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Honored by the Argus

PetalumaArgusCourier6-20-13_1I feel deeply honored to be the subject of a feature article in the June 20th issue of my award-winning hometown paper, the Petaluma Argus-Courier.  Here’s how it all came about.

A little over two weeks ago, John Burns, the Argus publisher, contacted Steve Rustad, my marketing consultant.  Would I be willing to give them an interview, John asked, to discuss my new book, Trauma: Healing the Hidden Epidemic?  I was more than happy to oblige.

Next, I received a message from an Argus reporter named Rose Teplitz.  She sounded young and energetic on the phone and I agreed to meet with her later that morning.  As Rose walked through the door of my institute and introduced herself, I discovered how truly young and energetic she was.  Rose is a Casa Grande High School student in their well-regarded journalism program and is serving as an intern at the Argus for the summer.

During the next hour, Rose conducted a thoroughly professional interview and was a joy to talk with.  I spoke with her at length about my book and my work and gave her some materials to use in preparing her article.  Last Thursday, “Finding a Path Toward Inner Healing” appeared on the front page of the Petaluma Community section of the Argus-Courier.

Rose is an excellent writer, doing both the Casa journalism program and the Argus proud.  She accurately and thoughtfully communicated my message that emotional trauma can be healed.  Her words conveyed my passion for helping military personnel and their families, and people who have suffered during our financial downturn to recover from their “hidden wounds” and move forward in life.

Thank you, Rose.  Thank you, John.  I appreciate this greater opportunity to give hope to hurting people.

Crisis and Reinvention

In my last blog post, I shared the CDC’s recent findings on the rising tide of mid-life suicides over the past decade.  I proposed that the background forces driving this alarming trend include such recession-related issues as unemployment or underemployment, foreclosures and bankruptcies.  I also referred to military combat experience as another potent source of the kind of stress that leads to suicide—a fact also borne out by recently published statistics.  The magnitude of people experiencing these and other sources of distress and burnout leads me to call what we’re seeing now a hidden epidemic.

And, in fact, that phrase is a key part of the title of my new book, Trauma: Healing the Hidden Epidemic.  In it, in simple language, I cover the causes and symptoms of emotional trauma and share practical guidelines for healing and resolution.  After forty-three years of private practice working with patients suffering from PTSD, depression, anxiety, addiction, phobias, and childhood abuse, I’ve come to believe that emotional trauma is at the core of most of our mental health challenges.

But I’ve never been an intellectual, in spite of the diplomas on my wall.  I’m unwaveringly committed to therapy that works, that makes a practical difference in the lives of the people who walk through the doors of my institute.  I closed my last blog post promising to answer the question, “How in my own life and the lives of my patients have I been able to help create emotional healing for modern-day stresses and crises?”  I’ll say again today that I have a message to share of hope and reinvention.

In my estimation, suicides (and other self-destructive behaviors) arise from despair and hopelessness in the face of crisis or a challenge to change.  Let me take that statement apart.

First, let me define what I mean by crisis.  From the chapter, “Crises and Hard Times” in my book:

A crisis is different from the daily challenges of living.  Crises are life-defining moments, periods, or stages.  As opposed to the normal fears and anxieties that come up on any given day, they are unique.  A crisis is an event that completely overwhelms us.  It is terrifying.  We spend every ounce of energy, every thought, every effort to ensure our survival.

Crises can build slowly or come on suddenly.  Either way, once we become aware that we are in one, we may already be overwhelmed, feeling unable to find answers, unequipped to go on.  We are squarely faced with the following challenge: Is this crisis going to be the end, or is it going to be a turning point in my life?

No matter how helpless we feel, we always have choices.  But in order to make choices, to act, we must feel a sense of personal power.  In simple terms, the strength we find within us in the face of a crisis makes the difference between “the end”—collapse—and “a turning point”—reinvention.

When we come to the place where we want to yell, “Things can’t go on like this!”, where the need for change is absolute, we face the choice between despair and hope, between giving up and growing up.  Change requires the belief in the possibility of something better, the courage to make a decision, and the strength to turn that decision into action.

Where does emotional trauma come into this picture?  Trauma in the present moment, trauma from our past lives, and, especially, a potent combination of the two, can disrupt and sabotage every step of the reinvention process I’ve outlined above.  We can have every intention, every desire to move forward in life in spite of pain and difficulties, and never fully understand that the wounds we carry inside keep getting in the way.

That’s the hidden epidemic I’m talking about.  And, as with other health epidemics, professional help is often needed to survive and heal.  How can we find help in a crisis, for ourselves or for a loved one?  Many experienced counselors and therapists and many valuable resources are available.  Including my new book, Trauma: Healing the Hidden Epidemic.

Now You See What I See

The Centers for Disease Control and Prevention (CDC) recently published a study on suicide among adults aged 35 to 64 years, based on National Vital Statistics System (NVSS) mortality data from 1999 to 2010.  On May 2, 2013, the Wall Street Journal reviewed the CDC study in an article by Timothy Martin titled, “Suicides Soar in Past Decade”.  “The number of deaths caused by suicide has risen precipitously in the last decade,” Martin writes, and adults aged 35 to 64 “are the group most responsible for the increase”.

What magnitude of increase did the CDC find?  “From 1999 to 2010,” they reported, “the age-adjusted suicide rate for adults aged 35-64 years in the United States increased significantly by 28.4%”.  Which group suffered the greatest increases?  Men in their fifties, who committed 49% more suicides, and women in their early sixties, who committed 60% more suicides.

In absolute numbers, according to the WSJ article, “suicide rates for working adults were double that of other demographics, with people in their 50s showing the highest numbers”.  “For suicides among the middle-aged,” Martin continues, “men outnumber women by a 4-to-1 ratio”.

What does the WSJ think might be going on?  Martin speculates, “Downturns in the economy have been correlated with rises in suicides, according to CDC research.  As people lose their jobs or work part-time, many struggle to make ends meet.  This last decade has been particularly punishing, as the worst recession in decades wiped out stock-market wealth, home equity, college savings and retirement funds for many workers—in addition to heavy job layoffs”.

Martin adds, “The suicide growth among middle-age adults has gone largely undetected.  ‘It’s been a creeping erosion that’s been difficult to see,’ said Eric D. Caine, director of the Injury Control Research Center for Suicide Prevention, a CDC-funded team, and a leading expert on suicide deaths.”

Undetected?  Difficult to see?  Not from where I sit.

I agree with Martin’s assessment of the background forces recently driving more men and women to suicide.  He’s right on.  But I disagree with Mr. Caine.  Since the start of our Great Recession about six years ago, this significant and disturbing trend of increasing stress, distress, burnout, and suicide has been immediately clear to me.  This tragedy has continued to play out in the lives of the patients who walk through my doors, hour after hour, day after day.  It has been one of the strongest motivating forces driving me to complete my recently-published book, Trauma: Healing the Hidden Epidemic.  The despair that many people feel now is a part of the hidden epidemic of my subtitle—an epidemic for which people desperately need healing and resolution.

These suicide statistics show just how desperate people, and particularly working men, have become.  Here’s how I describe our nation’s situation, from my chapter titled “Crises and Hard Times”:

“As I write this book, we are experiencing a strange and historic time.  The United States has been at war for more than a decade.  Thousands of men and women have lost their lives in this conflict, and those who survive return home broken with little hope for repair.  The U.S. economy is the worst it has been in eighty years.  Millions have lost their jobs, and hundreds of thousands more face foreclosure on their homes.  And those who haven’t are afraid that they will. People are scared.  They fear what is to come.  Worst of all, they feel powerless to change their circumstances.

“To say that these are ‘hard times’ diminishes the suffering and difficulty that many are going through.  Many people have had their worst fears come true.  They have no income but plenty of financial obligations.  They may have lost their homes and moved in with relatives or friends.  Or worse, they may have lost their homes and have nowhere to go.

“Things happen in the world that we cannot change or control.  But because these moments are unavoidable, the traumatizing nature of such events is often erroneously dismissed.  Financial hardship and drastic changes to a person’s surroundings and situation can be emotionally and psychologically unsettling.  Crises can arise in the form of financial adversity and familial conflict.  Millions are struggling with what could ultimately be the most difficult years of their lives.  If we want to emerge completely from this crisis—as individuals and as a nation—we must be willing to take care of each other and take control or our own emotional healing.”

How can we do that?—How in my own life and in the lives of my patients have I been able to help create emotional healing for modern-day stress and crises, so we don’t become suicide statistics?  That’s the topic of my book.  My message is one of hope and reinvention.  I’ll continue with this theme next time.

A Priceless Souvenir

Last week, I had the privilege to attend the Navy SEAL graduation ceremonies at Naval Amphibious Base Coronado in San Diego, California.  It was one of the high points of my life.  At the invitation of Admiral Ray Smith, USN Retired, former SEAL commander, I witnessed a momentous rite of passage for some of our country’s future heroes.  The event was marked, for me, by the personal connections I observed between the commanding officers and the newest members of this great branch of America’s military.  It was at this heart-felt occasion that I picked up the most valuable souvenir of my trip—something which required exactly no room in my luggage to be able to bring home with me.

Commander Jay Hennessey, USN, was one of many outstanding speakers at the graduation.  He spoke of courage and determination in the face of difficulties, a topic I will return to frequently in the near future.  He used a phrase which struck me and stayed with me, and I want to share it with you.  His phrase, which was my valuable souvenir, went like this:

“Adversity introduces a man to himself.”

How profound.  In six words, Cdr. Hennessey distilled an essential fact about trauma, hardship, resilience, and reinvention—other topics I will also be returning to—in language that cuts to the core of what I believe to be the common experience in our culture today.  I call this common experience “hidden trauma”.

What is hidden trauma?  Funny you should ask.  I’ve just written a book about it.  It was another red-letter day in my life, March 28, 2013, when my long-awaited, long-toiled-over book, Trauma: Healing the Hidden Epidemic, was published.  My goal in writing Trauma was two-fold: to distill and share my over forty years of clinical experience helping people resolve emotional and physical pain and trauma; and to expose the kind of trauma so many people are experiencing now but which isn’t on the media “radar”.

Most of us are conscious of the kind of trauma that makes headlines.  Terrorist attacks, bombings, battles and IED explosions, car accidents, sudden heart attacks, earthquakes or building collapses.  There have been too many tragic events such as these in the news lately.  Hidden trauma is just as real, can be just as devastating, but usually evades notice by all but some of the more observant helping professionals in the field.

A big source of hidden trauma is the economy.  How long ago did our recession hit?  Are we still in it?  We can debate these details endlessly, and experts do so, but one thing is completely clear to me.  People are still suffering significantly from our recent economic downturn.  Unemployment and underemployment, bankruptcy, foreclosure, tight budgets and reduced circumstances are still rampant in the lives of the people in my practice.

Constant financial stress has placed further strain on relationships between couples, between parents and children, and between coworkers.  Individuals under stress are reacting negatively by either being self-destructive (indulging in risky behavior, substance abuse, or suicide) or by being hurtful and endangering to other members of their families or communities.

I want to draw attention to these pervasive, pernicious issues.  However, most sincerely, I also want to give hope.  I am firmly convinced that we can have hope in these difficult times.  I know this, not because I read it in a book somewhere, but because I’ve lived it.  My story illustrates the need for continual reinvention in the face of adversity.  Maybe I would have preferred an easier life, but I doubt it, and that’s not what life had in store for me.  I included parts of my personal story in Trauma to illustrate that I know personally, as well as professionally, what I’m talking about.  I have hope.  My story, and the stories of my patients, can inspire you.  If you are experiencing difficulties right now, even crises in your life, you can have hope.

Adversity introduces men, and women, to themselves. More on that next time.

Military Suicide and Unemployment

Many factors contribute to the current unacceptably high rates of military suicide.  I’ve written before about a recent policy brief by Dr. Margaret Harrell and Nancy Berglass of the Center for a New American Security, “Losing the Battle: The Challenge of Military Suicide”, which identifies several causes and recommendations for this unfolding tragedy.  Combat injuries, including such invisible wounds as PTSD and traumatic brain injury; mental health issues such as depression and anxiety; other symptoms of trauma such as sleep disturbances, substance abuse and addiction, and high-risk, adrenaline-fueling behaviors – all can play a role.  Harrell and Berglass also observe that the relative absence of three protective factors – belongingness, usefulness, and an aversion to pain or death – are crucial predictors of a service member or veteran’s likelihood of succumbing to suicidal tendencies.

In a New York Times op-ed piece responding to Harrell and Berglass’ study, Peter D. Kramer, a clinical professor of psychiatry at Brown University, proposes another factor overlooked in the policy brief: relatively high unemployment rates among young veterans of Iraq and Afghanistan.  In “The Best Medicine Just Might Be a Job”, he cites an astronomical unemployment rate of 28 percent for male veterans 18 to 24 years old.

Kramer respects the “comprehensive” brief but expresses his concern about the omission of unemployment among the list of causes identified.  While he characterizes himself as “hardly an expert”, he reveals that “study after study correlates unemployment with suicide”.  “When soldiers leave the military,” he continues, “they lose what service provides: purpose, focus, achievement, responsibility and the factor the CNAS report calls ‘belongingness’.  The workplace can be stressful, but especially for the mentally vulnerable, there is no substitute for what jobs offer in the way of structure, support and meaning.”

High unemployment rates among veterans have no one simple cause.  In “As Wars End, Young Veterans Return to Scant Jobs”, Shaila Dewan of the New York Times (who cites unemployment rates for veterans aged 20 to 24 at 30 percent) lists several issues and challenges for both employers and potential veteran employees.  Employers “fear the aftereffects of combat or losing reservists to another deployment”, and veteran job-seekers need to learn basic interview skills while often still “overwhelmed by the transition from combat to civilian life”.

Veterans can be characterized as mature for their age, disciplined, and possessing valuable skills transferable to the marketplace, Dewan emphasizes.  But employers aren’t so sure military service training and experience really translate to civilian industry.

And the competition for jobs is high.  Veterans often serve as reservists or in the National Guard and Dewan points out that this can impose a particularly heavy burden on companies.  Employers of reservists potentially face losing their valuable staff to deployments of up to 12 months in length, while being required to guarantee a job on the reservist’s return.  Even though it is illegal to discriminate in hiring based on military service and status, these requirements can make it nearly impossible for small companies to survive and compete in our difficult economy.

And, in my experience with veterans, both characterizations mentioned above are true.  Former service men and women are more mature and disciplined.  They are skilled, purpose-driven individuals with the kind of values I respect.  But they can also be very troubled individuals, still reeling from their traumatic, combat-related, employment-complicating experiences.  They are often in need of help to work through their lingering psychological invisible wounds.

I assist service members and veterans in this kind of healing.  I hope to do even more when our non-profit, Sonoma Coast Trauma Treatment, begins accepting veterans into its planned comprehensive, case-managed treatment program, which will include providing job-readiness training and skills.  Another promising development to address veteran unemployment is the creation of entrepreneurship programs specifically tailored for vets.

The Wall Street Journal recently reported on several of these programs in “Military Veterans Prepare for a New Role”, by reporter Sarah E. Needleman.  Independent-minded veterans who want to start their own businesses, but lack business start-up know-how, are starting to have a resource in “business accelerators”. Accelerators are programs offering everything from cubicle space and peripherals like Internet and copy/fax services, to expert guidance with business plans, financing, and marketing.

I’m familiar with the business accelerator model.  In my community, my good friend Dr. Michael Newell heads up Sonoma Mountain Business Cluster, an excellent “incubator” program for emerging technology start-ups.  Michael and his team of talented mentors, with the financial backing of local businesses, support aspiring men and women with innovative ideas by providing the best possible opportunity to transform their ideas into jobs and income through facilities, services, and training.  The business school of Sonoma State University also gets involved, helping incubator members create high-quality business plans.  A program of this sort would be an excellent resource for returning veterans in our community and I would love to see one get established.

I recognize the causes and solutions for veteran unemployment are complex.  Nevertheless, I also believe, with Dr. Kramer, that veteran unemployment is a factor we need to consider in addressing our tragedy of military suicide.  We must do a better job of providing employment-related “structure, support, and meaning” for returning vets.  Meaningful work is essential in the process of restoring our service members and veterans, who have sacrificed so much for us, to health and wholeness, and to a place of value in their families and communities.  We owe them nothing less.

Stop Stress from Turning into Trauma

Today I’m going to wrap up my on-going, forced-move story about the Morrows and the Bodens – and my illustration of stress and trauma and the differences between them.  As promised, I’m returning to the list of ten suggestions I offered last week for preventing unavoidable stress from turning into avoidable trauma.  I’ll flesh out these ideas for you and explain how to get very practical in your application of them.  Using this ten-step action plan can help you navigate through these stressful times with more resiliency and achieve more success with your efforts.  They’ve worked for me, they’ve worked for my patients, and I’m betting that they’ll work for you, too.

Ten-Step Action Plan for Combatting Stress

1.  Slow down, don’t panic

In a difficult, stressful, or traumatic situation, the first thing to do – always – is to slow down.  Racing thoughts and a racing heartbeat can speed you across the finish line into panic, where nothing constructive can take place.  None of the steps that follow this one will help you if you panic.  Slowing down to find some calm in your storm is absolutely essential to prevent unavoidable difficulties from turning into avoidable trauma.

2.  Remember you’re not alone

After panic, the second-greatest threat to successfully coping with stress is self-deception.  Believing you are the only person experiencing distress leads to believing there is something wrong with you, that what’s happening to you is somehow your fault and you deserve it.  On the contrary.  You are not alone.  Many, many people today are struggling and suffering with problems similar to yours.

3.  Think through your options

When you steer clear of panic and self-condemnation, you will be able to think clearly.  You’ll be able to use your rational, creative abilities to identify good ways to respond to problems and crises, rather that reacting impulsively and thoughtlessly.  You’ll recognize the best choices for how to deal with the situation in front of you, and come up with a plan of action for moving forward in a positive way.

4.  Ask for help, don’t isolate yourself

Along with panic and self-deception, isolation is your enemy in the war on trauma.  Alone, our energy and personal resources are limited.  When we reach out to others – family, friends, loved ones – we gain strength and valuable perspectives unavailable to us on our own.  I can’t emphasize this enough; reach out and share your burdens.  Let people help you.

5.  Take good care of yourself physically and emotionally

Wars can be fought with exhausted troops, but victory is more sure when warriors are rested, well-fed, and in good physical condition.  You may not think you have time to take care of yourself physically and emotionally when you’re battling stress, but letting yourself get run down will cost more time and trouble in the long run.  Make self-care a high priority.

6.  Don’t blame yourself for things beyond your control

You are human.  Let me say that again: You are human.  You are not perfect, and are not supposed to be.  There are things beyond your control, beyond any one person’s control.  You may have gotten behind on your mortgage payments, but our enormous financial downturn – which no one could have fully anticipated – is not your fault.  Take responsibility for your part, and let the rest go.  Guilt and blame will drain your spirit and keep you stuck and traumatized.

7.  Reduce the pressure on yourself in every way possible

Get very clear on what is essential to deal with in the present, and leave everything else alone.  Simplify your priorities and commitments.  Examine your “rules” – such as “I have to pay all my bills on time, no matter what”, or “I’ve got to always keep my house clean and organized”, or something else from your own personal list.  What truly matters right now?  Choose taking care of the people you love (including yourself, see #5), over taking care of things every time you can.

8.  Keep your perspective

Our Great Recession has been going on for so long it can be hard to remember when times weren’t tight and difficult.  Hard times are here for now and for the near future, but better days will return.  When they do, we won’t be the same people we were before.  We have the opportunity to grow from our experiences, or become devastated by them.  It’s your choice.  Look forward.

9.  Look for ways to help others, give back to those who’ve helped you

The quickest way I know to move out of a fog of discouragement is to lift my head and look for someone else who’s hurting too.  Mobilizing ourselves to help others can give us the energy to not only make a difference in their lives, but in our own, as well.  Being able to give fellow sufferers support and encouragement (and a helping hand to move furniture or make a meal) gives meaning and purpose to these dark, distressing times.

10.  Don’t lose hope

Never, ever give up.  If you lose heart and collapse, get back up again.  Accepting defeat is never the answer.  Remember the hard times you’ve been through before and believe that you can survive this one, as well – even if this time is the hardest time yet.  Surrender the things it’s time to let go of, and fight to the end to save the things that really matter.  Feed your spirit and keep hope alive.

As I said last week, these ten steps are fairly simple, but I know personally that they are not easy.  Some of them can, in fact, be very challenging to conquer.  But they’re worth the attempt.  Like all of life’s “basics”, these ideas are worth studying, putting into action as best you can, and then coming back to think about some more.  I wish you much success as we journey together through the challenging days to come.

No, It’s Trauma

Last week I wrote about two fictional couples, the Morrows and the Bodens, as they faced a sudden, forced move from their homes in a foreclosed apartment building.  I used their scenario of dislocation to illustrate the differences between stress and trauma.  I mentioned that many of the people I meet and talk to believe they’re under enormous stress during this, our Great Recession, but would deny that they’re experiencing trauma.  In my professional and personal opinion, I disagree.  I think many, possibly most people don’t understand what trauma is, and have actually been traumatized rather than just stressed by the events of the recent past.

Most often, when people hear the word trauma they think of some horrific and shocking event.  They think of tragedies like car accidents, violence and brutality, death – something horrendous and devastating.  These kinds of events are certainly trauma: a type called shock trauma.

But there are many other traumatic experiences that, while not shocking, are beyond the ordinary.  Extraordinary experiences beyond normal fears and normal circumstances can produce a kind of trauma, too.  When these events occur repeatedly over a period of time they erode our physical and emotional reserves.  They can be very strong and significant and extremely destructive.  I see the symptoms of our “wearing down” in higher divorce rates, higher suicide and suicide attempt rates, and higher rates of disease and depression.

If you wondered, when you read last week’s illustration about the Morrows and the Bodens, whether there might be “more to the story”, you were right.  What if I were to go back in the history of the two families, and fill in some of the gaps?

Take Mr. Morrow, the head of the family who experienced stress, rather than trauma, from their enforced move and handled the transition in a healthier way.  Let’s say, pre-move, he had enjoyed the security of a steady job for the last decade, he and his family were in good health, and had maintained close, loving ties with friends and an extended family of supportive relatives.

Now let’s take Mr. Boden, whose family suffered significant trauma around their relocation.  I could shed some light on his struggle by proposing that his family’s move was just one more trial in a series of unfortunate recent events.  Let’s say he was laid off three years ago and has been alternating between unemployment and scraping together small jobs since then.  Let’s say he has chronic back pain, his wife has stress-induced migraine headaches, and his kids aren’t doing well at school.  Let’s say, even, he’s the son of an alcoholic father who was unavailable both in the past and the present.

My point is that at the outset, going into this sudden and difficult need to move, Mr. Morrow had physical and emotional reserves that Mr. Boden did not.  And how many of us can confidently say, after over three years of economic and personal hits, that we still have plenty of energy reserves for the continuing challenges coming almost daily down the road?

In 2008, when the stock market fell, and the real estate market tanked, and jobs started to disappear – when the Great Recession got its start – we all felt shocked, we all felt traumatized.  Even though it had been coming for a while, it was a shock when it first hit, and it hit fast and hard.  And it was devastating.  That we’re still in pretty much the same place, three years later, is one of the things I think is unique to this period of time.  I see that people are somehow getting used to our hard times and adapting in some ways, and so they don’t realize they’re experiencing ongoing, or developmental trauma.

Developmental trauma occurs when an individual experiences a series of events which may or may not be shocking of themselves, but are painful, disturbing, and overwhelming.  This type of trauma is called “developmental” because it disrupts the normal intrinsic development, or maturation, of a child or adult.  A child suffers developmental trauma, for example, when they are subjected to repeated verbal or physical abuse.  Adults can experience developmental trauma also, when the circumstances of their lives prevents them from growing or thriving in physical, emotional, mental, or spiritual ways.

The economic straightjacket of our recent past has put a severe limit on opportunities for adults to grow and prosper.  People are feeling thwarted and trapped in their efforts to provide for themselves and their families.  They’re learning to adapt, or they’re dealing with their frustration and pain by going numb.  Some of us respond to crises with denial.  Some of us respond with action; some of us tend to freeze into paralysis.  There are many things people do to survive in times of crisis and difficulty.  In the meantime, whether they feel it or not, they’re frying emotionally and physically.  Their systems are under siege, 24/7.

My heart goes out to all of you who find yourselves in this painful, devastating situation.  I too have experienced recent financial trauma.

In the hope that it will provide you some relief, I promised last week to include suggestions for how to deal with ongoing stress – the “wealth, health, and stealth” kind.  These suggestions may make it possible for you to keep your unavoidable stress from turning into avoidable trauma.  You saw some of these ideas at work in the story of the Morrows and Bodens.  In the midst of difficult circumstances and events, I encourage you to try the following:

  1. Slow down, don’t panic
  2. Remember you’re not alone
  3. Think through your options
  4. Ask for help, don’t isolate yourself
  5. Take good care of yourself physically and emotionally
  6. Don’t blame yourself for things beyond your control
  7. Reduce the pressure on yourself in every way possible
  8. Keep your perspective, others are suffering too
  9. Look for ways to help others, and to give back to those who’ve helped you
  10. Don’t lose hope, focus on the positive

These ten steps are fairly simple, but I know they are truly not easy.  I’ll be back next week to go through these steps in more detail.  I’ll provide suggestions for how you can get started using these steps in real-life, practical ways.  I know these steps can help you, because I use them and teach them to my patients, and I’ve seen them make a world of difference in these hard times.  I encourage you to give them a try.

It’s Just Stress, Isn’t It?

Over the last several weeks, I’ve pointed out what I believe are the three major sources of stress in our lives today.  I see them in my practice, at the gym, at church, and over dinner at one of my favorite restaurants.  I’ve catchily coined these stress-inflictors “wealth, health, and stealth”.  “Wealth” stands for our long-standing and devastating financial downturn.  “Health” stands for breakdowns in our physical and emotional health resulting from the downturn.  And “stealth” represents the challenges and struggles of our nation’s veterans as they come home and try to reintegrate into their lives, families, and communities.

Also, over the last several weeks, you may have noticed that I used the word “trauma” to describe what’s been happening to us during the three-plus years of our Great Recession.  When I suggest to people – in my practice, at the gym, etc. – that what we’ve been enduring is not “just stress” and has actually been traumatic, they most often respond, “Oh no, trauma happens to other people.  That’s not me.”  I disagree.

What is stress?  What is trauma?  How are they different?  And why is this important?

Rather than starting with textbook definitions (I prefer a practical, straight-forward explanation over academic jargon any day), I want to give you a real life example to illustrate stress and trauma, and the difference between them.

Let’s say two families live in an older apartment building near downtown.  We’ll call them the Morrows and the Bodens.  Their apartment building has been for sale for some time and the owners have notified the tenants that foreclosure is a possibility.  Well, the building doesn’t sell, the bank forecloses, and it all happens suddenly.  The new owners of the building know several idle contractors willing to work for bargain rates, so they decide to completely renovate the apartments.  The building is in a part of town that is becoming more desirable and they’ll be able to charge higher rents, post-update.  All the tenants must go, and quickly.

From the moment they heard the building was up for sale, the Morrows considered that they might have to move.  When they heard about the possible foreclosure, they put even more effort into spreading the word among their friends and family that they could need a new place to live.  It didn’t seem likely that they would find anything affordable in their current neighborhood, so they started getting to know other neighborhoods, checking out schools, shops, and parks.  They involved their kids in the planning process, letting them know what was happening, in a way that was appropriate for their ages.

When the foreclosure came down, they found a new place – a house in a great neighborhood, actually – but which wouldn’t be ready for them in time for the move.  Again they put the word out to their friends, and were able to temporarily store their belongings in someone’s garage, and stay for a couple of weeks with a relative.  When their new rental was ready, they gathered a big moving party and got settled in fairly quickly.  It didn’t take them long to start making the new house feel like home.

The Bodens had an entirely different experience of their move.  Seeing the “For Sale” sign go up on their apartment building left them almost frozen in fear of being put out on the street.  They hoped against hope they wouldn’t have to do anything, that the building would sell and nothing would change.  When the foreclosure came, and the short notice to move out, they panicked.  Not able to find a place in the same neighborhood that they could afford, they rushed out and grabbed the first place they could find that was cheap and close.

Too upset to let their friends and family know what was happening, the Bodens struggled through the move by themselves.  The parents didn’t really explain what was happening to their kids, who ended up feeling uprooted and insecure.  The chaos the Bodens felt inside left them desperate to stay in control, to get it all done and over with as quickly as possible, and the move ended up being a horrible experience for them all.  On top of that, the Bodens quickly learned that their new apartment and neighborhood weren’t all that great.  They hadn’t checked it out enough to discover that the apartment was actually dingy and depressing and the neighborhood wasn’t safe.  At the end of it all, the Bodens felt regret, disappointment, anger, and discouragement.

Let’s pause for a moment in the lives of the Morrows and Bodens for some definitions of stress and trauma.  I define stress as pressure, strain, or tension on our emotions.  Trauma, however, is an experience, possibly a shock, that goes beyond strain to create significant pain or an “injury” to our emotional selves that may be deep and lasting.

Back to the Morrows and Bodens.  Both families experienced the very real disruption of change, of needing to move and find a new home.  Moving is a stressful experience for anyone.  The Morrows, however, responded to this reality by facing it and asking for help.  They kept their calm but quickly went into action to find a new place that would be right for them.  They communicated with each other and their friends and family, and coped well with the upheaval of their move.  They started out determined to find a good place for their family to live.  The Morrows wanted to create positive change and begin a new stage in their family’s life.  While they felt pressure and strain, they coped and had faith in the process.

The Bodens, on the other hand, avoided dealing with the situation until the need to move was in their face.  The pressure and panic they felt then caused them to close down and cut themselves off from potential help from friends and family.  They didn’t even talk among themselves about what was happening to them and how they felt about it.  The kids felt left in the dark.  The family lost any hope for finding a good place to live, let alone something better than the old apartment, in their frantic search for anything affordable and quick.  They felt wounded and in pain, and lost faith in themselves and the process.

It’s probably not hard to guess which family experienced stress and which one experienced trauma.  The Morrows, now happy in their new neighborhood, accepted and dealt with the stress of their forced move as best they could.  The Bodens, now stuck in a depressing environment, panicked and isolated themselves in their trauma.  The same experience – a quick, forced move – happened to both families, yet they reacted entirely differently.  Why?

This question reveals another key aspect of stress and trauma that I’ll return to in next week’s post.  I’ll also suggest important ways that can help you prevent unavoidable stress from turning into avoidable trauma.  Stay tuned.

We’ve Got a Bad Connection

This week I want to return to a disturbing statistic, taken from a recent Pew Research Center survey of veterans and the American public, which I quoted in my last post.  Only about half of our civilian population feels that our armed forces’ sacrifices have been greater than their own, post-9/11.  I want to repeat that, as I repeated it last week – only about half.  I think this reveals a bad connection, an enormous disconnect between our veterans and our communities.  Of those civilians who do believe the military and their families shouldered greater burdens with their combat service, about 26% believe it to be unfair, while 70% consider it “just being part of the military”.  I find that attitude very disturbing as well, and I will get back to it later in this post.

First, some good news.  The survey results indicated that 96% of veterans are proud of their service, 93% say the military helped them mature, and 74% say their military experience has helped them get ahead in life.  Over 80% would recommend a military career to a young person close to them.  Also on the positive side, as reported by Tom Bowman of National Public Radio, the general public holds the military in “highest regard.  It towers above organized religion, big business, and Congress”.  The negative?  Only 40% of civilians surveyed would advise a loved one, friend, or acquaintance to join the armed forces and bear the heavy burdens of military service.

Now, some bad news.  Of the veterans surveyed, 44% experienced a difficult adjustment back to civilian life, 50% reported signs of post-traumatic stress, and 75% live with nightmares and flashbacks from their combat experiences.  And, of the general public, only 25% say they follow the progress of our wars in Afghanistan and Iraq closely, down from about 50% just a couple of years ago.  Marine Sergeant Jon Moulder, interviewed in Afghanistan by NPR’s Bowman, didn’t need the Pew survey to tell him that people back home are losing interest.  “We’re starting to fall by the wayside,” he feels.  “This has been going on for so long.  It’s America’s longest conflict running to date.  Kind of like the bastard children of our generation.”

What’s happening?  Why don’t these wars feel like a national experience?  Paul Taylor, editor of the Pew study, observed, “We’ve never had sustained combat for a full decade, and we’ve never fought a war in which such a small share of the population has carried the fight.”  According to Taylor, just one-half of 1% of the population has served on active duty in the past decade, while 9% of Americans were in uniform during World War II.

Having such a small fraction of the public in uniform this time, according to Martin Cook, a civilian professor of military ethics at the Naval War College, makes it “much more easy to deploy U.S. forces in tough environments for long periods of time because the vast majority of Americans don’t feel they have any skin in the game.”  “I’ve often speculated,” Cook continues, “could we have fought wars for 10 years if this was a draftee army and I doubt it.”

These Pew Research Center survey statistics leave me with a lot more questions than answers.

Are the sacrifices of our veterans – and their families – really “just being part of the military”?  Have recruits been fully able to anticipate the potential physical and psychological health risks of combat?  Did they know just how bad warfare conditions would be in Afghanistan and Iraq?  Did they expect multiple deployments?  Did they realize how menacing it would be to police terrorists embedded within a civilian population?  And, if their “job-related” stress has become debilitating, can service members “quit” – like civilians can – without long-term consequences, such as a less-than-honorable discharge?

Here are some more uncomfortable questions: Do we all agree that the 9/11 attacks – which killed thousands of innocent Americans, and targeted not only our nation but our way of life – required an armed response?  Do we all believe that without our Homeland Security and foreign military commitments post-9/11 more innocent lives would have been lost on American soil?  Haven’t these battles been deemed necessary by politicians on both sides of the aisle?  Hasn’t our involvement in Afghanistan and Iraq in fact benefitted all Americans?

Does the military serve our government, or do they serve us?  Aren’t they fighting on our behalf, for our sake?  Isn’t whatever happens to them in country more than “just being part of the military”, more than just their tough luck?  One of our greatest presidents, Abraham Lincoln, declared in his Gettysburg Address that ours was a government created “of the people, by the people, and for the people”.  Are we willing to uphold this long tradition, sharing in the decisions, commitments, and obligations of our elected representatives?

I believe, as “the people”, that the government’s promise and obligation to restore veterans’ physical and psychological health post-service is our promise and obligation as well.

I know my calling: to provide health and healing for veterans and their families.  To restore them to full participation in life and in their communities.  To say, “Thank you for your service”, in the most practical, effective way I can. And I‘m asking, can we – can you – make a commitment to be better aware of the pressing needs of our returning veterans?  Can we all make a commitment to care?  A commitment to stop the disconnect?

Your Neighbor, Your Co-Worker, Your Friend

Last week, I offered my take on the top two sources of stress in our lives today – “wealth”, or our lingering financial downturn, and “health”, the toll that downturn is taking on our physical and emotional well-being.  Today, I want to add what I see as the third major source of stress, and I’m going to call it “stealth”.

Why “stealth”?  Because too few of us recognize it exists, or, when encountering it, prefer not to acknowledge it.  So what am I talking about?

I’m talking about, possibly, your neighbor or your neighbor’s son or daughter.  I’m talking about your classmate, your co-worker, the person you used to see at Starbuck’s, the movie theater, or church.  The one who’s been away for several months now.  The one who’s coming home sometime soon.  In uniform.

I’m talking about our country’s servicemen and women, and veterans.

The wars in Iraq and Afghanistan have been going on now for almost a decade.  Hundreds of thousands of Americans have served in some of the most physically and psychologically intense battlefields in our history, served repeatedly over multiple deployments, and none of them will come out of their stressful combat experiences without deep and lasting personal changes.  Those changes will be both positive and negative.

Along with the combat stress our returning service members and veterans have endured, they’re experiencing health and financial stress in disproportionately greater numbers than our general population.  Technological advances in personal and vehicle armor have increased the ability of service members to survive attacks both in battle and from improvised explosive devices.  The downside to this is that more veterans come home with significant wounds and physical health limitations that will follow them the rest of their lives.  Whether it’s the challenge of losing an arm or leg (or both), loss of sight or hearing, or loss of mental clarity and memory from repeated concussions, the stress from physical health restrictions is and will continue to be a very real part of many lives.

Studies of post-traumatic stress (PTS) rates in returning veterans vary, but I’d estimate maybe half will suffer some kind of emotional and psychological stress as a result of their service.  Symptoms can run from mild – sleep disturbances, short tempers – to extreme – drug and alcohol addiction, paranoia, and suicide attempts and completions.

Financial stress for veterans runs extremely high, as well.  Statistics show that the unemployment rate for former servicemen and women is well over 20%, more than double the rates for the rest of the country.  Individuals who have prided themselves on their abilities and contributions to society are finding themselves without purpose or value in our stagnated job market.

I’ve also seen a kind of spiritual stress in the returning veterans I’ve treated: a crippling self-loathing because of the acts they committed in country, some necessary and some beyond the stipulated rules of engagement.  Men and women, who left the States with a strong set of ethics for their thoughts and behavior, return having violated their innate personal code.  Along with the bullets and IEDs, they find their personal honor and worth have exploded as well.  In some ways, I feel that this loss is the most tragic.

About that word, “stealth”.  I believe that the combat stress of returning American service members and veterans, and their families, can be characterized as stealth because of my own experience and because of a recent survey by Pew Research.  In an article in USA Today, “Veterans Proud but Struggling in Civilian Life”, reporter Gregg Zoroya summarizes some of the survey results from about 1800 veterans and about 2000 members of the public.  One question throws an extremely disturbing light on the different ways the public and service members see the sacrifices our military has made on the battlefields of Iraq and Afghanistan.

Only about half of the general public surveyed believed that American troops and their families made more sacrifices than all other citizens, post-9/11.  Only about half.  Eighty-four percent of service members, however, say that “the public has no idea of the problems incurred as a result of wars demanding multiple deployments”.

I’ve seen this myself, even in my own, much-loved hometown.  There seems to be some kind of irrational disconnect between the community and our veterans who are coming back devastated from the wars, having faced atrocities we can’t even begin to imagine.  There doesn’t seem to be real recognition by enough of us that we’ve been at war, and there’s a lot of good people – service members, their extended families, and neighbors – who are truly traumatized and suffering.  I’m a veteran of the Vietnam War era, and still I’ve never seen such a complete disconnect between the community and our military and the wars that are being fought.  This hits very close to home for me; it almost breaks my heart.

The Pew Research survey included many other significant findings, some encouraging and some disturbing.  I’ll return to share more of those results, and more of my perspective, next week.