By Mike McMahan, LPC

Let me just say right off the bat: if you haven’t seen this past Sunday’s Game of Thrones (Season 6, Episode 5), stop right here. This post is full of *SPOILERS*.

Still here? Good. I assume this means you have already seen the episode. I, like every other Game of Thrones fan, was on the edge of my seat as the hour built to its rousing climax. As if the origins of the White Walkers was not a big enough reveal, we also learned why the only phrase that Hodor utters is “Hodor” and it was heartbreaking, to say the least. This post is not a full recap of this great episode, but there are plenty of good ones out there.

As it turns out, when Bran used his incredible powers to visit Hodor’s youth (when he was able to speak and apparently not suffering from neurological impairment), the present-day command to “Hold the door!” seeped into the past, causing the trauma that rendered Hodor in the condition in which we’re accustomed to seeing him, only able to (mis)speak the phrase “hold the door” as “Hodor.”

Now, I am not qualified to speak on cognitive damage caused by warging as I am not licensed in Westeros (::eye roll::). I am qualified to address trauma here in this world, however. And "trauma!" was my immediate thought when I viewed this scene. There are many things we don’t yet know or understand about the brain, and one of them is the reason that the brain holds on to trauma so deeply. It may be that it is an ancient survival instinct, left over from a time when not learning a dangerous lesson could easily mean death next time. This type of brain activity can easily lead to Post-Traumatic Stress Disorder (PTSD), which is frequently seen in combat veterans, sexual assault survivors, and other people who have survived potentially deadly or life-shattering encounters.

However, what most intrigued me about is the way that Hodor’s brain latched onto the phrase “hold the door” after the warging (or whatever) occurred, as it seemed to parallel the way our own brain may latch onto something. For survivors, it is not uncommon for smells or sights to cause triggering reactions due to the brain’s alarm system being tripped. This can be especially pronounced in people with a PTSD diagnosis and is often the basis for the diagnosis.

Continuing our examination into Hodor’s situation, trauma can obviously be a life-changing experience. In my work with sexual assault survivors, I have discussed the opportunities that trauma may be bring. It’s a cliché in Lifetime movies, but look how many women in these films are assaulted, lose a child, or survive something similarly difficult and painful. Many of these stories have basis in truth or are “inspired by true events.” Regular followers of the news know this to be true. Often the story ends with them urging legislators to pass a new law or otherwise achieving something that they would not even have considered before. Many of us know people in our own lives who have completely remade themselves post-trauma. I will sometimes tell clients “life has opened a door and you can choose to walk through it.” Now, people are ready to hear this sort of input at different points. This is not obviously something a counselor would tell someone who was assaulted mere hours before, when they are scared and still trying to come to terms with what has occurred. However, once some trauma work has been completed, it might be appropriate to discuss this matter. After all, trauma does allow people a chance to rise above.

Is this what happened to Hodor? Well, Westeros is a very different place from our world. It’s a safe bet to say that most of these characters have been through more trauma than most of us can conceive of. Frankly, they would probably benefit from therapy--I feel traumatized every time I see a scene with Ramsey or Joffrey. But I do know that when Hodor held off the White Walkers,  saving Bran's life, I did wonder if he could have risen to the occasion so bravely without a challenging life, speaking only the phrase “Hodor” for years. RIP Hodor. We'll always miss you.


Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC

Kudos to Geezer Butler for his honesty. Unfortunately, the rise of so-called “emo” culture is perceived to have increased prevalence of the self-harm activity known as “cutting.” This is exactly what it sounds like—purposely harming oneself with a blade or other instrument in order to cope with psychological pain. The stereotype of the person who engages in this behavior is the “teenage goth girl” and that this behavior is a relatively recent phenomenon. But, as with so many stereotypes, this masks the truth. Cutting and other self-harm behaviors don't discriminate, and can be present in any race, age or gender. Rock legend Geezer Butler, bassist for Black Sabbath, recently opened up about his own self-harm behaviors, which occurred during the band’s heyday in the early ‘70s.

There are actually two points of interest to mental health in this article. “I used to be a cutter,” Butler said. “I’d cut my arms, stick pins in my fingers, that kind of thing. I used to get really depressed and it was the only thing that could bring me out from it.” This type of explanation is typical of people who self-harm. They often report a sense of “de-realization” or distance from the world and that cutting, through the pain, eliminates that feeling and brings them back from this isolating feeling. Treatment for cutting generally involves psychotherapy and/or medication. I approach this issue by addressing the feelings generating the behavior (depression, anxiety, effects of trauma or a host of others) and gradually reduce the behavior by helping the client substitute the self-harm behavior for more healthy coping skills.

It is important to note that while most “cutters” don’t intend their actions to be suicidal, the behavior can be dangerous. Sometimes people cut deeper than intended which can cause damage to arteries, veins and tendons. In addition, if the wound is not seen my a medical doctor, there is the chance of infection.

I also appreciated Geezer’s statement from 2013 (cited in same article) that “Basically, it’s just about depression, because I didn’t really know the difference between depression and paranoia. It’s a drug thing; when you’re smoking a joint you get totally paranoid about people, you can’t relate to people. There’s that crossover between the paranoia you get when you’re smoking dope and the depression afterwards.” As marijuana moves toward legalization, it is important to realize that it is not completely benign. I do believe it is much safer than alcohol, for instance, but there are risks as well. Brains do not fully mature until approximately mid-20s, and marijuana may impact still-developing brains. In addition, while it has not been shown to cause psychosis, there seems to be a correlation between marijuana use and psychosis. It may be that for people who have underlying psychosis, that the use of marijuana and other drugs in the hallucinogen class triggers acute symptoms or a psychotic break. Acclaimed literary legend Kurt Vonnegut’s son, Mark, believes this to be the case and wrote of his experiences with mental illness in his excellent memoir, The Eden Express.

If you are facing any of the challenges outlined above, please speak to your doctor, a therapist or another mental health professional.
 

Mike McMahan is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC

Kudos to actress Jamie Lee Curtis for opening up about her years long struggle with painkillers. The actress, who most recently killed it (literally) on Scream Queens, wrote in an essay on Huffington Post that she has “been in recovery from opiate addiction for 17 years.” It’s not easy to speak about these matters when you are in the public eye, as it’s guaranteed to create a lot of (perhaps unwanted) media coverage.

However, in this case, it seems the actress wanted the publicity in order to bring light to the topic of painkillers. Prince’s recent and shocking death has generated many leaks and rumors, as well as general oddness (Sinead O’Connor alleged Arsenio Hall was his drug supplier—sounds more like a mashup of “Where Are They Now?” and VH1’s Celebrity Rehab!). But, if the rumors and allegations are true, it seems that Prince may have been struggling with Percocet after being prescribed the powerful narcotic for hip pain.

While there is a stigma regarding use of so-called “street drugs” (cocaine, heroin, methamphetamine, etc), this stigma, regrettably, is not attached to prescription drugs, which are equally dangerous. One has to look no further than radio host Rush Limbaugh, who famously railed against drug addicts, calling for extremely harsh measures as punishment. Ironically, he became addicted to drugs himself—OxyContin. My point here is not to rail against Limbaugh (I'll admit, it's tempting), but to, instead, demonstrate the mindset that “because these were prescribed by a doctor, they’re safe.” I seriously doubt Rush felt like he was using "drugs" in the same sense that a heroin addict might. This idea that they're "safer" may be true initially, but unfortunately, many patients find that they need more and more of the meds to control their symptoms. This can lead to the use of “street drugs” such as heroin, which work in very similar ways to painkillers. In fact, some addiction experts even call painkillers such has Percocet “synthetic heroin.”

From 2001 to 2014 there was a 2.8-fold rise in total number of deaths from prescription drugs. I find that statistic very alarming. If you are in a situation where you are struggling with drug use (prescription or otherwise), please seek help from an addiction specialist or talk to a mental health professional.

 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC

Kudos to Frozen and Veronica Mars actress Kristen Bell for speaking out about the seeking treatment for depression and anxiety It’s not easy for non-Hollywood types to address these issues with family and friends. It’s even braver to open up to the entire country when you know your story will be splashed all over social media and entertainment news sites.

Unlike many people who acknowledge that they struggle with the challenges of mental illness, Kristen has clearly sought treatment and educated herself, two key pieces in living a mentally healthy life. She notes in the interview that the women in her family have struggled with these issues for years, endorsing the widely acknowledged belief that there is a genetic predisposition to these disorders.
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She also manages to acknowledge that a stigma that still exists regarding mental health services, asking quite logically, “If you do decide to go on a prescription to help yourself, understand that the world wants to shame you for that, but in the medical community, you would never deny a diabetic his insulin. But for some reason, when someone needs a serotonin inhibitor, they’re immediately crazy or something.”

For those who enjoy looking a little deeper into a person’s art when they make a personal disclosure, consider the character of Elsa in Frozen, and the ice powers she hides for years by wearing gloves. And the fact that she barricades herself in an ice castle when those powers are revealed at Elsa's coronation. Considering the cold feelings of isolation that depression can invoke, an ice castle is not a bad metaphor. Now, given that Kristen was not a screenwriter on Frozen, it’s hard to imagine this was the goal of the movie. However, given that actors pull from personal experience to lend gravity to a performance, it’s not unreasonable to conclude that she may have pulled from personal experience.

To continue in this vein, as a strength-based practitioner, I encourage people to take a different perspective on mental health struggles. Great art is often produced by those with mental health struggles; perhaps it gives them insight into others pain, or perhaps it gives them the drive to complete artistic pursuits. After all, ask any musician/writer/artist and they will confirm the old adage that it’s “1% inspiration and 99% perspiration.” Art may provide an outlet for the dark feelings associated with depression.

Here are the clinical criteria for depression and Generalized Anxiety Disorder. If you feel you meet these criteria or are struggling with any of the symptoms, please speak to a doctor or therapist.

Correction: An earlier version of this piece mistakenly identified Elsa's coronation as "Anna's wedding."

 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.