When Call-Outs Make Sense

I personally believe in the power and appropriateness of call-outs. I’ve seen call-out culture accomplish volumes in the last couple weeks on social media especially. Here are some of the things I consider when deciding to call-out vs. call-in:

1. Do I have their ear? This can pertain to a person who isn’t open to taking in information from me, or literally isn’t available to me e.g. I don’t have access to Amazon’s executive team.

2. Do they have the capacity to understand what I’m saying? Cognitive capacity is real and some concepts will be too complex for another to follow.

3. Am I after accountability, or shame? Call-out culture seems to get tied to shaming, but that isn’t necessarily it. A lot of call-outs these days are action-motivated. (If yours is shame-motivated, you gotta check yourself!) Also, a reminder: You can never control whether the other party FEELS shame regardless, but that isn’t your responsibility!

4. How much urgency is there? Who is being harmed? Is there room for slow and gentle inroads over time, or is action required now? Can a mass of people or public pressure force accountability faster?

5. Has calling in failed? If a number of people in their inner circle have already tried to call them in and they ignored, it’s time for a call-out.

6. Is this actually about disregard? If someone is doing something blatantly wrong, gentle reminders aren’t needed. It’s not a matter of them not knowing it’s wrong to pay Black folks less than White folks, for example. It’s about them NOT CARING, or gambling that they’ll get away with it. No need for calling-in here. In the words of Assata Shakur, “Nobody in the world, nobody in history, has ever gotten their freedom by appealing to the moral sense of the people who were oppressing them.”

Last but not least, I consider what MY time, interest, and expertise look like. Sometimes I won’t have the energy or skill to handle calling someone in or out, but that doesn’t have to mean doing nothing instead. There are options less than call-outs and call-ins that respect my needs + express disapproval. For example, I can not laugh at a racist joke, or simply say, “I don’t find that funny.” On social media, I can unfollow someone, comment that I won’t be buying their products anymore, or like someone else’s comment that resonates. There’s a whole spectrum of possibilities, but it’s imperative we adopt a stance, and not get gaslit by the Rules of Engagement in the process!

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Note: I've moved most of my writing over to Instagram - you can find me @bfrbtherapist

The Opposite of Addiction

Former (… after he was caught plagiarizing in 2011) UK journalist Johann Hari put out this Ted Talk about addiction in 2015. It has become popular and, without making any claims about his credibility, I think there is still something to draw from the idea presented here. Hari says that the opposite of addiction isn’t sobriety, it’s connection. One of my observations about body-focused, repetitive behavior (BFRB) sufferers is that they don’t feel the urge to pick, pull, or bite when they are engaged in good conversation. They also don’t feel the urge to pick, pull, or bite when they are crying or yelling. What this suggests to me - if we think of BFRBs as behavioral addictions - is that connection may be at play here too. Connection may not be limited to social interactions either - it may refer to others, but can simply be to ourselves. I tend to think of BFRBs as occurring when we are subconsciously trying to feel or find something - when we need some kind of anchor amidst uncertainty or open-endedness. BFRBs offer us a mental and/or physical focus, which we wouldn’t need if we could already locate ourselves.

Clinically, this means that if we can work on engaging ourselves in a non-hair/skin/nail-based thought, feeling, or project, it may adequately compete. We are often zoned out while we pick, pull, or bite. Research has even substantiated such links between BFRBs and dissociative phenomena (Corfield et al., 2004). The antithesis then is mindfulness or presence, and doesn’t even have to mean formal meditation. The next time you are in a BFRB episode, see if you can turn your attention to anything else in yourself or your environment - it can be a colleague’s manner of speaking in your meeting, the feel of the water as you wash dishes, or even your desire to resist your BFRB. Zeroing in on a negative possibility like pissing off your boss, for example, may trigger more discomfort —> greater instincts to avoid —> more picking, pulling, or biting. But what if this thought could exist as more than flat out rumination? Consider a situation in which you could observe yourself having this experience of worry, almost as if you are an alien studying an anxious human for the first time. See if you can get curious about the reactions it brings not only to your mind, but also your body. Allow yourself to become fascinated by the speed at which your thoughts fly, the restlessness in your hands, or the impulse to seek reassurance from a friend. You’ll find that doing something mindlessly doesn’t work once you are actually mindful.

"Just tell me what to do."

“Just tell me what to do.”

This is probably what most people coming through my door want to say to me plainly. Whether you are battling depression, social anxiety, or body-focused, repetitive behaviors (BFRBs), the wish for straightforward solutions is completely understandable. The problem is not just that answers tend to be more complicated, it’s that straight up answers also tend to be insufficient. It’s easy to answer “what to do” in the case of BFRBs: be vulnerable, get more comfortable with what you don’t know, and practice acceptance, self-compassion, boundaries, and curiosity broadly. But now what do you do with that?

I do believe in the above prescription, but listing the items does little to get you closer to adopting any of them. This is because intellectual knowledge can’t take the place of actual transformation. It is not enough to simply be able to name the problem or the solution. When someone repeatedly asks me “what to do” or “how to stop” their BFRB, it usually comes from a place that wants to bypass all of the uncomfortable parts. They feel the need to be on the other side already, and haven’t learned to bear struggle. They desire change without the confrontation that comes from changing.  I don’t blame anyone for this, but commitment of time and money in the face of uncertainty, the uncovering of painful truths, the awkwardness of a new and unique relationship, and the vulnerability of being seen as less than perfect ARE the work. Going through the therapeutic process as intended matters. Forming a relationship - with yourself and with me - in which you are opened up to feel without any guarantees about outcomes is a living example and cultivation of the path through.

Quick answers from a manual or book instead are only going to preserve the same conditions that have you picking, pulling, or biting to begin with. They offer fantasies of perfect predictability and control within a closed system that are comforting but doomed to disappoint again and again. Conceptual awareness can help you to recognize when a problem is occurring, but doesn’t supply the tools to get you out of it. (Example: recognizing when you’re feeling jealous doesn’t magically make your jealous feelings go away). This is why tracking logs often frustrate clients similarly. Being able to identify the moments you are picking/pulling/biting (e.g. 10 pm, level 4 urge, in front of a computer) is not enough to stop them. Tracking logs can be completed like an academic exercise without developing your patience, trust, or intuition. Facts and information are a start, but buying into the notion that they can be everything will leave you ill equipped and feeling like a constant failure.

Knowledge of a thing doesn’t equal command over it, and does control need to be our primary objective anyhow? Can we stand opening ourselves up to more than our mental activity?

How Do You Experience Your Emotions?

I often hear people say they are afraid of “going there” in their anger, or “going back there” in their depression. It makes it clear to me that folks often find something very unapproachable about these emotions. Yes, feelings of anger, sadness, or fear are unpleasant, but that doesn’t have to make them unapproachable… just unpleasant, as things in life can be sometimes. So, to understand why we work so hard to avoid negative emotions, we should start by learning how we perceive them.

Let’s start with anger, sadness, or fear… pick one that feels most relevant in your life:

If you think of your depression, is it like a dark cloud that follows you around? Is it like those giant stone blocks in Mario video games that stomp you flat? Is it like a deep pit you fall into and can’t get out of?  If you think of your anger, is it like the red character in Inside Out who shoots fire out of his head? Is it like a closed fist? If you think of your anxiety, is it like a knot in your stomach?

Expand more…

What would it feel like if you touched it?
If you had to give it a color, what color would it be?
How much space does it take up?
How heavy is it?

Once you give your feelings shape, texture, color, volume, etc., you’ve already taken a significant first step towards approaching them. You’ve given them form, and with form comes possibilities…

If your depression is like clouds, clouds move and part with bursts of light interjecting. If it is like a Mario block stomping down on you, have you forgotten how they quickly lift and and you inflate back to size? We can build steps in your pit, and we can unclench your fist and loosen knots. The point is to break down this giant, amorphous, monolith of a thing that makes things feel unapproachable.

A key to experiencing emotions in a healthy way is knowing they contain more possibilities than you think. This includes the possibility that they can be survived without devouring you and everyone you love. You will continue a life controlled by avoidance of difficult emotions if this belief goes unchallenged. No matter the negative feeling, they are not just a concrete block of a thing that plops down and squashes everything you ever cared about for a forever time. Every emotion you’ve ever felt came and also went. And life continues while they exist, which means times of intermittent activity, energy, connecting conversation, lessons, and joy. Colors can change, space expands and contracts, and objects can be taken with you. This is not the whole solution, but being able to name and describe your emotions are the first steps.

Substitutes, Fiddle Toys, and Blockers

Employing outside aids - sensory substitutes, fidget toys, behavioral blockers - are not by rule good or bad. I am, however, thoughtful about when I recommend them. The key to me is whether they are being employed honestly and earnestly. Slapping them on yourself in an automatic attempt to stop your picking, pulling, or biting is different from putting them on after you have gone through the hard work of choice.

Our first reactions to our BFRBs commonly involve unanimous censure of, “You need to stop,” which differs from the personally and eventually attained, “I want to stop.” Beanies, vaseline, stress balls, and gloves should not be employed at times when you try to impose a No when you are honestly feeling a Yes (to picking, pulling, or biting). They have to be tools that merely support your decision for a different outcome in a BFRB moment. The root of change needs to be YOU because you will always be more powerful than any piece of fabric, cloth, lubricant, etc. (and thus can simply ditch any of these). They can and will not stop you unless you want them to! Furthermore, expecting these random things to do the work for you instead of because of you will maintain a belief that hope, power, and salvation lie outside of you when they do not.

BFRBs offer a source of comfort, so we turn to them as simply as a child would to their blankie or pacifier. For adults, choosing to go from comfort to absence requires commitment and possibly help. These outside tools come in and ease the burdens of follow through once you have surrendered to the reality of your BFRB, made your choice, and now can simply use some support. (Mindful awareness, internal reflection, emotional vulnerability, weighing of outcomes is hard work!)

I don’t believe anyone should have to “fight” themselves, and it is no longer “restriction” when you are giving yourself what you have resolved you want. Remember that these tools shouldn’t be exploited to “block” you, but embraced to aid you. Invoke them once you have arrived at a feeling in a BFRB episode that you truly want to desist and you don’t want to do it alone (because you don't have to!). Remember to leave time for the urge to pass, and that you can also involve PEOPLE and not just things.

Best of luck, devotion, and skill!

BFRB Group - Call for New January 2018 Members!

Almost three years ago, I began running a psychotherapy group which oriented group members to the full spectrum of their body-focused, repetitive behaviors (e.g. hair pulling, skin picking, nail biting). We reviewed the demographic backdrop to these behaviors, treatment options, and factors such as motivation that affected their outcomes. We began exploring our own pulling/picking profiles and uncovering the emotional and sensory factors that fed them. I started this group to foster intellectual understanding, and even more so, to foster relationships between individuals and not just ones with our bodies. In the safe and controlled space of a psychotherapy group dedicated to BFRB sufferers, we began to heal shame and rely on one another. This group that began in 2015 proved incredibly rich and fulfilling, and lasted approximately 6 months. Since then, I have now run four chapters that have grown longer and stronger every time. Each round I become even more convinced of the importance of having this unique space for encountering sameness, difference, sharing, and receiving with like peers.

I have been getting a number of calls these days and believe we have reached a critical mass to begin a new group January 2018. The curriculum will include familiar and novel components that focus on overt behavioral management of the BFRBs, and also tackle discomfort, relationships, self-compassion, and self-assertion. All of this learning will happen experientially and through guided exercises and conversations.

I am aiming to begin this group January 2018, but will adjust according to members' availability. I am currently envisioning a meeting time of Wednesdays from 6:15 - 7:30 pm, and meeting place as my usual office at Post and Divisadero in San Francisco. Session fee would be $80/session, which if you submit for reimbursement can be claimed on your insurance superbill as well.

If you have any interest in the group, please let me know by email: dr.nmayeda@gmail.com, or by phone: 415-735-0029 in the next couple of weeks. Again, please reach out to me if you have any interest at all. Your inquiry will by no means by a commitment, just a chance to get more information so we can mutually determine fit.

5 Major Variables

Everyone's #1 question is usually how to get over their BFRBs. The answer is that there won't be a way over or around, you will have to go through and work with them. This entry is meant to help distill this sort of behavioral change down to 5 major variables. Perhaps the most important thing I've learned as a general approach is that surrender contributes to change more easily and sustainably than any overt management efforts.

I may add to or modify this list over time, but it does encapsulate that change is about much more than pure will:

1. Objectivity - This is 90% of the work to me. Most people have such judgmental thoughts and feelings about their BFRBs that they can't incorporate the reality of them into their planning or decision making. Imagine someone who chronically loses track of time. They desperately don't want this to be true so they keep acceptance of it at bay, clinging onto belief (even if entirely wishful) that they will remember to feed the meter or move the car when it's street cleaning this time. Tickets and towing fees pile while no ameliorative measures are put in place. Once this person can come to terms with the fact that they have weaknesses when it comes to time, they can begin setting alarms, using mobile parking/payment apps, or handing over the task of moving the car on street cleaning days to their partner! Objectivity is required to be able to evaluate a situation like this clearly, and to determine what is needed within it. Too often what we WANT to be true gets in the way of dealing with what IS true. Returning back to BFRBs, this means that you have to be able to approach you and your situation with enough non-judgment to be able to anticipate pulling-prone moments, to say when you really would like to continue biting for another 5 minutes, or to recognize that what you really need in this moment is not smoother skin but a hug from a friend.

2. Ownership - The capacity to choose does not always translate to the willingness to choose. We can be stubborn as human beings, and resistant to doing things we feel like we "should" or that someone else wants of us. This is true with BFRBs too. Even if you possess enough objectivity to make clear decisions, the feeling that your good outcome is going to belong to someone else is hardly reinforcing. This is why someone else swatting your hand away or telling you to stop usually inspires the opposite. It is also why reminders to track, suggestions to go for a walk, or utterances of, "I knew you could do it" or "I'm so proud of you" can irritate even if well intended. Unless this was aid or feedback you explicitly asked for, it can feel like unwelcome insertions of another's feelings or preferences about YOUR behavior. Even if it is a "bad" behavior, it is still YOUR possession pertaining to YOUR body. Change will not come until you feel agency over your moment-to-moment decisions to pull or not pull/pick or not pick/bite or not bite, which is understandably difficult to cultivate internally in a society that features clearly and ubiquitously expressed opinions!

3. Momentum - This one is rather simple but commonly overlooked. Momentum has to do with the energy to keep going. It is MUCH easier to maintain a state of non-pulling when you're boasting a whole head of hair - there is something you can concretely feel you're protecting. Inversely, it is really hard to get motivated when you have all your fingernails whittled down to barely-there stubs. The resignation of "What's the point?" is strong. A feeling of POSSIBILITY is critical to motivation, so be compassionate that you may not be able to do the most with the least.

4. Facilitative environment - Not all this work is internal. There is a real external world that plays into your success. I have not come into my "success" (always subjectively defined) with my BFRB from internal work alone, but it was my internal work that helped me to initiate concordant, external changes. This included changes to my occupation, which is now based primarily on human instead of computer interaction, and on private practice instead of corporate membership; my hobbies, which grow the relationship with my body to offset the one with my mind; and my people relationships, which I have narrowed down to compassionate, flexible thinking, and emotionally honest types. You can do all sorts of intellectual or insight-oriented work and not see progress if you remain in toxic workplaces or with ill-fitting people.

5. Whole and real relating - It can be hard to give up your BFRBs when they are a physical manifestation of your private truth that you don't have it all together. Individuals with BFRBs tend to hold oppressively high standards for themselves, and picking, pulling, and biting can serve as a confined place for not caring, not thinking, and not controlling. It can also be the container and the proof of your messiness, failures, and fear so that you can temper the burden of total perfection. But everyone deep down wants to be seen as they truly and fully are, and if you can learn to allow for your needs, questions, and suffering to be represented openly, outwardly, and in their original form, there will be no need for them to be expressed on your face, scalp, back, hands, or legs. Choosing to relate to yourself and others in a whole and real way means that it will be OK to not have it all together - this will be an expectable part of being HUMAN. It requires a decentering of your lifelong preoccupation with what is smart, good, agreeable, or right, and favoring of personal congruence instead. The things you don't know, the times you hurt or hate, and the times you just don't feel like it will no longer be dangerous. Refuge isn't necessary when you live with freedom!