Tagged ‘stress‘

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.