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Section 2
Diminishing Malaise with the "Say Goodbye and Say Hello" Exercise

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In the last section, we discussed we discussed three motives for and manifestations of denial in women who are beginning menopause.  These three denial motives and manifestations included:  disbelief; appearing weak; and youth obsessed culture.

In this section, we will examine three concepts of malaise in menopausal women.  These three concepts of malaise in menopausal women include:  malaise vs. depression; transitory grief; and comorbid risks.

3 Concepts of Malaise

♦ #1 Malaise vs. Depression
The first concept of malaise in menopausal women is malaise vs. depression.  The symptoms of malaise may feel very similar to symptoms of depression in many women.  For instance, many of my clients have described moments of unexplainable weeping or crying.  They may feel unmotivated or unresponsive to once positive events.  This malaise is often associated with the drop in estrogen. 

Many clinicians liken it to the same hormonal changes found in pubescent adolescents who often experience the same sporadic and drastic emotional shifts.  However, this malaise does not fit the DSM criteria for clinical depression as the symptoms are not quite as strong as those with diagnosed clinical depression.  Generally, menopausal women feel what they describe as "the blues" or "the blahs."  They may feel lethargic, but not incapacitated; sad, but not hopeless. 

However, although these malaise clients’ symptoms may not be as severe as those diagnosed with clinical depression, they still report their symptoms affecting their lives in a negative way.  Jean, age 51, suffered from general malaise which she said interfered with her work.  She stated, "Sometimes, when I’m on the phone with a client, I’ll start to feel extremely weepy.  I try to control myself, but that doesn’t work.  I tell myself to get a grip, but then I just feel like I’m being too hard on myself.  In the end, I try to end the conversation as quickly as possible so that they don’t hear my voice cracking." 

Although Jean’s symptoms may not be as strong as clients with clinical depression, her own feelings of malaise impacted her life to such an extent that she had to adjust her work habits to cope.  Think of your Jean.  Is she suffering from general malaise similar to dysthimia?  Is this negatively impacting her life?

♦ #2 Transitory Grief
The second concept of malaise in menopausal women is transitory grief.  This cause of malaise is not associated with the decrease of estrogen in the bloodstream, but rather a response to the significance of losing the ability to reproduce.  As in all great life changes, menopausal clients will have to learn how to grieve the loss of their youth or even their loss of a sense of womanhood.  Once they have come to accept the idea of no longer being able to produce life, many women fall into a grieving stage in which they experience the symptoms of malaise. 

Much of this transitory grief stems from the client’s conceptions of their own sexual identity and the destruction of it by the new changes in body chemistry.  This loss of sexual identity can ultimately affect a client’s self-image and also their sense of worth.  Caroline, age 47, was grieving the loss of her ability to bear children. Up until that point, Caroline had had five children. 

She stated, "I was raised to believe that having children was the ultimate reward for a woman.  Being a mother and having the ability to be a mother is the greatest gift I can give the world, and now that gift is gone.  I feel like a worthless shell.  My husband may still love me, but what does that matter if I can’t love myself?  I feel so alone and unhappy."  I stated to Caroline, "Do you feel that the only way to be a mother is to produce children, or are there other ways to act motherly without getting pregnant and birthing children?"

She stated, "Well, yea, there’s more to it than bringing a child into the world."  I asked Caroline to consider going home and writing a list of activities she could partake in to fulfill her motherly needs and re-establish her identity as a woman.  The next week, Caroline brought in a list that included the following:
            -- 1. Volunteer at local daycare
            -- 2. Babysit for my grandchildren
            -- 3. Spoil my grandchildren
            -- 4. Get to know my neighbor’s children
Think of your Caroline.  Are there other ways she could re-establish her identity as a woman?

Technique:  Say Goodbye and Say Hello
To help clients like Caroline on the grieving process, I suggest that they try the "Say Goodbye and Say Hello" exercise.  I ask that they write two letters:  one addressed to their old concepts of womanhood and identity and the other addressed to their new identity.  The first letter should be a goodbye letter in which the client lets go of their old conceptions and comes to accept their loss.  The second letter redefines their identity and defines new characteristics of womanhood and sexuality.  Also, I ask that my client tries to emphasize the positive aspects of their new change. 

Caroline read me the following section from her letter:
"It’s not you, it’s me.  We’ve had a good run, but things have changed now.  I’m not the same person I was before and this just isn’t working out for either of us."
By including the phrase "it’s not you, it’s me," Caroline utilized clichéd comedy to lighten the mood. 

Her second letter included the following passage:
"I really think I can make this work.  I can now put down the pressures of being a mother and begin to live life like a woman.  I can concentrate on my hobbies and do things I never thought possible before."
Think of your Caroline.  Would she benefit from the "Say Goodbye and Say Hello" exercise?

♦ #3 Comorbid Risks
In addition to malaise vs. depression and transitory grief, the third concept of malaise in menopausal women is comorbid risks.  If a female client suffers from an already diagnosed disorder, the feelings of malaise common in menopause may have a negative effect on his or her condition.  It may worsen any clinical depression she may be experiencing.  Some clients feel frustrated that they have undergone extensive therapy only to be beset by a minor depression.  One client even quit therapy, believing that nothing could completely cure her. 

If a client is close to menopause, I feel that it is important to prepare her for the possibility of feeling these symptoms of malaise.  I have often found that clients who suffered from PMS during their reproductive years are more likely to experience malaise in their menopausal stage, partly due to the fact that their bodies are already sensitive to hormonal fluctuations.  Ramona, age 49, was suffering from schizophrenia.  Although she had balanced out with the help of medications, she still required therapy when she began to have paranoid tendencies. 

Because she was on the verge of menopause, I asked Ramona if she had ever had severe PMS.  She stated, "Well yea, I have actually.  I used to get really anxious right before my period, and it would make my hallucinations worse."  Because her disorder often responded to fluctuations in hormones, I asked Ramona to be on the lookout for menopausal malaise, which could cause her to feel depressed when there was no reason to be.  Because of her proclivity to paranoia, I decided to have Ramona monitor her moods from day to day in order to give me a better idea about her emotional fluctuations. 

Think of your Ramona.  Does she have a comorbid disorder that could be affected by malaise?

In this section, we discussed three concepts of malaise in menopausal women.  These three concepts of malaise in menopausal women include:  malaise vs. depression; transitory grief; and comorbid risks.

QUESTION 2
What are three concepts of malaise in menopausal women? To select and enter your answer go to Test.