What is validation?

Validation is one way that we communicate acceptance of ourselves and others. Validation doesn’t mean agreeing or approving. When your best friend or a family member makes a decision that you really don’t think is wise, validation is a way of supporting them and strengthening the relationship while maintaining a different opinion. Validation is a way of communicating that the relationship is important and solid even when you disagree on issues.

Validation is the recognition and acceptance of another person’s thoughts, feelings, sensations, and behaviors as understandable.

Learning how to use validation effectively takes practice. Knowing the six levels of validation as identified by Marsha Linehan, Ph.D. will be helpful.

The first Level is Being Present.

There are so many ways to be present. Holding someone’s hand when they are having a painful medical treatment, listening with your whole mind and doing nothing but listening to a child describe their day in first grade, and going to a friend’s house at midnight to sit with her while she cries because a supposed friend told lies about her are all examples of being present.

Multi-tasking while you listen to your teenager’s story about his soccer game is not being present. Being present means giving all your attention to the person you are validating.

Being present for yourself means acknowledging your internal experience and sitting with it rather than “running away” from it, avoiding it, or pushing it away. Sitting with intense emotion is not easy. Even happiness or excitement can feel uncomfortable at times.

Often one of the reasons other people are uncomfortable with intense emotion is that they don’t know what to say. Just being present, paying complete attention to the person in a non-judgmental way, is often the answer. For yourself, being mindful of your own emotion is the first step to accepting your emotion.

The second level of validation is Accurate Reflection.

Accurate reflection means you summarize what you have heard from someone else or summarize your own feelings. This type of validation can be done by others in an awkward, sing-songy, artificial way that is truly irritating or by yourself in a criticizing way. When done in an authentic manner, with the intent of truly understanding the experience and not judging it, accurate reflection is validating.

Sometimes this type of validation helps someone sort through their thoughts and separate thoughts from emotions. “So basically I’m feeling pretty angry and hurt,” would be a self-reflection. “Sounds like you’re disappointed in yourself because you didn’t call him back,” could be accurate reflection by someone else.

Level Three is Mind-reading

Mind-reading is guessing what another person might be feeling or thinking. People vary in their ability to know their own feelings. For example, some confuse anxiety and excitement and some confuse excitement and happiness. Some may not be clear about what they are feeling because they weren’t allowed to experience their feelings or learned to be afraid of their feelings.

People may mask their feelings because they have learned that others don’t react well to their sensitivity. This masking can lead to not acknowledging their feelings even to themselves, which makes the emotions more difficult to manage. Being able to accurately label feelings is an important step to being able to regulate them.

When someone is describing a situation, notice their emotional state. Then either name the emotions you hear or guess at what the person might be feeling.

“I’m guessing you must have felt pretty hurt by her comment” is Level Three validation. Remember that you may guess wrong and the person could correct you. It’s her emotion and she is the only one who knows how she feels. Accepting her correction is validating.

Level Four is Understanding the Person’s Behavior in Terms of their History and Biology.

Your experiences and biology influence your emotional reactions. If your best friend was bitten by a dog a few years ago, she is not likely to enjoy playing with your German Shepherd. Validation at this level would be saying, “Given what happened to you, I completely understand you not wanting to be around my dog.”

Self-validation would be understanding your own reactions in the context of your past experiences.

Level Five is normalizing or recognizing emotional reactions that anyone would have. Understanding that your emotions are normal is helpful for everyone. For the emotionally sensitive person, knowing that anyone would be upset in a specific situation is validating. For example, “Of course you’re anxious. Speaking before an audience the first time is scary for anyone.”

Level Six is Radical Genuineness.

Radical genuiness is when you understand the emotion someone is feeling on a very deep level. Maybe you have had a similar experience. Radical genuineness is sharing that experience as equals.

Understanding the levels may be easy. Putting them into practice is often more difficult. Practice is the key to making validation a natural part of the way you communicate.

Consider this example

Joanna calls you and talks about her diet. She complains that she has eaten chocolate cake and other sweets and wants to eat more, but she doesn’t want to gain weight. What level of validation can you use?

Level 3 would be a good choice. Joanna didn’t mention any feelings though she is eating for emotional reasons. You could say, “Has something happened? My guess is you’re upset about something.” Then she might tell you that the cat she’s had for six months died yesterday. At that point you could use a Level 5 or 6, depending on how you feel about losing a pet.

When Shawna was a teenager, she almost drowned in a large pond. She was a poor swimmer and swam out further than she realized. When she stopped swimming, her feet couldn’t touch bottom and she swallowed water. She panicked and a friend swam to save her. Since that time she’s been afraid of water. A neighbor invited her to a pool party. A guy who was flirting with her pushed her into the pool and she panicked, even though she was only in waist high water. She tells you that she’s ashamed of her reaction and she hates being crazy.

Level 4 validation would work in this situation. “Given your history of almost drowning, of course you panicked when you were pushed into water. Anyone with a history of drowning would probably react the same way.”

Emotional Invalidation

Emotional invalidation is when a person’s thoughts and feelings are rejected, ignored, or judged. Invalidation is emotionally upsetting for anyone, but particularly hurtful for someone who is emotionally sensitive.

Invalidation disrupts relationships and creates emotional distance. When people invalidate themselves, they create alienation from the self and make building their identity very challenging.

Self-invalidation and invalidation by others make recovery from depression and anxiety particularly difficult. Some believe that invalidation is a major contributor to emotional disorders.

Most people would deny that they invalidate the internal experience of others. Very few would purposefully invalidate someone else. But well-intentioned people may be uncomfortable with intense emotions or believe that they are helping when they are actually invalidating.

In terms of self-invalidation, many people would agree they invalidate themselves, but would argue that they deserve it. They might say they don’t deserve validation. They are uncomfortable with their own humanness. The truth is that validation is not self-acceptance, it is only an acknowledgement that an internal experience occurred.

Verbal Invalidation

There are many different reasons and ways that people who care about you invalidate you. Here are just a few.

Misinterpreting What It Means to Be Close: Sometimes people think that knowing just how someone else feels without having to ask means they are emotionally close to that person. It’s like saying they know you as well as you know you, so they don’t ask, they assume, and may even tell you how you think and feel.

Misunderstanding What it Means to Validate: Sometimes people invalidate because they believe if they validate they are agreeing. A person can state, “You think it’s wrong that you’re angry with your friend,” and not agree with you. Validation is not agreeing. But because they want to reassure you they invalidate by saying, “You shouldn’t think that way.”

Wanting to Fix Your Feelings: “Come on, don’t be sad. Want some ice cream?” People who love you don’t want you to hurt so sometimes they invalidate your thoughts and feelings in their efforts to get you to feel happier.

Not Wanting to Hurt Your Feelings: Sometimes people lie to you in order to not hurt your feelings. Maybe they tell you that you look great in a dress that in truth is not the best style for you. Maybe they agree that your point of view in an argument when in fact they do not think you are being reasonable.

Wanting the Best for You: People who love you want the best for you. So they may do work for you that you could do yourself. Or they encourage you to make friends with someone who is influential when you don’t really enjoy the person, telling you that that person is a great friend when it’s not true. “You should be friends with her. She’ll be a good friend to you.”

There are also many different ways of invalidating. I’ve listed a few below.

Blaming: “You always have to be the cry-baby, always upset about something and ruin every holiday.” “Why didn’t you put gas in the car before you got home? You never think and always make everything harder.” Blaming is always invalidating. (Blaming is different from taking responsibility.)

Hoovering: Hoovering is when you attempt to vacuum up any feelings you are uncomfortable with or not give truthful answers because you don’t want to upset or to be vulnerable. Saying “It’s not such a big deal” when it is important to you is hoovering. Saying someone did a great job when they didn’t or that your friends loved them when they didn’t is hoovering. Not acknowledging how difficult something might be for you to do is hoovering. Saying “No problem, of course I can do that,” when you are overwhelmed, is hoovering.

Judging: “You are so overreacting,” and “That is a ridiculous thought,” are examples of invalidation by judging. Ridicule is a particularly damaging: “Here we go again, cry over nothing, let those big tears flow because the grass is growing.”

Denying: “You are not angry, I know how you act when you’re angry,” and “You have eaten so much, I know you aren’t hungry,” invalidate the other person by saying they don’t feel what they are saying they feel.

Minimizing: “Don’t worry, it’s nothing, and you’re just going to keep yourself awake tonight over nothing” is usually said with the best of intentions. Still the message is to not feel what you are feeling.

Non-verbal Invalidation

Nonverbal invalidation is powerful and includes rolling of the eyes and drumming of fingers in an impatient way. If someone checks their watch while you are talking with them, that is invalidating. Showing up at an important event but only paying attention to email or playing a game on the phone while there is invalidating, whether that is the message the person meant to send or not.

Nonverbal self-invalidation is working too much, shopping too much or otherwise not paying attention to your own feelings, thoughts, needs and wants.

Replacing Invalidation with Validation

The best way to stop invalidating others or yourself is by practicing validation.

Validation is never about lying. Or agreeing.

It’s about accepting someone else’s internal experience as valid and understandable. That’s very powerful.

This is a shortened version of the article published originally by Psychology Today: https://www.psychologytoday.com/blog/pieces-mind/201204/understanding-validation-way-communicate-acceptance

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Co to jest walidacja?

Kiedy potrzebna jest nam w zyciu walidacja?

Walidacja jest czesto niewidzialna czescia interakcji miedzyludzkich. Mozemy ja poczuc gdy jest i poczuc gdy jej nie ma. Kiedy ktoś wzrastał w unie-ważniającym środowisku i ma w zwyczaju ignorowanie, wyśmiewanie, szydzenie z własnych reakcji wewnętrznych (z wlasnych emocji czy myśli) to jest to oznaka braku samo-walidacji. Nie trudno zgadnac ze przyczyny tego typu sytuacji pochodza ze srodowiska w ktorym czlowiek sie wychowal. Jesli dostawalismy walidacje jako dzieci to bedziemy sami dawac walidacje innym.

Gdy cos zachodzi w naszym wnetrzu wtedy walidacja staje sie nam potrzebna aby w stosunku do samej/samego siebie zachowac uczciwosc. Walidacja nie dotyczy jednak tylko i wylacznie nas samych. Ona sie od nas tylko zaczyna. Walidacja przydaje się we wszelkich relacjach z innymi ludzmi np w relacji terapeutycznej, romantyczno-intymnej, w relacji rodzinnej rodzinnej, czy jeśli ktoś z twoich bliskich przechodzi przez okres cierpienia.
Cierpienie jest subiektywnym doświadczeniem (kazdy doswiadcza cierpienia na swoj sposob).

Cierpienie jest kwestią subiektywną, zarówno w postaci bolu fizycznego jak i w postaci bolu (cierpienia) psychicznego. Są osoby, które przeżyły piekło wielu traum, okropienstwa katastrof naturalnych (tajfuny, trzesienia ziemi, wybuch wulkanu, pozary lasow i utrate dachu nad glowa, etc) i nic im po tym nie zostalo na dluzej w ich psychice. Ale są tez takie osoby dla których odwołany koncert, czy ból brzucha są wielka tragedią. Walidacja polega na uznaniu prawdziwości doświadczenia tego wlasnie malego czy duzego bólu tej jednej konkretnej osoby. Dotyczy to “tragedii odwołanego koncertu” czy “strasznego bólu głowy”. W uznaniu subiektywnego cierpienia związanego z tymi wydarzeniami chodzi o zauwazenie tego co doswiadcza drugi czlowiek. Nie oznacza to, że jako rozmowca zgadzasz się z tym punktem widzenia. Oznacza to tylko, że słyszysz, widzisz, rozumiesz i pozwalasz aby takie odczucia docieraly do ciebie jako prawdziwe i zaistniale w rzeczywistosci.

Mamy 6 poziomów walidacji

W terapii dialektyczno-behawioralnej Marsha Linehan (tworca terapii) wyróżnia 6 poziomów walidacji. Ta „technika” uzywania walidacji w relacjach miedzyludzkich nie ogranicza się do stosowania jej tylko w stosunku ludzi z problemami psychicznymi. Istnieja ogromne ilosci danych o tym ze każdy czerpie bardzo duza satysfakcje z doswiadczenia walidacji na wlasnej skorze. Taki sposob reagowania na drugą osobę poprawi każdą relację miedzyludzka.

Poziom 1

Pierwszy poziom walidacji to bycie obecnym w 100%, pelna uwaga, nawet jeśli po drugiej stronie są intensywne emocje: bliska ci osoba np krzyczy, płacze, rozpacza, a ty jesteś obok i rozumiesz jej cierpienie ale jednoczesnie nie mówisz tej osobie, że ma się uspokoić, czy opanować.

Poziom 2

Drugi poziom walidacji to prawidłowe odbijanie jak lustro tego co się usłyszało od drugiej osoby. Odbijamy obraz własnymi słowami: twoja przyjaciółka/ przyjaciel rozstaje się z toksycznym partnerem i bardzo cierpi wiec ty zamiast powiedzieć, „nareszcie” mówisz: „widzę, że cierpisz z powodu rozstania”.

Poziom 3

Trzeci poziom walidacji to odczytanie czyjegoś zachowania i odgadnięcie, co ta osoba czuje: osoba opowiada jak to spotkała się ze swoim byłym partnerem, który nie chce oddać jej/ jemu rzeczy, a ty mówisz: „domyślam się, że spotkanie z byłym było przykre/ frustrujące i uważasz, że on/ona zachowuje się nie fair wobec ciebie.

Poziom 4

Czwarty poziom walidacji to zrozumienie zachowania, które w tej chwili nie jest naj (optymalne) ale ma to sens w kontekście historii życia tej konkretnej osoby i jej uwarunkowań biologicznych. Na przykład, jeśli ktoś mial poważny wypadek na nartach, to mógł się potem zrazić do sportów zimowych, i unikać zimowego wyjazdu ze znajomymi na narty. Z kolei ktoś wychowywany przez bardzo krytycznych rodziców, może być bardzo wrażliwy na krytykę. Rozumiem, że trudno ci było na spotkaniu z szefem, kiedy mówił o tym, że twój projekt nie został wybrany, biorąc pod uwagę twojego krytykującego cię od zawsze ojca, to musiało być wyjątkowo przykre miec taka rozmowe z twoim szefem. Rozumiem dlaczego następnego dnia nie poszłaś/ poszedłeś do pracy.

Uwaga to nie oznacza, że akceptujemy to zachowanie, czy nie oczekujemy pracy nad jego zmianą! Mówimy tylko, że rozumiemy to przez co przechodzi druga osoba. Potem możemy poszukać razem w trakcie rozmowy wspólnych rozwiązań.

Poziom 5

Piąty poziom walidacji to znormalizowanie emocjonalnych reakcji, które miałby każdy, czyli powiedzenie, że to normalne denerwować się na pierwszej randce lub że każdy tak ma. Uwaga- nie dodawać: „nie przejmuj się” to jest unie-ważniające stress drugiego czlowieka zwiazany z ta konkretna sytuacja.

Poziom 6

Szósty poziom walidacji to traktowanie osoby w gorszej sytuacji zyciowej czy w kryzysie jako prawdziwej z prawdziwymi uczuciami, a nie jak kogoś z chorobą, kogos nienormalnego czy niezdolnego do radzenia sobie z własnymi problemami. Chodzi tu o traktowanie tej osoby jako czlowieka równego nam samym. Czyli na przykład zamiast proponowania rozwiązań pytamy: jak uważasz, co możesz zrobić, żeby wyjść z tej sytuacji?

Walidacja jawna i ukryta

Wyróżnia sie takze jeszcze 2 inne podtypy walidacji:
– Walidacja werbalna jawna, czyli te omowione poziomy walidacji wymienione powyżej ktore wyróżnila Marsha Linahan.

– Walidacje funkcjonalną ukryta, gdzie potwierdza się bardziej reakcja i czynami to co sie slyszy czy widzi (reczej niż słowami). Na przykład, kiedy ktoś ma problem ze znalezieniem mieszkania, pomaga mu się rozwiązać ten problem, czyli doprowadza się do sytuacji, że osoba ma wieksze szanse na znalezienie mieszkania.

Również mowa ciała i mimika twarzy to walidacja niejawna czyli jeśli ktoś jest smutny my również mamy odpowiedni wyraz twarzy w kontakcie z ta oasoba, jeśli ktoś opowiada nam o swoim sukcesie to okazujemy to na naszej twarzy I cieszymy się razem z nim. Oczywiście walidacja musi być szczera inaczej rozmowca czuje niedosyt i zmieszanie zamiast satysfakcji.

Walidacja wzmacnia relacje miedzyludzkie i akceptację siebie

Następnym razem, kiedy pomyślisz, że twoje emocje czy myśli są – nienormalne, irracjonalne czy dziwne spróbuj odnaleźć coś prawdziwego w tej swojej “nieakceptowanej” reakcji. Uznaj, że tak właśnie teraz jest. Uszanuj to, że tak teraz myślisz i czujesz. Tak samo zrób w stosunku do drugiej osoby. Znajdź coś prawdziwego w reakcji drugiej osoby i znajdź sposób, by wyrazić to uznanie. Czasami wystarczy tu sama obecność, bycie obok i empatyczne, pelne zrozumienia kiwanie głową.

Tekst przeedytowany na podstawie strony https://emocje.pro/psychoterapia-dialektyczno-behawioralna-uprawomocnienie/

How does the survivor prepare themselves for confrontation with the abuser?

The below described considerations refer to adult victims of childhood sexual abuse who might be considering confronting their abusers in adulthood.

Survivors seek support before confronting the parent abuser:
– Conversations with therapists about recovery including confrontation
– Conversations with the siblings about support in confrontation
– The threat of “the abuse news” to the integrity of the family
– Survivor expectation of abuser“ acknowledging (validating) and apologising”
– Family expectation of survivor “forgiving and forgetting”

The aim of the confrontation is to step out of the victim position
– The confrontation is optional to step out of the abuse related victim position
– the content is about validation of memories / consequences of the abuse for the survivor
– sometimes the confrontation happens spontaneously with no preparation
– it is important to consider the option of the false memory syndrome (wrongful accusation)

The power of the confrontation should belong to the survivor:
– it is the survivor who initiates the time, place and the form of the confrontation
– the place of the confrontation has to be safe for the survivor (own home, own work place, therapist office, a public place like a restaurant)
– effective confrontation can be done in therapy with/without the abuser being present
– effective confrontation can be done in a phone call/a letter without the abuser being present
– it is the survivor who wants to set the records about past straight
– it is the survivor who says things from herself about herself to the abuser operates from within her own integrity
– the confrontation is supposed to provide closure to the victim/ a finished business
– the confrontation is supposed to clarify the relationships within the family

The doubts of the survivor about confronting the abuser could be caused by:
– a fear of hurting abuser’s feelings
– a guilt about putting herself first, before the abuser
– uncertainty about the past events (amnesiacs)
– fear of unexpected health consequences of the abuser (heart attack, stroke, etc)
– fear of rejection of the memories of abuse by the parent
– fear of anger reaction of the abuser
– fear of being socially ostracised/abandoned by this parent or by the whole family

The survivor has to stay realistic about the denial of the abuse by the abuser, which grows along with the level of social condemnation of the crime that had been committed

Contents extracted from the book by Catherine Cameron “Resolving Childhood Trauma. A Long-Term Study of Abuse Survivors (the US population research)” (Year 2000, Sage Publishing), Chapter 12 – Confronting the Abuser

Jak dobrze przeprowadzic konfrontacje ze sprawca przemocy?

Ponizej zaprezentowany material dotyczy przygotowania sie do konfrontacji ze sprawca przez osobe pokrzywdzona. Tematem konfrontacji jest wykorzystanie seksualne dokonane przez sprawce na osobie pokrzywdzonej w dziecinstwie.

Osoby pokrzywdzone zwykle szukają wsparcia innych bliskich sobie osob przed skonfrontowaniem sie ze sprawcą wykorzystania:

– prowadza rozmowy przygotowawcze ze swoim terapeuta podczas spotkan terapii tak aby dobrze przygotowac sie do konfrontacji ze sprawca przemocy (moze tu miecmiejsce realna badz symboliczna konfrontacja),
– prowadza rozmowy ze swoim rodzeństwem na temat wspomnien i weryfikuja z nimi wspomnienia z przeszlosci aby uzyskac wsparcie w trakcie planowanej konfrontacji,
– podczas konfrontacji dochodzi do zagrożenia spojnosci/sily rodziny przez „rewelacje o nadużyciach” i rodzina czesto uruchamia mechanizm zaprzeczania prawdy co ma niby „ochronic” rodzine przed rozpadem,
– osoby pokrzywdzone oczekuja od sprawcy „przyznania sie do winy (potwierdzenia faktow) i przeprosin za to czego dokonal gdy one byly dziecmi”,
– rodzina oczekuje od osoby pokrzywdzonej „wybaczania i zapomnienia” co moze byc trudne do realizacji biorac pod uwage wieloletnie skutki przemocy na psychike osoby pokrzywdzonej.

Glownym celem konfrontacji jest wyjście osoby pokrzywdzonej z zajmowanej przez nia przez wiele lat (ukrytej lub jawnej) pozycji ofiary:

– osoba pokrzywdzona musi pamietac ze konfrontacja ze sprawca nie jest procesem bezwzglednie koniecznym aby skutecznie wyjść z pozycji ofiary,
– treść konfrontacji dotyczc powinna osobistych wspomnień oraz emocjonalnych i praktycznych konsekwencji nadużycia dla osoby pokrzywdzonej (nie mowimy tu „to ty jestes winny” ale „przez to co mi zrobiles bylam nie do zycia przez x lat, etc..),
– czasami konfrontacja dzieje sie spontanicznie bez przygotowania i tak tez moze spelnic swoja role i okazac sie byc skuteczna,
– dla osoby pokrzywdzonej ważne jest takze rozważenie opcji posiadania „falszywych wspomnien” (ktore moga prowadzic do oskarżania kogos kto faktycznie nic nikomu nie zrobil).

Konfrontacja powinna pozwolic osobie pokrzywdzonej odzyskac wewnetrzna sile aby o siebie walczyc zawsze gdy jest jej to w zyciu potrzebne:

– to osoba pokrzywdzona powinna zainicjowac czas, miejsce i formę konfrontacji ze sprawca przemocy,
– miejsce konfrontacji powinno być bezpieczne dla osoby pokrzywdzonej (np własny dom, własne miejsce pracy, znajomy gabinet terapeutyczny, znajome miejsce publiczne jak restauracja),
– skuteczna konfrontacja może być przeprowadzona w trakcie spotkania terapii z lub bez uczestnictwa sprawcy (technika dwoch krzesel),
– skuteczną konfrontację można przeprowadzic w formie rozmowy telefonicznej lub w formie listu bez koniecznosci widzenia sie twarza w twarz ze sprawca,
– celem konfrontacji jest potwierdzenie co faktycznie zaszlo w przeszlosci miedzy osoba pokrzywdzona a sprawca,
– osoba pokrzywdzona powinna w trakcie konfrontacji mówic od siebie o sobie samej (to ja cierpialam, to mnie dreczyly koszmary, to ..) co pozwala osobie pokrzywdzonej zachowac spojnosc wewnetrzna,
– konfrontacja ma za zadanie zapewnić zakonczenie procesu mocowania sie osoby pokrzywdzonej z przeszloscia oraz zamknięcie niewyjasnionej sprawy miedzy osoba pokrzywdzona a sprawca raz na zawsze,
– konfrontacja ma na celu wyjaśnienie i nazwanie skomplikowanych relacji miedzy poszczegolnymi czlonkami rodziny osoby pokrzywdzonej.

Wątpliwości co do pomyslu nt konfrontacji ze sprawca mogą być spowodowane:

– strachem osoby pokrzywdzonej przed emocjonalnym zranieniem sprawcy (szczegolnie gdy jest to rodzic),
– poczuciem winy osoby pokrzywdzonej z powodu postawienia sibie samej na pierwszym miejscu przed sprawcą (szczegolnie gdy jest to rodzic),
– niepewnościa osoby pokrzywdzonej co do tego czy faktycznie doszlo do naduzycia seksualnego (moze miec tu miejsce czesciowa amnezja i niepewnosc co do realnosci wlasnych wspomnien),
– strachem osoby pokrzywdzonej przed nieoczekiwanymi konsekwencjami zdrowotnymi „rewelacji z przeszlosci” dla sprawcy (zawał serca, udar, itp.),
– strachem pspby pokrzywdzoenej przed zaprzeczeniem przez sprawce nt jakichkolwiek naduzyc,
– stracemh osoby pokrzywdzonej przed pelna gniewu i agresji reakcją sprawcy na „rewelacje”,
– strachem osoby pokrzywdzonej przed zostaniem odrzucona lub porzucona przez sprawce (szczegolnie jesli sprawca to opiekun z dziecinstwa) lub przed zostanie odrzucona lub porzucona przez całą swoja rodzinę.

Osoba pokrzywdzona musi pozostać realistą jesli chodzi o mozliwosc zaprzeczania nadużyciom przez sprawce przemocy. Sprawcy przemocy tym bardziej zaprzeczaja ze czegos nie zrobili im wyzszy jest poziom społecznego potępienia popełnionego przez nich czynu.

Powyzsze tresci pochodza z książki autorstwa Catherine Cameron „Leczenie Traumy z Przeszlosci. Długoterminowe badanie przeprowadzone na grupie osob wykorzystywanych seksualnie w dziecinstwie (na populacji pacjentow w USA)”(rok wydania: 2000, Sage Publishing), Rozdział 12 – Konfrontacja ze sprawca przemocy

Staying awake: the surprisingly effective way to treat depression (republished)


Using sleep deprivation to lift people out of severe depression may seem counter-intuitive, but for some people, it’s the only thing that works. Linda Geddes reports.

The first sign that something is happening is Angelina’s hands. As she chats to the nurse in Italian, she begins to gesticulate, jabbing, moulding and circling the air with her fingers. As the minutes pass and Angelina becomes increasingly animated, I notice a musicality to her voice that I’m sure wasn’t there earlier. The lines in her forehead seem to be softening, and the pursing and stretching of her lips and the crinkling of her eyes tell me as much about her mental state as any interpreter could.

Angelina is coming to life, precisely as my body is beginning to shut down. It’s 2am, and we’re sat in the brightly lit kitchen of a Milanese psychiatric ward, eating spaghetti. There’s a dull ache behind my eyes, and I keep on zoning out, but Angelina won’t be going to bed for at least another 17 hours, so I’m steeling myself for a long night. In case I doubted her resolve, Angelina removes her glasses, looks directly at me, and uses her thumbs and forefingers to pull open the wrinkled, grey-tinged skin around her eyes. “Occhi aperti,” she says. Eyes open.

This is the second night in three that Angelina has been deliberately deprived of sleep. For a person with bipolar disorder who has spent the past two years in a deep and crippling depression, it may sound like the last thing she needs, but Angelina – and the doctors treating her – hope it will be her salvation. For two decades, Francesco Benedetti, who heads the psychiatry and clinical psycho-biology unit at San Raffaele Hospital in Milan, has been investigating so-called wake therapy, in combination with bright light exposure and lithium, as a means of treating depression where drugs have often failed. As a result, psychiatrists in the USA, the UK and other European countries are starting to take notice, launching variations of it in their own clinics. These ‘chrono-therapies’ seem to work by kick-starting a sluggish biological clock; in doing so, they’re also shedding new light on the underlying pathology of depression, and on the function of sleep more generally.

“Sleep deprivation really has opposite effects in healthy people and those with depression,” says Benedetti. If you’re healthy and you don’t sleep, you’ll feel in a bad mood. But if you’re depressed, it can prompt an immediate improvement in mood, and in cognitive abilities. But, Benedetti adds, there’s a catch: once you go to sleep and catch up on those missed hours of sleep, you’ll have a 95 per cent chance of relapse.

The antidepressant effect of sleep deprivation was first published in a report in Germany in 1959. This captured the imagination of a young researcher from Tübingen in Germany, Burkhard Pflug, who investigated the effect in his doctoral thesis and in subsequent studies during the 1970s. By systematically depriving depressed people of sleep, he confirmed that spending a single night awake could jolt them out of depression.

Benedetti became interested in this idea as a young psychiatrist in the early 1990s. Prozac had been launched just a few years earlier, hailing a revolution in the treatment of depression. But such drugs were rarely tested on people with bipolar disorder. Bitter experience has since taught Benedetti that antidepressants are largely ineffective for people with bipolar depression anyway.

His patients were in desperate need of an alternative, and his supervisor, Enrico Smeraldi, had an idea up his sleeve. Having read some of the early papers on wake therapy, he tested their theories on his own patients, with positive results. “We knew it worked,” says Benedetti. “Patients with these terrible histories were getting well immediately. My task was finding a way of making them stay well.”

So he and his colleagues turned to the scientific literature for ideas. A handful of American studies had suggested that lithium might prolong the effect of sleep deprivation, so they investigated that. They found that 65 per cent of patients taking lithium showed a sustained response to sleep deprivation when assessed after three months, compared to just 10 per cent of those not taking the drug.

Since even a short nap could undermine the efficacy of the treatment, they also started searching for new ways of keeping patients awake at night, and drew inspiration from aviation medicine, where bright light was being used to keep pilots alert. This too extended the effects of sleep deprivation, to a similar extent as lithium.

“We decided to give them the whole package, and the effect was brilliant,” says Benedetti. By the late 1990s, they were routinely treating patients with triple chrono-therapy: sleep deprivation, lithium and light. The sleep deprivations would occur every other night for a week, and bright light exposure for 30 minutes each morning would be continued for a further two weeks – a protocol they continue to use to this day. “We can think of it not as sleep-depriving people, but as modifying or enlarging the period of the sleep–wake cycle from 24 to 48 hours,” says Benedetti. “People go to bed every two nights, but when they go to bed, they can sleep for as long as they want.”

San Raffaele Hospital first introduced triple chrono-therapy in 1996. Since then, it has treated close to a thousand patients with bipolar depression – many of whom had failed to respond to antidepressant drugs. The results speak for themselves: according to the most recent data, 70 per cent of people with drug-resistant bipolar depression responded to triple chrono-therapy within the first week, and 55 per cent had a sustained improvement in their depression one month later.

And whereas antidepressants – if they work – can take over a month to have an effect, and can increase the risk of suicide in the meantime, chrono-therapy usually produces an immediate and persistent decrease in suicidal thoughts, even after just one night of sleep deprivation.

Angelina was first diagnosed with bipolar disorder 30 years ago, when she was in her late 30s. The diagnosis followed a period of intense stress: her husband was facing a tribunal at work, and they were worried about having enough money to support themselves and the kids. Angelina fell into a depression that lasted nearly three years. Since then, her mood has oscillated, but she’s down more often than not. She takes an arsenal of drugs – antidepressants, mood stabilisers, anti-anxiety drugs and sleeping tablets – which she dislikes because they make her feel like a patient, even though she acknowledges this is what she is.

If I’d met her three days ago, she says, it’s unlikely I would have recognised her. She didn’t want to do anything, she’d stopped washing her hair or wearing make-up, and she stank. She also felt very pessimistic about the future. After her first night of sleep deprivation, she’d felt more energetic, but this largely subsided after her recovery sleep. Even so, today she felt motivated enough to visit a hairdresser in anticipation of my visit. I compliment her appearance, and she pats her dyed, golden waves, thanking me for noticing.

At 3am, we move to the light room, and entering is like being transported forward to midday. Bright sunlight streams in through the skylights overhead, falling on five armchairs, which are lined up against the wall. This is an illusion, of course – the blue sky and brilliant sun are nothing more than coloured plastic and a very bright light – but the effect is exhilarating nonetheless. I could be sitting on a sun lounger at midday; the only thing missing is the heat.

When I’d interviewed her seven hours earlier, with the help of an interpreter, Angelina’s face had remained expressionless as she’d replied. Now, at 3.20am, she is smiling, and even beginning to initiate a conversation with me in English, which she’d claimed not to speak. By dawn, Angelina’s telling me about the family history she’s started writing, which she’d like to pick up again, and inviting me to stay with her in Sicily.

How could something as simple as staying awake overnight bring about such a transformation? Unpicking the mechanism isn’t straightforward: we still don’t fully understand the nature of depression or the function of sleep, both of which involve multiple areas of the brain. But recent studies have started to yield some insights.

The brain activity of people with depression looks different during sleep and wakefulness than that of healthy people. During the day, wake-promoting signals coming from the circadian system – our internal 24-hour biological clock – are thought to help us resist sleep, with these signals being replaced by sleep-promoting ones at night. Our brain cells work in cycles too, becoming increasingly excitable in response to stimuli during wakefulness, with this excitability dissipating when we sleep. But in people with depression and bipolar disorder, these fluctuations appear dampened or absent.

Depression is also associated with altered daily rhythms of hormone secretion and body temperature, and the more severe the illness, the greater the degree of disruption. Like the sleep signals, these rhythms are also driven by the body’s circadian system, which itself is driven by a set of interacting proteins, encoded by ‘clock genes’ that are expressed in a rhythmic pattern throughout the day. They drive hundreds of different cellular processes, enabling them to keep time with one another and turn on and off. A circadian clock ticks in every cell of your body, including your brain cells, and they are coordinated by an area of the brain called the suprachiasmatic nucleus, which responds to light.

“When people are seriously depressed, their circadian rhythms tend to be very flat; they don’t get the usual response of melatonin rising in the evening, and the cortisol levels are consistently high rather than falling in the evening and the night,” says Steinn Steingrimsson, a psychiatrist at Sahlgrenska University Hospital in Gothenburg, Sweden, who is currently running a trial of wake therapy.

Recovery from depression is associated with a normalisation of these cycles. “I think depression may be one of the consequences of this basic flattening of circadian rhythms and homeostasis in the brain,” says Benedetti. “When we sleep-deprive depressed people, we restore this cyclical process.”

But how does this restoration come about? One possibility is that depressed people simply need added sleep pressure to jump-start a sluggish system. Sleep pressure – our urge to sleep – is thought to arise because of the gradual release of adenosine in the brain. It builds up throughout the day and attaches to adenosine receptors on neurons, making us feel drowsy. Drugs that trigger these receptors have the same effect, whereas drugs that block them – such as caffeine – make us feel more awake.

To investigate whether this process might underpin the antidepressant effects of prolonged wakefulness, researchers at Tufts University in Massachusetts took mice with depression-like symptoms and administered high doses of a compound that triggers adenosine receptors, mimicking what happens during sleep deprivation. After 12 hours, the mice had improved, measured by how long they spent trying to escape when forced to swim or when suspended by their tails.

We also know sleep deprivation does other things to the depressed brain. It prompts changes in the balance of neurotransmitters in areas that help to regulate mood, and it restores normal activity in emotion-processing areas of the brain, strengthening connections between them.

And as Benedetti and his team discovered, if wake therapy kick-starts a sluggish circadian rhythm, lithium and light therapy seem to help maintain it. Lithium has been used as a mood stabiliser for years without anyone really understanding how it works, but we know it boosts the expression of a protein, called Per2, that drives the molecular clock in cells.

Bright light, meanwhile, is known to alter the rhythms of the suprachiasmatic nucleus, as well as boosting activity in emotion-processing areas of the brain more directly. Indeed, the American Psychiatric Association states that light therapy is as effective as most antidepressants in treating non-seasonal depression.

In spite of its promising results against bipolar disorder, wake therapy has been slow to catch on in other countries. “You could be cynical and say it’s because you can’t patent it,” says David Veale, a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust.

Certainly, Benedetti has never been offered pharmaceutical funding to carry out his trials of chronotherapy. Instead, he has – until recently – been reliant on government funding, which is often in short supply. His current research is being funded by the EU. Had he followed the conventional route of accepting industry money to run drug trials with his patients, he quips, he probably wouldn’t be living in a two-bedroom apartment and driving a 1998 Honda Civic.

The bias towards pharmaceutical solutions has kept chronotherapy below the radar for many psychiatrists. “A lot of people just don’t know about it,” says Veale.

It’s also difficult to find a suitable placebo for sleep deprivation or bright light exposure, which means that large, randomised placebo-controlled trials of chronotherapy haven’t been done. Because of this, there’s some scepticism about how well it really works. “While there is increasing interest, I don’t think many treatments based on this approach are yet routinely used – the evidence needs to be better and there are some practical difficulties in implementing things like sleep deprivation,” says John Geddes, a professor of epidemiological psychiatry at the University of Oxford.

Even so, interest in the processes underpinning chronotherapy is beginning to spread. “Insights into the biology of sleep and circadian systems are now providing promising targets for treatment development,” says Geddes. “It goes beyond pharmaceuticals – targeting sleep with psychological treatments might also help or even prevent mental disorders.”

In the UK, the USA, Denmark and Sweden, psychiatrists are investigating chronotherapy as a treatment for general depression. “A lot of the studies that have been done so far have been very small,” says Veale, who is currently planning a feasibility study at Maudsley Hospital in London. “We need to demonstrate that it is feasible and that people can adhere to it.”

So far, what studies there have been have produced mixed results. Klaus Martiny, who researches non-drug methods for treating depression at the University of Copenhagen in Denmark, has published two trials looking at the effects of sleep deprivation, together with daily morning bright light and regular bedtimes, on general depression. In the first study, 75 patients were given the antidepressant duloxetine, in combination with either chronotherapy or daily exercise. After the first week, 41 per cent of the chronotherapy group had experienced a halving of their symptoms, compared to 13 per cent of the exercise group. And at 29 weeks, 62 per cent of the wake therapy patients were symptom-free, compared to 38 per cent of those in the exercise group.

In Martiny’s second study, severely depressed hospital inpatients who had failed to respond to antidepressant drugs were offered the same chronotherapy package as an add-on to the drugs and psychotherapy they were undergoing. After one week, those in the chronotherapy group improved significantly more than the group receiving standard treatment, although in subsequent weeks the control group caught up.

No one has yet compared wake therapy head-to-head with antidepressants; neither has it been tested against bright light therapy and lithium alone. But even if it’s only effective for a minority, many people with depression – and indeed psychiatrists – may find the idea of a drug-free treatment attractive.

“I’m a pill pusher for a living, and it still appeals to me to do something that doesn’t involve pills,” says Jonathan Stewart, a professor of clinical psychiatry at Columbia University in New York, who is currently running a wake therapy trial at New York State Psychiatric Institute.

Unlike Benedetti, Stewart only keeps patients awake for one night: “I couldn’t see a lot of people agreeing to stay in hospital for three nights, and it also requires a lot of nursing and resources,” he says. Instead, he uses something called sleep phase advance, where on the days after a night of sleep deprivation, the time the patient goes to sleep and wakes up is systematically brought forward. So far, Stewart has treated around 20 patients with this protocol, and 12 have shown a response – most of them during the first week.

It may also work as a prophylactic: recent studies suggest that teenagers whose parents set – and manage to enforce – earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light–dark cycle is important.

But sleep phase advance has so far failed to hit the mainstream. And, Stewart accepts, it’s not for everybody. “For those for whom it works, it’s a miracle cure. But just as Prozac doesn’t get everyone better who takes it, neither does this,” he says. “My problem is that I have no idea ahead of time who it’s going to help.”

Depression can strike anyone, but there’s mounting evidence that genetic variations can disrupt the circadian system to make certain people more vulnerable. Several clock gene variations have been associated with an elevated risk of developing mood disorders.

Stress can then compound the problem. Our response to it is largely mediated through the hormone cortisol, which is under strong circadian control, but cortisol itself also directly influences the timing of our circadian clocks. So if you have a weak clock, the added burden of stress could be enough to tip your system over the edge.

Indeed, you can trigger depressive symptoms in mice by repeatedly exposing them to a noxious stimulus, such as an electric shock, from which they can’t escape – a phenomenon called learned helplessness. In the face of this ongoing stress, the animals eventually just give up and exhibit depression-like behaviours. When David Welsh, a psychiatrist at the University of California, San Diego, analysed the brains of mice that had depressive symptoms, he found disrupted circadian rhythms in two critical areas of the brain’s reward circuit – a system that’s strongly implicated in depression.

But Welsh has also shown that a disturbed circadian system itself can cause depression-like symptoms. When he took healthy mice and knocked out a key clock gene in the brain’s master clock, they looked just like the depressed mice he’d been studying earlier. “They don’t need to learn to be helpless, they are already helpless,” Welsh says.

So if disrupted circadian rhythms are a likely cause of depression, what can be done to prevent rather than treat them? Is it possible to strengthen your circadian clock to increase psychological resilience, rather than remedy depressive symptoms by forgoing sleep?

Martiny thinks so. He is currently testing whether keeping a more regular daily schedule could prevent his depressed inpatients from relapsing once they’ve recovered and are released from the psychiatric ward. “That’s when the trouble usually comes,” he says. “Once they’re discharged their depression gets worse again.”

Peter is a 45-year-old care assistant from Copenhagen who has battled with depression since his early teens. Like Angelina and many others with depression, his first episode followed a period of intense stress and upheaval. His sister, who more or less brought him up, left home when he was 13, leaving him with an uninterested mother and a father who also suffered from severe depression. Soon after that, his father died of cancer – another shock, as he’d kept his prognosis hidden until the week before his death.

Peter’s depression has seen him hospitalised six times, including for a month last April. “In some ways being in hospital is a relief,” he says. However, he feels guilty about the effect it has on his sons, aged seven and nine. “My youngest boy said he cried every night I was in hospital, because I wasn’t there to hug him.”

So when Martiny told Peter about the study he had just started recruiting for, he readily agreed to participate. Dubbed ‘circadian-reinforcement therapy’, the idea is to strengthen people’s circadian rhythms by encouraging regularity in their sleep, wake, meal and exercise times, and pushing them to spend more time outdoors, exposed to daylight.

For four weeks after leaving the psychiatric ward in May, Peter wore a device that tracked his activity and sleep, and he completed regular mood questionnaires. If there was any deviation in his routine, he would receive a phone call to find out what had happened.

When I meet Peter, we joke about the tan lines around his eyes; obviously, he’s been taking the advice seriously. He laughs: “Yes, I’m getting outdoors to the park, and if it’s nice weather, I take my children to the beach, for walks, or to the playground, because then I will get some light, and that improves my mood.”

Those aren’t the only changes he’s made. He now gets up at 6 every morning to help his wife with the children. Even if he’s not hungry he eats breakfast: typically, yoghurt with muesli. He doesn’t take naps and tries to be in bed by 10pm. If Peter does wake up at night, he practises mindfulness – a technique he picked up in hospital.

Martiny pulls up Peter’s data on his computer. It confirms the shift towards earlier sleep and wake times, and shows an improvement in the quality of his sleep, which is mirrored by his mood scores. Immediately after his release from hospital, these averaged around 6 out of 10. But after two weeks they’d risen to consistent 8s or 9s, and one day, he even managed a 10. At the beginning of June, he returned to his job at the care home, where he works 35 hours a week. “Having a routine has really helped me,” he says.

So far, Martiny has recruited 20 patients to his trial, but his target is 120; it’s therefore too soon to know how many will respond the same way as Peter, or indeed, if his psychological health will be maintained. Even so, there’s mounting evidence that good sleep routine can help our mental wellbeing. According to a study published in Lancet Psychiatry in September 2017 – the largest randomised trial of a psychological intervention to date – insomniacs who underwent a ten-week course of cognitive behavioural therapy to address their sleep problems showed sustained reductions in paranoia and hallucinatory experiences as a result. They also experienced improvements in symptoms of depression and anxiety, fewer nightmares, better psychological wellbeing and day-to-day functioning, and they were less likely to experience a depressive episode or anxiety disorder during the course of the trial.

Sleep, routine and daylight. It’s a simple formula, and easy to take for granted. But imagine if it really could reduce the incidence of depression and help people to recover from it more quickly. Not only would it improve the quality of countless lives, it would save health systems money.

In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts.

A week after spending the night awake with Angelina, I call Benedetti to check her progress. He tells me that after the third sleep deprivation, she experienced a full remission in her symptoms and returned to Sicily with her husband. That week, they were due to be marking their 50th wedding anniversary. When I’d asked her if she thought her husband would notice any change in her symptoms, she’d said she hoped he’d notice the change in her physical appearance.

Hope. After she has spent more than half her life without it, I suspect its return is the most precious golden anniversary gift of all.

 

Author of the article: Linda Geddes, originally published on 22 Jan 2018 on https://mosaicscience.com

References

Fransesco Benedetti’s profile page at San Raffaele Hospital, with an overview of his research interests.

An overview of the effectiveness of different types of chronotherapy.

A 2013 paper by Benedetti and colleagues outlining the effectiveness of triple chronotherapy on drug-resistant bipolar depression.

An introduction to circadian rhythms, by the US National Institute of General Medical Sciences.

An article on understanding sleep, by the Cleveland Clinic.

 

Ukryte rany

Sa rany fizyczne, widoczne i sa rany duszy – niewidzialne slabosci wynikajace z niedoborow lub dramatow przeszlosci. Ter any sa zapisane w naszym umysle i w naszym ciele. Czasami sa to rany swiadome, czasami uspione. Slabosci te czynia z nas ludzi znajdujacych sie miedzy dwoma swiatami: swiatem pozornej normalnosci i swiatem skrytej anormalnosci.

Przez dlugi czas marzylismy o tym, zeby te rany, te slabosci, nie istnialy. Potem marzylismy, ze byc moze kiedys znikna: z biegiem zycia, z miloscia, z czasem. A dzisiaj, mimo wysilkow i mimo uplywu lat, musimy przyznac, ze one wciaz tu sa. Na dlugo. Byc moze na zawsze.

Uczymy sie wiec zapominac, nie myslec o nich, zachowywac sie tak, jakby nie istnialy. I na ogol to skutkuje. Potem, od czasu do czasu, pod wplywem stresu czy smutku, wszystko sie budzi, upiory znow wychodza z szafy.

Jesli mielismy depresje lub starchy czy paranoje albo inne zaburzenia emocjonalne, blizny sa uspione. Jestesmy tylko w sumie w fazie remisji. Poniewaz uplynal jakis czas, poniewaz sie zmienilismy, poniewaz zycie zlagodnialo. Kiedy jednak zycie staje sie surowsze, blizny znow sie otwieraja i powraca uczucie, ze moglibysmy zalamac sie, tak po prostu, na oczach wszystkich. Te chwile, w ktorych znow opanowuje nas to wszystko, co jest w nas “nie tak”, to nasze “wewnetrzne skrzyzowania”. Mozemy wtedy dzialac i stawiac temu czolo. W duzo wiekszym stopniu jest to mozliwe niz nam sie wydaje w tego typu sytuacji.

Dlatego wlasnie wprowadzono praktyke “medytacji uwaznosci” do swiata psychoterapii: zeby wesprzec to, co nazywa sie “prewencja nawrotow”. Tradycyjne terapie, takie jak psychoanaliza, i ich poglebiona refleksja na temat zrodel naszych cierpien nie wystarczaly. Nowsze terapie, jak terapie poznawcze i behawioralne, radzily sobie z tym lepiej, lecz niedoskonale. Zaproponowano wiec, aby dodac do wszystkich tych podejsc terapeutycznych i rozwiazan “prace z uwaznoscia”. Dzisiaj wyglada na to, ze to byl dobry pomysl; u osob praktykujacych uwaznosci nawroty wydaja sie rzadsze i mniej gwaltowne.

Uswiadomienie sobie ponownego uaktywnienia sie rozpaczliwych mysli w wyniku presji sytuacji i w wyniku pospiechu codziennego zycia pozwala nie ulegac tym myslom albo przynajmniej nie calkiem sie im poddac. Uswiadomienie sobie ponownego uaktywnienia sie rozpaczliwych mysli pozwala dokonac prawdziwego wyboru; wyboru by je uslyszec i mimo to pojsc dalej. Wyboru, by isc do przodu i czynic wysilki , nawet jesli te mysli szepcza nam, ze to ponad nasze sily, nawet jesli wrzeszcza bysmy zrezygnowali. Przede wszystkim nie ulegajmy tym myslom dzieki sile naszej woli.

Dzieki “pracy z uwaznoscia” nie dajemy sie osmielic tym rozkazom pochodzacym od nas samych. Gdy praktykujemy “uwaznosc” w chwilach zlego samopoczucia , umieszczamy te swoje zwatpienia, strachy i niepokoje w “przestrzeni uwaznosci”. Praktykujac “uwaznosc” takze gdy nie czujemy sie najgorzej, mierzymy sie bez presji sytuacji z malymi falami, by potem moc o wiele lepiej stawic czolo sztormom….

Poza tym, liczy sie tez to ze nie siedzimy z zalozonymi rekami. “Praca z uwaznoscia” ma sojusznikow – na przyklad “dzialanie”. Mozna postapic tak, jak w czasie wyczerpujacego marszu kiedy lapie nas pokusa, by sie zatrzymac gdy zatrzymanie sie nie jest mozliwe. Mozna w takiej sytuacji przykladowo schylic lekko glowe i isc naprzod , krok za krokiem, metr po metrze ale do przodu. Mozna “dzialac” i isc naprzod , nawet jesli nie jestesmy pewni, czy to przyniesie jakis pozytek. Mozna “dzialac” nawet nie majac pewnosci co do skutku swojego dzialania. Mozna “dzialac uwaznie” nie sluchajac podszeptow otaczajcych nas nakazow naszej wewnetrznej bezsilnosci. “Uwaznosc” pozwala nam wyczuc te nasze stare automatyzmy, ktore wylonily sie z przeszlosci i ktore staraja sie przejac wladze nad nami tu I teraz, nad nasza terazniejszoscia. “Uwaznosc” pozwala nam mimo wszystko isc dalej.

“Uwaznosc” pozwala nam pozostac w kontakcie ze swiatem ktory otacza nas “tu i teraz” (nie odcinamy sie od swiata). “Uwaznosc” pozwala nam podniesc glowe i przesiaknac wszystkim tym , co istnieje tu I teraz wokol nas. “Uwaznosc” pozwala zobaczyc nam jak ogarniaja nas mysli pelne zwatpienia – lecz – dzieki “uwaznosci” nie zamykamy sie z tymi myslami w naszym wnetrzu. Z “uwaznoscia” otwieramy szeroko drzwi i okna naszego umyslu na otaczajacy nas swiat.

[…]

Z “uwaznoscia” w “dzialaniu” wiemy, ze gdy jestesmy w uscisku nieszczescia , zastanawianie sie moze spowodowac jeszcze wiecej nieszczescia. Zatem “dzialanie” ze swiadomoscia “co jest dla nas dobre” (czyli “dzialanie” po namysle) jest tym, co ma dla nas najwiekszy sens. Potem nalezy pamietac aby “dzialac” z poczuciem calkowitej pokory, dzialac ze swiadomoscia “ ze to co robimy pomoze nam przezyc”.

“Dzialanie” takie mozna praktykowac przez aktywnosci dnia codziennego jak spacerowanie, zajecie sie roslinami w ogrodku, , posprzatanie w domu, ugotowanie zdrowego posilku, majsterkowanie, pracowanie. “Dzialanie” w takiej formie nie jest juz generowane po to by “uciec”. “Dzialanie” w takiej formie nie pojawia sie z braku lepszego pomyslu na to co by mozna bylo zrobic. “Dzialanie z uwaznoscia” jest podejmowane z premedytacja, z pelna swiadomoscia ze jesli “nie zrobimy nic” to zatoniemy. Takie “uwazne dzialanie” jest jedna z wielu aspektow naszego zycia.

Fragment pochodzi z ksiazki nt praktyki uwaznosci autorstwa Christophe Andre pt Medytacja dzien po dniu – 25 lekcji uwaznego zycia. Fragment zostal przeze mnie delikatnie przeredagowany.

Depression and genes

“Depression runs in families, we know. But it is only very recently, and after considerable controversy and frustration, that we are beginning to know how and why. The major scientific discoveries reported last week by the Psychiatric Genomics Consortium in Nature Genetics are a hard-won breakthrough in our understanding of this very common and potentially disabling disorder.

If your parents have been depressed, the chances that you have been or will be depressed are significantly increased. The background risk of depression in the general population is about one in four – each of us has a 25% chance of becoming depressed at some point in our lives. And if your parents have been depressed, your risk jumps by a factor of three.

However, controversy has long swirled around the question of nature or nurture. Is the depressed son of a depressed mother the victim of her inadequate parenting and the emotionally chilly, unloving environment she provided during the early years of his life? Or is he depressed because he inherited her depressive genes that biologically determined his emotional fate, regardless of her parenting skills? Is it nature or nurture, genetics or environment, which explain why depression runs in families?

In the 20th century, psychiatrists ingeniously teased out some answers to these questions. For example, it was found that pairs of identical twins, with 100% identical DNA, were more likely to have similar experiences of depression than were pairs of non-identical twins, with 50% identical DNA. This indicated clearly that depression is genetically heritable. But well into the 21st century, the precise identity of the “genes for depression” remained obscure. Since 2000, there has been a sustained international research effort to discover these genes, but the field has been bedevilled by false dawns and inconsistent results.

That is why the study published last week is such a significant milestone. For the first time, scientists around the world, with leading contributions from the UK’s world-class centres of psychiatric genetics research largely funded by the Medical Research Council at the University of Cardiff University, University of Edinburgh University and King’s College London, have been able to combine DNA data on a large enough sample to pinpoint which locations on the genome are associated with an increased risk of depression. So we now know, with a high degree of confidence, something important about depression that we didn’t know this time last year. We know that there are at least 44 genes, out of the 20,000 genes comprising the human genome, which contribute to the transmission of risk for depression from one generation to the next.

However, this raises at least as many issues as it resolves. Let’s first dwell on the fact that there are many risk genes, each of which contributes a small quantum of risk. In other words, there is not a single smoking gun, a solitary rogue gene that works like a binary switch, inevitably causing depression in those unfortunate enough to inherit it. More realistically, all of us will have inherited some of the genes for depression and our chances of becoming depressed will depend in part on how many and their cumulative impact. As research continues and even larger samples of DNA become available for analysis, it is likely that the number of genes associated with depression will increase further still.

Stress provokes an inflammatory response by the body, which causes changes in how the brain works

This is telling us that we shouldn’t be thinking about a black-and-white distinction between us and them, between depressed patients and healthy people: it is much more likely that our complex genetic inheritance puts all of us on a continuous spectrum of risk.

What are these genes and what do they tell us about the root causes of depression? It turns out that many of them are known to play important roles in the biology of the nervous system. This fits with the basic idea that disturbances of the mind must reflect some underlying disturbance of the brain.

More surprisingly, many of the risk genes for depression also play a part in the workings of the immune system. There is growing evidence that inflammation, the defensive response of the immune system to threats such as infection, can cause depression. We are also becoming more aware that social stress can cause increased inflammation of the body. For decades we’ve known that social stress is a major risk factor for depression. Now it seems that inflammation could be one of the missing links: stress provokes an inflammatory response by the body, which causes changes in how the brain works, which in turn cause the mental symptoms of depression.

Knowing the risk genes for depression also has important implications for practical treatment. There have been no major advances in treatment for depression since about 1990, despite it being the major single cause of medical disability in the world. We need to find new ways forward therapeutically and new genetics is a great place to start the search for treatments that can cut through more precisely to the cause or mechanism of depression. It is easy to imagine how new antidepressant drugs could in future be designed to target inflammatory proteins coded by depression risk genes. It is exciting to think that the new genetics of depression could unlock therapeutic progress in psychiatry as well.

Finally, although I think these genetic discoveries are fundamental, I don’t see them as ideologically divisive. They don’t prove that depression is “all in the brain” or that psychological treatment is pointless. The genetics will be biologically pre-eminent but, as we understand more about what all these “genes for depression” do, we may discover that many of them control the response of the brain or the body to environmental stress. In which case, the treatment that works best for an individual patient could be a drug targeting a gene or intervention targeting an environmental factor such as stress.

In short, I believe that a deeper understanding of the genetics of depression will lead us beyond the question we started from: is it nature or nurture, gene or environment? The answer will turn out to be both”.

Author: Edward Bullmore is head of the department of psychiatry, Cambridge University and author of The Inflamed Mind (Short Books). This article has been originally published on 29 Apr 2018 by The Guardian