"LIFE IS NO NINTENDO GAME": BE YOUR OWN HEALTH ADVOCATE

Have you ever asked yourself the following questions: "If I only had one year to live, what would I do differently? With whom would I spend my time? How would I spend that time?"  Most of us don't think in those terms unless we are faced with some sort of crisis that challenges our mortality.  However, it can be helpful to stop and reflect on where we are in life and where we are going, before we are faced with its impending end. Questions that can help give our lives direction include ones such as, "Am I on the path I want to be on? What can I do to change things if I am not?"  As Eminem's lyrics tell us, "You don't get another chance, life is no Nintendo game."  There are no do-overs, and no rewinds, so we must make the most of life while we can.  In some cases, this means we must be assertive in getting our needs met.  Often, this assertiveness must come in the form of advocating for our own health needs.  

There are many people who struggle with anxiety about their health, even when there is no health crisis that is evident.  Health anxiety is one of the most common types of anxiety I see in my private practice.  It is easy to understand why. We have all heard stories of people we know suddenly passing away with no warning.  They were healthy individuals who exercised daily, had healthy diets, and went to see their physician regularly.  Then suddenly one day they have a heart attack, or find out they have stage four cancer, or discover some other sort of ailment that will significantly alter the course of their life. The Covid-19 pandemic certainly did not help these types of fears.  Many people lost loved ones to Covid, and it seemed to have the effect of increasing the incidence of both health anxiety and OCD (at least in my clinical practice).   

Sometimes there is a fine line between obsessive health anxiety, and being proactive in your own healthcare.  I have clients who feel they need to see their physician all the time for minor ailments, and in contrast, those who avoid physicians unless its an absolute emergency.  Many people find themselves in the emergency room only to learn that their symptoms were caused by anxiety. The healthcare system seems to have changed in ways that can make patients more anxious and uncertain about making the best healthcare decisions for themselves. Today, in some ways, medical professionals seem more unaccessible than in the past.  Medical offices have shorter hours in which they are open, and patients rarely get to have a direct phone call with their provider.  Most offices now have physician assistants or nurse practitioners, making it even harder to have contact with their doctor.  In addition, patients are often hesitant to ask questions or to disagree with their physicians. Many of my clients tell me they are afraid to bring up concerns to their physicians because of past experiences in which medical professionals have told them something to the effect of  "its all in your head."  This is not a helpful response from a physician.  Of course, most physicians are not dismissive to their patients. Yet, I see many clients who report these types of experiences, leaving them at a loss for how to deal with both their health anxiety, as well as how to advocate for themselves regarding their actual medical illnesses.   

I experienced what I felt was bias from a physician for the very first time when I was thirty three years old. I was still young and uncertain of myself, and I went to meet an ob/gyn that I had not seen before.  I was already the mother of a preschooler, and I told the doctor that I had recently taken several urine pregnancy tests, and that they were all positive.  She told me that because it was too soon for a pregnancy test to be positive, according to my typical cycle, that it was unlikely that I was pregnant.  I told her how I had symptoms of pregnancy similar to when I was pregnant with my first child, but she insisted that perhaps my symptoms were due to other reasons.  She even referred to a disorder in which women believe they are pregnant when they are not.  I was offended, to say the least.  I insisted that she give me a blood test to determine whether or not I was pregnant, since blood tests are more accurate.  I knew in my heart (and in my nauseous, tired body) that I was pregnant.  She argued with me that it was unecessary, but eventually agreed to the blood test.  My pregnancy, which the doctor said was not real, grew to be my 18 year old son who is now finishing his first year of college. Obviously, I switched providers after that, although not without some serious irritation.  Please do not misunderstand. I am not telling you not to trust your healthcare provider.  I myself am a healthcare provider and have the utmost respect for all medical professions.  I am simply saying you need to be a health advocate for yourself at all times, especially when you feel something is not right. 

There have been other times over the course of my adulthood that I have found myself in conflict with a healthcare provider.  Often, a physician will disregard something and say it's just due to stress.  I hear from my clients often about how a provider disregarded their health concerns as anxiety, only later to find out that in fact they had some medical disease. That's not to say that stress and anxiety don't play a role in health.  It certainly does.  There is a vast amount of research literature to support this.  However, its better to rule out the physical disease before automatically assuming a symptom is purely psychological. For example, a supervisor of mine during my training as a psychologist told me about a client who reported symptoms of olfactory hallucinations (the perception of smells that aren't really present), only to later discover she actually had a brain tumor causing these symptoms.  While this is a rare occurring example, it highlights the point that it is always better to rule out the medical causes first. 

Years ago I was referred to a neurologist for symptoms I was having that my doctor thought I needed to get checked out.  The neurologist ran some tests and told me I was fine, and suggested that it was just from stress and anxiety.  As it turned out, it was from a medication I had been taking, and the side effects caused these issues. As soon as I discontinued the medication, my symptoms resolved.  There are research studies to support this relationship between the symptoms I was experiencing and the effects of the medication.  I wish physicians would give more credence to their patients.  It is so important for patients to feel seen and heard by their medical professionals, and it is even ok for patients to be anxious about their health.  It doesn't always mean they have an "anxiety disorder".  Sometimes, they have a valid health issue, and health issues naturally cause anxiety.  There is a difference between normal anxiety related to a health problem, and someone who obsessively worries about their health when there is no evidence of a medical issue.  

Margaret Thatcher said "You may have to fight a battle more than once to win it."  Overcoming a challenge may require repeated efforts and perseverance.  In the same way, if you have health concerns, you should pursue answers until you have evidence one way or another.  If you feel dismissed by your doctor, seek a second opinion. I have had to do this before, only to find out that in fact I was correct in my concerns. "It is better to be safe than sorry" as the saying goes. It is better to take action now to investigate a concern, in order to avoid negative consequences later on. This is especially true when it comes to one's health.  In the same way (and to circle back to the original questions), it is better to make changes to improve our life satisfaction now, rather than wait until it is too late and the opportunities have passed us by.  "You don't get another chance, life is no Nintendo game."

JUST BE

In today's world, in the year 2024, there are so many distractions in daily life that it is hard to slow down and focus on one's own well-being.  We are constantly being pulled in different directions, and it seems as though there is never enough time in the day to accomplish all of our goals. As we race to keep up with our tasks each day, it becomes difficult to pause and be mindful of each moment.  We get caught up in the have to's, the should be's, the need to's, etc. I hesitate to quote from the movie Ferris Bueller's Day Off (as it is quite overused, and I have probably discussed it in previous blog entries already), but it still holds true.  "Life moves pretty fast. If you don't stop and look around once in awhile, you could miss it." As such, it is imperative that we make an effort to pause and appreciate everything that is in the present moment. 

The other day I was walking around my neighborhood thinking how nice it was to "just be." What I mean by that is, it was nice to just pause, breathe, and be present in the moment.  I was noticing the warm sun on my skin (which can be a rarity in the fall months in Michigan). I was enjoying looking at halloween decorations, and watching neighborhood kids playing with their friends. I did not have anywhere I needed to be at the moment, or anything I needed to do.  I was not in a rush, as I usually am, and I was able to leisurely walk through the neighborhood, as though I did not have a care in the world. (I did, of course, as we all do, but during this walk I was able to put those worries aside). I was being intentional about being aware of my surroundings, using my senses to appreciate my environment, and focus outwardly, rather than inwardly.  It is a precious gift to appreciate the world around us, for those of us that are able to use our senses to do so.  For example, we can enjoy the taste of sweet chocolate chip cookies, the relaxing feel of a warm shower, the scent of roses, the melodic sound of children laughing, and the sight of the vast blue ocean.   

During my walk, I was able to let go of the need to think about anything other than what I was doing at the present time. I was able to be happy with what was happening in that moment, and not worry about what would be, or what had been. I think we all get to a point in our lives where we just want things to quiet down.  We want less chaos, less stress, and less uncertainty.  We want things to be simpler, whether it be our jobs, our relationships, or our health.  Maybe it is getting older that brings this to the forefront of our minds, realizing that life will end at some point in time, and wanting our days until then to be peaceful and rewarding.  Or maybe it is having enough life experience to realize that happiness can be hard to come by, and that worry is hard to avoid, and so we learn to be grateful for the joy that we do have.  

Speaking of worry, there is nothing like a natural disaster to exacerbate one's worry. Last week, a hurricane was headed towards my family in Florida.  While they were dealing with preparing for the impending hurricane, all I could do was sit back in Michigan and hope for the best. I watched news reports all night, and kept in contact through phone calls and texts, but there was nothing I could do but wait. It was all out of my control.  (It was out of everyone's control, of course). All I could do was just be...just be patient, just be calm, and just be present.  A hurricane is a great reminder of how things can change in an instant, and how lucky we are when there is no immediate crisis to manage. We learn to relish in the quiet moments, where we get to be grateful that we are able to just be.  

Last week, a day or so after the hurricane had hit, I watched the live-streaming of a sermon that was given by a local Rabbi on the holiday of Yom Kippur.  He made reference to the song "Don't Worry, Be Happy" by Bobby McFerrin.  He said that a better way of thinking about the name of that song is, "Worry, and Be Happy." Worry is an unavoidable emotion that is part of being human.  Yet, it is necessary to be able to be happy even amidst our worries. (It should be acknowledged that, separate from typical worry, many people struggle with persistent worry and anxiety that is hard to control and interferes with daily life. Psychological services from a professional can help one learn to better manage this prevalent mental health issue.)  In regards to the sermon,  Rabbi stated that, with everything that goes on in today's world, and in our lives, we "can't just be miserable and scared and angry all the time" because this negatively impacts our relationships, and our lives.  He spoke of how we have the capacity to choose to be happy and to find joy even in the hard times. (This idea is actually similar to the entries in this blog, which I started in 2013, to highlight the importance of finding the silver linings even in challenging situations). Rabbi explained that it is actually "a mitzvah to enjoy your life".  A mitzvah is the Hebrew word for a good deed, with the literal translation being a commandment to be performed as a religious duty. As the Rabbi discussed, we have an obligation to appreciate and enjoy our lives. We should do so, even in times of difficulty and stress. Or perhaps, especially in times of difficulty and stress.  

I might add, in addition to needing to appreciate our lives and the joy that comes with it, we have the opportunity, and the right, to "just be." Today, while waiting at an appointment, I overheard a lovely 91 year old woman talking to her husband.  She was laughing and joking with those around her, and seemed quite content to be there, just sitting in the waiting room. I thought to myself, I want to be just like her at that age, and hope that I get that opportunity. I hope we can all be like her...to just be present, to just be patient, to just be open to seeing what happens, to just be in the moment, and to just be ourselves.  

NINE RED FLAGS OF NARCISSISTIC ABUSE

A few years ago, I posted a blog entry about toxic, manipulative people.  Things have changed a bit since then, as these days there is much more talk of narcissism in casual conversation than ever before.  The word Gaslighting (which refers to an abuser trying to manipulate their victim by getting them to question their own perception and judgment) has become common in everyday language. It seems that anyone who has a former significant other likes to refer to their ex as either a gaslighter or a narcissist. Unfortunately, this takes away from the actual seriousness of narcissism and the damage that it causes. Narcissistic abuse is real. A narcissist is more than just a selfish person who is insensitive to others. Narcissists prey on empathetic people who provide "supply" in the form of admiration and attention.  Narcissists are attracted to those who possess the qualities that they lack, such as compassion and empathy. They seek to gain control over their victims by putting on a fake image in order to maintain their own feelings of self worth.  There is a certain type of narcissist, called a covert narcissist, who can be especially hard to identify.  A covert narcissist may appear to be shy, withdrawn, and sometimes even self-deprecating (in contrast to the boisterous narcissist who is always boasting about himself).  As Taylor Swift's song Anti-Hero states, "Did you hear my covert narcissism I disguise as altruism".  This statement is an example of how these individuals try to appear helpful when in fact they are doing it for their own selfish reasons.  For the purpose of this blog entry, I am going to outline nine red flags of narcissists (although there are many more), using examples from a couple, whom I will refer to as Mac, the male covert narcissist, and RT, his girlfriend. (To protect their privacy, these are not their real names or initials.) 

Mac and RT started dating several months into Mac's divorce. (Side note: It's never a good idea to date someone while they are going through a divorce). Mac jumped into the relationship quickly, and he made it appear as though RT was the center of his world, essentially his "dreamgirl".  At first he would share all of his thoughts and feelings with RT.  He said he had never felt this way before. Mac and RT's relationship started out like a beautiful love story, or so it seemed. Mac had mastered the art of love bombing (Red Flag #1: Love bombing, which is not based on a genuine connection, but rather a tool to gain trust and dependency from one's partner.) Love bombing involves showering another person with attention and affection to win them over. Mac would tell RT that they were two peas in a pod. He would mold himself in ways that appeared to RT that they were similar.  However, real connection takes time to build and grow. Trust takes time to develop.  Mac would surprise RT every day by leaving sweet gifts at her door.  He called and texted throughout the day, always making sure she had everything she needed.  He planned dates and outings for the two of them.  He made it seem like it was a love like no other he had ever experienced.  RT tried telling Mac that he should slow down and figure out his new divorced life without being in a new relationship with her so soon. She suggested that they stop dating while he figured out what he really wanted.  Yet Mac insisted that he was certain he was meant to be with her.  Mac took his love bombing so far that he would even send RT listings of houses that he wanted to one day look at with her, as he constantly talked of moving in together. (Red Flag #2: Future Faking, and making false promises about the long term potential of the relationship).  Mac continued to try to convince RT that she was the love of his life and that they had a beautiful future ahead of them. 

Then one day Mac changed his loving behaviors and began to pull away.   He started being hesitant to commit to anything with RT. RT started noticing that he was inconsistent in his words and actions (Red Flag #3: Words and behavior not matching up suggests dishonesty). He would promise one thing but then do another.  He would always have an excuse as to why something did not happen the way it was supposed to happen. After RT expressed her concern, Mac decided he would let RT see his location, using a phone app, thinking that this would reassure her that he only had eyes for her.  Of course, while those location apps are not 100 percent accurate, there was enough sketchy pieces of information on multiple occasions to lead her to wonder what else might be going on. 

Mac had a plethora of women friends, none of whom he would allow RT to meet. (Red Flag #4: Keeping his world separate from her and information shared only on a need-to-know basis). It seemed like perhaps he wanted to keep his options open with other women, despite constantly denying that. In fact, early on he told RT that she should date other people, but that he only wanted to date her. (If she was the love of his life, as he called her, then how could he fathom the idea of RT going on dates with other men?) He made changes to his privacy settings on social media so that she could not see his friendships. He would say he was going out of town to see family, but later RT would learn that in fact he never left and just didn't think to mention it to her. The shadiness and dishonesty was growing daily. Mac wanted RT to think he was trying to be transparent, so he began letting her check his phone occasionally, with his permission. Each time, there would be some little tidbit of information she would find that would raise her suspicions even more.  Once she overheard him talking on the phone with one of his close female friends.  The woman referred to him as "honey".  Mac said this was just how she spoke. This particular female friend's texts included heart and kissing emojis. She wasn't the only one though.  There were texts with multiple females. They were women Mac said he grew up with, women that lived near him, women that he worked with, and women that he was doing work for, etc. None of them were women that RT was allowed to meet, despite multiple promises of doing so "when the time was right."  Mac was insistent on keeping his world separate from her. One night, in the middle of the night, RT received a text from Mac about something related to his job, but it ended in love emojis like they would send to each other.  He insisted he was half asleep and that the text was meant for RT, even though the content looked like it was meant for a co-worker. Interestingly, Mac once told RT that his ex-wife used to think he was cheating on her with someone from work.  Perhaps she was right. 

As time went on, whenever RT wanted to talk about something that concerned her, Mac would either get extremely angry, or withdraw, or disappear completely.  It seemed he never had any intention of trying to make the relationship work. (Red Flag #5 :Avoidance and anger as a communication tactic to control the situation). His behavior often appeared like that of a child's temper tantrums. Furthermore, there was never an apology for his behavior.   He could be sweet and loving and kind one minute, and then the next he would appear out of control. He said that RT was at fault, because she was accusing him of things he was not doing. He blamed RT for his anger. Mac's anger, like most narcissists, was a force to be reckoned with, as his outbursts would occur without warning, in an effort to control the situation and avoid having to talk about anything.  One time he threw something off the kitchen counter and it left a hole in the wall. Another time he got angry while driving, and slammed on the brakes in the middle of a 45 mph road. There came a time when RT needed a medical procedure done and she was relying on Mac for help before and after. Unfortunately, the procedure went poorly, and she ended up with doctor's instructions not to be left alone afterwards.  Mac refused to stay with her, stating that he was tired of her accusations and done with the relationship.  When Mac had angry outbursts, he would blame RT for them, never taking accountability for his own behavior.  If he was called out on any of it, a tantrum would ensue.  He would walk out on her and then leave RT's texts unread for days, or take days to reply. This behavior of ignoring someone was meant to exert control. Ignoring someone invalidates their feelings and makes them feel invisible. He would take everything to the extreme, blocking her calls and texts when he was angry. 

One day, RT found an old phone in Mac's car. (Red Flag #6: Using technology to engage in deceptive behaviors). He said it was so he could access things regarding his divorce, without his ex wife knowing.  However, RT found dating apps on Mac's old phone.  He said he downloaded dating apps years ago during his marriage, when things were first strained, but insisted he never used them and never even made a profile. However, it was also possible that these apps were current, and he was using them to cheat on RT.  In addition, in regards to technology, one weekend RT went out of town with a friend, and came back to find her video doorbell and her internet were hacked.   RT was worried about the security of her technology, and she asked Mac to come over that night to help her. (Ironically, prior to her leaving town, he had offered to come by while she was away to help her with internet issues she had been having, although she had declined). Mac refused to come over that night, saying he had other things to do. His behavior surrounding the whole situation seemed odd. When he finally showed up, he demonstrated a complete lack of concern for her well being, and wasn't interested in helping her find a solution to the problem.  There were also times prior to that when he would visit her, and he would do something secretly on his phone but not let her see it. He told her each time that he was turning off his wifi so he didn't connect to other people's internet in nearby houses and thereby slow down his phone.  (Why would he be connecting to her neighbors' wifi? Or was that just an excuse for something else that was shady that he was doing?)  The use of technology in today's world offers a variety of opportunities for dishonesty and manipulation. 

There were too many questions, and too many negative events. Mac was suddenly like a tornado in RT's life. RT broke up with Mac on multiple occasions.   However, he kept returning, trying to "hoover" her back into his life with repeated love bombing (Red Flag #7: Hoovering is an informal word used to describe when one manipulates another person back into a toxic relationship). Mac had always insisted that once he was done with a relationship he was gone forever.  However, he kept coming back, trying to convince RT to give them another chance.  

Mac appeared to believe that no matter the topic, he was always correct. He had a haughty, arrogant way of giving the impression that he thought he was better than others, without ever actually coming out and saying so (Red Flag #8: Acting as if one is better than others). RT would notice Mac's arrogant smirk at something she said, or see a smug look cross his face. Mac seemed to think he was always right, and RT was always wrong. The entire time they dated, RT knew in her gut something was very wrong.  She knew this from the very beginning, when they first met. She sensed there was more than meets the eye, and used to joke with him that he was a mystery man giving off lots of mixed messages. As time went on, it was clear it was no longer a joking matter, as Mac began to give her the feeling that she was not safe around him (Red flag #9: Your gut instinct is telling you something important). She would get stomach aches and anxiety around him, always wondering what was really going on behind her back.

We all might be wondering, why did RT stay? She happened to be an intelligent, loving, attractive woman, so why would she stick around for all this nonsense? It should be noted that narcissistic abuse can happen to anyone. Covert narcissists are especially adept at hiding their true intentions. Intermittent reinforcement is a tool used by a narcissist to provide love and support, and then suddenly take it away, only to give it back again. It is a cycle that has similar effects on one's brain as becoming addicted to a drug.  Despite all of the toxicity that RT experienced, she still held onto the hope of potential she saw from the beginning, when Mac was so convincingly good to her.  Yet, Mac was a chameleon, and underneath his intermittent charming exterior, he was cold hearted and only looking out for himself.  As time went on, Mac was cruel to RT much more often than he was kind to her. His transparency decreased daily, and his disrespect grew.  Mac likely eventually came to realize that RT would never go back to seeing him the way he wanted her to see him, now that his true colors had shown through.  RT's mistake was that she assumed that she was immune to the traumatic effects of his deceitful ways, and that he would not be able to take advantage of her in the ways that he likely did with others.  She stayed in the relationship for the time that she did because she was determined to get to the bottom of what was really going on. Mac and RT's relationship did not last all that long, however it was long enough to make an impact.  No one can ever win with a narcissist, because they don't participate in or experience relationships like healthy people do. As Olivia Rodrigo tells us in her song Vampire "You said it was true love, but wouldn't that be hard? You can't love anyone, 'cause that would mean you had a heart." 

EMPTY NESTING...AND REFLECTIONS ON TIME

The other day it occurred to me that I have not written a blog entry in several years. I was disappointed by this realization, as I used to love writing. I would get fulfillment from putting my thoughts on paper, rather than just keeping them stuck swirling around inside my head. I suppose the reason for not writing, as is true for much of life's plans, is that time passes so quickly that we never get around to achieving many of our goals. "Life is what happens to you while you're busy making other plans" is a famous quote that speaks to this idea. Today I decided it was time to remedy this situation.  As I reflected on how much time has passed since my last blog entry, I realized that the topic of time needed to be an entry in and of itself.  

Time. It is the one commodity that we can never get back.  As both of my children are attending college this year, I am constantly reminded of how quickly time passes. My daughter is a senior and my son is a freshman.  Having not just one, but both of my children away at school this year, is a sharp reminder of how the years go by in the blink of an eye.  In my private practice as a psychologist I work with clients who are young adults through retirement age.  There are so many milestones and transitions in life that highlight the importance of time. Many of my current clients are in the child rearing stages of life, and discussing parenting challenges with them is a stark reminder of both the joy and loss inherent in the passage of time.  

Recently, a friend and I were talking about how exciting it is for our college aged children to have everything ahead of them.  There are so many possibilities as a young adult, for career, for love, for adventure.  In contrast, we discussed how we are at the stage of life now where all of the excitement of uncertainty has faded, and instead, we are left with the fear of uncertainty in its place.  We no longer think we are invincible with a lifetime ahead of us.  Rather, we realize how precious time is, and how we don't know when our journey will come to an end. Every day we learn of another loss of human life, for all kinds of reasons, and we know that eventually our time will run out as well. Being an empty nester is a reminder that while we are headed downhill towards the conclusion of life's adventures, our children are on the journey upwards, where all kinds of wonderful possibilities hopefully await them.  In this awareness is the underlying understanding that seeing our children grow up means, in essence, that we are growing old.  

Speaking of empty nest syndrome, hindsight is 20/20, as the saying goes.  Every day I am flooded with memories of my kids growing up. I reminisce about activities we did, trips we took, and events we celebrated. I have been a divorced parent the majority of their lives, and the challenges of co-parenting certainly took its toll.  While my children don't remember these struggles in exactly the same way that I do, (as they were not privy to the whole picture as young children), these taxing moments are forever etched in my mind. Parenting is difficult, no matter what. Single parenting, for anyone, is even more difficult. Nevertheless, I would not take back a moment of parenting my children. It is the most challenging and yet most rewarding job that exists.  If I could do it all over again I am sure I would do it better this time around, as wisdom comes from experience.  

The other day I was in Target and I watched a mom and her toddler strolling the aisles as if they didn't have a care in the world.  They were playing and being silly while looking at Halloweeen decorations. The child's laugh was so joyful and infectious that I could not help but smile to myself.  There are days when I wish I could turn back time and do it all over again.  Like the mother and toddler in the store, I miss the days when my kids thought I was the best thing that ever happened to them, and would hug me like they never wanted to let go.  However, there is freedom and peace in seeing that my kids have grown up to be independent, kind, loving, responsible, contributing  human beings in society.  I'd like to think that I am, at least partially, responsible for that.  I wouldn't change a moment of the past memories, even the difficult ones. They flood my mind like videos playing on repeat...memories of sleepless nights, colic, breastfeeding, birthday parties, playdates, bike rides, vacations, dance competitions, travel baseball tournaments, teenage angst, first loves, college applications, and more. When each of my children turned eighteen I thought, "We did it!"  We made it through.  We survived.  And, even with the trials and tribulations that life brings, they thrived.  If I could go back and soak up every moment of their childhood again I would.  However, those days are gone, and in its place I am left with pride and joy watching my young adult children navigate their way through the world.   It is hard to get older and see that the life ahead of you is much shorter than the life behind you. However, these days I get to turn the focus around a bit and ask myself, what do I want next for myself? How can I spend my time in the most meaningful ways possible? My children have their roots and their wings, and now it is my turn to thrive.  

TOXIC MOLD, TOXIC MANIPULATORS: PERCEPTION IS NOT REALITY

Many years ago, I was in a relationship with a man whose house had an odd smell to it, and there were ominous looking dark spots on his ceiling. He had been unwilling to investigate it previously, assuming it was an insignificant issue.  However, by the time I moved in and insisted we have it checked out, it had gotten so bad that the remediation company said we had the highest levels of toxic black mold that they had ever seen.  It had multiplied over the years, starting from a small leak in the ceiling that grew into an infestation that affected the entire house. It required us to move out and dispose of many of our belongings.  I moved out, and moved on from both the toxic mold and the harmful manipulation I had endured throughout that relationship.  Manipulators, like mold, can slowly and stealthily try to take over many areas of your life.  It is important to see the warning signs of both, as your health and well-being depend on it.  

Over the years, and especially during the pandemic, I have had a surprisingly large number of clients contact me for therapy related to narcissistic abuse and other toxic relationship issues.  Sometimes, clients seek out therapy because they are well aware of what has transpired in their relationships, and other times, they are blindsided by the manipulation and emotional abuse they have endured.  The manipulators have been their husbands/wives, boyfriends/girlfriends, dates, friends, and bosses.  Manipulators tend to seek out those that are very empathic, as they feed off of the attention and care that compassionate people give to their partners.  Often, the narcissist will be good looking, charming, intelligent, and appear to be compassionate as well.  They seem to know just what to say and do.  They try to give you what they think you want from them. Sometimes they use drawn out explanations of things, with more detail than might seem necessary.  Despite the detail they use in relaying a story, it can seem like they are giving vague or evasive answers. They may have odd excuses for the simplest things. For example, I met a guy once who told me the reason he was late to our date was that he needed to bike ride over to his brother's house because his brother had a toothache (Spoiler alert: No, he is not a dentist, and no, he was not actually at his brother's house). If you pay close enough attention to the red flags, you may find that things don't add up.  If you figure out that they are being dishonest, and they become aware that you can see through their lies, a manipulator will do anything to either convince you that you are wrong, or they will disconnect from you.  

Unfortunately (but perhaps not surprisingly, as I tend to be an empathic person), I have had my fair share of encounters with toxic people.  I once dated a man for several years who I realized had been cheating on me.  There were multiple signs that he was being unfaithful, such as finding women's clothes and jewelry in his house that did not belong to me or anyone that lived there.  He would not always be where he said he was going to be. He would hide his phone when we were together, and be inaccessible when he was out of town.  He told me when I met him that he had cheated in the past, and that he always had an exit plan in relationships, until he met me (of course). Looking back after the relationship ended, I realized how everything had to be on his terms.  He would talk about how I was the only one for him, but in reality, he was the only one for him.  I should have left as soon as I saw the signs, but like many people do, I tried to communicate about it and make it work, for awhile anyway.  

Sometimes, you find these manipulators already in your work or social circles, which can be especially difficult to navigate. For example, I found myself in the presence of a man who raised red flags, but whom I had to see often in my regular daily life.  From the beginning, I felt he wasn't being truthful, and I pointed out his inconsistencies, as well as the fact that he seemed to be trying to cross boundaries.  It appeared as though he was simply playing a game for his own entertainment. He told me from the beginning "Perception is not reality."  There is some truth to the saying that we see things as we are, not as they actually are.  In this case, however, it seemed like an attempt to tell me that whatever negative thing I would come to think I knew about him, or hear about him (something he was very concerned about), that I would be wrong.  He tried hard to convince me of his good intentions, and I played along for awhile. I tried to give him the benefit of the doubt, and to be friendly, because of the frequency with which we had to cross paths. However, there were too many inconsistencies, and a lot of words not backed up by actions.  When he realized he was unable to convince me, he did what he could to disconnect.  

As in the example of mold discussed earlier, when it comes to a manipulator, you might not always realize right away that there is a problem.  Beautiful paint and decor (like a charming smile and lots of attention) can cover up the toxicity which exists underneath.  Perception is not always reality.  When dealing with a toxic person, it can be difficult to know what is real and what is not.  Over enough time, however, things usually become clear.  The following are ten key points to remember that relate to the examples I just described above.  Keep these in mind if you find yourself dealing with a toxic, manipulative person.

1. Trust your gut. There is research to support the idea that your gut instinct is correct, and aware of pertinent information, even before your logical brain has a chance to process and make sense of it.   

2. Pay attention to actions, not words.  Narcissists, liars, and manipulators tend to say things they think you'll want to hear, but their actions usually fail to back them up.  They may make promises they can't keep, and may insinuate a closer relationship with you than what actually exists. 

3. Keep your eyes and ears open, but keep your observations to yourself. Knowledge is power, but not when it's shared with the manipulator.  

4. Intermittent reinforcement is not good. Recognize it for what it is.  Psychological research shows that reward delivered at irregular intervals results in the greatest effort from research subjects. In toxic relationships, it makes the person feel more bonded to their abuser, and makes them try harder to make things work. The attention and affection from the manipulator is sporadic and unpredictable, which serves to keep the person connected. 

5. The best predictor of future behavior is past behavior.  A leopard does not change his spots.  If you think your partner has a history of dishonesty, it would be wise to pay attention, as it is possible for that behavior to continue.   

6. Know your own worth. Once you do, you won't settle for a toxic relationship.  

7. Don't engage. Don't poke the bear.  Don't try to get answers or give explanations.  Just Don't. You will never win with a manipulator.  Freedom from their control or influence is the only way to win.  

8. Peace of mind is priceless.  Always put your well-being first.  It is always better to be alone than to be in a toxic relationship.  

9. True, meaningful connections take time to develop.  "Lovebombing" is when a toxic person showers you with attention, gifts, compliments and affection in the beginning of a relationship, only to later withdraw it.  It is not true love, but part of the cycle of abuse. 

10.  Don't let one bad apple spoil the bunch.  Or rather, don't assume that every person out there (especially in the dating world) is out to take advantage of you. Yes, there are the manipulators.  However, there are still good, honest men and women out in the world trying to make true connections. Take things slowly, keep your eyes and ears open, and true colors will emerge over time.  

PANDEMIC PONDERINGS

As I write this blog entry, we have now been living through the COVID-19 pandemic for the past six months.  In some ways, time has flown by, and in others, it feels like time has stood still.  I have had many thoughts about the pandemic and have made many interesting observations along the way. Yet as I sit here now, on the holiday of Labor Day, it all still seems very surreal.  

Labor Day is an annual tribute to the achievements of American workers.  It originated in the late 19th century at a time when the average American was working long hours, in poor conditions, with little pay. Over time, labor unions began organizing strikes and protests. Eventually, the holiday of Labor Day was created to recognize the contributions of the American worker.  In recent times, Labor Day weekend also represents the end of summer and the start of the back to school season. However, this holiday weekend brings with it many cautions, as the CDC warns that a lack of social distancing is likely to increase spikes in coronavirus cases.   

The pandemic that began towards the end of 2019 has now spanned the entire globe.  At present, it has resulted in over 27 million cases of the COVID-19 virus globally, and 881,000 deaths.  There does not seem to be an end in sight, although there is hope that a safe and effective vaccine will be readily available in 2021.  I have viewed this "unprecedented" time in history from multiple lenses.  As a clinical psychologist, I have seen the detrimental effects it has had on mental health.  Anxiety disorders and depression are at an all time high, and those that used to feel like their mental health challenges were somewhat manageable, now find themselves unable to cope.  I have also seen the grief and loss when client's family members have become sick with the virus and have died.  I have seen the unique challenges the pandemic has created for our youth, and the toll of social isolation and missing out on milestone events.  I have seen how much of a struggle it is to be divorced and try to co-parent when an ex-spouse has different perspectives on what it means to stay safe, and to keep kids safe.  I have seen how parents of young children have struggled with the unique challenges of juggling virtual school and work.  I have personally experienced feeling more at risk because of my health history of being a cancer survivor.  Mostly, however, I have been surprised to see how people's opinions can differ so greatly. I have been disheartened by how much inequality exists in our world, how corrupt politics can be, and how unfortunately, science doesn't always conquer all, especially when it is sometimes blatantly ignored.  

At the start of the pandemic, I moved my psychology practice to Telehealth sessions.  As I was packing up my office, I noticed that the last quote I had written on my quote board was one by Ralph Waldo Emerson. "Fear defeats more people than any other one thing in the world." At this point, I'm thinking COVID-19 might be the one thing that defeats more people than anything else in the world.  However, fear is certainly vast and powerful in these uncharted times. The anxiety and uncertainty that humans have faced due to this pandemic is likely to persist for years after this global crisis ends.  Through the toilet paper shortage, the stay at home orders, the unemployment rates, the online schooling, and everything in between, we have learned just one thing is certain.  That is, there really is no certainty in life. You can't always predict or plan for tomorrow.  If we've learned nothing else from these challenging times, we've certainly learned that you never know what tomorrow brings.  Learning to be flexible and adapt to uncertainty is possibly the most important life skill you can ever learn.  It is also one of the most difficult.  Additionally, we've learned how important it is to appreciate the people in your life, because you never know what might happen that will prevent you from getting to see them again.  For single people, such as myself, the pandemic has taught us even more about coping with increased times of isolation. 

For some, the pandemic has created an increase in feelings of guilt and questions of morality.  The idea that socializing with others has become dangerous is something we would not normally think about.  I find many people struggling with whether or not they are "bad" if they choose to attend a social event or decline it.  These are questions we may ask ourselves now that would never have been factors in our decision making in the past.  Likewise, wearing a mask (or not wearing one) has certainly become a focus of conflict.  I will admit, I've been surprised at how many people refuse to wear a mask to protect themselves and others.  Just the other day I was in line to use a public restroom, and the other people nearby smirked and laughed at me for wearing a mask. Likewise, I was discouraged to see patients and staff at a medical office without properly worn masks. The issue of masks has been at the center of violence in many situations and places.   

In the beginning of spring, when our country was becoming overwhelmed with increasing cases and deaths from the virus, my clients with OCD would tell me how they felt better than their friends and family.  Ironically, they were coping better than others, as they felt they had been preparing for this their whole lives.  Avoiding germs and contamination came naturally to them.  Granted, for some of my anxious clients it was the tipping point in which they felt they could not handle any other stressor in addition to this one.   However, some felt like the rest of the world was finally getting to know what it was like to have mental health challenges. Did anyone without anxiety ever think of disinfecting their groceries before this pandemic hit? Unlikely.  Suddenly germaphobia was the norm.  Similarly, for my introverted or socially anxious clients, the stay at home order was a nice reprieve from the social pressures of our fast paced daily lives.  

So what are all these "pandemic ponderings" really about, besides just describing my observations? And what, if anything, does a pandemic have to do with Labor Day anyway?  It comes down to one thing, really. The only way for us to overcome COVID-19 is to work together.  Whether it's working together towards a vaccine, or working to teach our children virtually or in person, or working to help our friends and family stay healthy and safe, the only way to do so is to join together.  On this Labor Day, let us remember that this holiday is not just about barbecues and family and friends, but rather it is a tribute to the contributions workers have made towards the strength and prosperity of our country.  It took a common goal and joint effort to get to a point where workers could see improvements in their work life, and have a national holiday created to acknowledge them.  The unrest and rallies and protests that ensued for years before Labor Day became a holiday is a reminder of how we cannot give up when people's health and safety depend on it.  In my opinion, the next celebration of strength, well being, and contribution, such as historically describes Labor Day, would be the day that our world overcomes COVID-19, together. Happy Labor Day, and please be safe!

THE IRONY OF LONELINESS

In my private practice, I often see clients who are struggling with feelings of loneliness and isolation. Many state that, if only they felt less lonely, they would be able to experience more in their life, and they would be happier.  People feel lonely for different reasons.  Some may experience loneliness because they are without a significant other, while it can seem like the rest of the world is coupled up.  Some feel lonely because of a lack of friends and social support.  Some feel lonely because they actually do have a partner, or a large social network, yet they still feel separate and alone, despite this social connectedness.  Whatever the cause of one's loneliness, the irony of it is that we all feel lonely at one time or another.  Loneliness, which makes us feel separate from others, is actually the emotion that unites us all together.

Like most people, I have known different kinds of loneliness. I've known the unique loneliness of temporarily living in a foreign country and having everyone I know thousands of miles away.  I've known the more common loneliness of being in unhappy relationships.  Being in a bad relationship can often make people feel more lonely than if they were actually alone.  I've also known the loneliness of losing friendships, of not seeing my kids every day, and of battling medical issues without family or a significant other around.  Most importantly, I have known that, regardless of these life challenges, the feelings of loneliness are temporary and changeable.  We are all connected by the universal human experience of feeling lonely.  It is ironic that, when you have times that you feel all alone, you are actually experiencing the same feelings shared by many others.

Loneliness and social isolation not only challenge our emotional well-being, but threaten our physical health as well.  Research has found an association between loneliness and increased risk of mortality.  This may be due to many factors. For example, social connection is associated with positive health behaviors, such as eating healthy, getting exercise, and receiving medical care.  In contrast, loneliness can influence people to engage in behaviors that are not good for their health, such as smoking, drinking, drug use, and weight gain. Relationships can make people feel accepted and cared for, and thereby reduce the impact of stress, whereas loneliness can have direct negative effects on the immune system.  There have been increased studies in recent years on the association between loneliness and health problems.  These include conditions such as high blood pressure, cardiovascular disease, Alzheimer's disease, depression, suicide, cancer, and obesity.

Today's world of technology and social media certainly plays a role in the issue of loneliness.  There are several ways of thinking about this. We can view it as a remedy to social isolation, as it connects people all over the world.  For example, if you are struggling in some way, there are websites and chat rooms to find support and feel less alone in facing challenges.  If you are looking for friends or a date, there are apps to connect you to others looking for the same thing.  However, social media can  have its drawbacks.  Social media tends to create an atmosphere of increased social comparison that might not occur to such an extent without the internet.  We can see this to be true especially for teenagers.  If you can see that all your peers are at a party without you, or that you're the only one who didn't find a date for the dance, or the only one who didn't make the basketball team, then social media can increase feelings of aloneness.

If you are feeling lonely or socially isolated, there are steps you can take to change this. Try volunteering for a cause you believe in, as helping others can bring a sense of community.  Join a club or group where you can meet like-minded people and spend time doing activities you enjoy.  Make a phone call to that longtime friend or family member whom you haven't spoken to in years.  Even spending a few minutes talking to a stranger standing in line with you at the grocery store can make you both feel more connected to the social world.  If loneliness becomes chronic for you, don't hesitate to reach out for professional help.  Speaking to a psychologist can help you identify negative thinking and behaviors that may impact your feelings of loneliness, as well as take steps to feel more connected and less alone.