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[THE DOCTOR IS IN]

Dr. Matt Conner

Even though Movember is over, our commitment to our readers health, mental and otherwise, is far from over. I would like to share Dr. Matt Conner’s final Movember contribution with you. If you haven’t seen his previous articles, I would highly recommend reading his take on avoidance, baggage, and boundaries. Today we learn about responsibility.

I was telling Matt that I’ve learned some of these lessons myself over the years, though I haven’t been able to articulate them as eloquently or succinctly as he has. Other insights he shared were revelations to me. Which is weird, because they are all so simple and make so much since, but unless you’re actively thinking or aware of them it is often difficult to see these simple solutions in emotionally-charged situations.

There are certainly relationships and problems I have had in the past, that it would have been wonderful to have Dr. Matt’s advice in my toolkit. But, as we learn today, I shouldn’t lament the mistakes of the past. I can only learn lessons, move forward, and apply them in situations to come.

If you found these articles helpful, please join me in thanking Dr. Conner in the comments on this and his other articles. He doesn’t know this yet, but I plan to ask him to continue contributing these on a monthly or any other temporal basis he desires; because these have been truly wonderful. I am grateful for his friendship and taking the time to share with us all here.

Jared A. Godar

In the first three weeks of Movember, we covered avoidance, baggage, and boundaries. My plan was to cover responsibility for the fourth week, I swear. But I didn’t, and Jared offered to post my last article a week late. And I’m going to explain that as an example of responsibility, but in the meantime, check out this amazing track by Ron Pope—the themes have a lot in common. You’ll see.

Remember last time I talked about the language of boundaries: I am not responsible for my thoughts, feelings, or beliefs; and I have no control over any other person’s. But I am accountable for my decisions. I can’t help it if you remind me of my third-grade teacher who was so mean. You didn’t know her, you didn’t get that haircut on purpose; but hey, I see the connections I see. What I can help is whether I choose to let my attention stay on those thoughts or make an effort to redirect to you, right now, in this space, whatever your haircut looks like. What I can help is whether I shift into closed-off body language or fake like I’m fine or say, “I’m so sorry, you remind me of someone I used to know, this is weird. Anyway, what were we talking about?” See? I can’t take responsibility for your choices, nor can I give up responsibility for mine.

I couldn’t say if I loved her
or if we were not there yet
we were young
and living on lies and cigarettes

Ron Pope—”Lies and Cigarettes”

Something I see in a lot of the people who come to my clinic is regret. Men talk about having cheated on their spouses, having gotten away with small crimes, having picked a college for a dumb reason and then had to live with that decision. We touched this in the piece about baggage, holding on to memories of the one that got away. But what happens when you’re holding on to bad behavior? When you were “young and living on lies and cigarettes?”

Well, if it’s affecting you in 2018, then 2018 is a great year to take some responsibility for it. If it’s a bad decision you’re still making, you are responsible for recognizing it and seeking the help you need to stop. One of the most frustrating challenges for a therapist is when someone wants to simultaneously maintain the affair he’s in as well as a healthy, happy, relationship with the spouse he’s lying to. It’s common practice in these situations to halt therapy until the client can make up his mind about which side he wants help with—ending the affair and fixing the problems in the marriage that made him vulnerable to it, or keeping the affair and honestly admitting to his partner that he is finding love and sex outside their agreement and that they either need to change their expectations about monogamy or break up. I know, “it’s not that simple.” But it’s not that much more complicated, Casanova.

Let’s say you’ve already done that. You made a decision, it stopped, but you’re haunted by having made it. You kept dating that person a couple months after you realized you didn’t love her. You fudged a number on your 2014 taxes. You “wasted” time on a grad degree you’re not using now. You flip through old Facebook posts and see a comment that looks so racist now. What do you do?

So I dial most of her number
and then I change my mind
our friends say she’s doing better now
so I let her live her life


Ron Pope—”Lies and Cigarettes”

You start out by looking at responsibility. Yeah, you made that mistake. You have zero obligation to change the past. Couldn’t do it even if you were supposed to. And that sounds simple, but I see so many men who don’t realize that’s what they’re asking for: a time machine. Your responsibility is here and now. Your responsibility is to acknowledge what happened, to name it as a mistake. You didn’t have all the info, or you made a bad choice based on the info you had; but regardless, it happened, and you don’t approve. Good. That’s really good. This part takes a long time to do (see the article on avoidance if you want to read more about why).

Don’t use passive voice in this part. If something was an accident, okay, but let’s look at your role in it. You didn’t mean to hit that other car, and they shouldn’t have been driving in your blind spot, but you were distracted. The affair didn’t “just happen, I don’t know, chemistry can’t be denied.” You made choices. I’m not saying you should call yourself a bad person. That won’t help. That’s actually counter-productive and just makes you feel shitty. Good people make good and bad choices. Your job here is to see your role in the decision that won’t stop chewing at your subconscious.

Next, and this is the most crucial part, you fucking learn from this. You say, “I made this choice, for whatever reason, and it was bad, and I do not want to do it again.” You say, “I wanted to have sex with her, and I had sex with her, and I regret that, and I learned I am capable of cheating, and the next time I want to, I am going to tell my wife about it, even though I am ashamed, and we will talk, and we will figure out what to do together, and I will be proud of my actions because I am a good person and I deserve to feel good about myself, and I deserve to talk about mistakes I might make before I make them so I can get help to not make the mistakes.”

You say, “I shoplifted and I cannot return the merchandise but I feel bad about this and I learned that when I’m stressed, I steal, and I will talk to my therapist about better ways to handle my stress and, if I still feel guilty about what I can’t undo, I will donate a reasonable amount to an appropriate charity, and I will not steal again, and I will treat myself like someone who has served his time rather than someone in jail.”

You say, “I am appalled by the language I used back then. I won’t deny saying it, but I was wrong to say it, and I have since learned that these words can hurt people who are already marginalized by greater society and need my support, not my slurs. I now review my comments before I hit ‘send’ to make sure I’m representing myself like I want to.”

You say, “I ended that relationship badly, and I hurt him, and I can’t take my words back, but I can make one heartfelt apology and then I can stay away from him and let him do what he needs to do to heal on his own, and I won’t hurt the next guy the same way.” Like Ron Pope says, you have to “let her live her life.”

So how does this relate to turning an article in a week late? I can say, “Gosh, Jared, with Thanksgiving and all, time got away from me.” But that’s pathetic. That’s passive voice. That’s taking my responsibility and giving it to the calendar. Instead, I can say, “Jared, I’m sorry. I prioritized other things, and I didn’t get them done in time to work on this article. If you still want it, I can work on it and turn it in; if not, I understand and hope you forgive me.” Am I pulling melodrama out of a late assignment? Yep. But if we don’t practice responsibility in small things, it makes it a lot harder to practice it in big things. So the next time you say you’re sorry, really dig into it. What specifically are you sorry for? What were you responsible for that you didn’t do the way you wish you had? What will you do differently now that you know this and own your present-day actions? Because when we were “young,” it was okay to live “on lies and cigarettes.” But we’ve grown up. And we get to act like it.

Thanks to Jared for this opportunity to talk to you about mental health this month (technically last month, I admit). I hope this has given you something to think about, and I hope you’ll take that to friends, family, and/or a therapist of your own. Because man, I don’t know you, but I know you’re awesome, and I know you deserve the healthiest life you can get.

[MOVEMBER][ORIGINAL FTNB CONTENT][THE DOCTOR IS IN]

How To Be Perfect Men

posted by Holland Neifer, LPC November 30, 2018 0 comments

Here we have another Movember guest post by Holland Neifer, LPC. Thanks for taking the time to share some insight.

Jared A. Godar

As a mental health professional, my days are filled by stories of abuse, loss, trauma, and the various ways people cope with such realities—often the problematic use of alcohol and other drugs. Despite the circumstances, I am humbled to witness clients take courageous steps towards recovery and their hope for a brighter future. For this piece, I chose to write about singer-songwriter Jason Molina, an artist who knew all too well the power of the bottle.

Jason was unable to triumph over his own battle with alcoholism, dying of multiple organ failure at the age of thirty-nine, but his music lives on to remind us that we are not alone in our struggles. When I hear a song such as “How To Be Perfect Men” from the 1999 album Axxess & Ace, I can feel pure emotion, pouring from this Lorain, Ohio native and his project Songs: Ohia.

This song begins subtly, withdrawn, and subdued. I love the shift in dynamics as it prepares the listener for Jason’s brutal honesty, as well as the driving instrumental end. The lyrics are unpretentious while achieving depth.

Of all that I should be
And perfect men would never be
Jealous or desperate
My ghost and I in our graves will lie

Jason Molina, “How to be Perfect Men”

Although I am unsure of Molina’s mental health history, I am reminded on an almost daily basis that it is nearly impossible to separate mental health from substance abuse and subsequent dependency. Working for a non-profit that treats dual-diagnosis clients, it saddens me that few agencies exist to manage both concurrently. Whether that stems from a lack of resources or not, I can tell you that nearly every client I assess uses substances to self-medicate an otherwise untreated mental health condition or that they have now developed a mental health disorder from the consequences of their drug use. I approach all substance abuse from a mental health lens to explore what is really going on.

I have heard Molina’s art referred to as “Depression Music” and I cannot say that I disagree. “How To Be Perfect Men” appears to be a declaration of one’s own shortcomings and a sense of powerlessness that comes with failure. Unwanted, invasive, self-sabotaging negative cognitions can cripple people to the point of total despair. We have this expectation of how we “should be,” a large product of our environment, confronted by our actual selves, which often sets us up for feelings of worthlessness. These thoughts can truly make us feel like ghosts. In fact, as Jason later wrote in the song “O! Grace,” that he felt “as lonesome as the world’s first ghost.” Wow!

Meeting people in this headspace is heart-wrenching, but so REAL. So real that a whole manual, the Diagnostic and Statistical Manual of Mental Disorders exists to describe those very feelings that so many of us experience. My copy is spineless, missing the back cover, and tattered from use matching symptoms to disorders.

Some clients take comfort in the label that this book provides. People like to know that they are not “crazy,” but that they are exhibiting common symptoms in reaction to their circumstances. The label normalizes a stigmatized experience. Others would rather focus on the symptoms at hand.

At the end of the day, my goal is to simply help people feel better and to legitimize their experience when they might otherwise not able to do that for themselves. Music is such a powerful vessel that can accomplish the very same task. Everyone deserves to have their reality recognized. We are not perfect men. Thank you, Jason, for sharing this truth.

If you ever find yourself feeling “as lonely as the world’s first ghost,” questioning your place in this world, or merely needing someone to talk to, please call the confidential National Suicide Prevention Lifeline at 1-800-273-8255, available 24 hours every day. You can also use their Lifeline Chat,  https://suicidepreventionlifeline.org/chat/

Additionally, if you or someone you know is struggling with substance abuse, you can contact the Substance Abuse and Mental Health Service Administration’s (SAMHSA) National Hotline at 1-800-662-HELP (4357) for resources in your area.

Dr. Matt Conner

Kesha has probably had a worse few years than you. It’s not a competition, but if it wer, her cards to play include a loss in court against her accused rapist, an eating disorder, and a rehab stint. But she came back a healthier artist, dropping the hottest album of 2017. Rainbow is dripping with extremes of up-tempo rock anthems, glitter-snarl attitude, and thoughtful ballads. I didn’t stop dancing or singing along once when her tour hit Raleigh.

But more than great music, her album proves she has learned a lot in her recovery. I could write a post about easily half the tracks on this record. The one I’m picking for Movember, the one I think best applies to us men and is so rarely actually taught to us, is “Let ‘Em Talk.”

That’s right—it’s Boundaries week here on Fighting The Nashville Blues!

Shake that ass
Don’t care if they talk about it
Fuck all that
haters, just forget about them

Kesha, “Let ’em Talk”

“Boundaries” is a word us shrinks use to talk about the essential rules of communicating in relationships. It’s a little tough to define, so I’ll give you some examples instead.

I’ve got a lot of thoughts, feelings, beliefs, opinions, attitudes, etc. Some of them, I can choose. I can, like we covered last week, opt to spend my attention on the past or the present. I can recognize that thinking about old mistakes is more likely to get me in a sad mood compared to thoughts of my present-day options. But I’m not ultimately responsible for my feelings. I can’t help it if I feel sad seeing a picture of a refugee camp, or if you remind me of that jerk in middle school, or if a plate of olives makes my stomach twist up and my nose do that scrunchy reflex thing my mom told me was rude and that I had definitely inherited from her mother-in-law.

What I am responsible for is my actions, including what I say and how I say it. “No thanks” is probably going to be better for my relationship to my host than, “Olives are gross. I won’t eat them, and I think less of you for thinking I would.” Even if that’s true. And it is.

Remember, that same rule applies to every other person in your life. People are responsible for their actions, not their thoughts or feelings. If somebody’s putting you down, it’s absolutely okay to point that out to them. But if they’re generally cool to you, you can stop analyzing why. That’s on their side of the boundary.

Here’s where that gets awesome: As long as they keep their comments civil, their opinions don’t actually mean anything. It’s good to know them. Part of an authentic friendship is a curiosity about a person’s inner world. But if they don’t like how you do something, well, “fuck all that.” You want to tell me I stepped on your foot? Please do, I need that feedback. I’ve affected you. You think I need to take a few lessons and lose ten pounds before I share your dance floor? Thanks for letting me know your thoughts, that’s cool, I’m still dancing until I decide not to. Maybe you won’t like me. A risk I’m willing to take.

Do your thing
don’t care if you make ‘em jealous

Kesha,”Let ’em Talk”

So does that mean we get to say whatever we want? Like, if your hurt feelings aren’t under my control, why should I even think about you? No, and here’s why:

We are all people together. We’re existentially alone, it sucks. We’re all going to die and probably not together; and until that day, we’re just walking each other home, my friends. That shared community, however loose or arbitrary, means we have a responsibility to each other. We have to take ownership of our side of the health of our relationships.

If I said something and it pissed you off, you may be overreacting. I don’t know you. Maybe you take everything too personally. But if I want a relationship with you, I owe it to both of us to ask what happened. “I have no idea if this is because of something I did, but you look/sound angry; and since I haven’t tried to piss you off, I’m confused. If you tell me what’s bugging you, I can explain or apologize for my side of it. If you need time, that’s cool, too, but message received, you’re mad, I get it.”

Because I don’t have a responsibility for you. I’m not in charge of reading your mind or predicting your emotional reflexes. But I have a responsibility to you. I factor in what I know about you when I talk to you, and if I step in something, I apologize or ask about it.

Until then, what do I do when I freak out that you’re judging my dancing or hurt by my speaking up for myself when we tried to pick a movie for our next date? I get to remind myself of the boundaries. The freak out is on my side of the boundary and not controllable. What you think about the situation is on yours and is just as far out of my control. What I say to you or where I put my attention, that’s up to me. So I’m going to talk myself down as many times as I need to. And we’re going to be just fine.

It used to hurt me
Used to bring me down
But do your worst
Cuz nothing’s gonna stop me now

Kesha, “Let ’em Talk”

Special case: People in relationships with people using drugs or alcohol to avoid emotional pain may have an extra-tough time with this “responsibility to versus responsibility for” thing. It can be hard to trust a person to take care of himself when his substance abuse keeps him from really doing that well. So people can end up thinking it’s on them to keep the family going, to keep the neighbors from asking questions, to make sure she doesn’t have a bottle hidden in the bathroom. If this sounds familiar, please check out Al-Anon, a free group that meets all over the world and even on Skype. There’s no better way to learn boundaries.

Let’s all take a lesson from Kesha this Movember. Let’s dance, not like nobody’s watching, but like we don’t have to take responsibility to keep them entertained. Let’s use our boundaries to give ourselves a break for the natural moods we feel and to get closer to the people we love. And let’s let ‘em talk.

[FTNB EXCLUSIVE][MOVEMBER][THE DOCTOR IS IN]

The Doctor is In: Matt Nathanson “Mine”

posted by Matthew Conner, M.D., P.L.L.C. November 12, 2018 1 Comment
Dr. Matt Conner

Here’s the second installment of the FTNB “The Doctor is In” guest series by Dr. Matthew Conner. This one really spoke to me. If you missed his first article, read it here.

-Jared Godar

Matt Nathanson has been a favorite of mine since 2003’s amazing, sensitive collection, Under These Fireworks. Lightning usually only strikes once, but last summer’s Sings His Sad Heart is arguably his best one yet. It’s only fitting that the disc is a ten-song collection about a man who can’t let go of the past.

I got a text from your sister

it’s been a while

I see this a lot when men come to therapy. Sometimes, like the song says, you’re on your own and get a sudden reminder of your ex—that song on the radio, you bump into her sister, the reunion invitation that comes in the mail. Occasionally, your current partner does something that gets on your nerves and you just know that never would have happened with the one that got away.

Whatever the cause, the end result is dissatisfaction. How could you have made this choice? Why are you with this person? Maybe you should just text…

NO! Consider this your intervention. I’m going to talk to you a little bit about hanging on to old things, and I’ll teach you how to let it go.

All the ways I try to rewind when you were mine

The fantasy of “the one that got away” comes up all the time, and I think it’s going to lose some of its hold on you once we talk about where it comes from. The usual cause is anxiety: there’s a “right” answer, the one person you’re supposed to be with. If you don’t guess right or keep that person, that’s the reason why anything feels wrong in your life. If you feel bad, or anxious, or unsure, well, that must be proof that you just haven’t found the right person. But what happens when you find the right person and then you feel bad, or anxious, or unsure?

Most of the guys I see take that as a sign that they must have guessed wrong and dig into things like breaking up, affairs, or even trying to blame or change their partners. Gotta find the next right person. But I try to help these men by telling them two secrets: There is no such thing as a right answer here and everyone feels bad once in a while. It’s going to happen with this person, or the next, or alone—it’s not her, it’s you.

I know this isn’t always the case. There may not be right answers, but there are wrong ones. If you’re in a relationship that feels controlling, withholding, or cruel, you need to run that by friends you trust or a good couple’s therapist. Couple’s therapy is not forcing you to stay together, nor is it a sign you’re breaking up. It’s just asking a neutral third party to apply their understanding of relationship patterns to your situation and if there’s something toxic you need to know that.

But the answer isn’t that your high school sweetheart should never have dumped you for that skinny guy with the guitar at the first college party. Let’s work on letting that one go.

First, recognize that it’s completely normal to wonder what might have been. You were with your ex for a good reason, and it’s fine to remember those good times. It’s normal to feel dissatisfied and go back in time for a few minutes.

But then, tell yourself that not every relationship has to last to be successful. We all hit spots in relationships where we aren’t going to learn or grow anymore and most of us have that experience when we’re too immature to deal with it without hurting each other. It sucks, but it happens, and it’s how we learn. No amount of playing that tape over is going to make you feel okay that it’s over. She may be funnier than your wife is, he may load the dishwasher the way your husband just can’t figure out; but remind yourself that even with the good parts, this wasn’t your last relationship, and it ended. You can learn from it and make better choices now, but you can’t undo it and you don’t have to.

In the end I was practice

Yeah, you kissed me like an actress running lines

Here’s the last step: be in the now. You’re here and you’re with your partner. You may feel dissatisfied, but you’re both still in it. If you stay present, you can’t be in the past. Sounds oversimplified, but it’s true. We don’t multitask the way we claim to.

Think about things you like about the person you love and build up to things you love about them. Try to stick to the positive—more “She saves me the corner piece of the lasagna, which sounds lame, but I like that best and she remembers” rather than “Umm, she doesn’t sweat too much, I guess.” If that’s too hard, remember what first attracted you. Make a list. Write it down. Or better yet, write it to her. Say it to her. Make it part of the daily routine until it doesn’t feel awkward anymore. Don’t you want to know what your partner loves about you? Why not make that the last thing you say when you separate in the morning? I have had plenty of arguments with boyfriends, but if I can say, honestly, “I’m mad, but you are usually really considerate, and I want to remember that before I say anything else.” I stop comparing them to the exes.

I’m not saying you can’t think about them. This is your story, you’ve learned from it. But when you’re nodding to Matt Nathanson singing, “All the ways I try to rewind when you were mine” remind yourself that part of the tape is over, and hit “Play” instead.

[MOVEMBER][THE DOCTOR IS IN]

David Dondero “Real Tina Turner”: The Doctor is In

posted by Matthew Conner, M.D., P.L.L.C. November 5, 2018 3 Comments

This Movember, FTNB is hosting a series of guest posts by mental health professionals addressing mental health in song.

Movember is a charity started in Austraila to raise awareness
and funds for men’s health issues including prostate and testicular cancer with a focus on mental health, depression, and suicide. If you are interested in learning more or helping out, please join or contribute to  the Fighting the Nashville Blues Movember team.

Our first post is by Matthew Conner, M.D., P.L.L.C. Matt and I have been friends since I moved to Texas in the eighth grade. He completed his medical degree at the University of Texas Southwestern Medical Center in Dallas, his residency in psychiatry at Duke, and has been practicing in the Research Triangle area for over a decade.

-Jared A. Godar
David Dondero – Real Tina Turner

The song’s a catchy one, a deceptively upbeat song about loss, missing the New Orleans and the “real” music of his youth. And of course, his life right now sucks, with the last of his worldly possessions (even his “voter registration card!”) stolen last night. But his sad lyrics have the curve of a smile at the edges, and it’s easy to miss the first two lines.

Men have a reputation when it comes to taking care of themselves. We know unmarried men die younger than married men, and we have reason to assume that’s because left to our own devices, we prefer to cultivate a stoicism rather than go to the doctor. As a result, our cancers don’t get caught early enough. Our bad habits get entrenched and out of hand. And we commit suicide, possibly because we don’t trust that talking to someone can help.

If it wasn’t for the liquor and the weed

We never would have made it through the winter.

-David Dondero

So how do men cope with stress? Well, according to the Substance Abuse and Mental Health Services Administration, we abuse substances, with SAMSHA’s latest report that twice as many male adults have had a drinking binge in the past year compared to women the same age and twice as many males over age 12 reporting illicit drug use. (https://www.samhsa.gov/specific-populations/age-gender-based)

And what’s the problem with that? If it gets you “through the winter,” who cares, right?

It’s avoidance. We can talk about the long-term health consequences of chronic alcohol use, the liver scarring, the memory problems, the weight gain; but I think everyone knows that, and we do the denial thing about it. On some level, we can all point to that alcoholic over there with the shaking hands and know that’s not us, never will be.

But chemistry and physiology aside, when a person hits a lot of stress and drinks it away, he’s not learning about it. He’s not figuring out what he can do to support himself, he’s not building up the support network he needs, he’s not proving to himself that he can feel uncomfortable for a while and that it’ll pass. He’s giving himself the message that he doesn’t have to acknowledge feelings. Shut those down. Do it now, do it fast, don’t let it register, I’m just getting through.

Developed the habit of washing your hands to the point that your fingers would bleed.

-David Dondero

And the hand-washing thing, that’s avoidance, too. If I can make it about the germs, even subconsciously, then it isn’t about my life being out of control or my regret for my decisions or the responsibility I’m going to end up having to take. It’s hand-washing. I can do hand-washing. I can do hand-washing until my skin cracks.

And when the skin calms down, when the buzz wears off, when the bill comes due, everything I’m avoiding is right there. So I guess I need to go back and do that thing that didn’t work in the first place. Gotta make it through the winter.

What’s the alternative?

Approach.

Talk to someone who might understand whatever “winter” means to you, and if you don’t know, talk to someone about the patterns you’re using to cope. If you only cope with stress in one or two ways, those are going to get overloaded, and I promise you, investing in a social network is the best way to develop a broad range of healthy responses to stress. Including joining a book club. Including joining a class at the gym. Including signing up for the open mic night and putting your struggle to music and talking to the people who go on before and after you. Including Crossfit or kickball or the yoga studio. Including paying a counselor. Including going to free 12-Step programs like Alcoholics Anonymous, Narcotics Anonymous, or Al-Anon for people who recognize a need to support healthy boundaried relationships.

Because hey, I don’t know you. But I know enough about you because of the work I’ve been doing with men for ten years. I have yet to meet someone who really lived down to his fear that he can’t handle talking about his pain. Your emotion may be bigger than you right now. I get that. But it’s not bigger than us.

Put the bottle down. Turn off the hot water at the sink. And make it through the winter with the people who hear your music instead.