A Prcscntition ofThe National Committee on 1'outll Suicicic Prevention

and /American Association ol'Suicidolo ;;y

in consultation Nvith I iirvircl Medical School,DcnartmmiL of Psychiatry, The Carnbricigc I Ioshital

M, it lc Ito"'il)It' hy,I' ;I

IIIIII()III

SmithKline Beckman

tlt "tliv,atvl IWlw,ulv,wm " mwU alItl,

, u "tnt""" .vul to vllly ~ "m "Recognizing Young People in Crisis

anti I'rcvcntil1-; Suicicic in Young People.

Icfralifwing the IssueAccording to a recent study, 50 percent of American

teenagers have seriously considered suicide by the time theygraduate from high school . As many as one in 10 has actuallyplanned his or her own death .

The frequency of adolescent suicide in this countryhas dramatically increased in the past three decades, makingit the second leading cause of death among young peoplebetween the ages of 15 and 24 . Each year, more than 5,000young people reportedly kill themselves : an estimated500,000 make suicide attempts . Only accidents take the livesof a greater number of teenagers and young adults . Andauthorities believe that many fatal accidents may actually beunrecognized or unacknowledged suicides .

Suicide touches-and too often kills-young peopleof every race, religious faith, .ethnic background, personality,geographic location . and economic circumstance . The causesare as diverse as the individuals involved .

Mc._ ; people considering suicide are issuing a cryfor help, a cry that should be heard by someone who caresenough to respond . You can be that someone. Often, you canmake the difference between life and death .

Re(ognizing the Rish'Rarely do young people in crisis really want to die .

But they may feel that they have no reason to go on living .Those who attempt or commit suicide often fear that

their lives will always seem empty, painful, meaningless . Andthey believe there is nothing they can do to change that .

These troubled young people are looking for some-one who can help them deal with their overwhelming sense of

U11C

hopelessness and helplessness . That's why almost everyonewho attempts suicide tries to let someone else know that forthem the pain of living has become unbearable .

The young person at most serious risk of suicide isone who has :" Made a suicide attempt or gesture ." Discussed or threatened suicide ." Made specific plans to commit suicide and has given away

prized possessions ." Been preoccupied with death ." Known someone else who has committed suicide .

Depression is one of the main warning signs . It maybe rooted in such things as divorce, a nnove to a new town orschool, failure to become a member of a sports team, inabilityto sustain a romantic relationship . It may be disguised byapparent cheerfulness or serenity. It ma'y.,also lead to a suicideattempt,

Behavioral changes are common clues to depres-sion . Mood swings are normal in adolescence, but a sudden,dramatic change may be an effort to cope with pain . Anyuncharacteristic behavior that persists for more than a fewweeks should be cause for concern .

Other warning signs include :Isolation or withdrawal from family, friends . or activities .Eating too much or too little .Sleeping too much or too little .Unexplained fatigue .Apathy.Unexplained bruises .Hostility .

" Indecisiveness .- Alcohol or drug abuse .-

Lack of concentration .-

Inability to feel good about oneself or to express joy.- Crying for no apparent reason .- Thinking, writing, or talking about death or dying ."

Acquiring a weapon .It's difficult to acknowledge clues that seem to indi-

cate someone you care about may be planning to commitsuicide . But it can be tragic to disregard them .

Who Cart Hclp

You can . You may be a member of the family, or amember of the clergy. A teacher. A counselor . A psychologistor a psychiatrist . A neighbor . A classmate . A friend . Theimportant thing is that you want to help . And someone likeyou-listening, watching, caring-can make the differencebetween life and death,

You don't have to have years of training . But youhave to learn to listen carefully enough to understand theproblem . And you have to care enough to help find thesolution .

Holl , You Call 1-101)Become aware of the most obvious signs of depres-

sion . If someone you know seems troubled, voice your con-cern . Let the other person know you're trying to relate .understand, help .

If you're worried about another person's safety,remove all pills, medications, and other potential weapons

I(irvc'

Such as knives, guns, rope . And keep the car keys away fromhim . Stay with the person . Remind him that two heads arebetter than one when it comes to solving difficult problems .And point out that lie may be too closely involved to see thealternatives .

If you suspect that someone may be considering sui-cide, ask . Don't avoid the subject . But don't make accusationsor moral judgments, And don't act sh"otked if the other per-son says he has thought of committing suicide . Ask for specificdetails : The more thoroughly a plan of suicide has beenthought out, the greater the risk that it will be carried out .

Phrase your questions carefully. For example, "Howwest , you thinking of killing yourself?" conveys the messagethat you and the other person are going to move beyondsuicide to explore positive alternatives .

Adolescent suicide can be an impulsive act, but sim-ply raising the subject won't cause anyone to commit suicide,In fact, talking about suicide can actually reduce anxiety andlessen the impulse to act .

Encouraging an adolescent in crisis to share his ot-her fears may be the first step toward solving the problem,Listen carefully, Listen actively . Ask questions that give theother person an opportunity to talk about how he is feeling,

Share your observations . But remember that offer-Ing solutions too readily may be interpreted as failing to graspthe gravity of the situation . Anyone who thinks suicide is theonly way out will resent and reject what-seem to be easyanswers and simple solutions .

Those ire CriSl~ Nccd HelpRemember that your main priority is to fret help for

lain'

someone in crisis . You may be that help . You may be the onewho puts the young person in touch with someone else . Butyou need not and should not assume total responsibility forthe situation .

A person who confides suicidal intentions may insistthat you promise not to say anything to anyone . Promise ifyou must . But remember that saving a life is more importantthan keeping a promise . When someone's life is at stake, con-fidentiality is no longer appropriate .

Call or visit a guidance counselor, parent, favoriteteacher, religious leader, physician, or friend . If necessary, getin touch with a psychologist, psychiatrist, social worker, orother mental health professional . Explain the situation andrequest an immediate appointment .

People with suicidal intentions do not always admitthat they plan to take their own lives . If you believe someoneis at risk, don't simply accept a denial . Offer to discuss anyproblems the person may be experiencing . You may berebuffed, but the act of initiating the dialogue reduces the risk .

Share your concern with someone the other personknows and trusts . If no one like that is available, offer to helpthe at-risk individual get help . If he refuses to talk with any-one, you must discuss the problem with a professional whocan help you understand and respond to the situation .

Suicide prevention involves more than thwarting asuicide attempt . Most of those who survive -@ suicide attemptwill attempt suicide again . And many of them will die . Unlessthey get help .

That's why compassionate, concerned interventionis crucial . If someone you know seems troubled, take the ini-tiative . Become involved . Show that you,care . You could save

life .

[3t' a Parl v( Ific SvlulionAdolescent suicide is a wasteful tragedy, a terrible

choice made by young people who feel they have no otherchoice and who are unable to perceive alternatives to thepain that envelopes them .

Every young person who attempts or considers com-mitting suicide is precariously poised between life and death .You can tip the balance . By noticing . By trusting your instincts .By caring enough to get involved .

Copyright r'amcla Cantor, NO)- I Um7

DIFFERENT ENERGETIC S'T'ATES

CLINICALTERMS USED TO

DESCRIBEDEPRESSION

The whole spectrum ofenergetic states- from feeling fullyalive to feeling hopelessly depressed- is divided in the chart(below) into six levels ofliveliness . In clinical terminologyonly the more severe stages ofdepression are sub-divided, soI have included the clinical equivalents whereapplicable .

Reactivedepression means depression as a reaction to an ex-ternal event . lb:dogenotrsdepressivn means depression fromwithin (i .e . caused by genetic or biochemical factors) . Theseterms were based on the historical belief that milder depres-sion was usually "reactive" to an outside situations whilesevere depression was usually not related to external events .It is now realized that this is not necessarily true . So the twoterms reactive depression and endogenous depression arenow usually used only to denote the severity of depression -roughly equivalent to the categories used in this book, "grey"and "black" . Depressive psychosis means a depression so se-vere that there is a loss oftouch with reality . The person iscrazy with depression . Such cases are extremely rare andusually seen only in psychiatric hospitals .

ENERGETIC STATES AND THEIR CLINICAL EQUIVALENTSIn this chart, the spectrum of energetic states is divided into six levels of liveliness . These levels are

used as categories throughout the book .

Compulsory admissionsto hospital (white orblack) : 0.13 per 1000

People with grey depres .sion who donot consulta doctor : possibly150per 1000

HOW COMMON IS DEPRESSION?

Patients seen by a psy .chiatrist, but not admitled to hospital (usuallygrey) : 1 .9 per 1000

According it) the World I "lealth Organization, something like100 million people in the world are depressed at any one time .Figures on the incidence ofdepression over the last fewdecades seem to show thw the incidence is rising alarmingly .In the 1930s the incidencrohdepression in manystudieswasfound to he less than one in 1000, whereas now, studies of theprevalence ofdepression in society show incidences ol' be-twecn six and 25 percent . The difference probably dependsentirely on the definition ofthe word "depression", whichhas become more fashionable and is being used to describe I ; I rmilderstatcs than previously . Ifyou include "loss ofsparkle"as it category ofdepression, over 90 per cent of people aredepressed . 1'erhops it is, at the moment, more acceptable tosay that 90 per cent ofpcople are less lively than they couldbe, and ofthese, about 15 per cent have thequalityohtheirlives seriously affected by periods ofsevere depression .

THE EXTENT OF DEPRESSION

Admissions to hospital(usually black) : 0.77per 1000

Patients seen by theirGP (usually grey): 12 to15 per 1000

People with loss ofsparkle : possibly750 per 1000

Level of Energetic state Common reply to Clinical termsLiveliness question : "How do

" you feel?"

GOLD You feel good and fully alive . You are "Great" Healthyconfident, creative and energetic

LOSS OF SPARKLE You feel alright, but somehow life is not "OK" Healthysatisfying enough

BLUE You have temporary episodes where "Fedup" or Healthyyou feel a bit lowon energy "Depressed"

GREY You have a longer episode where you "Depressed" Reactivefeel verydown and lose confidence and depressionself-respect . The world looks grey

BLACK You feet utterly hopeless. Your "Depressed" Endogenousthoughts are of sell-blame and suicide . depressionThe future seems black

WHITE There Is no future, only nothingness . No reply DepressiveYou believe there Is nothing inside you . l I psychosisYou lose touch with reality

The following flow chart lists some compar.

to find out your own level, you may be able toative characteristics of each level of liveliness .

Identify with some of the characteristics andHaving answered the questionnaire on page 12

feelings described.

" GOLDOnly a small percentage of people live out thepotential colour, variety and creativity that ispossible to them, given the limits of their t .31-enls and situations.Some characteristics (though not at all timesin all situations) :" Confidence" A feeling of self-worth" Creativity" Love of self and others" Physical energy" Mental interest" Vivid emotions" Sexual energy" A sense of "aliveness"" The would appears bright and Interesting" Clear and acute senses (vision, hearing,touch, taste and smell)" A capacity to wonder" Inquisitiveness" Full responsibility taken for life decisions andlife course

-Advice : stay here If you can. See Keeping,depression out of your life, page 188 .

N LOSS OF SPARKLE 0Few people manage to keep to the very highstandards of gold . More frequently they copeexternally and may be very successful, but lifeis a little muted, less vivid, more routine .

Continued in next column

DIFFERENTLEVELS OF LIVELINESS

Continued from previous column

Some characteristics:" Less inner confidence" The world appears less vivid" Life is not enjoyed to the full" Pressure and will-power are often required tokeep going" Curiosity is diminished" Satisfaction and pleasure are limited, thoughthere may be no awareness that there could besomething more to life" Pleasure Is limited" Some distance between self and others" Experiences tend to lack immediacyAdvice : see Self-help, page 121, andKeeping depression out ofyourlife, page 188.

" BLUE 9Everyone gets the blues now and again . Tem-porary episodes of feeling down occur afterunfortunate events or sometimes for no tan-gible reason . Popularly termed "depression",the episodes usually last only a few days, oreven a few hours.Some characteristics:" Feeling down" Feeling listless" Questioning the point of everything" Temporary loss of energy and motivation" Temporary loss of Interest" Temporary loss of care about self or others

Continued in next column

5Continued from previous column

n Considerable willpower may be needed tokeep goingAdvice : see Self-help, page 121 .

BARRIER OF WILL

" GREY(Reactive depression)

The first category which would clinically betermed "depressed" . You may lose the will orinterest to keep fighting, though you have notlost your sense of hope altogether .Some characteristics :" Feeling down and empty" Lack of belief in self" Loss of energy, creativity and interest" Loss of concentration, forgetfulness" Loss of self-respect and confidence" Loss of feeling and libido" The world looks grey" Self-pityAdvice : see Lifting depression, page 118.

BARRIER OF HOPE

BLACK(Endogenous depression)

A number of physical characteristics becomeprominent and there is a feeling of being takenover by an Irresistible process of emptiness .Some characteristics : characteristics ofgrey, plus :" Loss of appetite and/or weight" Tendency to wake early in the morning" Hopeless and suicidal thoughts

Continued in next column

Continued from previous column

n Depression is worse in the mornings" Strong feelings of guilt, though with somerealization that this is not wholly justified" The future seems black ; indeed, it is difficultto contemplate a future at allAdvice : consult your doctor immediately. SeePhysical treatments, page 169 .

it WHITE fr(Depressive psychosis)

Contact with reality is lost and awful delusionssurround a core feeling of terrible stagnation .There is complete abdication of responsibility .Some characteristics : characteristics of greyand black, plus:" Suicide appears the most positive action,perhaps including killing one's loved ones tosave them from the terrible world" Physical neglect - you can no longer bebothered to eat or wash" "Retardation" - movements of the bodybecome slower. This is accompanied by a slowing down of speech and in extreme states,muteness . "Agitation" may occur instead ofretardation -wringing of the hands and pacingup and down in despair" Delusions: of smelling bad ; of poverty anddisease ; of imminent catastrophe ; of guilt (youbelieve you havedone something for which youdeserve to be punished) ; of paranoia (you be .lieve others are plotting against you) ; or ofnihilism (you believe your brain is empty or thatyou literally have no head or body)Advice : consult your doctor immediately. SeePhysical treatments, page 169,

Energyand

initiative(requiredto carry

out suicide)

Strengthof suicidalthoughts

andimpulses

SUICIDE - AVAILABLE INITIATIVE AS DEPRESSION DEEPENS

No loss of initiativesufficient to detersuicide attempt .

momm

Depth of depression

SUICIDE - INTENT AS DEPRESSION DEEPENS

Questions on thepoint oflife .Moments ofnotwantingto faceanother day. Oc-casional thoughtsofsuicide butno intent.

Loss of sparkleand blues

Future seems grey .Suicidal thoughtsare more fre-quent but usuallyresisted .

Grey

Future seemsblack. Suicidalthoughts arefrequent andinterrupt otherthoughts andactivities . Suicidebegins to seemlogical. Suicidalplans may be laid.

Black

Depth of depression

SUICIDE AND AI`hEMI'TED SUICIDE

Challenging every symptom (continued)

SYMPTOM ACTION

a If theworld is in trouble, you can at least change the little bitof the world thatis yourself; as theold Chinese proverb says "Better to lighta candle than cursethe darkness".a You may have made mistakes . Right now. you maybe miserable andboring,but youare probably not a bad person.

Believing there's

aGive . if necessary make yourself give something. There is no greaterproofnothing inside you

that there is something inside you.

Negative thinking : loss

a Doa't forge! that positive !houbhi is just as powerful as negative thought..of faith

When you consider the vicious circle of negative thinking (depressive thoughtsreducingyour effectiveness. which verifies your depressive thoughts), considertoo that positive thinking has a similar circle which feeds itself. If you can staypositive in your thoughts for long enough (a few seconds is all that's required)to initiate a positive activity. the result will then support your hope and positivethinking . Positive thinking cannot exist inavacuum; it requires anactivity toaffirm it. Be patient with the activity and don't expect miracles .n Dont tell yourself you have no faith. You have faith that you will take anotherbreath and that after you sleep you will wake up . You therefore know that thereare powers which are beyond your control . If they are beyond your control, whoare you to saythat such powers cannot heal you.a Write down a list of your assets (this can include your personal assets ofcharacter, your material assets. and assets of friendship and family)and thenanother list of your liabilities . After you have looked at them, considered themand perhapsadded more items. throw the list of liabilities away. Keep the list ofassets and read it every day.

Negative coloration of

aMake a list of all the positive things you have done in your life and of all thethe past: on looking

people you have helped, even in the smallest way. If you are too depressed toback everything seems

dothis on yourown, get someone who knowsyou to help you remember. Readawful

the list every day.a Make another list of moments of pleasure you have had. If you can,getsomeonewholoves you to help. Read the list every day.There maybe thoughtslike "Yes,but this will never happen again' . Put them aside fora moment andread your fist .

The future seems blank

aConsider the possibility that your loss of hope is a statement of pride.Thereand everything is

is an element ofbragging about the statement "My situation is hopeless', andgetting worse; negative

since you cannot be in control of all the elements within and around you thatcoloration of the

affect yourrecovery, you cannot know there is no hope foryou.future; loss of purpose:

aSometimes you need to accept that there is nothingyou can do fdrtheloss of hope

moment_ Accepting your own limitations or powerlessness can be a relief.a It may not be your privilege. yet. to know what your purpose is .a After your worst part of the day (perhaps the morning), and aftertakingsomeexercise or completing an activity successfully, do the questionnaire in Part I{seepage 12) andwrite down the score. In the same manner, repeat thequestionnaire, answering as honestly as you can, once a week, and put theresults on a graph. If the graph goes down . knowingyou are getting worse isbetter than fearing it . If, as is more likely, it goes up, you have documentedproof that your thinking is coloured .aWhen you have a slight upswing in mood, and after vigorous exercise . writedown some goals that are realistic and achievable in the future .a If you cannot feel hope . remember there is always hope of hope.Know that depression, even when untreated. gets better.

Challenging every symptom (continued)

SYMPTOM ACTION

Indecisiveness

" Consider the fact-that it is indecisiveness rather than the direction ofyourdecision that is more likely to create failure . Therefore decide, one way oranother, and take that course of action without furtherthought. If you reallycan't decide.use a coin ora diceand obey the result . This advice does notapply to major life decisions when you are depressed, and should never beused ifyou are suicidal . If you are wondering whether to kill yourself, don't.Hang on .

Loss ofinitiative and

" If your job does not involve too much initiative, keepworking (but seedifficulty in getting

Changingthe situationat work page 127) .started at anything

ii Getsomeone else to give you orders and to organize you."Make a list of everything you need to do . From that list take out two things,one that you will hate doing and one that you will like doing. Both must bethingsthat you know you can do and that can be done in a short time -a fewhours at the most . Your goal must be small, realistic and achievable .

Start with the thing you hate suchas writing a certain letter or completingatax return. You may have been putting it off fora tong time . Doing it may betedious but can relieve you from a large amount of wasted energy worryingabout. or avoiding worrying about what you haven't done.Set yourself adeadline and start straight away. If you miss the deadline, rather than beratingyourself, set another that is more realistic and start again. Completing the jobprovides satisfaction and hope .Then do thejob that you enjoy doing." Do things with other people. Make an appointment with somebody else sothat there is a little pressure lobe somewhere by a'certain time. Do theshopping with a friend. Arrangeto go to a friend's house and have him orhercome to yours on alternate occasions so that you can work together.

Loss of concentration

" Write things down. If you find yourself continuously forgettingthings, keep aandshort-term

penand note pad close at hand to remindyou and help you concentrate .memory

Loss ofcare about your

"Suspendanyjudgement you may have on thesuperficiality ofappearanceappearance

andtry some ofthe following as an experiment . Howyou look can not onlybean expression ofyourselfor ofwhat you hope for, but can also have a strongeffect on how you feel ." Buysome new clothes.Trysome different colours and different styles.Youmaylook good in many things besidesthe ones you are used to."Workon your body. If you arefat and do not want to be, diet but withoutharshness orself-recrimination-in otherwords don't focus on what you don'tlike, but focus on howyou would like to be and slowly work towards it . Perhapsgo to a daily exercise class (wearsome exciting clothes to exercise in) and workespecially on the partsofyourbodyyou want to firm up or develop." Try out some new looks with make-up or try a facial.

-

" Get your hairdone: trya different style, have it dyed an exciting colour orhave it permed ." Have a manicure and pedicure .

Loss ofcare aboutyour

" Clean and decorate (see Changing the physicalenvironment, page 129) .environment

Sulking: self-pity

Consider these points :" If life were easy, how could you ever achieve anything?" Any expectation that life should not give you pain or problems will cause youpain and problems .

Challenging every symptom (continued)

SYMPTOM ACTION

Sulking; self-pity

n Pitying yourself for your fallibility is not productive . Perhaps the worst(continued)

mistake you can make is to spend your life trying not to make mistakes . Thewillingness to make a mistake provides the freedom to respond more openly -there is no longerthe need to repress your responses for fear of error. Themaking of a mistake is often the richest source of learning : when this is so . eventhough you may not see it foryears. canyou still call this teachera -mistake"?mTo sulk when thingsdo not go your wayis. first of all, a punishment of life or ofthose who make things go wror:g, yourself included . Relpedia! action is moreprofitable than punishment .a Criticism is only someone else's opinion of you; you have the right todisagree with that opinion.

Giving up

uConsider the possibility that blame of self or others is virtually the opposite ofresponsibility of action ;

responsibility . if you say"1 am to blame", the emphasis is on 1. In self-beratingblaming yourself

and self-recrimination, the emphasis is on self . In an extreme form, self-blameisan obsession with yourself . While it may masquerade as concern, your onlyreal concern is foryour ownego. and the only thingyou can give to anotherperson is discomfort and a disguised demand to be soothed. Responsibility, onthe other hand, involves an ability to respond, the willingnessto take action andthe generosity to give some kind of reaction or to take care of your own oranother's needs. If you believe in free will, you must be ultimately responsibleforyour recovery, and the more responsibility you feel, the more you can helpyourself.The humility to accept your own free will is the opposite of thearrogance ofself-blame.

.mAskyourself if yourdepressiongives you a way out of responsibility andtherefore if there is notagenuine temptation to stay depressed. Don't be afraidto admit this if it is true . Accepting it is the first steptowards changing it.m Make yourself responsible for something or somebody. Look aftersomebody else's plants, or, better, an animal . Get a dog and take care of it.Concern yourself with somebody else's needs.w You can be helped by others, but there is no doubt that you have the final say.The powers of self-healing are already within you.

Hating yourself, losing

Consider these points:self-respect-, hating the

w Forgiving yourself and forgiving others are both healingprocesses. The moreworld; believing the

youcan forgive yourself. the more you canforgive others. and vice versa. forworld is bad; believing

the two are intimately connected.

.you are bad

" If you have had an unhappypast, you can change your history. If you were notloved as a child, you can find a way to love the child within you. One possibilityis to make a list of things you enjoy. or used toenjoy doing, for instance, makinga model. bakinga cake, planting seeds. Then, treating yourself as you wouldhave liked tobe treated as a child, choose an activity on your list and do it justfor fun with no concern about results.w If you find yourself using the newspapers to support yourview of how badthings are in the world. don't read them for a while.or better, write to yourpaper with a positive opinion . Even if they don't print it, you mayfeel better forthe activity of writing and getting your own thoughts in motion .a Note that there are miserable people living in affluence and good fortune andhappy people living in great hardship . It is your attitude, not the circumstances,that is ultimately important in your own happiness.u Put love into the things you do. Whether you are preparinga meal,tuning amachine, orlooking after somebody, do it out of love rather than duty . The loveyou put out with trust and no expectation will come back to you somehow.

SYMPTOM ACTION

CHALLENGING EVERY SYMPTOM

Loss of feeling; lack of

" Get angry. See the suggestions in Express the feeling. page 122.reaction ; numbness

" Cry . See the suggestions in Express the feeling. page 122." Laugh. Consider the possibility that someof your loss of humourand inabilityto laugh is, like a child in a sulk, because you won't. Onemoment of humour canchange your whole day. Even a wrysmile may help ." If you have a partner. try a period of sensualitytogether (see Express thefeeling, page 122) even if you have to make yourself start.

Loss of sensation;

Strong sensory stimulation can be a good way of jolting your senses back intoeverything is dulled

action . Here are some possibilities:anddimmed; the world

" Playsome music very loud and feel the reverberations inside you. Move yourseems grey

bodywith the music ifyou have the feeling to. If not. just let the music gothrough you and take you over. Afernetively. play some quieter music thatmoves you or used to move you." Physical pain . Heavy exercise can cause you aches or pain . The pain is atleast a sensation of life and feels better than being depressed." Go to a sauna or Turkish bath . followed bya cold plunge . Take a hot bath orcold shower . Go for a swim ." Use a perfume or after-shave that you enjoy or used to enjoy." Change the colour or style of your clothing ." Redecorate your room or house." Eat tastyand spicy food . Have a drink you are not used to so that itchallenges your taste buds ." Have a deep tissue massage, that is, a firm. hard massage.

Loss of creativity ; loss

" Get a large piece of paper and some liquid water-colour paints . Put aside anyof self-expression

trainingyou mayhave had in drawingor paintingand put aside anythoughtsyou mayhave about not beinggood at painting. The point is not to make a goodpicture but to give yourselfthe freedom to~express whateveryou want to. Closeyour eyes for a couple of minutes while you breathe quietly but deeply and letyour head drop forwards with your neck relaxed . Then, when you are ready.open youreyes; dip your brush, or your fingers, into the first colour that feelsright (without thinking about it). Carryon in this way, and forthe first picture atleast, paint very fast, without thinking. If you feel angry. splash the paint on. Feelfree to express yourself in anyway. When you have finished, don't waste yourtime with judgement- the point is the process of doing it. not the result ." Pottery. If you can, find a room ora piece of ground where you can make amess ifyou want to . Get a lump of clay and hold it in your hands. Read throughthe section on painting (above) to free yourself ofthe restrictions of trainingand self-judgement. After relaxingand breathing. knead the clay in any waythatfeels right (without thinking about it). If you feel like throwing it on the floor,throw it on the floor. Feel free tomake a mess. After getting the feel of the clayin your hands. make a couple of objects (which do not need to be representa-tional) according to your feeling,in the space ofa few minutes. Then, if youwant to. go on to spending more time making an object .keepingin mind thatthe only thing that matters is your process of expression, notthe result. If youlike the piece you've made, keep it- it may remindyou that you have both

.feeling and creativity." Dance. (See also Express the feeling.page 122).

Distance from other

"Say what you think and feel (see Express the feeling, page 122) .people

" Putjudgement and blame of others aside. Put judgement of yourselfasideand say what you need to say (see Creative expression, page 207) .