What the Heck is “Euthymia”, and Why Should I Care?

Before getting into details, let’s make note of this: I’m altering the definition of the term as a way of creating a framework that allows us to look at something we don’t hear enough about in psychology and counseling- what is healthy!  We’re great at discussing “issues”, what’s “wrong”, what’s “unhealthy”, “mental illness” and etc, but we’re not so great at talking about the opposite!  Something to work toward, identification of what’s mentally, emotionally, and “spiritually” healthy, is a great way to change our feelings and our lives.

Oversimplifying, “euthymia” is a medical term, a term most often used in psychology, psychiatry, or philosophy to describe happiness or wellness.  Wikipedia separates out euthymia in terms of medicine, and philosophy.  In both, it is used to describe a “non depressed” mood, or “world perception” or “view” (Weltanschauung) as noted by the famous Greek philosopher Democritus.  Wordnik, a preferred website of librarians and info scientists for definitions of terms, defines euthymia as: “n. Philosophical cheerfulness and calm; the avoidance of disturbing passions, as inculcated by Democritus and Epicurus.”

As anyone who knows or has worked with me can imagine, I prefer the more global definition, the one hinted at in philosophy.  As promised, I’d offer that euthymia as a term might be most useful if looked at this way: an emotional response that is reasonable, adaptive, and of “right size” intensity, in response to one’s current circumstances.  In short, a healthy emotional response to one’s current circumstances.  Or (again, oversimplifying), a way of knowing that one has a healthy emotional response to the world.

Let’s start by thinking about what might be some indicators of an unhealthy response to the world, commonly understood by the medical and psychological communities.  Someone experiencing a “low grade” depression for an extended period of time might be diagnosed with “dysthymia”.  These symptoms being present, in absence of “psychosocial stressors” (AKA “problems” in life…), is arguably an indicator of something south of optimum health.  Without anything “bad” happening, to be “depressed” is regarded as unhealthy by most helping professions.  In a like way, being “sad” or “depressed” in a way that prevents us from doing things in our lives (work, play, relationships…) about something that happened say, 10 years ago is arguably not a healthy response to what is happening now.  To exaggerate to make the point, in schizophrenia (literally to be “split from reality”), this is an extreme version, the opposite of “euthymia”.  More specifically, if one is seeing things (having visual hallucinations, a common symptom of schizophrenia), I sometimes like to describe this as a response that’s not euthymic.

One of my goals as a therapist is for all of my clients… people who are depressed, anxious, have low self esteem, addicts, codependents, whoever- to have a reasonable, here and now response to their given circumstance.  If we behave for instance, based on old hurts to a current circumstance we tend to at best not be able to resolve either issue, at worst, make one or more of those issues more difficult.  Another way of saying this is that, if I experience a perceived sleight (someone makes fun of me, forgets a “small” responsibility to me, etc), but respond to that with isolation, threats, emotional blackmail, substance use or etc, this isn’t a “right size” response- it’s not euthymic.  Knowing that we are not having a “euthymic” response in this example, or as a way of problem solving, can help a lot in terms of dealing with our problems as right size, and might enable us to problem solve more effectively.  For someone suffering from anxiety, low self esteem, depression, addiction and more, this can be a great tool to start on the road of dealing with our current circumstance as it is.

Going back to some more painful considerations, I would suggest that in taking the example of the death or similar loss of a loved one or animal or etc, being sad is a euthymic response.  Just as our body has less than comfortable sensations in response to illness or injury- these are indicators of recovery from them.  Why don’t we see our relationship with our feelings in a similar light?  As an example of this, when we fall off a bike and skin our knee, most of us who know a little about science know that much of the reason it hurts is because of the inflammatory process- this is due to the healing and protective agents of our bodies (white blood cells to fight off infection, proteins to rebuild the part, fluids for transport of these materials and etc…) being sent to heal the injured part.  It hurts both as an indicator for us to know not to do that again, but as much, because it is healing.  Endlessly interesting to me, humans don’t see their non physical feelings, their emotions, in the same light.  We regard them as something terrible, something to be avoided.  It seems to me that we have them because they give us other information about our environment that we might not otherwise discern from our other senses, and a way of healing other aspects of our lives- hurts, shames, losses and etc.  It’s not to say that our feelings are all necessarily facts, but indicators of possible realities (more on this idea from my blog here).

If the above paragraph is any indicator, in many circumstances, having “bad” feelings might be the process of dealing with non physical difficulties.  Extreme (in terms of intensity) or maladaptive (not useful) responses to these create in turn more problems, and in some cases, diagnosable difficulties.  Having the idea of euthymia as a guidepost, it might give us a more tangible way of gauging our problem solving, behavior, and more.

Difficulties, Diagnoses, the DSM.

In a New York Times Op-Ed piece from today, one of the leads on the DSM-IV (the “Diagnostic and Statistical Manual”, the current edition of an industry standard tool for mental health, primer here) task force wrote about the upcoming changes in the DSM-V (likely to be released in early 2013).  Summarizing, Allen was suggesting in part, “…after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription.”, and that the American Psychiatric Association was  arguably no longer in a place to be singularly in charge of the meting out of diagnoses, calling it a “monopoly” (offering that an agency akin to the FDA or National Institute on Mental Health might be examples of ways to provide oversight in the efforts to insure some science around diagnosing emotional and mental problems).

Am with Allen on quite a bit of this.  What comes to me often too, is that we have equally large fish to fry with the DSM and the profession than just the pathologizing and monopolizing he suggests.  We have been over-diagnosing ADHD (attention deficit hyperactivity disorder) and bipolar disorder, among others.  Our differential diagnosis (rationalizing one diagnosis vs another) has also been resulting in much harm to people by way of treating issues unneeded, and/or incorrectly.  We are also arguably guilty as a discipline of using interventions that are more “intrusive” than necessary (for instance, medicating a problem before efforts at traditional talk therapy and/or other interventions have yet to be tried).

It seems to me that in reviewing the DSM, we are more currently in need of insuring the accuracy and value of our diagnoses, in terms of insuring that those so suffering are treated more appropriately.  We do know ways to treat depression, anxiety, addictions, bipolar disorders and etc.  We do have means of helping people through grief/loss, communication problems, abuse, suffering with stress and etc.  As the saying goes though, the “cure” (a dubious word to begin with) is only as good as the diagnosis, and with the numbers of the diagnosed only increasing in the US year after year, either our diagnosing or treatment (or maybe a bit of both) are not faring as well as they might.

A quick aside here- not all of the missed treatment opportunities are about the above issues.  Some of them are due to the influence of Big Pharma (an intense imposition by the pharmaceutical industry), access and funding of mental health treatment, the insurance industry and more.

Specifically related to the DSM though, my hope is that we’d simply be better at a lot of the material we already have.  Adding diagnoses, or simply separating them into finer and finer constellations of symptoms seems both unnecessary and unhelpful, philosophically speaking.  Part of what I’m getting at above is that I think we have some good ideas about how to help many ills- I just wish we spent more time treating them, and less time diagnosing new ones.

“Show Your Work!”

When “solving problems” in addition to good “issue identification”, “diagnosis” (or whatever), it’s really important to examine methods/means to diminish or solve these problems, and have those methods be principled.  As Huxley opined:

“We are so anxious to achieve some particular end that we never pay attention to the psycho-physical means whereby that end is to be gained. So far as we are concerned, any old means is good enough. But the nature of the universe is such that ends can never justify the means. On the contrary, the means always determine the end.”

But even principled means don’t go far enough.  I have been discussing with a couple of clients and friends in the last week about getting from “point A” to “point B” as relates to The Work.  With these discussions in my head, have also come across a couple of psychology related blogs addressing resolution of specific problems.  What these conversations and blogs have in common, is my friends/clients complaining that when they’ve mentioned a problem to someone (anxiety, impulse control issues, depression, for example), and when given advice by some folk about how to resolve them, we have found essentially that at worst the suggestion amounted to “stop being __________ (anxious, impulsive, depressed)”, or simply suggesting that the opposite behavior/idea be employed.  Even from professionals.

Of course, the “middle part” here is really important.  There should be attention to the steps taken in the middle.  Those steps should specifically address the issue at hand, not simply be something rationalized as “good” or needed or healthy.  As some of my heroes have suggested, these ideas often amount to “activity instead of action”.

For instance, exercise arguably helps depression, anxiety and the like, but seems that in many cases does not specifically address the concerns identified that might be causing such in the first place (loss, abuse, etc).  In addition to that, the steps taken from anxiety to “calm” or “groundedness”, sadness/depression to happiness/serenity/gratitude (or somesuch) etc should be principled.  Meaning, they should be rooted in ideas that are repeatable, work for different kinds of problems, and preferably don’t create new ones in their wake.

Much of this is intuitive, but what keeps coming to me about these ideas is when observing “problem solving” from the outside, it’s often difficult to point to the work that is done.  Just like we’re encouraged in most math classes, we should be able to “show our work”.  When dealing with issues/problems/concerns, problem identification is really important.  So are means of problem solving- but what seems a good test of the effectiveness or value of such is the ability to point at the work done that specifically addresses the problem at hand.

As a simple example… telling someone to “calm down” rarely helps them behave differently, let alone feel differently.  There’s no steps to show, it’s difficult to see any principles this idea of “calming down” is based on.  While problem-solving emotional or relationship problems and the like it’s tempting to simply give advice and/or lean on philosophy, but there’s a lot of value in making such practical- something we can “point at”.

In our martial arts training group, if one of us has or is taught an idea/principle, we test that idea out in real time with a resisting opponent.  We also try to “break the idea”- see what conditions or problems it will not work with.  In some circles this is referred to as “pressure-testing the material”.  The same ideas might apply when solving other real world problems.  Clearly identifying the issue/context, having a principled means of intervention or “problem solving”, having a practical (empirical) means of determining the usefulness of the idea… showing our work and evaluating its utility.

Am advocating here for critical thinking when it comes to the utility of tools or ideas for problem-solving.  It seems that one of the places this utility is revealed is in whether or not we can show our work- make use of an idea in a way that is repeatable and observable (what we say/don’t say, do/don’t do).  As a therapist, I really endeavor (and hope other professionals) to give ideas that can be used by anyone, ideas that are practical enough to show the work that specifically addresses an identified problem, not something that simply gives us the feeling that we are doing something.

You can find out more about Petar at: April30th.org

Recognition for Partners in Recovery

Last Monday (9-26-11), Judy McGehee MFT, Melissa Lamoureux MS, Erika Gayoso MA, Ted Aaselund PsyD, Michael Cardenas, Jeffrey Craig, Jessica Wilson, Elvia Cortes MA and myself were recognized by the board of the Glendora Unified School District at their monthly meeting.  Formally, the agency is called “Partners in Recovery”, a nonprofit organization of clinicians providing services in Glendora and surrounding communities.

Judy, and I have been providing clinical supervision (a necessary component for grads and soon-to-be grads to get their “hours of experience” to sit for licensure as therapists or social workers) for the above mentioned interns and trainees.  Trainees are obtaining hours to graduate with their Masters degrees, interns are working on their hours (3000 hours of service over 104 weeks) to sit for the licensing examination with the Board of Behavioral Sciences.  In turn, the supervisees (the ones above and others from previous years) have provided thousands of hours of free services to the Glendora Unified School district, from elementary thru high school.  The supervisees from Partners have been assisting with issues of depression, abuse, family discord, eating disorders, suicide, addiction, grief and loss, bullying, self esteem, anxiety problems and more.

The program has been running since 2009 with Judy at the helm, and will continue at least through this year.  Judy, Ted, and the interns/trainees are all highly skilled clinicians.  It is a fantastic way for people to get services that might not have otherwise.  Nicely done everybody.

What to Do?

From P.16 of the PDF “Statutes and Regulations” from the California Board of Behavioral Sciences (the regulatory agency that oversees MFTs, Social Workers, and etc):

“§4980. NECESSITY OF LICENSE (a) Many California families and many individual Californians are experiencing difficulty and distress, and are in need of wise, competent, caring, compassionate, and effective counseling in order to enable them to improve and maintain healthy family relationships.”

Clients as above, come to us for wise counsel.  Among other things of course.  This idea has far-reaching implications, not just for our clients, but for us.  Wisdom is hard to come by!  Oversimplifying, “wisdom” in this case is often a euphemism for answers.

Claiming (or believing) one has wisdom or answers is of course a Bad Idea, yet it seems we have a responsibility to work toward them.  There’s some great ideas and techniques supporting the principle of not giving “answers” (suggestions, direction, etc) outright to clients (or loved ones, certainly) from the therapist’s chair.  My basic mode of operation is to try to lead someone to those answers, typically only giving direct suggestions when my efforts to lead a client to their own answers have been exhausted.

We do treat several diagnoses and/or issues that have “community standards”, fundamental practices or “conventions” most therapists agree on how to treat.  Schizophrenia, bipolar disorder, and other more severe illnesses for instance almost always direct the client to: not “self-medicate”, takes the best supportive medication regime as directed, and is getting :talk therapy” and/or peer/familial support with their illness.  There are few that argue with the utility of these interventions.  There are other examples for addiction, depression, anxiety, and more.

Two things are of interest to me though.  The first is that during the therapeutic process, I often see clients get a suggestion, and dismiss the suggestion out of hand.  What I think is happening is that rarely do I suggest an idea that in a vacuum will ever be sufficient.  What I mean is, most any suggestions I have will never be singular.  It seems that the depth of our sadness or anxiety or pain or whatever often keeps us from “getting” what is offered, unable to accept the responsibility of taking several suggestions.  Summarizing: rarely is one idea sufficient to change anything in the therapeutic process.

The second thing that prompts me to mull this over is the “active” therapists versus the “passive” therapists.  In my view there is room (and each therapist I think, ought use) both styles, often with the same client.  There are times that we should be directive, and not just in terms of extreme examples like when a client is being abused.  Discouraging self-medicating, engaging a support group, ruling out medical concerns with a physician, ways to stop a behavior etc are all examples where there is little controversy over giving someone “direction” about an issue.

People come to us for answers.  We are paid to have a toolset, methods, principles of operating that in many cases should help diminish depression, stress, relationship conflicts, behavioral concerns and the like.  On the subject of not holding these ideas close to one’s chest: there is a great (and occasionally controversial) martial arts instructor who critiques traditional means of training, idealizing the “teacher” and etc.  He also critiques traditional martial arts training as being “cultish”- keeping secrets, claiming answers from some (out of touch and unknowable) “higher source”.  His “instructors” are all referred to as “coaches” or by their first names, and their focus is very simple: performance improvement.  That last idea is part of what I’m getting at here- the “answers” we give as therapists should improve “performance”, which I would argue is diminished if we are too passive.  It is very significant of course, that what is being improved, is clearly defined.  If we think something might be helpful though- there are certainly compelling reasons we should disclose it.

When it comes to performance, we should be helping people get more in touch with their emotional condition, have those feelings gracefully, diminish (but not eliminate) the intensity of negative emotions.  Our interventions should help decrease or stop unwanted behaviors.  The direction we give should help increase intimacy.  Of course this is not an exhaustive list, it may take a long time for these things to happen, and some cannot happen without the others.

My experience has been that many (arguably most) of my clients have come into my office, suffering enough, and out of enough answers, that they are willing to do most things we come up with together.  Had they been in possession of this material on their own to begin with, there would be no (or little) need for my education and experience with the issues they struggle with.

My effort is to put me out of a job and it does people a disservice I think, to have an insight that I wait for them to come to on their own… which they’ve already arguably been trying to do.  Sometimes I ask my clients if they have spent a great deal of time in their lives, saying something like this to themselves: “I just wish someone would tell me what to do about this.”  There are many things, that most(not necessarily all) people can do, directly, to diminish feelings of low self worth, sadness, struggles in relationships and most of the problems they come to a therapist.  If I didn’t go to school to learn to help people know and do these things, then what exactly did I go for?

Transformation.

So, we can’t heal what we can’t feel.  If we’re really trying to transform “depression” (not a feeling, but a diagnosis), “anxiety” (another non-feeling), grief and loss, abuse, abandonment and neglect etc- we have to “let go of some old ideas” about how we perceive and experience these circumstances, and the attendant e-motions (emotions, energy in motion).

Some of these ideas we have to let go of are:

1.  That we can turn our feelings on/off.
Stimulus/response (to steal loosely from Gary Larsen and others).  All we perceive has a stimulus and response attached to it.  It both amazes and saddens me that despite such a fundamental law of physics we behave as if we can somehow do something (or not) that will allow us to not have a response to a stimulus about what someone says or does.  Some basic “untruths”: “I need to not take _____ personally, give _____ power over me/allow them to ‘get to me’, it’s water under the bridge, it’s all in the past…” etc ad nauseum.

2.  That we can decide how intense a feeling we are having/going to have.
Back to physics- we can’t decide or influence how much of a stimulus we take in.  Save with the use of drugs or alcohol, even despite attention- we experience what we experience.

3.  That we can decide what type of feelings we’re going to have in response to some experience.
Sometimes we feel sad about something, only to have a similar experience later and feel hurt instead.  If this were true- why couldn’t we simply “decide” to feel joyful, grateful, happy, etc about a thing?

There’s more, but these are a fairly good starting list.  If we’re going to transform our feelings (or help others to do so), we have to change our philosophy, our relationship to our emotional condition.  Some of the most frequent problems I run into both personally and professionally around this are around the kinds of beliefs above.

Beyond this, we do things that prevent us from being fully in touch with our emotions.  As Sheldon Kopp has famously (or not so famously) said, paraphrasing: “When we stop trying to overcome anxiety, avoid depression etc, we can experience how sad and scared and hurt we sometimes truly feel.”  I would argue that one of our most basic problems as humans is that we do things that put distance between us and us, us and others, us and the “universe” or “God” as we MISunderstand he/she/them and/or it.  The list of the things that we do that result in these effects, is the list of things we have to stop doing to have access to how we feel, and transform it.

On a professional level, I have been struggling deeply with how far away we’ve gotten from doing “depth work”, processing, “uncovering, discovering, discarding”, “naming it, claiming it, and dumping it” (or whatever euphemism one prefers) for dealing with the likes of grief, loss, addiction, depression, anxiety, relationship problems and etc.  “Outcome measures”, insurance companies etc do not support this process.  There are sociopolitical (or as I prefer, “sociopolytrickal” as in “many tricks”) forces that diminish both focus and support on these types of services.  The hows and whys of this are beyond the scope of what I’m getting at here.

My tactic for dealing with issues are (hopefully) pretty simple and direct.

1.  Take the list of things we do that put distance between us and us/others/the “universe” and/or “God” if one prefers, and stop doing those things.  If it’s hard to stop doing them, try doing these things.

2.  Take steps to survive not doing those things.  This may take therapy, a support group, a church, support group, or whatever.

3.  What will most definitely take therapy: process what comes up.

Even if one does need medical intervention with psychopharmaceuticals, has a medical condition that might prompt difficult feelings/behaviors etc, getting therapy can only support this process, and arguably in some cases, is insufficient without it.  These three simple ideas above support all the ideas about “processing” (like the “uncover, discover, discard” etc above).  Hopefully we will get past the era of simply thinking that we all only need to act better, or otherwise “get over it”.

Lastly, need to make mention that this is of course not this simple, and would encourage more work around these things to be “happy”, free of depression, anxiety, addiction, etc.  A “resource group” of supportive people is necessary.  An organized set of principles to deal with new issues is significant.  Would also say that it’s important to have principles that allow us to grow as people- doing the work to transform and/or let go of these issues are the bare essentials for us to get to these things… and are totally possible.

Utility of Sadness

We do some *ahem* interesting things with sadness.

Often, people ask us how we are.  I think the real question is about how we feel, but we will oft answer “good” or “bad” or “not so good”.  All judgments about how we feel.  Most of us would argue that “sad” is a “bad” feeling.  If we can get past that, we may use another euphemism: “depressed”.  Our relationship to this thing is often not great.

When I left my office this morning (my second office at the Life Fitness Center, a group that provides a more holistic set of services), I was sad myself.  I’d spent several hours with people who were in horrible circumstances, and had already been suffering.  Mightily, and understandably, I might add.  When I got to the light, I noticed a gentleman, probably 7ish, walking through the crosswalk with his mom.  One of my licensures is in developmental disabilities and other related problems, and I noted his cerebral palsy right away.  They were holding hands, and though his body was having a hard time- his soul certainly wasn’t.  He appeared really happy.

Behind my wheel though, I was pretty sad.  For my clients this AM, and for him (though he was probably fine).  Most of the time when we get sad, we find some way to resist it.  We push it away with our minds, set our attention elsewhere, numb it with all kinds of different behaviors, even shame ourselves for having such feelings in the first place.

Would argue though, that my sadness, has great utility.  Not only is it the most effective way to heal my losses, it certainly makes me useful to other people.  Exactly how it heals grief and loss is not quite the gist of this missive, and takes time with a therapist/counselor/life coach to know how to do effectively and gracefully.  Am certain that my sadness today assisted me in being kind and present for my clients, and likely would keep me “softer” when dealing with folk like the gentleman in the crosswalk.

My hope is that I never lose this.  As long as I am sad about the suffering of humans, I have business doing the work that I do.  The point of this though is that this is true not just in terms of my relationship to my clients or other folk in the world, but all of us in relationship to ourselves and one another in general.  Honoring our sadness does more to “cure” “anxiety” (sorry for the consecutive quotes), relieve “depression”, and make us available for intimacy than most any other thing I can think of.

Reconciling ourselves with sadness, and finding some “grace” in how we live with it, if the above is true, surely presents some great reasons we should stop treating our sadness as something repugnant.

On a different note: as a reminder, Judy McGehee and I will be on the radio/live stream/podcasting at the link below tomorrow from 1130AM until noon on the “Project Get Well America” show with Dr. Mark.  The link for the show is here.

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