I rarely go to movies, maybe once a year. Inception (2010) was an exception largely in part of the fantastic reviews and I'm a DiCaprio fan. However, I was also curious as a psychologist. The movie was about levels of consciousness and memories. Memory formation has been a controversial area of research for decades with implications from the law to abuse to your own memory (check out the TED Talk "The  fiction of memory").

As I reflected on the movie, my mind kept returning to the therapy process. There were many themes in the movie that I experience in the therapy room. Initially I thought my narcissism was kicking in. Is it a bit much to compare working with a patient to a blockbuster mind bender? Set aside the process of inception or extraction. Reflect more on the underlying process of entering someone's mind, circumnavigating their and your own defenses, and uncovering raw, genuine experiences. Read below and you be the judge.

A major theme of therapy is the patient protecting the unconscious. Dom Cobb (DiCaprio) offers a service to Saito (Ken Watanabe) of training his mind to protect its secrets from extractors when in a vulnerable mental state. In Saito's case, the vulnerable state of dreaming.  People protect their emotional world by gaining distance from real feelings by utilizing defense mechanisms such as repression, rationalization, and humor. These mechanisms offer protection from the power of our emotional world. 

Therapy is the process of extracting. Extracting that memory or experience that lies deep within the psyche. An emotional experience that's difficult to reach. In the real world, we present differently than we do in the privacy of our home or a therapy room. We work to maintain our composure in public, counting down the minutes until you can finally be yourself. Our public and private experiences are different levels of consciousness. Therapy is the plot of Inception, gaining the combination to a personal safe.

Enter the character of Robert Fischer (Cillian Murphy). Saito has asked Cobb and his associates to enter Fischer's subconscious. This is mantra the role of psychoanalytically informed therapy; bringing the unconscious to conscious. Freud posited that people have developed simple and complex mechanisms to keep unconscious thoughts, feelings, and experiences from entering consciousness. Freud utilized a number of strategies to bring the unconscious to the conscious including hypnosis, free association...and dreams. 

The process of entering deeper into the mind has a sinister feel in the movie. For therapy, the belief is the opposite: if emotions are brought from the unconscious to consciousness, experiences can finally be resolved, leading to psychological relief and growth. During the process of exploring the unconscious, the therapist will regularly encounter resistance in the form of the patient's defense mechanisms. 

The projections in the movie are the defense mechanisms that are present in therapy. The role of projections were to block Cobb's team from completing their extraction mission, much like a defense mechanism blocks a therapist or even you from accessing experiences and feelings in the unconscious. 

To illustrate, let's use a therapy example. A patient conveys a story where a family member forgets the patient's birthday. The patient dismisses the forgetfulness as a non-issue because the family member has a busy life. The patient may then state birthdays are blown out or proportion, and actually express relief that their birthday was forgotten. 

However, at a deeper level the patient may actually feel hurt and disappointed. At an even deeper level, the patient may feel dismissed and unloved by family. The deep, core issue here is feeling dismissed and unloved. However, the rationalization (e.g., busy family member) and intellectualization (e.g., debate of birthday value) of the situation  serves as a defense against the realization of deeper, more profound emotions. 

Each "kick" represented a different level in the dream state, with its own world and sense of time. The same applies to the different levels of consciousness for each person. In the birthday example, each level of consciousness came equipped with it's own defense mechanism as well as a unique sense of time. Just as in the movie, as you move to deeper levels, the laws of time are compromised, and more signals or markings are needed to keep perspective. 

Yusuf kept a sense of time by playing music in the van. In therapy, a sense of time may occur by recognizing the context of the memory (e.g. the physical location of the experience, who you were with, etc.). Just like the kicks, moving from one conscious state to another with a patient can be smooth or violently jarring. Just like a kick, therapy is finite, each session is limited to 50 minutes. 

With each "kick" into a deeper dream state, stability and predictability were compromised. Cobb's team experienced a loss of control as they descended into deeper levels of the dream state. In therapy, as you venture deeper into a patient's psyche, there is the risk of destabilizing the patient. It's one thing to process a family member missing your birthday, it's an entirely different thing to process feeling unloved and forgotten by family. 

It's a very delicate process to venture deeper into someone's mind. Now add the time constraint of 50 minutes. It's not often talked about but there is a psychic pressure similar to the experience of deep sea diving or climbing a mountain. If you ascend from a sea depth or ascent a mountain too quickly, the body and mind sometimes have difficulty transitioning which can result in a sickness, shock, or even death. If you move quickly in and out of the unconscious, the patient can suffer a similar experience of sickness, shock, or even psychosis. It's imperative to bring a patient out of a deeper psychological state, and help them recover toward the end of the session. When the session is finished, that's the "kick" back to reality, the return to the world outside the therapy room. 

The underlying subplot of Inception is Cobb's unresolved trauma of his wife's, Mal, psychosis and subsequent suicide. Cobb feels responsible for her death, and his own psyche proves to be a complex web for the inception team. Ariadne, the dream architect, repeatedly questions whether Cobb can keep his own projections contained during the dream extraction and inception. 

This subplot is quintessential countertransference. Countertransference is the therapist's feelings that are stirred and brought to consciousness by the patient's experience. Entering Fischer's dream state stirs Cobb's own dream experience with his wife. A patient talking about abuse, loss, or fear can stir the same emotions in a therapist. Like Cobb, the therapist has to be vigilant and set aside their own experiences to work with the patient and their psyche. Countertransference is a powerful experience and should be addressed whether in a therapist's own therapy or in peer consultation. 

Inception concludes with Cobb returning home to his children. He spins his totem, his reality check mechanism, and the screen goes black leaving the viewer wondering if this last image is in fact reality, a dream state, limbo, or all of the above. 

Memory and the patient's reality (whether accurate or not) is the foundation of therapy. I often encourage patients to journal or talk to their parents, if possible, about early childhood experiences that we process in therapy (I encourage you as well). Sometimes we are sure of a memory, then are surprised by how we are our own inception team. Each person decides how they are going to encode an experience into a memory, without the guarantee of accuracy.

For example, I was sure of a decades old memory until a year ago. I remember riding my bike home as a kid and seeing my mom pull out of the driveway with a child in the passenger seat writhing in pain. I remember feeling confused and wondering what happened. According to my memory bank, I found out the injury details hours later when everyone returned from the hospital. 

I revisited this memory with my mom last year and her recollection floored me. She recalled sending me out to find this child as she feared something bad had happened. I found him injured in the woods, carried him from there into the house, and my mother took him to the hospital. 

Two incredibly different stories for the same experience. Only one of us can be right. So if my mom and I both spin are totems, which spinner will continue to spin?

Take a moment and ask someone about one of your memories. Ask them their experience and compare notes. You might learn something about yourself.


As usual, feel free to share this post via facebook, twitter, etc. Comments are welcomed!

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support! 

This analysis will not focus on the usual variables that are debated ad nauseam by foreign policy “experts” on all news channels. The explanation provided here will be rooted in psychology with an emphasis on relationships and motivation. I'll be arguing that the role of psychology has been lacking in foreign policy equations, and until considered, American foreign policy will continue to falter, especially in the Middle East.

Relationships

Every relationship has complexities and a uniqueness. When working with someone in therapy, I conduct a clinical interview over numerous sessions gathering information including present, cultural, family, and historical issues. Some ask if this is necessary. It is, because the interview provides a complete picture of the person. Therapy can then be tailored to the individual's specific needs. Additionally, this helps me connect with the person which is integral to the therapy work.

The same should apply in relating to another country. If I were to clinically interview Iraq, a few issues would arise for consideration when it comes time to relate and intervene. For Iraq, you have to look at the people's psychology. The consensus is most Americans regret the 2003 Iraq invasion. The Iraqis generally feel negatively about American intervention, dating back decades.

From the Iraqi mindset, American foreign policy has been troubling. A lack of trust exists which is never good for cooperation. If American foreign policy continues as it has for decades, Iraqis won't buy in and any progress will be at a superficial level. Even if the policy can be successful, it will be met with resentment and hostility due to history. Much like in therapy, if I persist with the same intervention that hasn't been effective with a patient, it's unproductive and potentially harmful. 

Motivation

Motivation does not receive enough attention in the foreign policy world. The two types of motivation, are intrinsic and extrinsic. Intrinsic motivation is a desire to do something because it is personally important or appealing to you. Extrinsic motivation is the opposite; the drive for something is due to external factors such as praise, punishment, or money. Studying psychology because you have a natural interest in the subject is an example of intrinsic motivation. Studying so you can get an A on an exam is an example of extrinsic motivation. 

When you are intrinsically motivated, you tend to feel more satisfied, engaged, valued, and open to improvement (Wigfield, Guthrie, Tonks, & Perencevich, 2004). Americans are largely dissatisfied with their work which results in the loss of hundreds of billions of dollars to the economy each year (Gallup, 2013). It appears most people are extrinsically motivated to work. People work for money so that they can live. Employers are constantly looking for ways to intrinsically motivate their employees to increase productivity, efficiency, pride, and longevity. In therapy, one of the many techniques used is to cultivate extrinsic motivation to help patients to move forward, with the ultimate goal being to foster an intrinsic motivation for real change.

What does any of this have to do with Iraq? In many ways, a country is like a company and the citizens are employees. The citizens of the most successful, happiest countries in the world scored high on civic engagement, sense of community, and overall life satisfaction. All of these variables are associated with personal goals and intrinsic motivation. These traits are lacking in Iraq at a national level. For decades, the fate of Iraq has been in the hands of dictators or foreign nations, leaving Iraq without an identity. Instead of building a national identity and sense of togetherness, the country has been unstable and most citizens are focused on personal safety and survival.  

What does this mean for foreign policy?

Leaders of many countries repeatedly champion that all actions that are taken will be in the nation's best interest. When other countries hear this type of rhetoric, what are they to think? These type of statements can only weaken the relationship between two countries, especially if one country openly speaks about self-interests. Imagine two people being in a relationship and one person constantly does things because it is in their self-interest to do so. Does that sound like a healthy relationship?

Foreign policy needs to focus on mutual best interests, not just one nation's. This may sound like a weak stance but in reality it's an empathic, courageous approach. It's also the opposite of the policy that has been failing for decades. The goal of foreign policy should include identity formation, national building from within, and instilling a sense of pride and optimism at a personal level. 

Intrinsic motivation needs to be a part of any intervention. If Iraqis don't feel a personal and natural investment in their country, they won't fight for their country because it doesn't feel like their country. How do you nurture intrinsic motivation? Allow Iraqis to have a major role in the decisions and direction of the country. That doesn't mean step back and watch passively, it means allow the Iraqis to take the driver's seat. In therapy, real characterological change doesn't happen if the therapist is providing solutions and giving advice. Fundamental change occurs when the individual recognizes and works for increased awareness and self-improvement. As this therapy process unfolds, the therapist metaphorically transitions from the passenger seat, to the back seat, and eventually into an image in the rear view mirror.

Experts like to talk about historical events as examples to support current policies and interventions. A quick review of Iraq's history shows external interventions and values are ineffective in the long term. Even in America's history, the Civil War was a turning point because it was an organic, intrinsic conflict. Outside forces did not play an active role. Would America be the success that it is today if France or Spain facilitated the Civil War? Americans were responsible for the Civil War and that's why it had a profound impact on the direction of the country. Just like every patient, every nation is different. Foreign policy has to be tailored to each country's needs and goals. 

The same model has to be considered for Iraq. Ask the Iraqis what they want to increase their intrinsic motivation and investment in their country. Considering their goals and aspirations. If Iraqis want to isolate and manage the country on their own, so be it. If they want international intervention limited to assistance from bordering countries, so be it. If they want an Islamic state, so be it. With each decision there are positive and negative consequences. That is part of nation building and identity formation. It's important to recognize that Iraq is a country that is less than 100 years old. It takes time but Iraqis have to engage in their future, and that happens by giving them the keys to the car.

Just like therapy and self-improvement, it takes time and experience. Look where America was 100 years after it's founding. Some might say America in the 1870s was similar to Iraq in the 2000s in many ways. It may be messy and even tragic, but if Iraq is going to be self-sustaining and prosperous, foreign policy has to start with the Iraqi people. 


As usual, feel free to share this post via facebook, twitter, etc. Comments are welcomed!

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support!

As a child psychologist, I have worked closely with not only families, but also the schools. With these professional experiences (paired with my personal experiences), it has become abundantly clear that the best schools have the most active, engaged parents. 

I'm not suggesting that teachers, school staff, and other support staff are unimportant. They obviously are and will always be important. I'm suggesting that the best schools have parents helping in diverse and meaningful ways. There seems to be an underlying belief that the parental role is limited to making sure your child is punctual, homework is complete, and permissions slips are signed. Parents can and should do so much more. 

Yes, there are the basics: PTA meetings, parent-teacher conferences, and open houses. The basics, as in each parent should already be attending these events. Participation in these activities doesn't constitute getting "involved". Complaining without constructive suggestions and personal investment isn't getting involved. So if you have a problem and have no intention of removing your child from the school, bring a solution with your issue. 

How To Get More Involved

I know, every parent is busy. Everyone is busy to an extent. I'm not suggesting to volunteer 4 hours a week, or even 4 hours a month. Even 1 hour per month can make an impact.

Contact the school with your idea(s). Start with contacting the school with your ideas and how you can help. Again, if you have ideas, suggestions, or criticisms, be sure to include how you can be a part of the solution. In my experience, schools are always open to parents' suggestions. The deflating part is when the conversation begins and ends with the idea. 

Inquire on what the school needs. New computers, improved security, keeping the school grounds clean. Sometimes it's just being available during recess. Usually a school has a "wish-list". Ask about their aspirations and determine if you can help.

Be realistic. You don't have to develop a new academic standard or spend all week volunteering. Determine how much time you can give and plan accordingly. You'd be amazed by how many kids value even a 5-minute interaction, even if it's a chat about the weather. 

Be consistent. This is true in life, but certainly true if you are working with kids. There is always excitement at the beginning of a project, and sometimes frustration builds when you hit a road block. Stay consistent. If you say you're coming the first Monday of the month from 9:30-10:00am to help with snack time, then do it.

Put away your pride. If you are an artist and can help with the art program, then awesome. If you are a professional and the school needs someone to manage snack time, then do it. There is no shame in helping a school improve, regardless of the task. Sometimes you have to sacrifice your personal aspirations for the good of the school.

You Are Helping Your Kid, Even If They Don't See You

We depend on schools to foster academic achievement in our kids. Sometimes we mistakenly ask them to take the lead to foster emotional and social development as well. That's not their job, it's the parents job to lay the emotional and social foundation of our kids. The school provides emotional and social opportunities. 

By being more active in their school, you are teaching your kids to be engaged in the community, the spirit of volunteering, and that you are invested in their school experience. Your school involvement can boost your child's self-esteem, self-confidence, and the parent-child relationship. 

So do you want your child to attend a great school? It starts with you. 


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There is an underlying belief that the legalization of marijuana is harmful because marijuana is a gateway drug. I always ask law enforcement about marijuana being a gateway drug and the answer is almost always a unanimous yes.

However, research tells a different story. I'm not about to argue for the legalization of marijuana, that isn't the message I'm attempting to convey. Rather, I'd like to illustrate how alcohol is actually the gateway drug, and how we as a society seem to be okay with alcohol's harmful and often deadly consequences.

A recent study found that teens who abused alcohol are twice as likely to abuse prescription opiate drugs than those who only used marijuana. This is an important statistic because prescription drug abuse and overdoses are skyrocketing across the country. Opiate drug overdoses kill more Americans yearly than cocaine and heroin overdoses combined.

Alcohol research tends to focus on underage/teen use. In a recent survey by the Centers for Disease Control (CDC), 25% of 8th graders, 40% of 10th graders, and 53% of 12th graders reported drinking alcohol in the last month. If this isn't alarming enough, the study dug deeper and found that 79% of teens drank because it felt good, 67% to forget their problems, and 66% because of peer pressure. For me, these responses allude to underlying mental health concerns like poor self-esteem, deficits in coping skills, depression, anxiety, and loneliness.

Makes sense, right? Adolescence is tough for teens and parents. Teens are dealing with social and academic pressures, identity issues, and navigating the world of independence. So what's the excuse for adults? Over 35,000 adults die each year from dependent and non-dependent use of alcohol (CDC). When including unintentional deaths, homicides, and other indirectly related deaths, the 35,000 number more than doubles. According to the National Council on Alcohol and Drug Dependence (NCADD), alcohol plays a role in approximately 40% of all violent crimes in a given year. That equates to almost 4,000 violent crimes per day.

Most feedback from adults for reasons to drink ironically sound very similar to teen responses: for fun, to relax and forget about problems/stress, and because of social expectations. The problem here is the more you drink, the worse you think. Over time, social drinking can evolve into an addiction and into your preferred coping mechanism for stress or any issue.

So what is really being said when a teen is told that they can't drink until the arbitrary age of 21? You aren't old enough to handle the responsibility of drinking at this time, wait a few years. The problem is that millions of adults show time and again that they can't handle the responsibility either. Research repeatedly shows that most people use alcohol as a coping mechanism, as a way to avoid real life issues.

At a societal level, it seems there is a hint of “oh, he's been drinking, that explains it,” to justify behavior. It is almost as if alcohol is being blamed, taking away the responsibility from the individual.

There needs to be a shift in the alcohol dialogue. There needs to be more honesty and courage. Alcohol needs to be talked about for what it is, an unhealthy coping mechanism for many that kills tens of thousands every year. The statistics don't lie. Maybe “happy hour” should be renamed “ignore your problems hour".


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If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville facebook group by clicking here. You can also follow me on twitter here. Thanks for your support! 

By now you've all heard or read about the tragedy. A 16-year-old, Ethan Couch, killed 4 citizens (including 3 good Samaritans) and injured others, all while intoxicated on drugs and alcohol. He was sentenced to 10 years probation with probably 1-2 years in a rehabilitation facility.

As a human being, I am saddened and angered by this case. As a psychologist, I am terrified. The saddest part is there were many instances where Ethan wanted help and even showed he needed it. Passed out drunk in a truck at age 15 with a naked 14 year-old girl. Police find him, no consequences. Documented history of passive and criminal parenting. No documentation of parenting classes. Who knows what happened in that home, it certainly wasn't healthy.

Before saying more about Ethan, let's address a couple of things about the consulting psychologist and “affluenza.” Affluenza is a fabricated psychological disorder (does not exist now nor ever in the diagnostic manual) that was allowed to be used as part of the defense. This is bizarre to me, I don't know how a judge would allow a pseudo-clinical term to impact a decision. I'm embarrassed that a psychologist, Gary D. Miller, used psychobabble in his explanation. However, a part of me gives Dr. Miller the benefit of the doubt and hope it was taken out of context.

In a recent interview, Dr. Miller said people are focusing too much on the “affluenza” diagnosis (I feel dirty typing that). The focus should be on the clinical terminology. I've worked a few court cases, and in almost every case, lawyers and judges only focus on the last page of the assessment which often includes the diagnosis and clinical recommendations. So clinical terms matter. Dr. Miller also suggested Ethan behaved more like a 12-year-old. Problem is 12-year-olds know right from wrong. My kids have a sense of right and wrong and they aren't even in elementary school. Again, I hope some of this information was taken out of context.

So why am I terrified?

There were a number of warning signs that were ignored. The parents had years, the police had chances, and now this judge had a chance. All of them failed. In a previous post (here), I laid out how it's natural for kids to have sociopathic tendencies. It is part of the developmental process. The other part of the process is helping kids cultivate care, empathy, and awareness. His sociopathic tendencies weren't extinguished, they were validated. Each time an adult passively allowed Ethan to commit illegal acts without consequence, Ethan received the message that not only was his behavior not wrong, it was right. He was essentially praised for bad decisions.

Now, he has ended 4 lives and destroyed families. The judge, Jean Hudson Boyd, had a chance. Judge Boyd could have set a limit, she could have said what you did was unacceptable in our civilized society. Instead, she validated murder. She validated a code that money and power are more important than humanity and life. She has confirmed Ethan's belief that he is more important, more valuable than other people. She has given her seal of approval of Ethan becoming a full-blown sociopath. The icing on his sociopathic cake is experts in their fields (i.e., psychologists, lawyers, police, and now a judge) have put all the blame on the parents. To really send home the message that Ethan isn't to blame, they ordered him to a beach town in California (see picture) so he can get away from his parents and their influence.

Yes, we are taking about a teenager. He certainly has an opportunity to fundamentally change who he is as a person. I truly hope that he does. I won't ever give up on a kid, it's not who I am.

However, facts are facts. The fact is he had friends in the bed of his truck, and increased his speed to 70 mph when they pleaded with him to slow down. The fact is his blood alcohol content (.24) was 3 times over the legal limit (.08) and he had THC and Valium in his system. The fact is he hit 4 people with his truck, and said to his passenger, “I'm Ethan Couch, I'll get you out of this.” To be that calm and calculated in that moment (and under the influence) is the definition of terrifying. It also suggests Ethan's case of “affluenza” was actually a fancy way of saying he's a budding sociopath, possibly psychopath. I hope I'm wrong.


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It's common knowledge. It's accepted widely among both clinical and medical circles. It's a part of treatment and recovery. The notion that alcoholism is a disease. 

In working with individuals struggling with alcoholism, I've heard the disease statement many, many times. In some instances it served a positive purpose, providing certainty and direction; in others it served a negative purpose by empowering the addiction and undercutting self-efficacy. There has always been something that doesn't sit well with me regarding the disease approach. For my therapeutic approach to addiction, click here.

The word “disease” has a medical connotation. You have a disease, you see a medical doctor, go to a hospital, have a treatment possibly with medication. That's the association that I make, maybe I'm in the minority. In many cases, a disease suggests that the condition was something out of your control. Diabetes, cancer, multiple sclerosis. In some cases, there is little to no control, in others our choices have made them uncontrollable.

A major hurdle for the field of psychology is feeling inferior to the field of medicine. The former is a social, pseudo-science; the latter a legitimate, biological science. In a grasp for legitimacy, research has rapidly become the norm in psychology. Scientific terms like “evidenced-based”, “empirically-supported”, and “etiology” are commonplace. Research certainly is not a bad thing (even though it can be fallible), many advances have come from research. However, has the drive for legitimacy and respect had a negative impact on psychology?

Why does any of this matter? Great question. A major part of treatment is based on how a condition is conceptualized. In the case of alcoholism, my concern is the use of “disease” takes away from the social and psychological contributing factors. I'm not ignoring decades of research that give credence to genetic and biological factors of alcoholism. However, I believe alcoholism grows out of a combination of social and psychological issues to become a serious condition often requiring medical intervention.

In graduate school, a professor argued feelings weren't social, biological, or emotional. They were chemical. The release of a specific neurotransmitter. It's hard to argue that point, and you can make a parallel argument for the underlying factors of alcoholism (or most any condition, disease, or disorder for that matter). Bias to my training, in most cases I lean psychological. Even when the presentation is medical, I focus on the psychological variables. I am encouraging other clinicians to shift their perspective. If you aren't convinced, then consider conceptualizing alcoholism as a social or brain disease.

To be clear, I'm not advocating that society, clinicians, or friends and family should be more critical and harsh to those struggling with alcoholism. I'm suggesting the term “disease” can minimize personal factors and increase the belief that since it's a disease it is out of a person's control. I'm not saying this is the majority belief, but it does exist. I hope this post has brought a different perspective to a condition that has impacted millions.


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Facebook’s impact on the world is undeniable. The ability to connect with someone on the other side of the planet with the click of a button is remarkable. Be careful though, because studies examining facebook show an inverse correlation between the amount of time you spend on facebook and psychological well-being. In essence, the more time you spend on facebook, the worse you feel about your life.

Now with that said, many people use facebook to stay connected with family, maintain friendships (by not directly talking to friends…that’s for another post), network, and find others with similar interests. These reasons can all be healthy and actually improve life satisfaction. When facebook is used to stay connected with others, it can be very rewarding and beneficial.

So what's the problem? People by nature compare themselves to others. There are a number of theories (e.g., Festinger’s social comparison theory) that suggest people get their self-worth and value based on comparing themselves to others. Again, that’s not unhealthy. It can actually be very beneficial to compare yourself to others. The problem arises when the comparisons are not based on completely accurate information.

Facebook allows for a filtered, biased representation of the individual. Profiles are full of pictures of home-made meals, exotic trips, and daily highlights (kudos to those who share daily lowlights). With enough facebook surfing, these snapshots can seem like the norm. You start comparing your "average" life to friends who just returned from a vacation, make meals from scratch, or always seem to be having success. That becomes your belief of what others around you are accomplishing. You start to question your value and negative thoughts creep in.

It’s important to keep an accurate perspective. For every picture of culinary masterpieces, there could be countless pictures of leftovers. For every picture of breathtaking views of the beach, there could be hundreds of pictures of a somber office cubicle. People tend to share the good and not the bad, especially on social media.

Facebook profiles are like reality TV. They're edited to show the eye-catching highlights as the mundane routine couldn't get the ratings. Keep that in mind.

In the 1900s it was don't judge a book by its cover. For the 2000s, maybe it should be don't judge a person or yourself by a facebook profile. Neither a book cover nor facebook tell the whole story.

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I don't know if there is a right way to die, but Jo went out in a great way. In this past year, I have met with a number of Knoxvillians who work with the child/adolescent population. Jo was as vibrant and energetic as any. That's quite the feat considering she was living with two, rare autoimmune disorders that impacted her physical health and daily life.

News of her death last month was a shock. I had just met with her weeks earlier and she was as energetic as ever. As details became known, it became very clear that Jo had a sense all along. She developed plans for her "work" kids to help them cope with her death. These preparations were made months in advance and were incredibly thoughtful. Imagine writing letters to those you care about, knowing the end is near, and still being as dedicated to living as ever. Incredible courage and vitality.

I thought, "Wow, Jo was making new friendships as she was dying." This certainly isn't a rare phenomenon, but it is phenomenal. It's an incredible life lesson: Live life for you, stay in the moment. That's exactly what Jo did, she faced death and kept going. She easily could have retired or isolated herself. She continued living life, for herself and those she cared about. She valued herself.

Jo was the poster child for living in the moment. She blocked out outside and internal distractions, and was able to enjoy the moment for what it was. She could have had a tasty dinner and wondered if this would be her last great meal. Instead she chose to enjoy the meal for what it was, a great meal.

To be honest, I was confused and upset as to why Jo didn't confide in me, I am a psychologist after all. In a way it was shameful and egotistical, but it's how I felt at the time. Then it hit me: it wasn't about me, it wasn't about her, it was about living. Jo didn't let death take control, she lived on her terms. Talking about life expectancies, cell counts, immune systems, would have taken away from her essence of living. She was a genuinely open person, she accepted her fate.

I'm not doing Jo justice, she was more remarkable than words can capture. However, I hope you gained a sense of her spirit and love for life and others. I hope when adversity presents itself and you are feeling hopeless, defeated, and overwhelmed that you find your way and thrive. Regardless of the situation, you can have some sense of control. You have options, just like Jo.

You will certainly be missed. Rest in peace, Jo.


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One billion dollars is spent every year on dieting. Billion. Think of what you could do with that type of money. Ok, I just lied. It’s not one billion, it’s 60 billion. Sixty billion dollars on dieting, books, dieting drugs, and surgeries.

Weight gain is a numbers game. If you consume more calories than you burn, you will gain weight. Weight gain is your body saying, “I have no idea what to do with these extra calories so I’m going to store it in this love handle.” Remember that previous post about your body constantly talking to you (read it here if you missed it)? The same concept applies to eating.

Diets give you a framework for how to lose and maintain weight. In the end, it doesn’t matter what diet fad you adhere to, what matters is you. What are you doing fundamentally to change the way you view your relationship with food? Why are the diets not working?

Be realistic. Have realistic goals. Don't set yourself up for failure. Instead of cutting out all unhealthy foods, start by removing one food from your diet. If you eat out for lunch 5 times a week, set a goal to eat out 4 times a week.

Slow down. Take your time when eating. The faster you eat, the more you eat. Your body hardly has time to send you the “I’m satisfied” signal before another bite. Remember when you were young and everyone said chew your food 20 times? Well, chew your food 20 times.

Be mindful. Don’t just eat. Notice the flavor, texture, and other features of what you are eating. Being mindful changes your eating experience and helps you determine when you are satisfied before you are stuffed.

Recognize if you are actually hungry. Many people eat because they are bored, stressed, upset, it’s the typical eating time, or the opportunity simply presents itself. Ask yourself, “Am I hungry or am I just eating to eat?”

It’s okay to make a mistake. No one is perfect. If you gain weight or “cheat” on your diet, it’s okay. Reflect on what happened and learn from it.

Drink water. Your body is 60% water. It needs water. Water flushes toxins, transports nutrients, and can speed up metabolism. Most professionals recommend 12 glasses of water for men and 9 for women (8oz glass).

Water is also an appetite suppressant. For babies, the more food they eat, the less milk they drink. The more milk a baby drinks, the less food they eat. So, the more water you drink (which you need anyway), the less food (and calories) you will consume.

Avoid temptations. Alcoholics are taught to stay away from places where alcohol is readily available. Stay away from snacks and foods that are your weakness. Don’t peruse the snack aisle at the grocery store, and keep certain foods out of your home.

Adhere to your guidelines and be patient. Give your dietary change a chance. Your body needs time to adjust. If you don’t see instant results, stay positive.

Support. Changing your food lifestyle is hard. If you need support, get it. Whether that means a support group, dieting partner, therapy, or whatever is helpful for you.

The statistics are there: 95% of folks regain the lost weight within 5 years. Over 100 million Americans are dieting. Diets are short-term and superficial. Instead, change how you think about food and eating at the core (no pun intended), and you can change your life.

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Hey Salmaan, I wanted your opinion regarding conversion therapy considering you are in the field. Particularly because you are a Muslim, what's your opinion about conversion therapy and what role do your religious beliefs play in working with someone who is gay.

-- Anonymous, August 2013

I openly admit I do not have first-hand experience with conversion therapy, I have only heard stories from those who were willing and unwilling participants. The stories I have heard have been negative; however, I know there are positive stories out there.  I am not sure if a “conversion” to heterosexuality makes the therapy a success, or if the goal of conversion therapy is to manage homosexual desires in a heterosexual manner. It's certainly controversial, and therapy in general is usually a failure if the participant has been coerced into therapy.

In my professional work, when someone who is confused or struggling with their sexuality enters my office, I focus on the struggle and confusion. I never have and never will push someone to one orientation or another. That's me speaking as a psychologist and a Muslim. Maybe I'm doing my faith a disservice, but I don't think so. In my life and work, I believe it’s not my place to judge; my role is to increase understanding and awareness in your life.

Part of therapy with me is having a conversation about what would it be like to be straight and what it would be like to be gay. This allows for a genuine analysis of how the person feels and may bring clarity regarding their sexual orientation. If someone wants to talk about the role of their faith, that conversation is certainly explored. Many do struggle with balancing their religious beliefs and their orientation.

In my experience, people know their sexual orientation upon entering therapy. Therapy is usually more confirmation and supportive than analytical. A major part of the therapy is how to manage current relationships, especially family relationships. For many, the major stress is how to tell family, especially if the family is opposed to the lifestyle. The fear of being ostracized and disowned from their family is very real for many.

For those who have been adamant that homosexuality is a choice, I always say your political/religious affiliation is a choice, so spend the next 5 years genuinely being of a different political mindset or different religion. That might provide perspective into what it is like to pretend to be something that you are not. That’s my personal belief.

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Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support!