frontal lobes. This dopamine deficiency makes it hard to to take up boring tasks. Many of our life tasks can be mundane, repetitive, and frustrating.

So, what can we do? How can we harness the power of hyperfocus?

Mindfulness matters.
Focus can be combined with a mental health exercise: when you take out the trash, you can visualize an exorcism of anything nasty that happened over the week. I teach imagery, this is your chance to take out your accumulated trash.

Purpose matters. And Distraction helps.
I have a client who stands in a queue to pick up her kids after school for almost an hour. She loves them with heart and soul and wants them to be safe. In the meantime, I gave her a podcast that has appeal. Zoning out in the parking lot scrolling through social media was not making her very happy. Now she is stimulating her brain with a great podcast she rarely gets to fit into her busy life.

Practice matters.
Some of my teenagers have trouble with mindfulness and attention. Simple exercises can include, coming into a room, such as the kitchen. What do you see, what do you smell, what is the lighting? What do you hear. It pulls your attention back. And requires practice.

Timing and dosage.
Give yourself time you can play the heck out of the game that you love, watch the series that you are fascinated with, immerse yourself in the best book. Plan your binges. They don’t have to control you.
Also see, “On News Anxiety.”

Set external cues and reminders.
If you know you’re going to be lost in cyberspace, create multiple reminders. Set multiple alarms. Remember that we need to get up and move our bodies every 25 to 30 minutes.

Work with your own circadian rhythms.
If you work best in the morning with heightened alertness, do your toughest work then. If you’re tired in the afternoon, save that time for more rote tasks.

Engage with an accountability buddy.
This can be as simple as having a reminder that you need to get your stuff done, and then you can relax. Your buddy might say, we’re going to watch a great show tonight. Let’s get our work done.

Don’t set impossible standards.
Most people, optimally, cannot focus after 30 to 40 minutes, especially on complex tasks. Take a break. Regularly.

If there’s something that you really dislike doing, see if you can trade it off. We put off tasks that are aversive. I have a client who has sensitivity to washing dishes, it truly grosses her out, but she can do laundry and fold clothing like a luxury retail store. Ask your partner, child, roommate, colleague, to do things that you don’t love and vice versa.

Et Tu, Friend?

How to Survive a Friendship Breakup

Surviving the loss of a friend can be even more painful than a romantic breakup. In the mental health profession, a friendship rupture or rift is a frequent reason why people may seek support.

It is possible to heal from the loss; as you work through the pain, you’ll eventually become stronger. Your pain is real. Give yourself the space and time you need, just like you would with a romantic breakup or any other significant loss. A broken friendship may include a lack of trust, lack of communication, feeling disconnected, unresolved conflict, ongoing hurtful behavior, having nothing in common, financial discrepancies, splitting a friend group, possessions left behind, and/or one person taking all the responsibility for the friendship.

What Causes a Friendship Breakup?
We’ve all heard that friendships are like seasons: they come and go at different phases in your life. While that might seem comforting, it denies friendship’s much more complex nature. If you’ve gone through a friendship breakup, you know it hurts more than the inevitable passing of the seasons. You may feel broadsided by the loss, even if it has been culminating over months or even years. But why do friendships end?

Some of the reasons include:

    • Change of interests and values (moving, getting married, political views, having children, religious views)
    • Misunderstandings
    • Breach of trust
    • When one person feels unsupported
    • Feeling used financially or emotionally
    • Clashes with the partner of a friend
    • Attraction to the partner of a friend
    • Abusive behavior
    • Not making time for the relationship
    • Psychological disorders left untreated

Is it a Breakup or a Break?
You may face self-doubt about moving on from your friend, so take time to determine whether this is the right decision. Sometimes, you can save a friendship by investing more in the relationship. But, there has to be a balance between fighting for the people we care about and not tolerating harmful behavior.

You can (and should) be a friend’s support system, but it can cross a line when you become their therapist, bank account, or punching bag. The friendship might shift when one or the other person becomes more “successful.” If your friend is actively present when they need you, but fades away when you are no longer required, it was not a reciprocal relationship to begin with. Your friend might have secret resentments or perceive you as privileged or spoiled.

You’re the one who has to decide to move on or remain in the friendship, but here are some questions to consider:

  • Has there been a betrayal? If so, has my friend made any attempt to make it right?
  • Is this just a misunderstanding?
  • Have I taken steps to talk about how I feel with my friend?
  • Is my friend toxic?
  • Does my friend repeatedly poke at my vulnerabilities and guise it as teasing or joking?
  • Are they taking any steps to become a healthier person?
  • Is my friend repeatedly hurting me even though I’ve talked to them about their behavior?
  • Do I feel judged or belittled by my friend?
  • Does my friend hold me back or help me become a better person?
  • Does my friend say nasty things about me behind my back?
  • Is this disagreement something we can overcome, or will it only cause more harm in the long run?

Prioritize Your Mental Health
Moving on from someone causing you mental and emotional harm is OK. Studies have shown that social relationships can either sabotage or support behavior change. When you begin to experience personal growth, it can be frightening and even threatening to the people around you. Your personal growth and your friend’s inability to grow with you may have triggered the friendship breakup. If that’s the case, I applaud you for your bravery and the growth you are pursuing. A friend will be there for you in good times and bad.
Related post: When Your Friends Are Successful

Where Possible, Seek Resolution
Many people express confusion about a friendship breakup, not understanding why it happened or feeling they never got to say what they needed to. I call the friendship breakup, with ghosting, the “living death”. You don’t know what happened but they’re still out in the world. You may even cross paths with them. We are creatures that crave meaning and explanation. Ghosting is often a reprehensible act.
Related post: Ghosting and Mental Health

When possible, talking to your friend can be a healthy way to promote understanding, express how you were hurt, and even apologize. Remember, your goal isn’t to launch a personal attack on them or be defensive. Make sure you can speak calmly and, if possible, wish them well at the end of the conversation. At some point you genuinely cared for each other and that’s to be honored. If they aren’t open to talking, or it doesn’t feel appropriate or safe to you, try writing out what you’d like to say. Expressing your thoughts on paper or email facilitates a better understanding of what happened. Even if you don’t understand “why,” expressing your emotions in writing can restore a sense of control over a situation where you may have felt helpless.
Related post: Restorative Writing and Mental Health

Reasons you may be struggling to move on:

  • You felt silenced by the friendship and haven’t had a chance to express how you feel.
  • You have experienced abandonment in the past, and losing this friend has brought up those feelings of abandonment.
  • You’re still waiting for them to come back.
  • You feel guilty, and you’re carrying the blame for the friendship ending.
  • The betrayal has so many layers you don’t know how to unpack it.
  • You have so many happy memories of the friendship that it’s bewildering to let it all go.
  • You have so much shared history that you struggle to get the needed space.

How to start:

  • Get a piece of paper and write at the top, “What do I need to let go?”
  • Sit quietly and listen to your intuition to determine what may keep you from moving on.
  • If you aren’t sure, start writing and let your thoughts flow unhindered.
  • As you write, look for what blocks you from moving on.
  • Once you know what that is, explore what you need for resolution.
  • Healing happens in layers, so don’t be discouraged if you identify multiple things.
  • Choose one thing that resonates most strongly and work through that.
  • As time passes, continue to work through the different areas of pain. there is no timeline.

Often, current pain is complicated because it connects to past pain. If you discover the connections to past pain, embrace this as an opportunity for growth. Healing takes time; it is a process. So be gentle with yourself. Permit yourself whatever you need to heal, and don’t push yourself to move on before you are ready. Mourning has no checklist.

Give Yourself the Gift of Forgiveness
Amazingly, forgiveness protects health even in high-stress situations. One study showed the longitudinal impact of forgiveness on stress levels. Another study showed that self-forgiveness increases physical and mental health. Forgiveness is about taking a step forward to healing and moving on.

What Forgiveness Is NOT:

      • Weakness
      • Blind trust
      • Letting the other person get away with wrongdoing
      • Restoration of a relationship
      • Being in close contact with a person who abused you
      • A denial of justice
      • Saying what the other person did was OK or right

Forgiveness takes time and is more of a lifestyle than a one-off event. As you seek to move on from your friendship breakup, you won’t feel (or heal) all the feelings at once.

Part of the pain of losing a friendship is you are losing the possibility for the future. In a few months or years, you may hear your friend is married, moved away, is having a baby, wrote a book, or just got a promotion. Because of the pervasiveness of social media, you might even observe your friend having fun with others. In loving relationships where it is an expectation to share these life events, watching from the sidelines can be incredibly painful. It’s important to forgive and be kind to yourself as new pain surfaces. It can come and go.

Validate Your Emotions
A breakup is a feeling of rejection at the heart of a friendship. Whichever side you are on, there will be a sense that someone you were once so close to no longer values you as a person. One study found that feelings of rejection directly impact self-perception by creating feelings of hurt, loneliness, jealousy, guilt, shame, anxiety, embarrassment, sadness, doubt, and anger.

Society expects you to experience these emotions when you suffer a loss or a romantic breakup. There isn’t always the same understanding for a friendship breakup. So if your social circle isn’t supportive of what you are going through, you have to learn to understand and validate your own emotions. If it feels unbearable, talk to a therapist.

Don’t Let It Follow You
We find it painful and upsetting to see a friend move on because, the truth is, we haven’t. We want to believe we matter enough that they will experience the same amount of pain as we are experiencing. When they seem happy and unaffected, it can feel like we didn’t ever matter to them. Holding on to feelings of injustice may cause the friendship breakup to drag you down and spill over into other areas of your life.

So, ironically, one of the keys to moving on is… moving on. Ultimately you’ll have to let go of the need to know they cared. Instead of holding the pain close, release all of your expectations and disappointments. You’re not letting go of all the good things you shared. Instead, you are letting go of the need for them in your life. There is life apart from this other person. While they may have shaped a part of who you are or been with you through difficult and painful times, you are still a person, and you can recover from this.

Rebuild Your Ability to Trust
You may not notice this immediately, but over time, you may discover your friendship or the friendship breakup has impacted how you view others. Any time there is vulnerability and emotional intimacy, you enter into a relationship of trust. Whether that trust is intentional or not, it impacts your ability to trust others. If you are hesitant to get close to new people or withhold and withdraw from other relationships, it could be because of your friendship breakup.

Invest in Positive Relationships
As you move through the grieving process, there will come a time when it’s essential to begin making new friendships; intentionally investing in creating positive and healthy attachments. As you’ve worked through the steps of moving on, you’ve likely identified some of your own unhealthy behaviors. Take what you’ve learned from this last friendship to prepare you to be a better friend and to set good boundaries so you don’t accept harmful behavior from others. One patient said to me, everything I learned in my last relationship will make me a better person in the next. Friendships teach us a lot.

Form New Habits & Make New Memories
Sometimes, friendships can cause a narrowing of activities and even personality. Whether they were actively holding you back or your friendship allowed you both to become too comfortable or complacent, now is the chance to recognize your potential and expand your horizons. Instead of constantly reflecting on the things you did together, work to build new memories and experiences.

Related post:  On Friendship Pain

Love for Friends, a Tribute on Valentine’s Day

Women are frequently taught to compete with each other, to view others as rivals in the challenge for ‘finite’ resources like men’s attention, work opportunities, and seats at the metaphorical table.

‘Philia’ is a great love that develops over a deep, long-lasting friendship. In classical philosophy, it is noted to be as powerful as Eros (romantic love), Agape (selfless/sacrificial love), Pragma (dutiful love), and Storge (love for family).

Female friendships are essential to our health and they can even help us live longer lives. Platonic closeness gives us a healthy, stress-busting boost of feel-good hormones like oxytocin, dopamine, and serotonin—all vital to emotional wellbeing and physical longevity. Now more than ever, the intimacy we share with friends helps us avoid feelings of isolation, increases our sense of belonging, and helps us cope with the world around us. Friends wipe our tears, make us try the scary things, scrape us off the floor, tuck us in when we are absolutely done, check on us, make us laugh raucously, show up.

Notable aspects of female friendship have been explored by writers, poets, artists, and psychologists.

Soi Patano
The early 20th century Indian poet Rabindranath Tagore wrote with eloquence tinged with jealousy, about the friendship between his wife and her best friend, the activist, Amala Das, sprawled together on a divan,  deep in conversation, their affection and respect for each other completely transparent. He desired to have the intimate and heartfelt conversations that came so naturally to the friends.

In the late 19th and early 20th centuries, upperclass Hindu women formalized the friendship ritual (known as Soi Patano, in Bengali). They gave each other small gifts, came up with personal nicknames, had inside jokes, turned to each other for advice, wrote each other letters, and became each other’s confidantes. In a largely patriarchal society, this was a space that was safe, intimate, and private.

Modern Friendship-Courtship
Memes, text messages, girls’ night out, shared interests, new interests, advice, laughter, the shoulder to cry on; friendship is an immortal tradition. From book clubs to women’s encounter groups, women have gravitated to sharing their experiences with other women, with the concomitant closeness, conflict, grief, and loss. As couples therapists, we do more and more ‘friendship therapy’. Friendship ruptures and breakups can be incredibly painful, sometimes more than romantic ones. Interestingly, clinical psychology research shows that like romantic relationships, platonic friendships start with chemistry; an attraction and interest in getting to know a future friend.

Shine Theory
The psychologists Aminatou Sow and Ann Friedman coined the phrase ‘Shine Theory.’ It states that by consciously investing our full selves into our friendships, we can become allies instead of competitors. And when we encourage our friends to be their best selves, we also encourage ourselves. When we cultivate relationships based on mutual and unwavering support, we create the perfect conditions for long-lasting and deepening friendships. Instead of having feelings of rivalry, mindfully surrounding yourself with compassionate, creative, talented, stylish, successful friends, makes everyone better. Shine theory: when your friend shines, you shine.

Golden Girls
Friendship, across the lifespan: the concept of seniors moving in together and intentionally sharing a home has become known as the “Golden Girls” trend — named for the popular ‘80s sitcom in which four older, single women lived together, and it’s been gaining popularity among retired women. Older, single adults interested in aging in place and preempting isolation are embracing the trend of moving into homes together. In turn, they share companionship, household duties, resources, and financial responsibilities. While there are certainly pitfalls to be considered, it’s notable that there has been an exponential growth in this lifestyle for senior women.

There is another type of love described in classical Greek philosophy: Philautia. Self love and self esteem. No doubt, strong friendships contribute.

Dedicated to my friends, with gratitude.
Happy Valentine’s Day. ❤️🌹

Sit… Stay? When It’s Fido Or You.

A recent British psychology research study found, on average, couples fight about pet related concerns three times a week. Based on the average lifespan of a dog, that is more than 2000 arguments. Over 17% of the couples admitted that the arguments were significant enough that one or the other slept in the guest-room. Dealing with allergies, cleanliness, and overall sensitivities to pets and their behavior(s) were among the most significant areas of strife.

Reasons why pets may come between a couple:
Pets are a source of strong emotional connection, often pre-dating the start of new couple relationships

  • During the pandemic, in the face of loneliness, uncertainty, and quarantines, there was a significant uptick in animal adoptions. Not just during pandemic years, people report feeling significantly less alone at times of distress when they have companion animals.
  • Pets are good for medical health; they force people to get out of the house and take a walk, run errands to get food and supplies, and keep to routines essential for animal care.
  • Pets are great for mental health. A synopsis of studies on depression and suicidal thoughts indicates the following “perfect storm“ – feeling like a burden to others; feeling isolated; feeling hopeless/useless about the future. Having a pet can make people feel needed, loved, appreciated, and more structured on a daily basis.

As such, people may become a new couple in conjunction with an important pre-existing relationship… with a pet; a print by artist Stephen Huneck titled ménage a trois depicts a couple in bed with a large Retriever sprawled between them.  A male client recently told me after a series of hurtful arguments with his new wife about his love for his dog: “My pup was there for me when nobody else was. She is also my family.”

Pet problems spotlight deeper relationship issues 
Pets can become an area of compromise, acceptance, or non-negotiation. It’s not uncommon as a couples therapist to hear that an engagement or relationship ended because of disagreements over companion animals. Points of contention include shedding, licking, jumping up, pouncing, biting, accidents in the house, barking, begging or stealing food,  sleep disruptions, chewing, delegation of responsibilities, and odors.

While many of these concerns are certainly legitimate, they can usually be addressed with training, implementing household rules, and setting boundaries. When they cannot be addressed through training, couples therapy, or ongoing communication, it may speak to deeper-seated issues. Pet related conflicts can be based on cultural, family, religious, and individual differences in personal relationships with animals. In the United States, nearly 40% of pet owners describe their companion animal as their child, family member, or best friend.  However, many people grew up without pets, or in households or families where pets were present but not treated as “part of the family”.

Pets can create jealousy

In a 2018 survey conducted by Purina, it was found that half of all female dog owners say they would rather spend more time with their dog than their partner. Over 50% of individuals reported they turn to their pets as the primary source for emotional comfort during times of stress. At times, this can cause some feelings of resentment in human companions if time, attention, and financial resources are going to the pet rather than the partner.

Pets can spark financial arguments
Pets can be expensive. From standard veterinary care and medication, training, to the astronomical costs of medical emergencies, food, walkers and pet sitters, grooming, doggie day care, caring for aging animals and their needs, to treats, toys, outfits, and every type of accoutrement, the companion animal product and veterinary industry is increasing exponentially. Couples may not always agree on the appropriate amount of financial output for pets, from medical bills to cleaning requirements.

Spontaneity and event planning may suffer
Spontaneous outings, staying late at a party, taking a vacation, working late, and scheduling activities and events are all affected by having pets.

Pets require ongoing responsibility (both time and labor)
After returning from work, dogs have to be walked, animals have to be fed, kitty litter has to be changed. Pets require attention. These time sensitive commitments can be difficult for couples who are not used to building that into their day.

Pets can get in the way of intimacy
A questionnaire to 1,000 adults by Harris Poll found that over 70% of pet owners allow their pets to sleep on the bed. So that leaves about 30% of pet owners who don’t. If you’re someone who needs your pet there with you to sleep, it can cause an issue between you and your partner if they’re not into it.

What to do?
Practice Good Communication
If you’re starting a new relationship, take time to discuss your values regarding pets. If having an indoor cat or a dog that sleeps in your bed is important to you, you’ll need to ensure your partner shares these values or risk ending up in conflict. If you’re already in an established relationship, it’s time to begin communicating clearly and openly. Don’t get a new pet without consulting with your partner and getting their consent.

Get specific with the problem
When there’s conflict over pets, getting specific about the problem can help you figure out a solution. If your husband complains about your dog constantly or your wife snaps at your cat, you might assume that the pet is the problem or that your partner hates your pet. But a change as simple as teaching your dog not to beg or keeping your cat off the desk could remedy the issue. If you’re the pet lover, ask your partner specifically what the issue is and what would fix it. And if you’re the one resenting your partner’s pet, be clear about what you need to feel better.

Consult and expert
A poorly trained dog or aggressive cat can be frustrating to everyone, but the person who brought the pet into the relationship can sometimes feel more defensive. If your partner is annoyed by a specific behavior such as excessive mouthing, jumping, or scratching, it’s time to call an expert. A trainer can work with you to make your pet a more mannerly member of the family, and a veterinarian can help you uncover hidden health problems that could contribute to annoying behavior.

Accept differences
You and your partner don’t have to agree about everything. You may find that one of you is simply less in love with your pets than the other. As long as your partner isn’t abusive toward animals, they do not have to feel forced to cuddle with them.

Do the work
If you’re the one who brought the pet into the relationship, be prepared to do a little extra work. There’s no reason your partner has to love your pets as much as you do, or even spend as much time caring for them. As long as you can strike a fair balance that ensures your pet’s needs are met, consider giving your partner a pass on pet duties.

Related post: Teens and Their Dogs.

Embolden Psychology

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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