BEING HAUNTED BY OLD TRAUMATIC EXPERIENCES

Recently I stopped assessing and treating children and adolescents who were hospitalized on the Copestone Child and Adolescent Inpatient Programs on the St.Joseph Campus of Mission Hospitals.  I had planned to do this for over a year and thought that I was ready and well prepared for this change and transition in my life.  Some people kept referring to my retiring from my work at the hospital.  I found myself reacting strongly to this and kept clarifying that I was stopping my work at the hospital but not retiring. The term retirement  continued to bother me and I realized that I was feeling more stress about this change than I thought I should be.  Then, my wife and I were eating dinner with some new friends and one of them had been retired for 17 years and was healthy and loved being retired.  As I listened to him talk about this I suddenly realized that I associated retirement with death as my father had to retire due to illness [he had lung cancer] and then he died a short time later.  My brain [I] still connected retirement with dying!  I had explored my feelings related to my father and his death in some detail during a psychoanalysis that I had during my training in general and child psychiatry.  I felt that I had dealt with the stresses and emotions associated with his death and yet clearly not completely.  What I apparently had not done was disconnect retiring from dying.  After I made this connection I was able to reassure myself that my situation is different from my father's and that I did not have to be worried about it and my brain did not have to be on guard to protect me from a similar fate as my father suffered.  

Our brains are very good at storing information and maintaining a pattern of response unless we give our brains specific instructions to change the pattern.  It seems that we need to tell our brains in very clear terms that the old response no longer applies.  This requires that we name the old response and recall it and then confirm that it no longer applies and can be modified.  This happened for me when I recalled the connection of retirement and death for my father and knew that this connection does not apply to me and my brain does not need to be on guard trying to protect me from death if I retire.

I believe that frequently when someone has been traumatized, it is difficult to believe that they are not in danger like they were when the trauma occurred.  They have changed and are wiser and have different coping strategies and even though they can be stressed and feel overwhelmed at times, it is not at all like they way they felt when the trauma occurred.  

It seems critical for people to be able to recognize if they are still feeling at risk to be retraumatized as a source of their ongoing anxiety and stress and even physical symptoms. Then, they have an opportunity to clearly tell themselves that they are not at risk and why not. This can then relieve a lot of their stress.

CHURCHES PROVIDING PSYCHIATRIC SERVICES?!

A recent opinion piece in the New York Times by T.M. Luhrmann reported on an initiative to involve members of church congregations in the care of people with serious mental illnesses.  Rick Warren, the pastor of Saddleback Church, has joined with the local Roman Catholic Diocese and the local National Alliance for the Mentally Ill to start training members of local church congregations in how to provide mental health care.  Mr. Warren's son struggled with depresson and killed himself about a year ago. Mr. Warren hopes that members of congregations can be trained to manage psychiatric crises, run groups and help people with major psychiatric disorders to cope better and to receive the services that they need.  

A major problem in people with major psychiatric disorders receiving help is a resistance that some people with mental illness feel about psychiatric services as they do not want to be stigmatized or labeled.  In addition, they were often stressed by difficulty using the services as they often need to go to separate places to get help and may have to go to different pharmacies to get their medications filled. Also, many people with chronic mental illnesses are homeless and this further complicates their abiity to get help.  Importantly, while many of the chronically mentally ill complain of feeling stigmatized by their illnesses when they get mental health services, they will identify that they attend a church and do not feel stigmatized there.  A study of almost 90 women with psychotic symptoms and who were homeless by Mr. Luhrman, found that half of them had a church that they attended at least twice a month.  Also, over 80 % said that God was their friend.  When this initiative was announced many people there with major psyhciatric disordrs, stated that they were a person "I am not defined by my mental illness.  I am a person with mental illness, and I am defined by Christ. This would seem to increase the possibility that members of congregations of churchs can be helpful and a recent study published in Lancet indicated a small additional benefit for services connected to churches compared to those in psychiatric facilities.

So, one of the questions is whether or not people in the congregations of churches can be trained to help people in their congregations with chronic mental illness.  Considering that coping with mental illness can be isolating and stressful, it can be very helpful and stress reducing if they are helped to negotiate the different services, keep up with their medications and getting them filled on a regular basis; and providing a place that they trust to come to when they are feeling stressed.  Regardless, it is very helpful and necessary for all of us to feel part of a community where we are cared about and not judged!

IS IT OK TO TALK ABOUT YOUR SUICIDE ATTEMPT?

A recent opinion pieceby Benedict Carey in the April 14, 2014 New York Times national edition, talked about suicide prevention efforts now beginning to include input from the close to one million adults in the USA who have attempted suicide. [About 38,000 americans do kill themselves every year].  Mr. Carey reports that previously, talking about attempts was not considered helpful with fears that it would encourage people to attempt suicide and also worries that it would lead to increased stress for those who were sharing their experiencesbecause of the shame and stigma attached to such behaviors.  Only recently the American Association of Suicidology decided to recognize all those who attempt suicide and give them a voice in the suicide prevention efforts.  This is important considering that seven percent of people who attempt suicide actually kill themselves at a later date.  This is thirty times more than those who have never attempted suicide.   Hopefully, recognizing the importance of the experience and wisdom of people who have attempted suicide will help these people to feel better about themselves as they reach out to others at risk for suicide.

Mr. Carey then shared a number of personal stories of people who have attempted suicide.  The focus was on the pain that they experienced as they felt that they were shamed by professionals who did not allow them to share their experiences that led to their attempts.  They felt more support and acceptance from each other [others who had attempted].   More people who have made suicide attempts are talking about the attempts in more public forums.  It is hoped that sharing this information will encourage other survivors of suicide attempts to talk about their experiences and to be encouraged by those who are having success in their lives and are not held back by their having attempted suicide or by their moods.  

It is also hoped and a research project is testing out if people sharing their experiences with suicide attempts will lower the stigma that is often attached to people with psychiatric problems.  According to psychologist Patrick Corrigan at the Illinois Institute of Technology who is working with the San Francisco based Center for Dignity, Recovery and Stigma Elimination, having contact with someone such as by hearing them talk or reading what they have written can lower the stigma as education alone does not seem to lower it.

So, again it seems that we can help each other by being open to hearing other people's experiences and not judging or sterotyping others.  We all need each other and I believe that the people listening to others benefit as much as those sharing their experiences.  We are actually all in it [this wonderful life] together and judging or stereotyping others only separates us and increases our stress

EVERYTHING IN MODERATION?!

I have previously written about the importance of we [humans] being aware of doing things in a moderate way.  Now that doesn't mean much unless it is defined and it's meaning clarified.  One way that I have thought about this idea of moderation recently relates to what seems to be a problem in that important issues are frequently polarized by the two opposing sides taking positions that offer no room for compromise and portray the other view as being completely wrong.  This seems to have occurred with global warming, abortion, family values and poverty.  I have recently blogged about the negative impact of presenting information in an alarming way as people can start to feel overwhelmed and then protect themselves from this stress by not believing the information or denying it is real.  I believe that presenting information or one's position on something in a way that is alarming is like not using moderation.  The same goes for polarizing positions with each side not using moderation.  

This moderation theme might seem confusing or not really fiting the situation.  People frequently seem to feel that they need to shock people so that they get their attention and show them how serious the problem is.  However, I believe that this ends up making it very hard for anyone to keep listening to the discussion about the problem and often even if they are able to listen, they are overwhelmed enough that they feel numb and are not able to hear anything about ways to help reduce or solve the problem. This ends up causing people to feel separated from others.  This occurs either by the numbing experience that we use to protect ourselves from being overwhelmed or by identifying with the polarized postion where their opinion is the only right one.  

It seems to me that moderation might mean that we approach issues in a way that is open to other views and opinions and is focused on ways to help vs pointing out the magnitude of the problem.  As humans, like it or not, we are in this together.  It would seem best to come up with solutions that give all of us the opportunity to work together to understand and help reduce or solve the problems.

Recently, I was talking with a young person studying herpetology [study of reptiles and amphibians]. She related the large number of salamander species in North Carolina and also the risk to these species related to environmental changes [yes, global warming].  She was happy that a number of these species are quite adaptable to changing environments and she was happy that people were willing to make changes to help these salamanders.  She told me that when they find species at risk due to what land owners are doing, they will talk to the land owner and share their concerns and also share suggestions of what can be done to protect the salamanders.  She told me that almost all the time, the landowner will show concern and be willing to make changes to protect the salamanders.  She used to feel cynical about this and realized that she was judging the landowners unfairly and that she was wrong about them. 

So, together we can make a difference and if we treat each other with respect and listen to one another then maybe the sky [universe?] is still the only limit to what we can achieve.

WHY FRIGHTENING US DOESN'T WORK

I have previously written about the problem of allowing ourselves to become frightened and/or anxious by watching the news on TV as it is often about negative events with no information about what can be done positively to help stop or reduce the frequency of the event or similar events.  Seeing these events on the TV news often triggers within us a fear of being overwhelmed and instantly our brains react by numbing us and or avoiding the topic in the future or denying that it is true.  These coping mechanisms require a lot of energy by our brain to maintain and remove us from dealing directly with the stress.  This way of coping creates a chronic stress reaction as a way of coping with this kind of stress.

An editorial in the April 9, 2014 New York Times by Ted Nordhaus and Michael Shellenberger talks about the problem of trying to get us to change our behaviors by using frightening information often presented in an upsetting way with no focus on positive ways to help reduce the threat.  They were speaking about global warming.  They referred to studies by the Frame Works Instutute that identified that connecting global warmng to extreme weather events led to people viewing climate change as an act of God or exaggerated and mostly not true or even denying that it was happening at all.  Nordhaus and Shellenberger referred to a 2009 study in the journal Science Communication concluded that while shocking and catastrophy depicting of the impact of climate change get people's attention, it does not lead to people feeling engaged in doing something, but instead often leads to denial and other avoidance type coping responses.  Nordhaus and Shellenberger also reported on a 2010 study reported in Psychological Science showing that "dire messages" about global warming led to more skepticsim and denial about the problem.

It is clear then that frightening us doesn't work and contributes to some of the polarization that exists now with some people insisting that gloabal warming is being exaggerated or may not be true at all. Studies and common sense show that if the focus is on solutions to the problem and ways that we can work together to make our planet healthier and our lives better, we are more likely to respond and do things to help.  Nordhaus and Shellenberger also mentioned a recent study from Yale Law School's Cultural Cognition Project showing that people with conservative political views are less likely to be skeptical abut global warming if they are first presented with articles about nuclear power and geoengineering as ways to reduce global warming.  These type of solutions are often rejected by other climate change advocates who focus on solar and wind energy ways to reduce global warming.  

I wonder if the way to help us [humans] to embrace changes that will reduce global warming is to emphasize positive steps that can be taken that include different types of solutions and includes as many ideas and engages as many of us as possible.  Shocking us or polarizing us by attacking our ideas does not help.  We are all in this together and it is critical that we are all included and all have a voice.