Mental Health is as Easy as Learning to Tie Your Shoe
March 7, 2015
In the art program I created for people with dementia, Creative Connections, I use a Montessori based approach to making art activities accessible to people with dementia. The Montessori system is assumed to be only for kids, but I have come to find that it works with people of all ages and abilities. There are many components to the Montessori philosophy, but one main aspect of Montessori is the focus on breaking tasks down into manageable steps.
One Montessori teacher I spoke to said that in her training she was asked to write down all the steps it takes to tie a shoe. These would be the steps she would have to guide her students through so they could learn to tie their shoes. She had twenty-eight different steps that were needed to tie a shoe. Think about it: one hand needs to pick up the left lace, the other hand picks up the right lace, then you cross the right lace to the left side and the left lace to the right side, etc… That is 4 different steps and we did not even get the first part of the tie done. A friend who works with computers was telling me that in order to get a robot to tie a shoe, they need to program in 300 or so steps. The robot is actually far closer to what our brain needs to do in order to tie a shoe. There are many steps your brain has to take just to send a message down your arm to move your arm, then to your fingers to move your fingers, then to pinch the lace, and so on. If our brain is unable to understand or string any one of these steps together, you will be unable to tie your shoe. This article talks about how you have to consider many steps to get a robot to tie a shoe and if any step is wrong, the program screams “ERROR” at you and stops working. The same thing happens in our brain.
If you do not know how to break down a task into steps, you are unable to discover what step is not making sense and how to guide the person to follow through on that step. Instead, we just get mad at them and can’t figure out why, when we gave them the knowledge, they just did not do what we said. We need to take the time and break down the steps and demonstrate the steps repeatedly for someone to be able to do them. Here is a video on the Montessori tying lesson, which, you will notice, is done in silence (demonstrating), is broken down into individual steps, is done at a slow pace, and it is repetitive (five ties on the tying frame.) If a child could not follow any one of the steps in the demonstration, the teacher would go back, break it down further, and demonstrate it again and ask the child to follow.
Inadequate task breakdown happens all the time in treatment for people with various forms of mental illness. People with bipolar are told to just not to get angry at a spouse. Notice your anger and just stop it. People with anxiety are told the thousands of facts to why driving over a bridge is safe and then they are forced to drive over the bridge with the assumption that just because they got to the other side, they will no longer be anxious. People with depression are told to just make themselves get up out of bed and cook breakfast.
When we cannot follow through on this “treatment plan,” we are called “non-compliant.” After my seventeen years in treatment I finally learned to speak up and so “No, I am not non-compliant. I cannot follow your instructions. They are too big, too nebulous, too scary, too confusing, and too overwhelming. You need to break it down for me.”
For instance, the main problem with mental illness is that our brain chemistry and wiring has created negative or unhelpful loops in our mind that play automatically. For anxiety, it might be the message that water means death, for depression it might be that we believe we are worthless, for bipolar it might be that we think we fail at every task we take on. It is so easy for a therapist to say: “Water is safe, just jump into it,” or “you are not worthless, smile and you will feel better,” or “if you just followed through on things, you would not fail all the time.” None of that helps. It actually makes us worse. You have given us no manageable steps to take to reprogram those loops in our brain.
Instead, what I have found works much better is tiny steps. If I feel I am worthless and then get triggered into a depression by a small thing I forgot to do, I am not just going to be able to say to myself “You are not worthless. It’s not a big deal. You are great and can do anything. Just fix what you forgot to do.” That is too big of a step. I don’t believe it. My brain cannot comprehend that because it is very far from my reality.
So, I work with my therapist on ideas of what might be a smaller step, and we test those out. Can I tell myself there is a middle ground?- That I messed up, but it’s okay? Right now that is still too big of a step because my core belief of myself is that if I mess up anything, I am a bad person, and bad people need to be punished. A smaller step might be that when I think I am terrible for forgetting a task, I tell myself “I think I am terrible for forgetting this, I may be bad, but I may not be.” If that step is too far because in the moment I cannot even function enough to try and reframe anything, there is an even smaller step. I have talked to my husband so he knows that if he is there for an event like this, he can say: “I know you think you are bad. You may be bad, but you may not be.” Then I may get mad at him for being too nice to me, which is new information I have for my therapist. I found a new trigger. I do not feel safe when people are nice to me. So, we talk about the origins of that and we talk about small steps to take to rewire my brain to feel safe around kindness.
No amount of Cognitive Behavior Therapy, knowledge of Family Systems Theory, or understanding of the origins of my illness has helped me manage the actual moments of instability. I am not saying none of that works, because for some people that is all they need, but many of us need one step beyond these methods. This is because we cannot think or analyze our way out of an emotion rooted in trauma or a core belief system. You have to take all that initial, wonderful knowledge, and use it as the stepping point as the reason why you understand the need to do the work to take small steps to reprogram your brain.
Learning to tie your shoe is hard! That is one reason I could never find a shoe with laces for my son- everything was Velcro. It is hard for kids to learn this new and foreign skill and it is hard for parents to guide over and over again and leave enough time every day to practice the steps until it is mastered. Rewiring your brain is hard. You may have the knowledge, but the steps are just too big and we have few resources that can guide us over and over again and leave enough time every day for us to practice the steps to wellness. It can be done though, if we rethink about how we talk about “non-compliance” and we break down the steps to mental health for each individual person.