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.

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.

Wealth & Health

The biggest and most obvious source of stress right now is our long-running financial downturn.  Heavy hits from unemployment, foreclosure, bankruptcy, and vise-tight budgets are wearing deeply and destructively on people.  But another significant source of stress has been appearing lately.  I read about it in the newspapers; I see it in my practice.  There are a lot more serious health problems going on now than I’ve seen in years.

Chronic health issues – high blood pressure, strokes, diabetes, heart problems, insomnia, migraines – all seem to be on the rise.  Rates of suicide – tragic, heart-breaking suicides – as well as suicide attempts are up.  Destructive behaviors, including addiction and extreme risk-taking activities, are more prevalent.  Nagging infections, viruses, inflammation, and joint pain keep appearing and seem more stubborn and resistant to treatment.

I have two patients in my practice who came to me recently for help with chronic, debilitating physical pain.  Both experience excruciating symptoms for which the traditional medical community has found no direct cause or explanation.  Both even checked in to Stanford’s highly-regarded medical center and were sent home with an identical set of messages.  The spoken message was, “There’s not much we can do for you”.  The unspoken message was, “We’re not sure you’re really in pain”.  Believe me, their suffering is real.

Could there be a connection between our “health stress” and “wealth stress”?  Last week I mentioned a recent article from the New York Times, “Foreclosures Are Killing Us”, which identified our foreclosure epidemic as “a bona fide health crisis”.  The authors of the article, Professors Craig Pollack and Julia Lynch, along with a paper from the National Bureau of Economic Research which they quoted, all found a strong correlation between a community’s rise in health problems and its rise in foreclosure rates.  Losing a job, a business, a home, can bring people down hard.  Events like those are usually traumatic.  And I’ve learned from over forty years in my line of work that trauma, even purely emotional trauma, can cause physical damage and disease.

What can be done?  There are a lot of ways to approach the problem.  I’m going to continue to provide the best treatment I know for physical and emotional pain and trauma, the modality I created and call RMFR.  Pollack and Lynch also propose something I’ve actually been thinking about offering soon.  “Health care should be part of a comprehensive approach to foreclosure prevention,” the professors recommend.  “For example, mental health caseworkers should be embedded in mortgage counseling agencies.”

I’d like to make this extremely timely suggestion a reality by beginning to offer a new combination of personal and financial therapy.  In collaboration with a top-notch financial advisor, I’d like to integrate aspects of smart money management and financial survival skills into my established resiliency training and relationship counseling.  I’d include practical advice for self-care, stressing the importance of maintaining good physical, emotional, mental, and spiritual well-being in order to be able to confront the challenges of these difficult times.  I know the value of all these qualities and skills from personal experience.  Like almost everyone I know, our hard times have affected me, too.

I think the Professors Craig Pollack and Julia Lynch – and I – are onto something very important.  I intend to begin offering some real help, for our very real health and wealth problems, very soon.

Where We Are Now

Steve Jobs was a genius.  The technology savant – the unique “I” behind the iPhone, iPad, and iPod – knew what our media- and gadget-hungry society wanted, often before we knew it ourselves.  But even Steve Jobs could never have created the device most of us would love to get our hands on right now.  I’m thinking of a technological marvel that would absolutely fly off the shelves this coming holiday shopping season.  It would be a variation of a GPS unit – the “where are we and how do we get there” wonder – called an “FPS”: a “financial-positioning system”.  It would be capable of answering the question that is on almost everyone’s lips: How much longer before our economy starts to recover?

It’s been over three years, by my reckoning, since our economic downturn made itself depressingly obvious.  I’m a psychotherapist.  Depression is a part of my profession.  My job is to help people explore the issues, both past and present, behind their anger, hopelessness, anxiety, obsessions, and addictions.  With the help of my staff, I enable my patients to address and resolve their lingering traumas so that they can realistically and practically move forward in positive ways.  My job has never been an easy one, but these last three years have brought a dismayingly large number of struggling individuals, couples, and families through my doors.  I’ve been in private practice for over forty years and, frankly, I’ve never seen it this bad.

Despite some news reports that a least a partial recovery is underway, I don’t think things are getting better. I think that in some ways people are becoming more accepting of the distresses, but I don’t think our situation is getting better at all.  In fact, I believe things have gotten worse because of the intense level of stress that people have been under these last three-and-a-half years. I see that the needs of the community now are greater than ever, because people are starting to wear down. I think our economic downtown is finally taking a toll on people’s health in much more severe ways.

Last week, a New York Times article reviewed a health study of people living in communities hit with high foreclosure rates.  The results from the National Bureau of Economic Research indicated that massive foreclosures were not just a financial epidemic, but “a bona fide health crisis”.  The statistics were alarming.  Over one-third of homeowners surveyed had symptoms of major depression.  In an effort to save money, people were skipping doctor appointments and leaving prescriptions unfilled.  Significantly higher levels of suicide attempts, emergency room visits, heart failure, high blood pressure, and diabetes were observed as compared to communities where foreclosure was less of a menacing presence.

At the Bernstein Institute, we’ve seen financial stress turn into serious health complications, too; we know that this is true.  Prolonged unemployment or underemployment, homes lost to foreclosure, diminished outlooks and opportunities just wear people down.

These distressing realities are also beginning to affect how people relate.  They have a certain underlying desperation that gets expressed as anger, upset, and frustration.  They have short tempers.  Often they don’t act rationally.  Underneath the anger, they’re desperately afraid of what’s happening.  There’s no hope in sight, they fear, no relief coming.  What happened to the promised assistance from the government and President Obama that hasn’t come through? 

Instead of anger, some people feel defeated, victimized, and despairing.   They’re distressed at how they’re being treated by the banks and corporations and how exploited they feel.  Banks are treating them like they’re to blame, it’s their fault, they should have been more responsible.  It’s absolutely not true.  While every one of us can learn new and better ways to manage money during this downturn, I believe most of the people now suffering with unemployment and foreclosure issues are decent, hard-working, good people.  The way I see it, and I know I’m not alone, the banks and corporations are responsible for much of what’s been happening.

Can we have hope?  I fervently believe so.  The events of my life, past and present, and the successes in my patients’ lives are a testimony to the resiliency of the human spirit and to our capacity for courage and strength.  The support we can offer each other in our relationships and community is priceless.  Stay with me, and I’ll share the reason for my hope with you.