It’s All in the Mind

After studying medicine in Khyber Medical College in Pakistan and psychiatry at Memorial University in Canada, I started working as a psychiatrist in 1981. During the course of my work I realized that the methods of traditional psychiatry needed improvement as they were mainly illness-oriented and fostered the dependency of patients on medications and mental health professionals. Most of the traditional psychiatrists I met practised biological psychiatry. They focused on diagnosing the psychiatric conditions and relied heavily on psychotropic medications.

Most patients and their families I met did not feel satisfied with such treatment, as they did not understand the healing process. When psychiatrists tell the parents, "Your daughter suffers from Depression because she has a biochemical imbalance in her brain and we would prescribe anti-depressants which would increase the levels of dopamine and serotonin in the synapses of her brain" they are utterly confused, as they do not
understand the neurobiology of the brain. Many patients and families who see traditional psychiatrists for some minutes once a month feel helpless because they do not understand the treatment method and do not imbibe its essence.

For years after my graduation I tried to discover a model that would be simple and straight-forward enough for patients and their families to understand and effective enough to help patients help themselves. I wanted people I looked after to understand their emotional problems as well as they understood their physical problems. Patients suffering from Diabetes and Hypertension, for example, realize that by changing their diet and exercise patterns they can not only control their symptoms but also improve their quality of life. I wanted patients under my care to similarly understand their emotional condition and improve their quality of life without taking psychotropic medications. I wanted them to use medications as the last not the first step.

It occurred to me that if the psychological conditions of patients are explained to them in terms of easily comprehendible language, and methods of improving their conditions are described to them in counselling sessions, they have a better chance to respond and help themselves.
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Over the years I developed a familiar nomenclature for this purpose which the patients could effortlessly relate to. I call it a Green, Yellow, Red Zone Model. According to this model a person who is leading a normal life without any psychological problems is living in a "Green Zone". On the other hand, a person who is suffering a nervous breakdown and has a dysfunctional life is living in the "Red Zone." The space between these two extremes is the "Yellow Zone." It is the space that is inhabited by the people with minor emotional problems.

Once the patients identify their condition (with the guidance of a counsellor), they can make a sustained effort to ascend from the Red Zone into the Yellow and then into the Green Zone. In this way, the patients are able to measure their progress (or regression) themselves. This method worked very well. Gradually, other practicing experts came to know of it and they started referring some of their patients who had not responded to the traditional treatment, to my clinic. Many of them got well with our guidance and counselling but mainly due to their own efforts. They were able to determine which of their actions led them downward into the Red Zone and they would make conscious efforts to avoid them or deal with them in an effective way.

In married relationships, communication problems can destroy trust and mutual respect and the couple can end in the Red Zone. I've met many spouses who, rather than saying to their significant other, "Last night when I was talking to you, you seemed lost in your own world," prefer to jump in with both feet in the Red Zone and say accusingly, "You never listen to me." Such statements never help to solve problems; in fact they do just the opposite.

Likewise, it is emotionally dangerous in a healthy relationship to bring up the unpleasant "past" and keep on alluding to it in conversation. Such behavior also leads into the Red Zone.

This is illustrated by the following letter, which a husband wrote to his wife to make amends for his thoughtless and poor communication.

Dearest:

After our fight on Sunday, I thought a lot about how we started out fine and then the conversation really deteriorated. That seems to be a pattern with us. Thinking it over, I realized that whenever we try to discuss disciplining our daughter Sherri, I seem to hurt you by bringing up your past drug problems. You worked hard to overcome them and I guess I get worried about Sherri because I want you to be stricter with her. You want to let her do many things that I wouldn't support, so I can't help reminding you of how you used to live and what happened to you. Then you get mad about that and we end up fighting about the past instead of dealing with Sherri. I feel really bad about that. I promise that in the future I will keep the discussion focused on what we're trying about Sherri and respect your feelings about a closed chapter of your life.

Love, Robert

Although there are many different situations in real life and each one of them requires a different approach, identification of the respective Zones is invariably helpful in all these situations. I'll illustrate my psychotherapeutic method by the following example. This pertains to Leslie and Barry. Leslie agreed to share the story of their relationship problems and recovery with the help of the Green Zone Model with me in the following letter.

Doctor:

We were deep in the Red Zone. Marital therapy helped my husband and me clear up long-standing difficulties created by our different anger management styles. With direct teaching of some simple concepts: Green/Yellow/Red Zones and "Time Out," our relationships improved as we learned to communicate more effectively. I will attempt to show how we got into difficulty and how we both learned to sort out and resolve important differences using the aforementioned strategies. Let me start with how I fell apart and then attempt to show how the insight into our personal management styles plus skill learning and guided practice have literally given us a more serene, manageable life together.

My husband Barry gets angry quickly and forcefully. Stopping his anger is like trying to hold back a hurricane. For years I chose to avoid his anger like hiding in the basement until the storm blows over. My extreme fear of his anger made me want to avoid talking about anything that might provoke him. This gave him carte blanche to spend all he wanted on luxury cars, golf and electronics while I compensate for his spending with measures of my own. My solution to the problem was based on the mistaken belief that if I managed the budget better and spent less on myself, our problems would somehow be over. I shopped at second hand stores, taught night school and summer school as well as holding a fulltime job. Later I bought and sold a rental house and used the profit to pay off his credit card debt. I scrimped and saved to make ends meet. But of course the debts were not over (and could never be) because I wasn't solving the problem. My problems compounded at school as well as at home.

Kids got more difficult as the permissive pendulum swung to the extreme and I was forced to teach outside of my original subject areas. My official teaching subjects were Science and Physical Education and I was asked to teach English, History, Family Studies and Special education. The curriculum changed and 9 students were forced into single level classes to give them a chance to adjust to high school without being labeled by their public school as either capable or not capable of advanced curriculum studies. I just worked harder thinking that if I could simply teach perfect lessons student behavior would also improve. I was always anxious and stressed out and lived mostly in the Yellow Zone.

As our problems increased my resentment mounted and pleasure in life diminished to the point where I had to take time off school. I cried all the time and a perceptive friend remarked that I looked like a combat-weary soldier. Finally after being on leave from school with severe depression for four months and living in the Red Zone, I left Barry and went to live with my mother. I felt free from work and marriage for the first time in twenty eight years.

When I discussed my problems, Dr. Sohail, you encouraged me to write a letter to Barry sharing my perception of the problems. You offered individual, marital and group therapy to both of us. The shock of all this made Barry look at his life seriously and admit that his anger was interfering with other relationships as well as our own. I had decided to leave the marriage and had no intentions of going back, but when Barry agreed to get involved in therapy, I decided to give him the benefit of the doubt. So we attended regularly and began to renegotiate the terms of our twenty-eight years marriage. We lived apart, dated each other and gradually learned the skills to manage anger and resolve conflicts.

One of the first skills we used was to shut up when a Time Out was called by either of us. This was most effective when a simple referee's time-out hand signal was used. For some reason, a simple wordless signal is neutral enough to stop an angry barrage more effectively than words. We used this a lot when we were separated but dating and negotiating the terms of our relationship. It put a stop to blaming and non-productive inflammatory conversations; when our tempers had cooled, we could start again.

The other important concept we learned was Green/Yellow/Red Zones, the safe and dangerous times to negotiate. We'd make a date and have an understanding of the topic to be discussed and we'd meet right after breakfast when we were fresh, optimistic and cordial from being in our Green Zones.

Over the months I mastered the art of avoiding his anger (Red Zone) but I still had stuff to learn. Barry used to get angry and fall into the Red Zone quickly especially when pressured by time or irritated by the stupidity of others who could not see his point of view. I began to see that if I was on time and even early for things, I could keep things from entering the Red Zone. Of course I used all other good communication skills and life skills to keep things from entering the Red Zone. I tried to ban the phrase "You always..." from my vocabulary. Instead I learned to say "I don't like it when..." I learned to ask for what I wanted rather than complaining or criticizing. I didn't react to his anger and I learned to keep a balanced view of the good and bad in life.

Over the years I had developed a very negative view of the world. Little things...big results. I stopped trying to placate and began to deal directly with issues within the safety of Green/Yellow/Red Zone formula. We shared the ideas with family members and close friends so they could help us with anger management, better communication and understanding of our challenges. I began to announce "Red" or "Yellow Zone" to warn people when I was ripe for an angry interchange. This might occur on the golf course when I hit the ball badly, when people put women down or when I am driving. For the most part working out yoga practice and meditation help me stay in the Green Zone where I can safely deal with most of the situations life sends my way. Learning to manage time better and having realistic expectations for myself also keep me from becoming impatient with or critical of others. Over the years Barry and I have learned to stay in the Green Zone most of the time. Now we enjoy being with each other and also with family members and friends, and we have a happy marriage again.

Leslie
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This example explains the simplicity of the Zone approach. The patients themselves are able to diagnose their problems most of the time and can determine how to tackle them. A psychotherapist facilitates them to do what is most appropriate in a given situation. Keeping a diary or a journal is also helpful because a patient can understand a problem much better when he (she) is writing it out.

It has been my experience as a psychotherapist that we, as mental health professionals, need to focus more on the education and counselling so that patients and their families can accept their emotional problems and then take steps to help themselves. People who suffer from mental illness might need a combination of medications, education and psychotherapy. In my clinical practice I found Green Zone Model to empower people. It helps them deal with their personal, work and family problems effectively. I hope with the passage of time more and more people can learn about their emotional problems and help themselves so that they can decrease their silent sufferings and discover a healthy, happy and peaceful lifestyle that I call Green Zone Living.