Trusting Your Instincts in a Psychologically Abusive Relationship

Most people understand the concept of physical abuse. If you’re in a relationship where your partner is physically hurting you, this is an obvious sign that:

1. Things are not okay
2. This will probably not be the last time.
3. This relationship has the potential to be very dangerous.

Emotional abuse is more confusing. Depending on how someone was raised, where they grew up, and who influenced their life, the term “emotional/psychological abuse” may vary. While there is no official definition of the term, the outcome is usually the same. 

Emotional abuse can lead to:

  • Anxiety
  • Depression
  • PTSD
  • Problems with sleep
  • Low self esteem
  • Doubting oneself

Most emotionally abusive behavior is used as a way to control the victim. There are different tactics used when implementing this type of control. Verbal aggression is one of most popular forms and can be demonstrated by lying, screaming, intimidation, threats or even the constant use of sarcasm. When one partner uses “jokes” to put the other down, especially in front of friends or family, this can be an early warning sign for problematic relationship behavior. Although the partner may insist they are “joking”, this can leave the other partner with nowhere to go. It is very difficult to address a joke as worthy of serious attention.

Sometimes we can justify the behavior of someone we love. Since rarely are people all right or all wrong, there is a lot of wiggle room to excuse the actions of people we care about, especially if we are currently in a close relationship with them. When an emotionally abusive partner has all the external hallmarks of success, the process of understanding abusive behavior may be even more difficult. People who emotionally and psychologically abuse their partner can move in multiple social circles. Economic wealth, social class, and location have nothing to do with the prevalence of maladaptive relationships.

Instead of asking yourself if your significant other is manipulating or trying to control you through unhealthy behavior, it may be easier to accept the reality of abuse through observing your own behavior.

Below is a checklist of common responses to emotional abuse:

  • Do you feel as if you are on an emotional roller coaster? Is your partner loving and tender one minute, yet explosive the next?  
  • Do you “know what you have to do” to keep your partner from hurting your feelings?
  • Do you end up pushing his buttons anyway because of something small you’ve forgotten to pay attention to?
  • Do you miss your friends or family? Are you spending less time with them than you have in the past?
  • Do you feel unfaithful or guilty and are not sure why?
  • Do you smile more when you are around your partner in order to keep the peace?
  • Are you nervous to bring friends or family into your relationship?
  • Do you feel like you’re not capable of making good decisions?
  • Do you feel unworthy?
  • Do you feel trapped?

There are no obvious physical scars from a person who emotionally and psychologically abuses those that he/she loves. Because others may not recognize the extent of dysfunction in a relationship that may look perfect on the outside, it can become very difficult to trust gut instincts. Leaving an emotionally abusive partner can take a long time and it may happen in several gradual steps. The first step is to trust your instincts.

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What’s the Number One Coping Skills in Today World? Meeting Drama with Detachment

Detachment is not about being aloof or withdrawing from the world. We can be passionate, involved, enthusiastic and engaged with life in all its forms. Living in seclusion may help some people to go deep within, but for others that sort of separation from the world is not desired or possible. The detachment contemplated in this article is an internal process to be undertaken while remaining immersed in life matters.

Attachment to certain outcomes, exaggerated reactions to events, skewed perspectives and over-the-top emotions all create drama and turmoil. Especially in cases of over-care and over-identification where happiness and life’s meaning are based on success, achievements and possessions.

Compulsion, obsession, needing excessive validation, holding on too tightly, being shattered when expectations are disappointed or things don’t work out create much chronic stress, fatigue, conflict and burnout. Anxieties of various kinds, worry about unfavorable outcomes, potential dangers and change are also major contributors to physical and mental stress.

The Benefits of Detachment

With detachment we notice what is going on but are not drawn into its drama. Rather like a witness, we step back from the immediate turmoil and reflect on the true significance of events or people’s behavior. In many cases the overreaction is a result of seeing a mountain where there is really only a molehill. This is not to deny that there may be very serious problems that can throw us off-balance. However, more often than not, events are less catastrophic than we believe. In either case, only when we let the storm subside will be able to think and evaluate the situation clearly.

Detachment allows us to live an intentional life based on our values, goals and aspirations. It gives us the mental freedom to make choices about how to be, rather than being catapulted into turbulence. Assessing what is within our control and what is not, we can act accordingly. If our boundaries are violated we can stand our ground. Adversity does not break us, but taking a long view, we find ways of moving on from it.

Our core self is independent of external factors. With detachment, a sense of inner peace and integrity is ours, no matter what happens. We can be at home in ourselves, solid and trusting that we can deal with life’s currents and obstacles.

How to Practice Detachment

  • Emotional stability is key. Emotions often seem to have a life of their own, coming and going, rising and falling, seemingly of their own volition. You cannot deny or fight them directly. But they don’t have to control you. To tame them, you can work with your thoughts and self-talk. While they may seem true, they are not facts but commentaries colored by your beliefs and experiences. Challenge them and make sure your thinking is realistic and constructive. The second approach to manage extreme emotions is through the body, using self-calming techniques and other ways to settle your nerves.
  • Take responsibility for your actions, emotions and thoughts. You may be triggered by people or events, but no one can make you do or feel anything. How you respond to challenges is entirely your choice.
  • Contain your impulses. Not every spontaneous email or text message needs to be sent or works in your favor.
  • Clear emotional baggage: blame, bitterness, hate, regrets, guilt or self-pity. Hanging on to the hurts of the past will keep you stuck. To process and move on from negative emotions can only be done if you look at the past event with some degree of detachment, where you seek to understand what went wrong, who did what, when and why.
  • Accept the reality of a situation or person. Assess what you can change or need to let go, what is your issue and what is theirs. Not everything needs to be taken personally,
  • Focus on solutions instead of problems. Ruminating about what is or could go wrong only contributes to stagnation and overwhelm. How do I deal with this? is a good question to ask instead of thinking, all is lost.
  • Detach from other people’s choices, opinions and actions — even when you are in a close relationship with them. You can be supportive but their life is theirs to live. Everyone has their own path to walk.
  • Accept yourself. Don’t shrink from your failings and short-comings. Make amends if needed but be at peace with being fallible and imperfect like every other human being. In most cases, neither your mistakes nor those of others are calamities from which there is no way back.
  • Embrace uncertainty. If you can do something to create clarity, go ahead. If not, go with the flow and adopt the attitude that you have what it takes to deal with whatever lies ahead.
  • Be present in the here and now. Only then can you take charge of yourself.

And finally, consider this saying from award-winning author Tolbert McCarroll, “You always have the choice to take all things evenly, to hold on to nothing, to receive each irritation as if you had only fifteen minutes to live.”

What does detachment mean to you? How could it be relevant in your life? What would be the benefit if you adopted a detached attitude to drama?

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Do Beliefs Shape Outcomes?

“Man often becomes what he believes himself to be. If I keep on saying to myself that I cannot do a certain thing, it is possible that I may end by really becoming incapable of doing it. On the contrary, if I shall have the belief that I can do it, I shall surely acquire the capacity to do it, even if I may not have it at the beginning.” – Gandhi

I would venture a guess that most people who are reading this article have heard of a phenomenon called the placebo effect which is described as an inert substance either injected or ingested that has perceived benefit for the patient. It could take the form of a sugar pill in place of an actual prescribed medication.

A classic scene from the Robin Williams’, Nathan Lane led film The Bird Cage, showcases this concept brilliantly. In it, Lane’s character believes he is being given a mood stabilizing medication called Pirin, when what it really is, is aspirin with the letters a and s scratched off.

What happens in treatment when medication is not the only remedy and human contact provides advantageous impact?

Bernie Siegel, MD is a medical oncologist whose landmark book entitled Love, Medicine and Miracles opened the door to my own exploration of the ways in which our thoughts and beliefs create pathways to healing. It shaped many of the interventions I incorporate into my therapy practice.

In an article, Deceiving People Into Health, Bernie talks about his direct observation of the placebo effect in treatment of those diagnosed with various forms of cancer. He determined that when patients perceive their care to be benign (such as viewing radiation as sunbeams rather than lightning bolts or chemotherapy as a benevolent rather than toxic substance), they tend to have better outcomes. When they are treated with respect, kindness and compassion, they heal in ways that they may not otherwise.

Bernie refers to his patients over the length of time he has been in practice as exceptional. A long-standing group he began decades ago is called ECaP which stands for Exceptional Cancer Patients. Do some of his patience die? Of course, they do. As much as he believes that love heals, even it can’t keep people in their bodies forever. By observation, some die more healed than they lived.

Human beings find meaning in their beliefs. They can take the form of those listed below as well as their opposites.

  • Trust in a benign universe. A Higher Power or Divine Being versus doubt, fear and feeling abandoned.
  • Awareness of inner strengths, resilience and fortitude vs. embracing lack and limitations.
  • Pronoiathe idea that events are conspiring to work in our benefit, instead of paranoia, the assertion that everyone is against us.
  • Personal safety vs. danger which may trigger a fight, flight or freeze reaction.
  • Love-ability vs. self- loathing

When I consider the counseling clients I have worked with over the past nearly four decades, I have observed that those who find stability and recovery are those who view the world through clear lenses rather than those that are smudged by cognitive distortions, such as catastrophizing, personalization, blaming or jumping to conclusions. It is akin to looking in a fun house mirror and insisting that the images you are seeing are real.

Some share that others hate them, disrespect them, and want them to fail. When we dig deeper, I ask them if those were the words used. Much of the time, the answer is, “Well, not exactly, but that’s what they meant.” Again, I would query, and the response is, “That’s what it felt like.”

Since we act on what we believe, often they would shape their choices based on that perception and would find themselves awash in feelings of despair, frustration and anger. Some carry guilt and shame from childhood choices and judge themselves irredeemably damaged and unworthy of the love and approval they may so desperately seek. Fueled by substances or other habitual behaviors, it causes a downward spiral from which they fear they will never recover.

The Health Belief Model was developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels who were employed by the U.S. Public Health Services, It is described as one in which a person will take a positive action, such as giving up alcohol as is the case with many of my clients, if they can avoid a negative condition such as job loss, legal consequences or marital conflicts, and have a degree of certainty that if they do decide to refrain, an undesirable outcome can indeed be prevented and, lastly, that they are capable of such change. That’s often where they get snagged. They may express wanting to change, but lack the motivation to take the necessary steps.

I ask them on a 1-10 scale where they place themselves regarding desire for change. The next question is about how determined they are to execute change and lastly how willing they are to “put legs under” their vision for their lives. It is only when all three are at the same level that success is more likely. I have found that most people don’t do the best they can. They do the best they are willing to do.

I sometimes ask, “If you knew that in a year from now, your life could do a 180, how would you feel in the moment?” Most of the time, they would smile and say, “Great!” I tell them that I guarantee change in that period, since it occurs every day — but it will cost them their limiting beliefs, fear thoughts and scarcity mentality. Let’s make a deal… door #1 or curtain #2.

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My Recovery Isn’t Defined by a ‘Sobriety Date’

Ticking off each day that I don’t take a drug requires too much focus on an aspect of my life that I am trying to leave behind.

Do you know your sobriety date? If you’re doing the 12 steps, you probably have a collection of chips ticking off the years and months since your last use. You probably have a “birthday.”

Even outside of the 12 steps, many people track their sobriety dates. It’s supposed to be a way to quantify and celebrate how long someone has been in recovery, and to recognize our accomplishments. But I don’t agree with that thinking. I don’t keep a sobriety date, even though I’m in recovery from heroin addiction. If you’re anything like me, maybe you shouldn’t keep a sobriety date either.

“Relapse is part of recovery.”

Heard that one before? It’s repeated all the time. I’ve lost count of how many counselors, peer support specialists, doctors, and random people have told me that “relapse is a part of recovery.” I get it. It’s true. Just look at how the National Institute on Drug Abuse defines opioid addiction: “a chronic, relapsing brain disease.” That means addiction to opioids causes long-term changes to the brain, which may manifest as behavioral recurrences throughout the life of the disease. Relapse is normal. In fact, 70-90% normal, according to several independent studies.

Despite the mantra, however, many people in addiction recovery are taught that relapse is the ultimate definition of failure. When we come down from that relapse, we feel gutted. We feel ashamed, like we’ve lost (or thrown away) something sacred. It leads a lot of people to continue using. But it doesn’t have to.

I’ve been that person who relapsed and hated myself for it so much that I kept using to escape from the shame. Once upon a time, a single relapse meant a minimum of a three-month bender. A big part of the reason was my sobriety date. I looked at that brand new zero like it was the end of the world. All of my recovery was erased by one shot of heroin. So I’d go out and use more, until I became exhausted with the lifestyle once again.

Then I stopped keeping a sobriety date…

Learn more about why Elizabeth Brico doesn’t believe in sobriety dates — and why she thinks maybe you shouldn’t either — in the original article Why I Don’t Have a Sobriety Date at The Fix.

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Detachment: A Strategy for Friends and Family of Adult Addicts

For every adult who struggles with addiction, there are many affected by its destruction. Family, co-workers, and friends are among those who become witnesses to the downward spiral of self-destructive behavior. Attempts to fix a friend or loved one experiencing addiction become increasingly frustrating as the chaos becomes a part of daily life.

When you are affected by someone else’s drinking or drug use, it is important to remember that even though you cannot prevent what’s happening to them, you can regain your sanity by practicing detachment.

What is detachment?

Detachment is when you let other people experience their consequences instead of taking responsibility for them. This is a key component of the recovery process for family and friends of addicts. Redirecting focus away from an addict’s negative behaviors can restore the balance of the relationship dynamics, as well as re-start self-care.

Of course, detachment doesn’t mean that you stop caring. The popular phrase is “to detach with love” promotes loving the person, even when you don’t approve of the behavior. Detaching means that you lovingly let go of solving the problems associated with the addiction.

When a person experiencing addiction misses work, neglects his or her responsibilities, or does something like crashing the car, let them handle it. This invites the addict to take responsibility for his or her own mistakes and take control of his or her own life.

The central premise of detachment is letting go of trying to fix the addict’s life. This becomes especially difficult when the alcoholic chooses to do nothing because that refusal often triggers loved ones to rescue them.

However, by solving problems for the addict, you are preventing him or her from experiencing the pain associated with the addiction. Such pain is necessary in order for an addict to choose sobriety.

Family and friends of addicts often fear that the addict will end up incarcerated or dead. This fear is not unfounded; sadly, many addicts continue using despite the consequences to their health and well-being. Therefore, that fear leads you back to rescuing them. However, rescuing addicts trigger a cycle of control that depletes family and friends to the point of emotional and physical exhaustion. 

In Al-Anon, a 12-step program for friends and families of alcoholics, there is an important saying to help remind us of those necessary boundaries in relationships with addicts: “You didn’t cause it, you can’t control it, and you can’t cure it.” This phrase is helpful to consider in its parts:

You Didn’t Cause It

Regardless of why the addiction started, you are not responsible for the behavior of a loved one experiencing addiction. You are only responsible for your own behaviors and your own actions.

You Can’t Control It

Once a brain becomes dependent on a substance, rational decision-making is significantly impaired. This explains why an addict’s behavior is no longer rational: they cannot see the impact that using has on their own behavior.

You Can’t Cure It

An addict’s brain gets hijacked by the dependency, which impacts his or her ability to think and make sound decisions. These physiological changes make it impossible for the addict to see what’s happening to them.

To a non-addict, it may look like the addict can stop using. However, those who have never experienced addiction can’t understand the physical allergy that creates the addictive response. This lack of control is the hallmark of addiction.

The Affects on the Family

Over time, living with active addiction creates anxiety, depression, and chronic stress for those closest to an addict. Many family members suffer in silence, while the addict doesn’t see a problem. Children in particular act out and may become depressed or anxious.

The shame associated with addict’s behavior prevents family members and friends from seeking help. As family members of addicts, you may isolate socially because it’s embarrassing to witness the outbursts. You may stop talking to family and friends because you fear being judged.

Practicing good self-care becomes essential for restoring emotional and physical health of entire in the family. Dealing with active addiction creates a pattern of self-neglect that needs healing. Redirecting the focus back on what you need makes detachment possible because your energy is no longer spent solely on the addict.

How to Start Practicing Detachment

Detachment works best when you can detach with love. This means letting go of the anger and finding alternatives ways to handle the stress of living with an addict. Here are some beliefs that need to be addressed in order to detach:

  • Avoid making assumptions — if you stop helping, something bad will not necessarily happen.
  • Challenge the belief that you have all the answers.
  • You are not responsible for an adult addict’s problems.
  • It’s okay for you to get your own support system.
  • Self-care isn’t selfish, regardless of other well-meaning people say.

Detachment can transform the entire family dynamic. Practicing these behaviors will indirectly benefit the addict because he gets an opportunity to face the truth about his own behavior. Detaching also restores the family’s equilibrium since the attention is no longer focused solely on the addict.

By detaching, you will:

  • Not make excuses for an addict’s behavior;
  • Stop handling an addict’s problems;
  • Avoid becoming a passenger while he or she is intoxicated; 
  • Leave a situation before an addict becomes abusive;
  • Stop responding to an addict’s attempts to blame; and
  • Accept that you are powerless over the addict’s behavior.  

Simple Detaching Behaviors That Work

  • When confronted with verbal attacks, silence works. If you need to, leave the room.
  • Recognize that rescuing doesn’t help the addict long-term.
  • Take care of YOURSELF instead of trying to fix them.
  • Refrain from giving advice or preventing their use.
  • Keep children safe by minimizing their exposure.

Finding Additional Support

When considering options, recovery may include inpatient or outpatient treatment, individual and family counseling, and 12-step programs like Alcoholics Anonymous and Al-Anon.

Families often seek help before the addict does because watching the addict self-destruct becomes too painful. In recovery, the family learns not to force treatment but instead give the addict the dignity to decide on his own. Hiring a professional interventionist provides a more structured approach when the addict is out of control. 

In particular, consider Al-Anon, a free support group for families and friends of those who are struggling with addiction. They also have groups for children affected by the disease. If you are not comfortable in groups, try some individual or family counseling for a more private place to heal.

Detaching is not easy but it does preserve the relationship without participating in the addict’s disease. It separates the person from the addiction. Keep in mind that any addict has a disease much like mental illness. The addict cannot control their behavior, though they are responsible for their choices. Starting the process of growth and recovery is a delicate balance of loving the addict without attempting to rescue them.

It is very important that friends and family of addicts focus on taking care of themselves. To engage in self-care is difficult and takes practice; but ultimately, there is no lasting relief without it.

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When You’re Scared of Feeling Your Feelings

Experiencing sadness, anger, anxiety and other “negative” feelings can be hard. In fact, many of us just don’t do it. Because we’re afraid. We’ve “been taught that [negative emotions] are ‘not OK,’ that there is not a way to address them, or that they are not valid feelings,” said Britton Peters, a licensed mental health counselor in the state of Washington.

Maybe when you cried, your caregivers told you to be quiet and get over it. Maybe they sent you to time-out. Maybe they told you to stop whining and be strong.

Maybe your caregivers ignored or dismissed their own emotions or didn’t express them in healthy, responsible ways, said Kat Dahlen deVos, a licensed marriage and family therapist in private practice in San Francisco. Which means you dismiss or ignore your feelings, too.

Maybe you’ve always thrown yourself into work or a busy social life or several glasses of wine, deVos said. Which means you didn’t get much practice in actually feeling your feelings. And without much practice, it’s all-too easy not to trust that you can tolerate negative feelings. It’s all-too easy to think you’ll fall apart.

We’re also scared of negative feelings because as a society we see these emotions as weak, as making us open to hurt or betrayal from others, Peters said. “When was the last time you saw someone crying and thought how strong they were? Or heard someone discussing sadness and thought how brave they were?”

Instead, we think someone who’s crying or upset doesn’t have control over their emotions, or themselves. Maybe we think how embarrassing. Because we’d be embarrassed to be so exposed in public, or even with another person. Instead, we worship happiness, and prefer to gloss over and snap out of our sadness. So we pretend that everything is OK, because that’s what we see as “strong.” But vulnerability is strength.

And feeling our feelings is vital. It’s vital to our health and well-being. Because “whatever it is we don’t want to feel will eventually find a way to be known,” deVos said. It’ll find a way to be known through tension headaches or insomnia, or through anxiety or depression, she said.

By not feeling a feeling, we also “give it power to hurt us in the future,” Peters said. However, when we acknowledge and validate our feelings, we empower ourselves. We learn that “It will be OK,” and we learn “I have the necessary tools to handle when something uncomfortable comes.”

Below, deVos and Peters shared how to ease into feeling your feelings.

Notice your physical sensations. Notice the sensations that accompany your emotions. Tight chest. Queasy stomach. Heavy head. Heat in the face. Shallow breathing. Cold hands. Tension in the shoulders. “What we call emotions are actually just somatic, bodily, experiences that we’ve grouped together and paired with memories, associations, and meanings we’ve created,” said deVos.

Spotting your physical sensations is a neutral approach that prevents you from categorizing emotions as good or bad. Using such categories only fuels our aversion to our “negative” feelings. However, when we track our sensations, “we can ease into feeling the emotion without sounding the alarm to the brain that we’re doing so,” deVos said.

Bookmark your emotions. Once you get comfortable with noticing your physical sensations, you can move on to naming the emotion. According to deVos, “When you notice a feeling, stick a metaphorical bookmark in it by labeling the emotion, if you are able.” If you can’t identify the feeling, simply say, “Feeling,” she said.

Doing this helps you develop an emotional vocabulary, and it helps you “build your capacity to be with and tolerate uncomfortable emotions: As you lean into noticing and naming your emotional experience, your nervous system learns that it’s safe to wade into murkier feelings.”

Validate your feelings. Peters suggested practicing this “mindful cloud” imagery: Imagine a fluffy cloud over you. Your feelings are written in the cloud (such as “sad” or “hopeful”). Select one feeling, and address it. Consider where it came from, and how you can handle it. Next address another feeling. When you’re done, imagine the cloud floating away. “You have addressed and explored those feelings; they were just passing through.”

Reflect on your emotions. According to Peters, ask yourself these questions to gain a deeper understanding of your emotions: What emotions do I feel most often? What are they like? Which emotions spark fear? How do I express these emotions? For instance, you might note that when you’re sad, you scream at your spouse and then isolate yourself. When you’re furious, you become silent and stew in your anger.

Use more emotion words in your day to day. For instance, Peters suggested using emotion words in your conversations with friends, such as: “I’m sorry your boss yelled at you and sent you home early. That sounds really tough. I bet that made you sad and frustrated.” Add in how you felt when you’re describing your own events, as well. “You would be surprised how many unidentified/unrecognized emotional experiences you have in a day.”

Comfort yourself. Find soothing activities that specifically work for you, Peters said. For instance, you might diffuse oils as you listen to a guided meditation. You might stretch your body or take a long walk.

Peters likes this Ted talk, called “The 3 A’s of awesome,” from Neil Pasricha about the power of little things in our lives. “My favorite is when he mentions how wonderful, and underappreciated, warm sheets out of the dryer are. What a simple, but cozy experience it is to wrap up and feel warm and comfortable all over.”

Feeling our feelings is not easy. It’s much easier to dismiss them or to reach for a quick fix. But when we do, we’re only dismissing ourselves. We’re only stopping ourselves from learning and growing. Honor your feelings. Go as slowly as you need to acknowledge and experience them. The more you do, the easier and more natural it will become.

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Best of Our Blogs: December 12, 2017

I recently read this post by a singer with bipolar disorder. It opened my eyes to what self-care actually looks like when you’re suffering from a mental illness.

Instead of spa days, and yoga, she says for her it looks like slowing down, finding your own way and spending time with friends.

This holiday season as you get lost in other people’s expectations, why not create your own list? Not a self-care list that looks good, but one that feels good to you.

Our posts this week on dealing with emotional neglect, a loved one with borderline personality disorder and high conflict may be tips you want to add to your self-care tool kit.

The Link Between Childhood Emotional Neglect and Codependency
(Happily Imperfect) – If you struggle with people pleasing, perfectionism and sensitivity to criticism, this could be the reason.

4 Tips For Dealing With Your Emotionally Neglectful Parents
(Childhood Emotional Neglect) – You were raised by emotional neglectful parents. This is for you if you’ve always wondered how to interact with them while protecting yourself as an adult.

10 Tips for Living with a Borderline
(The Exhausted Woman) – If someone you love suffers from borderline personality disorder, this is a must-read.

The Perils of the Pretty Child
(Psychoanalysis Now) – A surprising downside to being beautiful. From spoiling to overprotection, it’s the dangers you didn’t foresee with having an attractive child.

How To Find Calm When High Conflict Prevails
(Unshakeable Calm) – Fighting with your ex is stressful for you, but it’s also harmful to your kids. Here’s a roadmap for peaceful co-parenting.

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Complex Post-Traumatic Stress Disorder: The Road to Recovery

Persistent neglect in childhood can lead you to believe that you don’t deserve to be loved or cared for. This idea begins to define you: you are a person who ought to be treated badly.

When we think of people with post-traumatic stress disorder (PTSD), a specific list comes to mind: soldiers returning from combat zones and police officers connected to terrible incidents in the line of duty; victims of sexual trauma and women who were beaten by their partners; the families who stood on the roofs of their houses in the aftermath of Katrina and those who managed to walk away from the horrific South Asian tsunami in 2004. We are right to think of these people and to recognize their experiences, but there are many others living with an equally damaging — yet much more invisible — condition: complex post-traumatic stress disorder or C-PTSD.

The psychological community credits Judith Herman as the originator of this diagnosis. She first described C-PTSD in her book 1992 book, Trauma and Recovery, complementing the diagnosis of PTSD that had been added to the Diagnostic and Statistical Manual of Mental Disorders 12 years earlier, noting that trauma-related disorders weren’t only the result of one intense, acute crisis, but also through chronic, subtler experiences of pain.

In 1992, I was four years old and my path toward a C-PTSD diagnosis had already begun. My mother had filed for divorce when I was two after years of enduring my father’s emotional, physical, and sexual abuse. I don’t remember that time in my life, but I’ve since learned that doesn’t matter; according to Lise Eliot, Ph.D., author of What’s Going on in There? How the Brain and Mind Develop in the First Five Years of Life, if a baby is exposed to inconsistent care or abuse, “he’ll fail to develop the confidence and emotional security that are so essential to a healthy psyche…For even though the child will never remember the specific events at any conscious level, his lower limbic system — and the amygdala in particular — does store powerful associations between an emotional state, like fear or pain, and the person or situation that brought it on, associations that may be indelible.” In other words, I can’t remember the specific things that my father did to my mother when I was an infant and toddler, but the part of my brain responsible for emotion, survival instinct, and memory retains those experiences.

By the same token, the more times I experienced fear or pain, especially as a small child, the more my brain came to believe that the world was inherently cruel. As a result, I slowly developed more and more symptoms of C-PTSD…

How does post-traumatic stress disorder from an acute crisis differ from that which develops after chronic, even subtle experiences of pain? Find out in the original article How I’m Recovering from C-PTSD at The Fix.

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Challenging the Stigma of Counselors with Mental Illness

My small Clinical Mental Health Counseling Practicum class gets out twelve minutes early. I strain to catch the eye of my classmate and friend on the other side of the room, a tall Indian woman with her hair in a sagging bob and sympathetic eyes locked on another classmate. I turn impatiently towards our classmate, who favors red lipstick and dramatic retellings of her life events.

Sighing, I give up and turn around, shifting my backpack’s weight on my back and folding a paper plate in my hands, evidence of enjoying a slice of the twelve pizzas someone had dumped in our counseling center that afternoon. I step into the narrow hallway and run into two classmates grabbing pizza. I spin around, looking for a trash can. People keep brushing against me. I keep stepping nervously, refolding the plate in my hands. The room begins to spin.

As the walls buckle, my chest constricts and I struggle to breathe. A classmate next to me says, “There’s a trash can behind the microwave.” She gestures. I lurch over to the microwave. Conversations and shadows echo around me. I become light-headed as everything begins to fade to black. Just before I faint, I rush out of the center and into the main hallway, gasping for air. Speed walking past my professors’ offices, I collapse on a table around the corner. I sit there, stunned. I just had a panic attack while at the counseling center, where I am currently learning how to become a counselor. I just came dangerously close to people finding out that this future counselor struggles with mental illness herself.

There is still a strong stigma against counselors with mental illness, though many counselors may have them. People are generally drawn to work in the mental health field due to life experience. I have met counselors who have shared that they have had mental illness or they have colleagues with mental illness. These professionals tell me that their struggle with mental illness helps them relate to clients, and their recovery process has uniquely equipped them to be more effective counselors. Still, few counselors come out publicly as having mental illness. The stigma against counselors with mental illness seems to hold people back.

Mental health professionals know the potential for recovery from mental illness, but also the potential risk. If you look at my medical chart, you see risk written over it in red script. There are my four hospitalizations, though they were fourteen years ago. There is my decade-long struggle with self-harm, although I have stopped. Most importantly, there are my diagnoses: Bipolar Disorder, Generalized Anxiety Disorder, and Dissociative Identity Disorder.

I was in another Clinical Mental Health Counseling program six years ago. I was working nights and going to school full time during the day. My psychiatrist warned me that working nights is not good for people with bipolar disorder; it can throw off our cycles. I thought I was handling everything well, but looking back now I see that I was rapid-cycling and lacked the self-awareness to realize when I was drifting towards mania. I took a year off to get a better job and living situation. When I reapplied, my application was rejected. I felt blindsided. Essentially, I was informed that due to my history of mental illness I was considered a liability who would over-identify with clients. My lack of self-awareness was cited as proof of my instability. I’m still not sure if it was discrimination or an accurate assessment.

Whatever the case, I manage my illnesses much better now. Working at the counseling center feels natural to me, perhaps because I have been in personal counseling for ten years, so I know how it goes. I am a creative person and use poetry and music in my sessions with clients. I have been careful not to reveal my mental illnesses around professors, until this semester when I confided in my instructor and supervisor for practicum. A petite doctoral student with a level intensity honed from years of working in a crisis center, she is a firm believer in my counseling ability but has warned me to be careful telling other professors or supervisors, since they may not be as understanding. She asserts that my self-awareness and ability to consistently perform well as a counselor and a student, despite my changing mental states, make me an asset rather than a liability.

Fifteen years ago, I was told that due to a mental breakdown I would never be well enough to go back to school or work. I returned to college and graduated summa cum laude. I have been working since then and am now excelling in a graduate program. It has taken me ten years of therapy and fifteen total years of recovery for me to get to the point where I am healthy enough to counsel others. Now I have an arsenal of coping skills, a deep self-awareness, and a steely determination that continually pushes me through obstacles. My mental illnesses do make me vulnerable at times. More importantly, the knowledge and skills I have acquired over years of coping with chronic mental illness will make me a valuable counselor.

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ADHD is Real (Like All Mental Disorders Are)

I recently came across the unintentionally funny op-ed piece by John Rosemond, a family psychologist known for his controversial views on attention deficit hyperactivity disorder (ADHD) and other childhood behavioral issues. In the piece, he laments how he was dis-invited from a recent speaking invitation because of his views.

In short, he says, “Those facts include that ADHD, oppositional defiant disorder (ODD), and bipolar disorder of childhood are not realities; rather, they are constructs.”

Of course they are constructs. But so is nearly everything we’ve created to navigate human existence.

Rosemond is known for being skeptical when it comes to the ADHD and other childhood disorder diagnoses. In a sense, I don’t blame him. Childhood disorder diagnoses have increased over the past two decades, leading some to claim there is an overdiagnosis of ADHD. A few years ago, I examined these claims and came to the conclusion that there may be increased diagnoses of these kinds of childhood disorders, but it’s hard to say it’s an “over” diagnosis.

After all, harried doctors giving out sloppy mental health diagnoses (and the resulting ADHD medications to help treat it) is a very real concern.

But it’s a long jump to make from these complicated issues to then claim, “Well, these aren’t even real disorders.”

You Can See a Tumor After All!

Rosemond provides a simple example to illustrate his proof that mental disorders aren’t “real:”

If a physician tells a patient that he has a tumor growing in his left lung, that can be verified with data obtained from body scans, biopsies, and other medical means. The same cannot be done with the behavior disorders in question. A therapist who diagnoses ADHD cannot provide any evidence that the child in question “has” anything. The child’s behavior is unquestionably problematic in certain ways and contexts, but that is all that can be factually ascertained.

Unfortunately, Rosemond’s argument skates over two very important points:

  • Most medical diagnoses cannot be verified by a specific laboratory test or scan. They are made from a simple review of the patient’s symptoms and matching them to a list of potential diagnoses, and then doing their best to rule out diagnoses that don’t fit the pattern. It’s a common misnomer and mis-perception that every medical condition has a straight-forward test that either confirms or denies the condition’s existence.
  • Diagnostic criteria for mental disorders is based upon some 40+ years of scientific research to differentiate between them and come up with (somewhat) reliable categories. It’s just not accurate to claim there is no evidence for an ADHD — or any other mental health disorder — diagnosis.

Just as in medicine, mental health clinicians go through a list of symptoms to discern or rule out a possible diagnosis. And just as in medicine, there isn’t a blood test or “body scan” that can pick up every diagnosis.1 The latest medical diagnostic manual — the ICD-10 — has over 67,000 diagnostic codes compared to ICD-9’s over 13,000 diagnostic codes. Do you really believe there are even 13,000 different lab tests a doctor can perform on you? (The answer is, of course not… there are just a few dozen, and even those won’t even come close to diagnosing 13,000 or 67,000 different conditions.)

Only someone who’s never seen a differential diagnosis decision tree in medicine could make a claim that medicine is somehow cleaner and simpler than the diagnostic process for mental disorders.

But Mental Disorders aren’t Really “Real”

The heart of Rosemond’s claim is similar to one made by Thomas Szasz in 1961, in his legendary tome, “The Myth of Mental Illness.” In that book, Szasz makes the claim that mental illness is simply a myth, created by perhaps well-meaning researchers and clinicians in an ill-fated attempt to help medicalize everyday human struggles and problems in living. Put simply, there’s no disease as one typically finds in medicine at the root of a mental disorder’s symptoms.

And that much is true. While mental disorders don’t take the same form as medical diseases, the past 20 years’ of neuroscience research pretty clearly shows there are significant changes going on a person’s brain (and perhaps gut as well) in people who have a mental disorder. Genetics is also a factor, but not the only factor. I believe you can’t look at this vast body of neuroscience and genetic research and simply dismiss it all because a single gene or a single neurotransmitter hasn’t been implicated as the singular cause for a disorder. As we have found out, our bodies and brains are far more complex than we had even imagined just 10 years ago.

Reality is Simply What We All Say It Is

Virtually everything we believe is “real” is simply a construct of human imagination and arbitrary labels we’ve all agreed to. The color blue is simply what we call a particular hue and shade that our eyes discern in a very specific spectrum of lighting; other animals on this planet likely perceive that as something completely different. In a different spectrum of lighting, blue doesn’t look very blue at all.

A piece of paper with some symbols and writing on it has no intrinsic value outside of the cost of the paper and ink. Yet we say a certain type of paper, with certain types of writing on it are of actual monetary value in order to make it easier to exchange goods and services. But paper money isn’t any more “real” than the color blue.

Once you agree that virtually everything in our world is a construct we’ve consciously decided upon,2 it’s far easier to understand why we have also created mental disorders and diagnoses that fit within categories that seem to make sense — at least at this point in time.

ADHD is Real, And so Are All Mental Disorders

Mental disorders are just as real as anything else in our world. To claim otherwise seems to me to be trying to split hairs that nobody but a few academics and philosophers would really care about. You can treat a mental disorder just as easily as you can treat any disease.

And that’s what’s important at the end of day — throwing off these stigma-driven views and seeking out treatment for a mental health concern. Serious mental disorders generally do not resolve themselves on their own with just the passage of time (or, if they do, it usually takes a very long time).

 

Read the original op-ed from John Rosemond: ‘My views on ADHD are controversial, yes, but factual’

Footnotes:

  1. For instance, how does an eye doctor diagnose near-sightedness? Is it through a medical scan of your eye, or your behavioral responses to external stimuli (e.g., reading from an eye chart)?
  2. After all, isn’t that what school is? Learning about all the things we as humans have all agreed upon as our objective reality?

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