Military Suicide and Military Families: Part 1

Today I want to return to the topic of military suicide and discuss a different and sadly overlooked side to this tragedy.  Yes, active duty service members and veterans are taking their lives at alarming rates, but suicide within service member and veteran families – among spouses in particular – is happening as well.

Two voices have recently spoken up about this underreported issue.  Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, delivered an address to the Military Health System Annual Conference in early 2011 on the topic.  Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation (a nonprofit organization dedicated to bridging the gap between civilians and military America), published an opinion in the New York Times last November.

Both Deborah and Kristy point out that we have no accurate accounting of rates of spousal suicides within the military, due to privacy rules, and that this in itself is part of the problem.  Recent studies of military suicide have excluded the mental health of military family members, “effectively ignoring half of the problem”, Ms. Kaufmann stresses.

Only anecdotal evidence exists on the numbers of suicides and suicide attempts.  “Three Army wives I knew personally all took their own lives,” Kristy writes.  “Suicide attempts and completions among family members occur far more often than many realize or care to acknowledge.”  She adds that “suicide among service members, veterans and families is an indicator of the amount and duration of stress we continue to bear.”

“War comes home,” Kristy eloquently tells us.  “No soldier comes back the same, which means no family is ever the same.”

Deborah Mullen’s revelatory conference speech deserves to be read in its entirety.  She points out that there are many specific programs in place to help spouses with challenges such as the day-to-day demands of being a single parent or being a new caregiver to a wounded veteran.   But, “we are still discovering, still revealing, fissures and cracks in the family support system,” she observes.

The first “fissure” she mentions is “secondary post-traumatic stress”, and I see this as an extremely important and relatively misunderstood phenomenon.  Secondary post-traumatic stress, or secondary trauma, is the stress and trauma we are not directly exposed to but experience through someone else’s eyes and memories.  It is also the pain we feel as we watch someone we care about suffer and change from those first-hand experiences.  Kristy put it well: War comes home.

Suicide is the most extreme and tragic symptom of secondary trauma, but there are plenty of other symptoms as well. Ms. Mullen clearly identifies many of them.  “Families experience depression, anxiety, sleeplessness, and headaches,” she observes, as well as cold sweats, lost concentration, panic attacks, and dread of contact with the outside world.  Many spouses are “unable even to get out of bed, to get dressed, prepare meals, or leave the house.  Some won’t even get their children off to school, leaving the care of little ones in the hands of older siblings.”

“We shouldn’t be surprised,” Ms. Mullen continues, “to learn that some spouses turn to the same remedies that troops with PTS turn to – alcohol, prescription drugs, and some even contemplate suicide.”

The military branches have recognized for some time the stigma attached to mental health issues within the ranks.  Programs have been put in place to address the issue so that more service members can get the care they need and deserve.  But Deborah Mullen points out something I think most people are unaware of: the stigma against military wives seeking help for their own mental health challenges.

First of all, she believes, they’re “embarrassed” to seek help.  They also “worry that in doing so, they could negatively impact a husband’s or wife’s military career.”  As a final straw, “the service member even warns the spouse against getting help.”  “The services have worked hard to reduce mental health stigma in the ranks,” Deborah states, “but we need to continue to work to eliminate it from our homes as well.”

What happens for the desperate spouses who do gather the courage to seek treatment within the Department of Defense and Veterans Affairs mental health services?  Deborah Mullen’s insider assessment paints a bleak, disturbing picture.  I will begin with that distressing portrait when I return next week.

Surprising Findings on Postwar PTSD

A recent op-ed piece in the New York Times by Anthony D. Mancini reported surprising and disturbing preliminary findings from a military PTSD study soon to be published in the British Journal of Psychiatry.  Mancini, an assistant professor of psychology at Pace University, and his colleagues set out to examine the stress responses of over 7000 United States service members, pre- and post-deployment to Iraq and Afghanistan.  The verdict?  “Fewer than 7 percent showed signs of PTSD following deployment”, and “among those with multiple deployments . . . only 4 to 5 percent” suffered from PTSD.

I don’t buy it.  Those numbers are way too low.

While we must wait for the full study to be published before drawing firm conclusions, Mancini’s contention that “the prevalence of PTSD among veterans” is “substantially lower than is commonly believed” should be a cause for concern. 

I want to see how the researchers set up the study, look at the guidelines and approach they used, and examine how they interpreted their data.  Researchers always go into a study with a goal, something they hope to prove, and possibly even additional agendas they are not fully conscious of.  These agendas can color the findings they report.  The study results quoted in Mancini’s piece on the low prevalence of PTSD among returning service members are so counter to what I’ve seen in my work that I suspect some bias crept in.

Mancini states that “many assume that humans are inherently vulnerable to trauma”, but that “a growing body of scientific research is telling another story”.  Only the first part of that statement is true.  Our nature as human beings, our biology and psychology, program us to respond to traumatic events in patterns that ensure our survival.  Almost everyone has heard of the “fight, flight, or freeze” responses, arising from our sympathetic and parasympathetic nervous systems.  These responses to danger make it possible for us to survive and then learn from threatening experiences.

Trauma, short-lived or lasting, arises when we fail to complete our natural trauma response.  Because we can bury and refuse to deal with the painful and overwhelming events of our lives, the intense emotions aroused by trauma (leading to that fight-flight-freeze) may never be released.  This happens all the time.  We can go back and resolve past trauma, but we are always “inherently vulnerable” to it, and our vulnerability to trauma increases the more we bury our previous “invisible wounds”.

The authors of the British Journal of Psychiatry study defend their results by characterizing their respondents as “not seeking treatment” and “representative of the military as a whole”.  They add that “[the participants’] reports were confidential and had no bearing on their military careers”.

I want to make a couple of points here.  First, and most importantly, why didn’t the study include service members who were seeking treatment?  How could the researchers’ study be “representative” without them?

Secondly, confidentiality is certainly an essential factor in getting accurate disclosure, but did the researchers take into account the lingering mindset of stigma within the ranks attached to a diagnosis of PTSD?  Most service branches have campaigns in place to de-stigmatize the invisible wounds of combat, but that message hasn’t yet been fully embraced by the military culture as a whole.

Mancini reports that “about 83 percent of respondents showed a pattern of resilience: they exhibited a normal-range ability to cope with stress both before and after deployment”.  What I want to know is, how did the study’s researchers define “normal-range ability”?  I have first-hand experience with government agencies who work with veterans, and I can absolutely state that their baseline definitions of good coping function are set appallingly low.  Their “good enough” is far from what I consider healthy, as a professional in the psychotherapy field for over 40 years.  I believe the average person would agree with me, and wouldn’t want to see the men and women who have served our country limited to life on such unsatisfactory and unfulfilling terms.

I am particularly suspicious – convinced, even – that the study’s parameters or methods were flawed due to their finding that service member resilience went up with multiple deployments.  This is absolutely counter to everything I’ve witnessed in my work and what many other professionals in my field have seen as well.

I also “do not want to stigmatize those with the disorder” of PTSD, as Mancini cautions.  But I also don’t want to minimize or mislead the military or the public about the true dimensions of what I and many of my colleagues believe will be a hidden epidemic.  I give Mancini credit for stressing that “even an estimate of 1 in 10 represents a public health issue of the first magnitude, requiring our full attention and resources”.  How much more, then, will be required if the real prevalence of PTSD is closer to 30 percent, which is my opinion?

Mancini closes his piece with a truly alarming statement.  He starts well by saying that “PTSD is a treatable condition and a realistic and informed understanding of our inherent coping abilities can only assist treatment”.  But he goes on to propose that “perhaps one day, even prevention of this debilitating disorder” will be possible.  That Mancini could make such a proposal betrays a profound misunderstanding of the nature of human beings and our innate, invaluable trauma response.

To prevent PTSD we would have to rid the world of cruelty, abuse, violence, and evil.  Or we would have to develop into one of two kinds of people: impervious automatons, able to turn off our feelings at will; or psychological super-humans, able to easily experience and quickly and completely resolve every shock, crisis, and horror, from the cradle to the grave.

My take on this?  Won’t happen anytime soon.

Military Suicides: Part 1

Today marks the first in a new series of posts about an appalling reality in our culture: the heart-breaking frequency with which United States military personnel are taking their own lives.  What I have to say about this topic will be serious and challenging; the number of recent service member and veteran suicides and suicide attempts should be absolutely unacceptable to every American.  I plan to not only share facts and statistics with you, but also to enlighten you about the underlying causes of this tragic epidemic from my over forty years of experience helping people resolve emotional trauma.

I recognize that this is a heavy subject.  Please stay with me on this one.  I’m going to primarily focus on suicides among combat troops of Iraq (OIF) and Afghanistan (OEF).  I firmly believe this topic must be addressed.  The men and women serving our country in our armed forces deserve to be heard before they use suicide to blast their way to our attention.

First, let me say that suicide attempts and completions are a symptom.  This ultimate act of self-destruction is a symptom of emotional trauma, or what has come to be called “invisible wounds” in our post-9/11 world.  As symptoms, suicide completions and attempts usually happen only after the development of other symptoms or warning signs, such as depression, reckless behavior, or substance abuse.  I’ll go into this later in more detail.  For now, I want you to understand that to effectively treat the symptom of suicide, we’ll need to comprehensibly address and heal our military’s invisible wounds.

The suicide statistics for veterans are truly alarming.  I’m going to start with data from a Department of Veterans Affairs study completed in 2010.  In his article for the Army Times, staff writer Rick Maze reported the following:

  • 18 veterans of all wars and conflicts commit suicide every day (that’s one suicide every 80 minutes)
  • 950 veterans in treatment with the VA attempt suicide every month (that’s 31 suicide attempts per day)
  • 98 veterans of OIF and OEF committed suicide between October 2008 and September 2009 (that’s one suicide every four days)
  • 1,868 OIF/OEF veterans attempted suicide during that same time period (that’s five attempts every day)

Let me tell you why I think these numbers don’t fully represent the magnitude of our veteran suicide problems.

First, this study is limited to information about veteran suicides that the VA knows about.  These statistics cover veterans receiving some type of treatment within the VA system combined with statistics the VA has been able to collect from other sources about veterans outside the system.  The VA’s internal data may be accurate, but many veterans outside the system can “fly under the radar” and their suicides and suicide attempts may not be measureable in any truly precise way.  For this reason, I would bet the VA numbers are low.

Second, I firmly believe that many suicides don’t end up looking like suicides or being reported as suicides.  An example of this that’s been in the news lately is the phenomenon of “suicide by cop”.  In suicide by cop, an individual acts in such a way as to present a flagrant danger to himself or others, in an effort to be shot and killed by peace officers.  Police responding to a scene of domestic violence, or burglary, or assault may find themselves face-to-face with a veteran desperate to end his suffering but unable to complete the act of taking his own life.  The veteran acts in an aggressive, threatening way to the officers, who necessarily shoot in defense of themselves and/or innocent bystanders.

Another example of disguised suicides and suicide attempts are deaths from reckless behavior.  A veteran feeling there’s “no way out” climbs on his motorcycle and speeds past control into a fatal crash on a winding country road.  Another veteran combines prescription medication with alcohol and no one really knows whether he slipped away by mistake or design.  Many incidents like these are masked suicides and not all of them will find their way into our statistics and awareness.

I’ve treated many OIF/OEF veterans and I’ve seen that they don’t want to draw attention to themselves.  When I ask the veterans I’ve been able to help how I can find and reach out to other hurting veterans in the community, they all say, “They don’t want to be found.”  This tells me the magnitude of our veteran suicide problem is probably significantly greater than we know, even with the most careful and conscientious reporting efforts.

What we do know is alarming enough.  Next week, in Part 2 of this series, I’ll present the results of another, recent military suicide report by the Center for a New American Security.

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.

Dis-a-What?

One of last week’s lessons from trauma concerned dissociation – a term many of you may not have heard of before, or fully understand.  I made the statement that “surviving can mean dissociating” and then went on to say:

“Dissociating is the capacity to distance ourselves from present-moment events and feelings.  Our innate, built-in survival mechanisms include the ability to dissociate during highly dangerous and traumatic moments.  This concept is valuable to a real understanding of trauma and the process of healing from it, and so I want to devote my next post to a fuller explanation of this aspect of our human nature.”

As human beings, we each have built into us a survival mechanism called the trauma response.  While everyone responds to crises in somewhat individual ways, the basic progression of our response follows a common pattern.  When a crisis event occurs, or we feel threatened, we first become acutely, extraordinarily alert.  This part of the trauma response is called hyperarousal.  The purpose of hyperarousal is to get ready, to mobilize the energy we’ll need to handle the crisis, whether it’s real or anticipated.

The next step of our response to crisis is called constriction.  Constriction is the way we prepare our body to deal with a threat, in much the way a fighter prepares for a boxing match.  The bell rings and he advances out to meet his opponent with his arms flexed and ready to strike, his chest tightened against a punch, his legs tensed and ready to move in any direction necessary.  Constricting our bodies into certain patterns prepares us to focus on and meet a threat with the best chance of protecting ourselves, or someone else.

Now we come to the time for dissociation.  We’ve put ourselves in the “ready position” as best we can, but we anticipate that painful events may still happen.  So we put some distance between ourselves and reality.  If we were to feel all the effects of the pain which may occur, it could incapacitate us and prevent us from fighting effectively or running away, whichever would make more sense in the situation.  Staying strong and doing what needs to be done may require us to not feel certain things that may happen, both emotionally and physically.  Our bodies are capable of numbing both physical sensations and emotional perceptions.

The ultimate dissociation response is a complete numbing or freezing, such as happens to an animal when it plays dead.  When a mouse is caught by a cat, it senses that death is imminent and may be unavoidable.  To protect itself from experiencing the overwhelming sensations of being killed by the cat, it completely dissociates by becoming unconscious.  Human bodies can also respond this way, in moments of complete panic and terror.

At any point in this progression, if the threat goes away, we can reverse our way back to a relaxed state.  We can unthaw, reconnect with our emotions and physical sensations, loosen our tensed muscles, and lower our high mental alert status.  We can “stand down”.  Because we’re human, however, and have a rational mind that can override this process, there’s no guarantee that we’ll always fully back off from a trauma response, even when the present danger is past.

Why is this?  Much of it has to do with our history.  The more trauma we’ve experienced without being able to let go of it, the more we continue to carry it around with us in our bodies and minds over time, and the less able we are to let go of the effects of our current responses to crises.  New responses pile on top of old ones.  We never really left our previous dissociation, restriction, and hyperarousal, and now we’re cementing all those states even further in place with more of the same.

Have I lost you?  I hope not.  This post has been more of a lecture than usual for me.  But I want to help you gain some awareness of how our bodies and minds work in a crisis to protect us.  There’s a real need and purpose behind the trauma response.  There are also ways that we can sabotage ourselves by not dealing with the aftereffects of our trauma stored in our minds and bodies.  I’ll have more to say about this process and its effects in upcoming posts.

Corvette Crash Course, Lap 2

Last week, I shared with you one of the most devastating traumatic events to happen to me in a long time.  On a summer evening two years ago, my wife Lynn almost died while I was virtually helpless to do anything about it.  The incredible men and women of the Two Rock Fire Department saved Lynn that night, she recovered very quickly, and my partner in love and life was restored to me.

I want to continue to share things I’ve learned in the aftermath of trauma.  Two weeks ago, following my post on an accident in which I totaled my Corvette, I mentioned five lessons I’ve been reminded of at somewhat great cost.  They are:

  • I am not in control.
  • I forget too quickly what’s really important.
  • “The Tortoise and the Hare” is not just for kids.
  • If I “know pain”, I can “know gain”.
  • I am human and mortal.

Today I want to add five more lessons from Lynn’s traumatic emergency episode:

1.  Life is fragile.

It was clear to me, as Lynn lay unconscious in my arms, that it could all be over, that she might be taken to heaven and I would have to say goodbye to her.  In that potentially disastrous moment, I recognized again how truly fragile life is.  One moment we can be alive and have the people we love with us, and in the next moment they, or we, can be gone.

2.  We are all dependent.

I also was forcefully reminded of how dependent I am on Lynn.  I like to think of myself as a strong, capable, and independent person.  In many ways, I am.  But Lynn takes care of so many things for us, some of which I’m aware of, and some I’m not.  She works very hard at maintaining our home and managing our finances, which are important and complicated right now.  The day after she went to the emergency room, she was taking care of some business matters from her bed in the hospital.  I had no idea about all the things she was keeping track of and staying on top off for us financially.  I am very grateful that she is so purposeful and committed, as I am, to our life together.

3.  Our lives have rhythm.

This lesson is related to the lesson from “The Tortoise and the Hare” – we tend to try to live our lives too fast.  We tend to overshoot that core, basic rhythm that each of us has but may be unaware of.  When we’re moving fast all the time, we can stop being tuned in to the pace of life that works best for us.  It’s a pace that allows us to accomplish what really needs to get done, while still permitting us to take the time to make wise decisions, pay attention to and discern what’s really important, maintain our health, and sustain our treasured relationships.  A traumatic event can strip away all that fast-paced, driven quality that keeps us consumed with all the things we’re so worried about.  As we recover, we can regain the pace of life that restores our balance.

4.  It’s harder to watch.

When my Corvette skidded out of control on Springhill Road, I knew what was happening to me and how I felt in each frightening moment.  I could tell whether the injuries I was sustaining were major or minor.  Someone looking on could not have known that I was only suffering a bump on the head and a slight neck strain.  When Lynn passed out and collapsed into my arms, I had no idea what she was feeling or what was happening to her.  I had no way of knowing whether she was in pain, whether she was suffering a heart attack or stoke, whether irreparable damage was happening inside her or if she would be able to recover.  There’s a helplessness that accompanies watching trauma occur to someone else, particularly someone we love.  It’s not just that we may not be able to stop what’s happening, we also can’t always know the extent of the crisis.  This helps make the experiences of secondary victims of trauma – the observers – so potentially shocking, overwhelming, and intense.

5.  Surviving can mean dissociating.

Dissociating is the capacity to distance ourselves from present-moment events and feelings.  Our innate, built-in survival mechanisms include the ability to dissociate during highly dangerous and traumatic moments.  This concept is valuable to a real understanding of trauma and the process of healing from it, and so I want to devote my next post to a fuller explanation of this aspect of our human nature.

My hope is that these lessons learned from my traumatic experiences will help and inspire you to better navigate these hard times we’re in.  As I do with my all my patients, I want to reach out to you where you are hurting and in need.  I want to  let you know you’re not alone and you can have hope as you learn and apply some of these universal life lessons that I too have had to learn so painfully for myself.

Not in the Driver’s Seat

For the last two weeks I’ve written about a recent accident that left me slightly injured and totaled my Corvette.  I experienced trauma that day, with its classic symptoms and aftermath, and I’ve shared some of my thoughts and realizations following the event.

Now, in order to give you a fuller understanding of the experience of trauma, I want to share another, much more serious traumatic incident that took place in June of 2008.  That may sound like a long time ago, but my memories of that night remain overwhelmingly vivid.  On this occasion, I was not the primary victim of trauma – not the person directly experiencing the crisis.  I was what is called the “secondary victim” – the person who observes someone else’s suffering – and who is connected to them either as a professional first-responder, or as a loved one or bystander who may be reduced to watching helplessly as horrific events unfold.

Late on a Wednesday evening, after coming home from a business meeting, my wife, Lynn, and I were relaxing in front of the television.  Lynn got up to leave the room and then returned shortly after, stumbling and semi-conscious.  As I sprang up to catch her fall, she collapsed into my arms.

As with so many traumatic events, it all happened so quickly.  One moment Lynn was fine, the next moment everything was completely out of control and I could tell she was near death.  I was terrified.  There was nothing I could do except hold her and love her in what I thought could be her last minutes of life.  The intensity of fear I felt inside was like normal fear times a hundred.  The velocity and intensity of my emotions felt like an engine that was racing with absolutely explosive power.

In that moment, I felt the full, overwhelming impact of the trauma.  I went into “hyperalert”; I didn’t disassociate, I didn’t mentally go away or numb out.  I needed to get help.  I couldn’t do everything myself, couldn’t both hold her and get to a phone and call 911, all at the same time.  I shouted to my son, who made the phone call, and within three minutes some fabulous people arrived to save us.  These fire and EMT personnel saw us in that naked moment, in our most vulnerable state, with tremendous compassion.  They did a wonderful, sensitive, and professional job of stabilizing Lynn and getting her to the hospital.

I believe in miracles, because Lynn came back to me as quickly as she started to go.  She went through all the tests at Petaluma Valley Hospital’s emergency room and she was fine.  What happened was just one of those freak medical episodes.  She recovered quickly and I felt such intense relief and gratitude to have her alive and with me. To this day, Lynn and I are very close friends with the Two Rock volunteer fire department crew who came to our rescue and who told us how very touched they were by the love and commitment they saw Lynn and I share.

Lynn’s emergency was a much more significant trauma than my car accident.  There is really no comparison.  But I want to use both these experiences – one in which I suffered the trauma, and one where I could only look on helplessly – to share some of my understandings about primary and secondary trauma and its victims.  I have other lessons I want to share from this earlier, most frightening and intense crisis.  I’ll make some of these insights part of my next post.

Corvette Crash Course

On the morning of April 16th, I lost control of my Corvette on the back road into Petaluma.  I was only slightly hurt in the accident – a bump on the head, a small neck strain – but my car was totaled.  As I stepped out of the wreckage, I stepped into the state of shock and loss that follows in the aftermath of a traumatic experience.

Like the calm after a storm, the time after a crisis ushers in a time of reflection.  It’s a natural sorting-out time, when deeper awarenesses and awakenings can emerge.  After our world turns upside down, we have the opportunity to decide if we want to turn it right side up again in exactly the same way.  It’s a natural time for choices and changes, for new goals and directions.

But the aftermath of trauma doesn’t feel good.  As great an opportunity as crisis provides for positive change, it’s still uncomfortable and scary to tackle putting the pieces of your life back together again.  Some people respond to the challenge with paralysis.  Some are able to go into action.  I want to share with you some thoughts and realizations, some things I’ve learned and relearned, that have come to me in the wake of my recent accident.

1.  I am not in control.

I only like to think I am.  I like to assume that I can predict the outcome of my decisions and actions.  I will take this turn, call this person, say these words, sign this paper, write this check, and I believe that rationally certain things will follow.  I will take this quick trip into town in my Corvette and be back in time for my staff meeting.  I can fool myself into believing that what I expect to happen will happen.  Sometimes what I expect does happen.  But there are no guarantees.  Control is an illusion.

2.  I forget too quickly what’s really important

Like being alive.  The things that really matter are the things you can’t replace easily, or maybe even at all.  The so-called “simple things”, like people and relationships.  Like health and moments of joy.  I could grieve the loss of my Corvette, but what I really miss are the moments I spent driving it, the freedom I felt rounding curve after curve.  I need to remember that the exhilaration and aliveness I felt doesn’t depend on the car.  I can feel that way again without it.  I can feel a thrill in just being alive, being in love with my wife, and embracing the next challenge.

3.  “The Tortoise and the Hare” is not just for kids.

Remember the fable?  The hare quickly goes out in front, but the tortoise wins the race.  I’ve been trying to live my life way too fast.  When I put myself under a lot of pressure and try to get too many things done at once, I can make mistakes or miss things.  I’m unable to give sufficient attention and time to important matters.  I can’t force an elephant through a keyhole.  I can’t ripen green tomatoes overnight.  Trying to get too much done in too little time is just like that.

4.  If I “know pain”, I can “know gain”.

If we give ourselves permission to go through our crisis and heal, we can be transformed in the midst of our trauma experience.  I can choose to respond to my accident in one of two ways: with resentment and bitterness, or by embracing change and growth.  I can remain stuck, angry that my Corvette is totaled, scared that if I get another Corvette I might crash that one too (and possibly suffer significant injuries), or I can go on from here into the unknown future, where there’s a whole lot more in store for me.  Where my story continues.  I want to embrace my life by going through my trauma, not going around it or stopping cold in my tracks.  I want to emerge a stronger, better person.

5.  I am human and mortal.

My life could end at any time.  An event like my accident urges me to remember that no one’s immortal.  I feel my humanity and vulnerability more now than I have in many years.  I don’t have that same feeling of security – physically or financially – that I took for granted for a long time.  And, just as quickly as it might have happened to me, someone I love could be hurt seriously or die.  I’m only human; I have no control over that (see Number 1 above).

I want to propose a somewhat radical picture of the lasting legacy of trauma.  I see the wound of trauma as a friend.  It is an uninvited, unexpected friend, to be sure.  But if I accept it and build it into my life, my life will be transformed in ways I can’t begin to imagine.  If I accept it, and share that with others – that this part of me is acceptable and so therefore this part of you is acceptable – we are drawn closer together.  We see we’re all the same: human, mortal, without control, but with strength and depth and intrinsic value.

This is living in what I call “extraordinary reality”.  It’s a quality you see in the lives of people like EMTs and other first responders to traumatic events.  Their experiences and the sacrifices they make in serving others make them different people to be with.  As a psychotherapist, I am a kind of “first responder”, too.  I help people survive and heal from trauma.  Experiencing trauma firsthand – as I did when I spun out of control on the way into town one recent fateful morning – and then embracing it, will only help me become more compassionate and skillful at the work which is my calling.