PSYCHIATRY • TALK THERAPY • SERVING GREATER PHILADELPHIA • NOT ACCEPTING NEW PATIENTS

Romantic partnerships begin with a mutual and delicious sense that the union will lead to better tomorrows. So much effort goes into a progressive mutual seduction which leads to a perfectly coiffed and hugely expensive day of days. There is a wonderful old fashioned term, courtship, which denotes that loving thoughtfulness and mutual appreciation of two people gratefully striving to makes things sweet for each other.

Then life happens, drop by drop, bringing struggles, problems and disappointments and alot less time and energy for courtship. Time brings unsexy responsibilities which crowd the loving thoughtfulness of courtship off of the top of the priority list where it used to be. The mutual memory of the earliest days can fade from view to be replaced in each partner by an unspoken private resentment, a sense that the courtship may just have been an opportunistic sales pitch by one’s partner to be dropped when the marriage contract was signed and sealed. Each partner can be so focused on feeling cheated as to be unaware that the partner may feel the same.

Even though many spouses take a vow to love for better or for worse, who ever really signs on to marriage ‘for worse’? Of course married life cannot deliver long term carefree living, but the shared memory of the sweet courtship that was the relationship at its birth needs to be recalled, cherished and celebrated repeatedly over time if love is not to be replaced by resentment.

Courtship is the spiritual glue and the of lasting relationships. When we notice couples who retain deep affection for each other, we see people who prioritize setting aside quality time to be alone together. With rededication to courtship never lose their gratitude for what the other has brought to them. They know that gratitude-filled courtship is not a short term premarital ritual rendered unnecessary by marriage but rather that time must be put aside and prioritized in the weeks and months of a lifetime to remember and to celebrate that which brought them together.

The blame game in decayed marriages is relational poison, a prescription for marital civil war. People mired in marital self pity and resentment need to be shown that the disappointment that they feel so strongly often occurs in both parties in marriage, not just in one, and that each partner bears some of the responsibility for reversing the relational decay. Each partner shares part of the responsibility to contribute to positive relational effort. Dates, baby sitters, hooks and eyes on bedroom doors, overnight getaways, and mindfulness of how the relationship brought blessed changes to one’s life, are all good, practical ways to recapture and sustain the relational magic of courtship in long term marriage. Acknowledging the distress of the other as well as on one’s own must occur. Change toward positive action requires effort but without it a much higher cost in family suffering will almost surely have to be paid by all. Like prime old real estate, great marriages require ongoing maintenance by all.

Article copyright 2011 Jerrold Bonn, M.D. All rights reserved. Any use of this article without the express written consent of Jerrold C. Bonn, M.D. is prohibited.

Shy people do not know that shyness is a common trait in people. In any gathering, many shy people tend to feel that everyone else except themselves are socially competent and having fun.  Shyness is a painful condition that, if untreated, can hamper many areas of living, vocationally as well as socially.  Is there anything a shy person can do when confronted with a family gathering, a new neighbor, a potential business client, etc?

Here are some tips for coping:

1. Realize that in any social situation, you are not the only shy person. Strong social confidence is a trait enjoyed by a relatively small percentage of extraverts, people with truly thick skins who are born natural leaders.Both shyness and social confidence are genetic inborn traits. There are many people in this world who have to wait for others to break the ice for them. Treat others as you would want to be treated:  talk to them, help them to engage, let them tell you about themselves. View yourself as one who can help those with skill levels below your own.  Realize that many, many people feel socially inept, and are socially inept.
2. Visualize the group or situation you are about to enter. Before you enter a situation likely to make you uncomfortable (e.g., a business meeting, a school reunion, a neighborhood barbecue), visualize that the group will include shy people, and some nice people inclined to be nice to you. Of course, the group may also include some folks who are wrapped up themselves, and who might give anyone the brushoff, not just shy people.  Most people are decent—even the socially skilled are usually decent and willing to throw you a lifesaver.  Don’t hold their social skills against them; give them a chance to help you. Be prepared for being alone between chats. Use the time to survey the event.  It is natural for someone to run along after saying hello to you. Use the time to count heads in the room.  Use it to think who you would like to meet.  Use it to find shy people in the room. Do anything to take the focus off your own discomfort.   Make eye contact and immediately offer a smile or a slight head tilt,  and, if the gift of your gresture is returned, walk to the person, or maybe the person will come to you.  If not, so what. Remember that you, too, have power to help someone else feel at home and that being the first to reach out rather than waiting uncomfortably for someone to make an approach can distract you from your own anxiety at least for a moment, forcing a reciprocal response and even evoking gratitude for helping them to be comfortable.  Keep the topic simple and light. “Great shrimp.”  “How about those Phillies last night?”  “Aren’t you with Acme Drilling?  I have been meaning to contact someone at your firm…”   Always start by giving your name clearly.  Extend a hand if it is that kind of gathering.  No one objects to a handshake. But be sure to say your name, even if all you can get out is your first name.  
3. Make a simple, small move, instead making yourself unapproachable by freezing or looking down or looking away. Head towards a lone person, perhaps of your own gender, and say, “Hi, I’m ___.”  Listen for the other person’s name.  Engage in some fail safe chat like, “what is your occupation?”  or “what company are you with?”  If you are talking to a man, you are pretty safe in asking about a sports team (yes, women follow sports, but it is not as sure a topic with women…) Whatever the other person responds with, go with it. Think of yourself as an interviewer who stays on the surface of things.  Let the other person talk about himself or herself. Don’t go too deep; keep it light. Think of contemporary subjects before you arrive, subjects likely to be known by the people you will be with.
4. If you feel uncomfortable, or that the conversation is dragging or if feel you are monopolizing the person, wrap it up with a positive spin, and move on.  “Heh, I need to say hi to someone who just came in.  It’s been great talking to you!”  Or, “Excuse me, it has been wonderful talking you, but I see that I must greet my former colleage who just came in.”   Or, “Heh, it is great talking to you, but I don’t want to monopolize all your time. I am just going to take a seat for a few minutes.  Have a great evening…”  Then move on, to the bar, to a seat, to the food, to the restroom.  Do not mention that you are uncomfortable and hate gatherings, as that will put the other person in an awkward position.  Always treat the other as you would like to be treated:  make them feel comfortable and that you are really grateful to have met them and go with the flow. If rebuffed, it only reflects on the rudeness or insecurity of the other person and not on us because they really don’t know us.
5. Remind yourself that many people at your gathering are not having a great time. Help them turn that around.  Find the lone person and have a simple, short chat.  Do not believe that every single person in the room is smoother and cooler than you are, or having a better time.
6. Ask for a name, and try to remember it.  Make an effort.  It is always ok to say, “I know we have met, but your name is slipping my mind.”  People very much appreciate that you are making an effort to remember them. Everybody knows that everybody forgets names. Help others by always offering your name when you enter a group or are approached by someone.   “Hi, I am ____. What’s your name?”  If you are in a group bring that new person into the group.  
7. Set a comfortable time limit for yourself.  Maybe you are not up to working a room for an hour.  Start by giving yourself the assignment of entering the group for ten minutes and having a conversation with one person.  Work up from there; next time, try fifteen minutes and meeting two strangers.
8. Say goodbye when you leave.  Find the host, or someone working for the host company,  and say you had a great time, it was nice to be included.  Every host needs to hear that.   “Heh, thanks for including me tonight.  I am Jane Doe from Acme.  It was fun. Good night.”

When it comes to coping with shyness, one might say that the Golden Rule, “Do unto others and you would have them do unto you,” is a shyness tool.   

I hope this is of help.

Jerrold Bonn, M.D.
Psychiatrist & Talk Therapist
Greater Philadelphia

Have you ever come close to being in a car accident? Can you recall how your body felt in the instant when someone almost hit you in the stomach? Do you remember how your body feels when you are about to have blood drawn? How does your body feel as you are about to have a root canal? How does your body feel when you are rushing for an important appointment, knowing you will let others down, and maybe suffer a reprimand?

Whenever we feel threatened, physically or socially, the human body automatically acts to protect and shield itself from attack through the action of bracing. Sometimes we notice our defensive body tightness and sometimes we do not. Bracing is probably a physical survival reflex long ago wired into us as a species, and bracing ourselves in times of perceived threat is an automatic response in us even at infancy. Have you ever seen an infant brace its entire little body when there is a sudden and frighteningly loud noise like thunder?

Bracing, the tightening of our body muscles to automatically shield us, is an important but under-appreciated part of feeling a threat or apprehension. We almost never hear people speak about it, and we are likely to be unaware of it when it is present. People who suffer from anxiety and a sense of threat or vulnerability in everday events (the threats may not be real, but the feeling is real), would do well to consider that their automatic body bracing may be adding a great deal to the total feeling of anxiety. Our worry can be multiplied by tight feelings from our defensively guarded, braced muscles. We worry, we tighten and we worry still more. Although we do not understand that it is just our muscles trying to guard and shield us, the tightness makes the sense of danger feel more real and immediate.

Learning to understand and to reverse the tight feelings in our body, especially in the torso, upper body, neck and shoulders, can help us with mental suffering such as:

1. The distress of chronic and situational anxiety
2. The terror of panic attacks
3. The mind-body trap of hypochondriacal suffering. (We can fall into the trap of thinking that we must be ill because our body really hurts, even after our physician has concluded that we have no physical disease. We can easily believe that we must be damaging our body parts because they are sore when we move them.  It is hard for us to accept that soreness may the result of our keeping them guarded and braced out of fear of self injury and that the soreness we feel may normal in any part of the body that has been kept tight and immobile.)

When we command our muscles to move gently in a slow and flowing way, they gradually stretch out and dissipate their tightness and bracing and even their soreness. Relaxation breathing means using extra big breaths to expand our tight abdomen as if we were allowing an inner balloon of air to gently stretch out our tight muscles in the area underneath our ‘six-packs’ and our diaphragm. Gently moving any part of the body that is sore or tight may be beneficial. Discuss this issue with your doctor and then decide.

I hope this is of help.

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Jerrold Bonn M.D.
Psychiatrist &Talk Therapist
Greater Philadelphia 

Journaling helps us to find the words we need to express in writing what lies within us. When we write we are giving ourselves time, space and privacy to enable the kind of self-reflection that clarifies what we think and feel.

Journaling can be powerfully healing. For some, journaling can be the start of a habit of thoughtfulness and inner awareness. It can be a means of self analysis: in a sense, through journaling we become both patient and therapist. Journaling is a psychotherapy tool whose price is right, especially in tough economic times.

Journaling can feel like we are talking to a friend on the paper. It can give voice to sadness or protest that we don’t feel quite ready to share with others. We can journal to lessen the pressure of feelings in the here and now.  Journaling can prepare us for encounters that we must ultimately face.  We can journal about possible ways to manage problems and tense communication with others. We can also journal about past events such as complicated traumatic experiences and about our life journey.

Although writing cannot totally replace the guidance of professional help, when we are in therapy, journaling can be like an extra session that we give to ourselves. Journaling can make us more active partners in our professional therapy. It can enrich the information that we bring to the therapy session. Because it enables us to keep our focus on the issues of therapy in between sessions, it can help us make progress with fewer or less frequent sessions.

Writing, like therapy itself, is never totally complete or perfect, nor is it meant to be. We should practice going over what we have written not to correct the grammar and spelling but to make it clearer, more focused and as close as possible to the heart of what we mean. Finding ever more accurate words is like working over time with a clay model, remolding it so as to more truly express our inner vision.

Writing about trauma can help to drain off a lot of the emotional pain associated with it and to lessen its intrusion into life today. Writing about formative life experiences can help us to understand the inner and often hidden person within ourselves, giving us a chance to see clearly the difference between our past and our present and helping us to get a grip on the emotional overreactions and senseless but repetitive fears that occur in everyday life.

I hope this is of help.

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Jerrold Bonn, M.D.
Psychiatrist – Talk Therapist
Greater Philadelphia

Almost every smoker wants to quit, but for so many people the process of quitting seems daunting and beyond reach.

To get a handle on the problem of smoking, it can be helpful to see it as two problems:

1. Physical addiction: enduring the painful physical withdrawal from nicotine. If this were the only problem, using the nicotine withdrawal patch alone would ease people through it.
2. Behavioral dependence: smokers are psychologically dependent on the physical act of smoking for relief from their daily stress.

In treating people with stress and anxiety disorders over the years I have been struck again and again by how physically tense and constricted a smoker is when he or she is without access to smoking. It is as if the smoker simply cannot relax and breathe fully when only smoke-free air is available.  To relax, it seems that the smoker wants only the smoky air to calm nerves and soothe the body’s muscles. Deep breathing, done without a cigarette, is unnatural to a smoker.  The smoker may think that she will cough uncontrollably if she draws pure air. A smoker may believe that his lungs are not prepared for pure air.  Most cigarette smokers separate their lives into two zones:  a cigarette-free zone of mental tension and tight muscles, and smoking zone where they can relax and loosen mind and body.

For many smokers, it is almost as though they believe they cannot relax unless they are smoking.

Smokers need to know that the same calming kind of breath that they take when they are dragging deeply on a cigarette is no different than what non-smokers are doing when they reach out for calmness by taking a deep breath.  Before trying to kick the physical addiction, I strongly recommend that smokers first learn how to break the behavioral pattern by learning to breathe deeply without a cigarette. Once they get the knack of taking breathing breaks without cigarettes, the use of the patch can then get many over the hump rather quickly.

For some, learning to deeply inhale the scent of an aromatic oil will do enable the smoker to tolerate deep breathing without cigarette smoke.

Of course, smokers who quit shouldn’t even try an occasional smoke. In the fight against smoking addiction, one can never be “a little pregnant.”  One cigarette a day often leads quickly back to the old habit. A helpful resolution is to vow never to light a match to tobacco ever again. Millions have quit and you can be one of them. 

I hope this is of help.

Jerrold Bonn, M.D.
Psychiatrist & Talk Therapist
Greater Philadelphia

There are many facts about relationships that are sometimes obvious to people and sometimes not.

The most important fact about relationships is often not apparent to many people who suffer with relational problems: no matter how much emotional pain we may suffer in relationships, we also have a great impact on how others feel by how we talk and behave, positively or negatively. We can be so absorbed by our own pain and self pity that we are blind to our own power to impact others.  When we open our eyes to our own relational power, answers to our relational problems come into focus for us.

Instead of obsessing about rejection, we can open our eyes to the fact that many people are shy to some degree.  Behavioral tools exist to make the world a more comfortable place. For instance, we can learn to be the first person in a situation to convey a positive greeting, however short and simple.  Maybe it is just eye contact.  Maybe it is a slight smile.  Maybe it is a short “Hello.”  Simple gestures like this convey respect and interest in others (others who may also be shy),  and trigger positive responses.  Those positive responses will trigger our own good feelings.  Shy people can discover a social power they never knew they had, one small step at a time. They need not strive to be a talk-show host or the life of the party.

Another important issue in relationships is that we need to try to trust in the idea that people really can’t see beneath our skin nor do they usually care to. Others cannot know what we deeply feel and think and we similarly cannot correctly guess most of another person’s deepest thoughts and feelings.

People who claim to know you inside and out just don’t. They are blowing smoke. Because there is much that others can never know, what they think about you is never as valid as what you know about yourself.

Other basic facts about relationships can add to our relational IQ:

It makes sense to consider that there is often a world of sensitivity, vulnerability, knowledge and potential good will in the other person, no matter what the other’s station in life.
We think well of people and they think well of us essentially to the extent that we each bring something positive into the lives of the other. People are almost always neutral to us if we do not affect them and hostile to us if we are seen as bringing something detrimental to them. The art of being likeable is therefore an art that is accessible to all of us.

In relationships, everything begets the same thing. Relationally we reap what we sow and almost instantly:

• Generosity begets generosity
• Attack begets attack
• Warmth begets warmth
• ‘Attitude’ begets ‘attitude’
• Trust begets trust
• Raised voice begets raised voice

Married and romantic relationships, like gardens, need to be tended to by each partner to keep alive the memory of the mutual goodwill that gave it birth. Marriage and in romance are built on a mutual hope of a better life with the other and remains so over the life of the relationship. Time always brings its load of problems, responsibilities and sometimes tragedy, but in taking time to remember the magic of the initial images of hope and giving, the partners can retain the sense that what gave rise to their union remains enduring.    

I hope this is of help to you.

Jerrold Bonn, M.D.
Psychiatrist & Talk Therapist
Greater Philadelphia

Good sleep is as vital to good mental health as good nutrition is to physical health. Good sleep supports effective coping with daily challenges.

When we are stressed by daily demands on our minds and bodies, getting and maintain good sleep can be difficult. When we feel that we are constantly fighting the clock, we often regard sleep as one more task to be done by somehow forcing ourselves.  Hard-driving people view sleep as one more job to worry about accomplishing.  Worrying about getting to sleep has complications, and can induce reliance on self-medication and counterproductive behavior.

Removing the pressure of sleep problems may require renegotiating how we share responsibilities with people in our personal and professional lives. It may require instituting brief breaks during the day in order to re-focus and re-gain perspective.  Even the shortest break allows us to coax physical tension out of our muscles.  A two minute break – something as simple as focusing on a photo of a child or pet or vacation spot – allows us to re-set our outlook. 

To gain a better chance at solid, natural sleep, we may need to heighten our awareness of our need for modest but vital rewards before, during and after our work day.  These rewards renew body, mind and spirit.  In the morning, allow yourself three minutes to plan these simple breaks for the day, and enforce these little breaks.  In the long term, these breaks are investments that will pay off.

Everyone needs to experience some reward each day in order to slumber easily and solidly.  Try to create small rewards throughout the day.  These rewards can be physical and they can be mental.  A physical reward might be a walk around the office to relieve the tightness of sitting in front of a computer.  It might be a walk around the block.  It might be going out to lunch.  It might be standing next to one’s desk on tippy-toes.  It might be a warm shower before bed. It might be a bottle of cold spring water. A mental reward might be a one minute look at your child’s artwork, or a glance at a photo of a  hoped-for vacation spot. It might be a look at the newspaper.  It might be fifteen minutes with a book, or some gentle music. 

The cues to yourself for small rewards can be slight, but they must be regular.  A routine before bed helps most people.  Make your bedroom a stress-free zone.  Handle your problems elsewhere.  Don’t leave reminders of your work and your problems in your bedroom. Throughout the day and especially in the half-hour before we try to sleep, we need to lose physical tension and gain perspective.  In doing so, we have a chance at easy sleep.

For some, late night eating or alcohol or drugs are their only rewards after a stressful day.  But these may impede easy and natural sleep in the long run.  They may create more anxiety, more stress, and stomach upset.   Better rewards are immersion in the senses…things like music, movement, touch, nature and pleasant aroma.

No matter how much we are inclined to push ourselves, pushing for sleep is counterproductive.  One simply cannot will it.  We need to create routines for regular re-setting of mind and body throughout the day.  Without these consistent, though minor, physical and mental rewards, getting quality and well timed sleep will often be a struggle. Once we have taken control of our re-focusing and reward issues, sleep medicines are no longer our only tools for sleep.  Better tools can be created.

***

In genuine, acute mental health crisis, stopping insomnia becomes an urgent issue. Although all of the behavioral ideas mentioned above remain important, using medication safely under a physician’s care to ensure sleep may be appropriate for some because insomnia itself rapidly can instigate or aggravate mental health crisis.  Medication is not for every patient, and self-medication can be dangerous.

Insomnia causes fatigue that undercuts daytime confidence in facing the crisis at hand.  It promotes a false but disturbing sense of helplessness and defeat, aggravating a depressed or even paranoid mood. Insomnia can expose us to negative repetitive thinking, agitation and exaggerated fears while lying helplessly in bed, aggravating anxiety and escalating apprehension into damaging personal over generalizations.

Good sleep is vital to good health and to restorative good mental health.

I hope this is of help.

Jerrold Bonn, M.D.
Psychiatrist & Talk Therapist
Greater Philadelphia