Rear view of family dressed all in black walking down cemetery path with rosesI hardly dare to write or even think about suicide, a topic difficult enough to discuss when it is not outright painful. Suicide, attempted or completed, has touched the lives of many. You may know someone who has died by suicide or someone who has made an attempt. You may have experienced thoughts of suicide yourself.

There are people who consider the act of suicide to be a sin, an act tantamount to murder, and consider it unforgivable under any circumstances. My personal belief, though, is that some situations, such as long-term physical pain or terminal illness, may make suicide seem like a rational course of action. Of course, emotional pain can be intolerable too. Severe depression, for example, which may feel endless and can be a match for tormenting physical pain, can often play a part in the development of suicidal thoughts.

When someone we love dies by suicide, whatever the reason behind their choice, we are likely to feel unspeakable grief. We may feel angry or hurt; we may perhaps experience guilt. Along with these emotions, we might feel a desire for answers and explanations. We want to know why this happened, how it could have happened.

When A Loved One Dies By Suicide

People who complete suicide sometimes leave notes or discuss their plans with loved ones. Other people might say nothing. Even when we have some knowledge or understanding of a person’s reasons, suicide leaves us ungrounded. We need something to hold onto.

I myself know people who have died by suicide. My father’s cousin, who was fatally ill, asked to be removed from his respirator so he could die on his own terms. Another of my cousins who was incurably ill and in pain did something similar. They both said goodbye to close family members before passing on.

One lovely young man I knew who was battling addiction also chose to end his life. He was extraordinarily kind, funny and smart—a feeling soul. Before he died, he took his mother on a trip to the northwestern United States, a place they had both wanted to visit. I don’t know if they discussed his plans, but I do believe this was his way to say goodbye and tell her he loved her. I do feel he was, in some way, looking to be close to her and compensate, in a way, for his death. [fat_widget_left]

Some months after this young man’s death, I read a Facebook post from an older woman, a message that was unusually warm.  Her wishes to her friends and her thoughts about life were so lovely—it took time and rereading to realize it had been a goodbye to those of us reading, a suicide note—that, in fact, she had already passed on by the time I read the post. Many of us wrote back, remembering her gifts and her compassion, expressing their love. I was not the only person who couldn’t believe she was dead.

A colleague with an incurable disease planned her suicide very carefully. She wanted to make sure she would succeed. She wanted to protect her husband and children. She wanted to live as long and as well as she could, and then she wanted to die.

Again, I hesitate to write about suicide. My intention is not to inflict pain, to challenge anyone’s beliefs, or to cause difficult feelings. I only want to help those left behind, the survivors, survive, but I’m not sure if I can.

The people I’ve written about just now had deep relationships with others. They took care of the people around them, both in their lives and in their deaths. Each of these people understood what they were doing and knew their choice would have an impact on the people close to them.

They said goodbye, either directly or metaphorically, to make sure those who survived them knew they were loved. And though their absence left a painful, unreal space, a hole, they are all still alive inside of me. There are always reminders that they are gone, as there should be. They were here, but now they are physically not, though they live in memories and as part of our emotions.

Some might consider love and suicide to be antithetical. But I believe death and love are both so big that they encompass their meanings and their opposites, their synonyms and their antonyms.

To me, the most touching death of all was that of the young man who traveled with his mother before he died. The enormity of his love, and of all that he left behind, is almost more than I can bear. I find his death so poignant because he was young—not yet thirty—and because he and his mother embodied the primal pair of mother and child. Birth and love. Ultimate connection, followed by the ultimate disconnection. But not. (The iconic image of the Pieta—the Virgin Mary holding the body of the dead Christ in her lap, appears before my eyes as I write this.)

When your life has been touched by suicide, working through the complicated feelings that develop can be a challenging process. The support of a qualified therapist or counselor can often be of benefit. If you are having thoughts of suicide, we urge you to reach out. The 988 Suicide & Crisis Lifeline (988) is available at any time, day or night. Additional crisis information and resources are available here.

If you would like to read further on this topic, I suggest Linda Phillips’ book A Beautiful Here: Emerging from the Overwhelming Darkness of My Son’s Suicide. [amazon_affiliate]

Close-up shot of two people holding hands on top of a table, water glasses out of focus in backgroundAlthough trauma-informed therapy is gaining in popularity, one crucial component is often missing from the conversation—the importance of healing from a perceived lack of relational safety that often accompanies posttraumatic stress (PTSD).

If you have experienced a life-altering traumatic situation, you may understand all too well the more commonly discussed symptoms of PTSD:

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While you may experience some or all of these symptoms as a trauma survivor, they paint only a part of the picture. Taken together, these symptoms often have an unfortunate effect of causing a person experiencing PTSD to distrust themselves and the world around them; to isolate by numbing or avoiding discussing their thoughts or experiences with others; and to feel unsafe in their body due to the hyperarousal symptoms. Healing from PTSD requires connection to friends, family, and community, support from others who have experienced similar symptoms, and a strong therapeutic connection with a therapist who understands how to help heal trauma symptoms. These relationships help restore both a belief and a felt sense that the world can be safe. Yet, paradoxically, PTSD causes those very connections to feel dangerous and threatening rather than potentially healing.

The first step to healing from trauma is recognizing the ways in which symptoms may cause you to want to isolate from others, whether loved ones or support groups or a therapist. This recognition is important, as it will be necessary when pacifying any fear, anxiety, or panicked feelings you may experience while interacting with others. These feelings are natural and understandable in the context of understanding trauma can cause a lack of trust in the world and in others. This can be even truer if the trauma was a result of harm caused by others rather than a natural disaster or events not directly related to a human cause.

Once you have noticed and recognized these isolating behaviors as being an effect of having experienced a traumatic event, you have the choice to deliberately make decisions and take actions that could lead to connection and trust.

While post-trauma survival instincts may cause you to feel most comfortable trusting only yourself, to isolate from others, or to turn to coping behaviors such as drinking or working long hours, these behaviors may prevent you from reestablishing connection and trust in the world and yourself—vital for healing from the effects of trauma and living a satisfying life. The effects of isolation can be even greater if you are living with the symptoms of PTSD caused by traumatic occurrences in childhood, in which case you may never have had the chance to build or experience deep, loving relationships or trust in the world around you.

Once you have noticed and recognized these isolating behaviors as being an effect of having experienced a traumatic event, you have the choice to deliberately make decisions and take actions that could lead to connection and trust. This may feel frightening or difficult, and you may find yourself having thoughts about other people being unsafe, untrustworthy, or not worth the effort. It is important to take small steps that may be counterintuitive to what your survival-based instincts are telling you, and then stop to reassess to see if your perceptions were true or not.

Two of the best places to experience safety and healing within a relationship are in therapy with a safe and understanding therapist, and in therapeutic or support group settings with others who understand your experiences.

If you are living with symptoms of PTSD, it is possible to recover and feel better. With courage, patience, and the help of experienced professionals and caring peers, you can rediscover the strength within to live a satisfying and meaningful life.

Water pouring into glass from above and overflowing down the sidesSomatic psychotherapists often use the informal metaphor of a “container” in describing a person’s state of overwhelm or resilience.

It’s a simple concept: If Janelle is experiencing a lot of stress, and/or her system isn’t very resilient, then one can say her container is overflowing, or close to it. On the other hand, if she successfully deals with her feelings and the external situations that cause them, she would create more “room” in her figurative container and she wouldn’t be so vulnerable to becoming stressed out. She could also work with a therapist in order to develop affect tolerance and self-regulation. She would then be making her container larger and less brittle, increasing her resilience across many life situations.

The container can be filled by our response to events earlier in our lives that we’ve repressed and not dealt with. Researchers and clinicians working with intergenerational trauma believe our containers hold the trauma passed down to us from the experiences of earlier generations. Such experience includes but is not limited to systemic racism and oppression. The field of epigenetics looks at changes in gene expression (which pieces of our DNA strands are being expressed, and which aren’t). These changes are thought to be responses to the environment, either current or historical. On the other hand, our containers can also be filled by present-day, acute stressors that we’re all too aware of. In practice, it’s usually a mix of both, and they can be interrelated.

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Sometimes it isn’t immediately evident how full the container is becoming, because we are experts at hiding this from ourselves and the world. When talking about this with a person in therapy, I’ll often use the metaphor of my coffee cup. It’s a metallic travel mug, and when I hold it up, you can’t immediately tell how full it is. It could be nearly empty, or it could be close to overflowing. (It’s just a visual example. No fair trying to gauge my mood in order to figure out how much coffee is inside me rather than still in the cup!)

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

Psychology is the study of human thoughts, feelings, and behaviors. It shares some overlap with sociology, political science, anthropology, etc. However, most clinical psychology focuses on the individual and their cognitive, developmental, marital, or family dynamics. After many years in this field, I would guess that the majority of what’s discussed in therapy rooms does not focus on larger cultural, sociopolitical, large-scale economic, or environmental factors. Or such factors may be acknowledged, but therapeutic interventions usually focus on the micro (person/family) rather than the macro (environment). In that sense, therapy can be a bit myopic at times.

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

However, just because we’re repressing something doesn’t mean it’s not affecting us and filling our figurative containers. The emerging fields of ecopsychology and ecotherapy assert that humans have an ecological unconscious. That is, since we are born of earth and our entire existence depends on our fragile biosphere (and the other species we share it with), anything threatening our planet causes stress and anxiety in us. Just about everyone I talk with has tremendous anxiety about the future of our environment, and for good reason. This often invisibly adds to the total “volume” inside our containers; and since people often tend to feel helpless about large-scale events, it may increase their tendency toward immobility and dissociation.

For some people, it might be a useful exercise to write out a list of all the things they can think of that could be impacting their stress levels. However, for many other people, if their container is filling up, then the exercise of looking at everything at once could send them into depression, immobility, or even panic (“Oh, my god, it’s so much worse than I’d thought!”). Somatic therapists are trained to gauge a person’s autonomic stress response on a moment-to-moment basis and intervene as needed, coaching the person in taking on a manageable amount at any one time, and using that experience to grow stronger.

In my opinion, the goal of therapy is to increase a person’s self-regulation, which increases coping, health, joyfulness, and myriad other desirable outcomes. People who are able to self-regulate tend to be more aware of their overall stress levels, including “whole-world issues.” They may be less prone to anxiety, depression, and immobility, so they can engage in effective self-care, including taking action to better their lives and the greater world.

References:

  1. Bell, A. (2016). What is self-regulation and why is it so important? Retrieved from https://www.goodtherapy.org/blog/what-is-self-regulation-why-is-it-so-important-0928165
  2. Sashin, J.I. (1985, April). Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures, 8(2): 175-202. Retrieved from http://www.sciencedirect.com/science/article/pii/0140175085900089
  3. Shulevitz, J. (2014). The Science of Suffering. New Republic. Retrieved from https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids
  4. Smith, D.B. (2010). Is There an Ecological Unconscious? New York Times Magazine. Retrieved from http://www.nytimes.com/2010/01/31/magazine/31ecopsych-t.html
  5. Weinhold, B. (2006, March). Epigenetics: The Science of Change. Environmental Health Perspectives, 114(3): A160-A167. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392256/

Rear view of person in black and red hooded sweatshirt walking alone down the middle of a road on a misty dayYou may know how common depression is—6.7% of all Americans age 18 or older experience at least one major depressive episode each year, according to statistics compiled by the National Institute of Mental Health. It might even be expected in certain contexts, such as the loss of a job or a loved one. Other times, it creeps in mysteriously. As a therapist, I see many people who struggled for a long time before they finally sought help.

One of the first things I do when meeting for the first time with a person experiencing depression is try to figure out if their blues are an internal or external job. This can take a little time to unravel, as there are many layers that can lead to someone feeling depressed. It’s important when treating depression to try to change what we can control and learn coping skills that can help us with the rest.

So how do you know if your depression is a product of your environment—family, friends, job, housing or financial situation—or if it instead stems from unproductive or self-defeating thoughts, self-esteem or self-control issues, or possible biological reasons that may warrant a medical assessment?

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When It’s an External Job

Perhaps this winter has been a difficult time in your life. The holidays are past, the weather is cold, and the days are short. The nation is apprehensive and divided about a new presidential term. Maybe you are worried about tax season, waiting anxiously on news from college applications, or feeling bad after excess food or drink at the end of the year.

Many people seek therapy after enduring a difficult situation. They have been caring for a sick family member, are going through a breakup, or have failed a class for the second time in a row. They need help for a depression which is mostly a result of a life situation that has happened to them. They feel like a weight has been put on them and can identify what it is.

Right now, many people are feeling the weight of conflict on a global scale. Some are worried about climate change, health care, humanitarian crises, or unemployment. “State of the world” depression, as I call it, is a common woe in 2017.

These cases call for action:

Taking action on external depression is an important step toward feeling better and more empowered. Fortunately, therapy can help—especially solution-focused therapy, which is practical and tool-oriented.

When It’s an Internal Job

Have you had a time in your life when you just couldn’t seem to get enough sleep? When the things you always looked forward to didn’t interest you or when you had trouble feeling much of anything at all? People with these depression symptoms might say their lives are “better than most” and may feel guilty for feeling down. They may struggle with feeling ungrateful because, at the same time, they feel like something is “missing.” Life may feel like an endless treadmill of nice-but-nothing-great.

The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future.

The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future. When we lose the ability to look forward to the things that historically keep us satisfied, we’re in trouble. People with internally driven depression may have grown used to being on the sidelines, watching the energy of the world bustle around them. They may find it tiring to make decisions or to engage.

These cases call for structured treatment:

Some things are out of my scope of practice (medical evaluations, for example), but since symptoms of depression overlap with some treatable medical conditions, if there is no identifiable external cause it’s always a good idea to see a doctor, too. Recently someone I work with in therapy felt too tired to socialize or exercise, which was creating problems at work as well as causing him to spiral personally. When he learned he was anemic and started following his doctor’s medical recommendations, his fatigue went away, which started positive momentum toward participating in his usual, satisfying life.

People with internally or externally driven depression can usually expect their symptoms to improve if they use structured, research-based treatment methods such as cognitive therapy. Depression tends to call for a lifestyle tune-up—and you don’t have to go it alone.

Reference:

National Institute of Mental Health. (n.d.). Major Depression Among Adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

Two half-filled glasses of red wine on picnic table with bread and cheese in the afternoonDo any of these statements sound like you?

If you identified with more of these statements than you would like to admit, it’s time to change your relationship with alcohol. According to the Dietary Guidelines for Americans, moderate alcohol consumption is having up to one drink per day for women and up to two drinks per day for men. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends up to four alcoholic drinks for men and three for women in any single day, with a maximum of 14 drinks for men and seven for women per week.

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I recommend the Dietary Guidelines’ amounts over NIAAA’s. Many people start to feel an effect after two or three drinks. Then they have a harder time sticking to their limits because their decision-making is getting altered. I also recommend against drinking every day. It can become a habit and the way you deal with difficult emotions.

Most of the people I see in my work have experienced consequences from their drinking but are not physically dependent on it. They have tried those meetings for people who want to quit, but they don’t quite fit in. They know they need to change their relationship with alcohol, but they do not want to totally give it up.

So I did the research. Then I designed the “How Do I Know If I Can Keep Drinking Quiz” to help figure out if moderation is an option.

Answer yes or no to the following:

  1. Do I have any mental health, medical, or legal concerns?
  2. Can I pick someone who will support my moderation plan?
  3. Have I had more than one blackout?
  4. Am I willing to monitor how many drinks I have?
  5. Have I had withdrawals from drinking?
  6. Am I free of illicit drugs?
  7. Am I drinking to change how I feel?
  8. Will my loved ones support moderation?
  9. Do the consequences of drinking outweigh the benefits of abstinence?

Trying to change your drinking can be challenging to do on your own. If you are wondering if you have a problem with alcohol, find a licensed therapist who is trained in both mental health and substance use.

In my experience, answering yes to the even-numbered questions increases the chances of successful moderation. If you answered yes to any of the odd questions, you may not be a candidate for moderate drinking.

Below are some tips on how to try moderation:

Trying to change your drinking can be challenging to do on your own. If you are wondering if you have a problem with alcohol, find a licensed therapist who is trained in both mental health and substance use. Make sure the person you choose to work with is familiar with the concept of moderate drinking.

Together with your chosen professional, you can decide what a healthy relationship with alcohol looks like for you. It may mean quitting. But it also may be changing the amount and frequency of your drinking.

References:

  1. Hester, R. K., Delaney, H. D., & Campbell, W. (2011). ModerateDrinking.com and Moderation Management: Outcomes of a Randomized Clinical Trial with Non-Dependent Problem Drinkers. Journal of Counseling and Psychology, 4, 215-224.
  2. Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: a practice-friendly review of research. Journal of Clinical Psychology, 66, 201–214.
  3. National Institute on Alcohol Abuse and Alcoholism. (1992, April). Alcohol Alert: Moderate Drinking. Retrieved from https://pubs.niaaa.nih.gov/publications/aa16.htm
  4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015, December). 2015–2020 Dietary Guidelines for Americans, 8th Ed. Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/

Parent holds out clothes and attempts to converse with teenager looks away and off to the side Raising a teenager can be one of the most challenging tasks of parenthood. One day you are raising a sweet, respectful child who loves to be with you, and the next, you are tiptoeing around your house hoping not to wake the bear. At some point during adolescence, many parents will classify interactions with their teen as unpredictable, confrontational, and/or dismissive. It is during these years teens and their parents often feel as though they are speaking different languages. And often, both parents and teens suddenly think talking louder, in a more animated way, will somehow get their points across.

After working with adolescents and their parents for almost a decade, I have found that my initial role as therapist is interpreter. From there, I work to help them learn each other’s languages so they can go back to healthy communication and connection. I have many tools in my toolbox to help parents and teens reconnect, but one of the most profound is validation.

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Validation is the act of acknowledging another person’s thoughts and feelings and communicating to them that those thoughts and feelings make sense and are understandable given the situation. It is important to note validating is not the same as agreeing. Validation is important because it shows you are listening, you understand, and you are approaching the person in a nonjudgmental way.

Now, let us think about validation in terms of interactions with teenagers. When it comes to interacting with their parents, they often feel judged, unheard, and criticized. These perceptions frequently lead to conflict with their parents and/or withdrawal from interactions with them. When parents take time to validate (i.e., listen without judgment), teens often feel more open to having a conversation and more responsive to information being shared by parents.

Validation is disarming and encourages dialogue. In my experience, parents just want to talk with their children. Using validation can open those lines of communication again. Teens like to talk with people whom they feel understand them. The minute they sniff judgment or criticism, they may shut down or lash out. So, leading with validation can encourage connection.

When parents take time to validate (i.e., listen without judgment), teens often feel more open to having a conversation and more responsive to information being shared by parents.

Sounds easy, right? Well, validating a teen can be difficult for parents for many reasons. First, teens can seem somewhat irrational at times, and it can be challenging to find something to validate. Second, after weeks, months, or years of built-up frustrations and disagreements, it can be difficult to want to validate. Third, I have found parents often feel stuck on the idea that by validating they are somehow saying their teen’s behavior is okay and/or they agree with what their teen is saying. However, it is important to remember validation is a form of understanding, not agreeing. By validating, you are not saying your teen is right—you are simply using a tool to help start a dialogue and prevent a potential conflict.

According to Miller, Glinski, Woodberry, Mitchell, and Indik (2002), there are six levels of validation. Jeffrey B. Jackson, PhD, LMFT, adapted these levels and five of the six are shared below.

Think about the last time someone validated you in one of these ways. Didn’t it make you feel good? Didn’t you feel understood? Didn’t it make it feel safe to share more? We all crave validation, teens included. In fact, validation might just be the key to better communication and a happier household.

Reference:

Adapted by Jeffrey B. Jackson, PhD, LMFT from Miller, A.L., Glinski, J., Woodberry, K.A., Mitchell, A.G., & Indik, J. (2002). Family therapy and dialectical behavior therapy with adolescents: Part I: Proposing a clinical synthesis. American Journal of Psychotherapy, 56(4), 568-584.

Five young people sit at table in coffee shop. One has digital device open. All are laughing and talking and looking at each otherWhen people think about attention-deficit hyperactivity (ADHD), social difficulties are not typically among the first things that come to mind. However, many children, teens, and adults with ADHD often find themselves struggling socially in a variety of ways.

People who have ADHD commonly struggle with the following social issues:

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If you have ADHD and identify with the struggles above, here are some ideas and tools you can use to help improve your social functioning:

  1. Strive to make plans with friends while still with them (i.e., after a movie, look at the calendar and schedule plans for the following week). This may make it easier to sustain seeing friends frequently.
  2. Schedule calendar events at preset intervals to remind you to call friends who live far away.
  3. Don’t commit to plans if unsure you will be free.
  4. If you have to cancel plans, give as much notice as possible and explain why. Offer to reschedule right away.
  5. Practice explaining things or telling stories concisely on your own. Go through what you want to say initially. Then tell it again and try to cut down the amount of time it takes. Next, try to summarize what you want to convey in a few sentences. The more you practice this, the easier it may become.
  6. When telling a story, think about the punchline or end point first. Try working backward.
  7. Practice following multiple people talking in a conversation. For example, watch a television show with scenes where multiple people are talking. Watch it first without sound, then watch with only sound. Finally, watch again with sound and picture. This may help improve your ability to use your different senses in observing social interactions. Write out key points each person is saying and draw a diagram or other visual representation, if needed.
  8. In social situations, always look at the person speaking; watch their body language and facial expressions. If you’re more of a visual person, imagine a line like a spiderweb being drawn back and forth from person to person as they speak. Then imagine a few keywords being displayed above them. Creating visual representations may help you follow conversations.
  9. If you often forget key things discussed, write them down, perhaps in your phone after each social interaction. Then you can refer to them before seeing the person again. For example, if your friend is dating someone or just broke up, make a note about it so you can refer to it for next time.

I hope these suggestions are helpful.

A young person with shoulder-length hair and scarf tied around neck sits on window ledge, looking up, against background of trees and rooftops at sunsetSpiritual abuse, a type of abuse that results from a spiritual leader, system, or indoctrinated individual’s attempts to control and/or manipulate another individual, can be difficult to recognize, and many people are entirely unaware that this type of abuse even exists.

Those who are aware of spiritual abuse may understand this concept as the oppression or domination of individuals within a particular religious organization, leading these people to follow the leaders without dissent or question. While this is one manifestation, any abuse—committed intentionally or otherwise–that occurs in a religious context and negatively impacts a person’s spirituality, effectively diminishing or breaking their spirit, can be described as spiritual abuse.

Spiritual Abuse in Intimate Relationships

Spiritual abuse may occur in relationships, though some may not recognize they are experiencing abuse. A key feeling to look for, if you believe spiritual abuse may be present in your relationship, is shame. Shame, obvious at times but less apparent at others, can be experienced in many ways, all of which are likely to lead to hurt and pain.

Spiritual abuse can be recognized in many of the following situations but is not limited to these:

Many churches teach that in a heterosexual relationship, the male has supremacy over the female: the man is the head; the woman is the help-meet. This was true in the church I attended in my late teen years. I, and other young women, were given multiple reasons why God had arranged it thus. “Ladies, you should be so lucky to find a man to help and support!” we were told. As much as I hoped at the time to fit into this box, I—strong, opinionated, and stubborn as I was, and still am—simply didn’t. I push back. I make decisions. I desire to be involved in all aspects of a relationship, as an equal member, not a lesser part.

My partner, another member of the church, did not support these aspects of my nature. On more than one occasion we had disagreements in which he told me, jokingly at first, to “submit,” persisting until I stopped talking. His “joke” response continued, silencing me again and again until I lost the energy and willpower to defend myself further. To avoid that word, “submit,” I forfeited my voice and my opinions.

In this way, messages from religious organizations trickle down, affecting relationships, shattering the spirits of many, often leading to religious trauma syndrome or another lasting negative impact on mental health and well-being.

Spiritual Abuse in Parent-Child Relationships

Parent-child spiritual abuse, while common, may be tricky to recognize, as the line between abuse and influence can at times be blurry one. When does the attempt to influence and shape a child’s moral outlook through religious upbringing cross the line into abuse?

I imagine many individuals, when considering the topic of spiritual abuse, think of the movie Carrie. In this film, Carrie suffers extreme physical and spiritual abuse at the hands of her mother, all in the name of God.

Spiritual abuse perpetuated by parents, not always obvious or blatant, can be seen when parents:

The parent-child dynamic of spiritual abuse should not be equated with a parent’s attempt to raise a child in a religious household. Parents who follow a particular faith may read their child stories from a religious text, explain why certain morals are important or why they hold certain beliefs, and bring their child to church events. These are not examples of abuse when they are not forced on a child.

Further, parents who encourage their child to ask questions and provide the child with explanations instead of simply saying, “Because God says so,” can help their child learn, grow, and think critically. It is often worth it for a parent to take the time to explain to a child why they chose to follow a particular faith, as this serves to introduce the child to that unique and important aspect of the parent’s life.

Abuse in Small Cults

Society as a whole has become more aware of cult practices in recent years. Cults might exist as small branches of major religions or are large organizations in their own right, and they may be difficult to recognize or define. People who have left them, however, often report abusive practices, though many share that they did not recognize these tactics as abuse until they had a chance to step away from them.

Some of the following may be questions to consider:

If you answered yes to any of these questions, you may wish to carefully consider the religious group to which you belong. It may be a good idea to seek the support of a trusted friend or family member along with professional help from a counselor, particularly one trained to provide help with spiritual and religious issues. A person should not have to worry that sharing their worries or opinions will lead to judgment or recrimination.

Abuse in Large Organizations

Spiritual abuse typically becomes more insidious as the size of the organization grows. In large organizations, however, the most common forms of abuse may be more difficult to identify.

One way of identifying whether you have been, or currently are, in a spiritually abusive relationship is to look at the leadership in your organization.

Spiritual abuse is sneaky. It hides in the fact that it is not commonly discussed and thus is often overlooked. But know that if you have experienced spiritual abuse or oppression, you are not alone, and compassionate help and support can help you overcome its effects.

The “loop” is an idea I have been developing as I continue my own spiritual exploration. Recently, the pastor giving a Christian church service I attended shared information I disagreed with. As I picked apart the message in my head, I experienced doubt about my own religious beliefs. As if the pastor had read my thoughts, he exclaimed, “And if you have doubt, that is because you are ensnared by sin.”

“Oh, that explains it,” I thought. “Now I need to do whatever he says I should to wipe out my sin, and that will ease my doubt. Wait. What?!”

This thought ran through my head as I processed what he told me. I was so quick to believe I was being manipulated by evil that my ability to think critically about his message was compromised by a loop he had created. He stated a “truth,” pinpointed doubt and critical thinking, and then he blamed it on outside forces like sin. My ability to deconstruct his message was inherently sinful, I interpreted.

Now, this was not a direct situation of spiritual abuse. That pastor was not intending to abuse his congregation. However, I can tell you that I did feel oppressed. My spirit felt crushed.

If you have felt similar oppression from this type of preaching, teaching, or reading, you may have felt abused. You may have experienced guilt, shame, or fear. Your emotional well-being may have been affected.

So what to do? How can you find an organization that affirms you and allows your spiritual self to thrive?

Spiritual abuse is sneaky. It hides in the fact that it is not commonly discussed and thus is often overlooked. But know that if you have experienced spiritual abuse or oppression, you are not alone, and compassionate help and support can help you overcome its effects.

References: 

  1. Kinsley, M. (2013, January 17). Eyes wide shut: ‘Going Clear,’ Lawrence Wright’s book on Scientology. The New York Times. Retrieved from http://www.nytimes.com/2013/01/20/books/review/going-clear-lawrence-wrights-book-on-scientology.html
  2. Tamm, J. (2011, April 14). What is a cult? Recognizing and avoiding unhealthy groups. The Huffington Post. Retrieved from http://www.huffingtonpost.com/jayanti-tamm/the-c-word_2_b_848340.html

Photo of young adult with brilliant smile laughing and looking off to one side, holding backpack straps out, standing on walking trailUnfortunately, all too often, I speak to people who struggle with their self-image. For the purpose of being entirely transparent, I sometimes do, too.

Here are things that sometimes surface in my conversations with others:

I saw a clip of the Today Show recently where they offered two women makeovers during an “Ambush Makeover” segment. One of the women was incredibly excited (it was her 50th birthday), and she was thrilled with the results of her “reveal.” The other woman expressed trepidation and stated she was more nervous than excited. The show’s staff assured her they’d take care of her.

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Upon seeing herself in the mirror afterward, and after the hosts exclaimed how gorgeous she looked, that woman calmly said “I like it” and then “My mom will like it” in a measured way, as though that was purportedly the correct response. Though she smiled broadly, it didn’t appear she was as ecstatic as the hosts. I got the feeling she might be eager to wash off the façade, that perhaps she never believed she needed a makeover in the first place. It was slightly awkward to watch because it drove home the notion one “should” want to present as aesthetically pleasing to others, even when one is perfectly content with being exactly as they are.

Often, what we truly perceive as beautiful is not what is traditionally externally pleasing to the eye. We recognize people in our lives as beautiful when being around them makes us feel good. We see them beneath their surface. The same can hold true for us.

One of the people with whom I work in therapy, when asked when she felt beautiful, replied “never,” her eyes welling with tears. As we continued our exploration of this subject, I asked her how she defined the word “beautiful.” She referenced someone from her past whom she described as kind, warm, smiling, welcoming, and friendly. That became a reference point for us, and she was then able to discern she had, in fact, felt beautiful at times.

Often, what we truly perceive as beautiful is not what is traditionally externally pleasing to the eye. We recognize people in our lives as beautiful when being around them makes us feel good. We see them beneath their surface. The same can hold true for us.

Here are some examples of things you can do to improve your relationship with yourself and feel more “beautiful”—according to your definition:

Think about what the word “beautiful” means specifically to you, and the moments in which you feel that way most deeply. How do you project your beauty into the world?

“What I want to be, girls, is beautiful. Beautiful means ‘full of beauty.’ Beautiful is not about how you look on the outside. Beautiful is about what you’re made of. Beautiful people spend time discovering what their idea of beauty on this earth is. They know themselves well enough to know what they love, and they love themselves enough to fill up with a little of their particular kind of beauty each day.” —Glennon Doyle Melton, Love Warrior: A Memoir

Black and white photo of adult with long hair putting arm around young teen with ponytail outside on benchEnmeshment, a family dynamic that can be described as blurred boundaries between members, can make it difficult or impossible for a child to develop an individual sense of self because they are overly concerned about others. Family therapist Salvadore Minuchin brought this concept to light in the 1970s, and the topic has become common in psychological discussion of late. But what exactly constitutes enmeshment? How does it develop? And how can it be addressed?

Recognizing Enmeshment

Typically the roots of enmeshment can be traced back to parents who over-identify with a child, a dynamic often passed down through generations. Within this dynamic, boundaries are blurred—and may even be viewed as undesirable—and the parent may regard the child as an extension of the parent, rather than their own person, and treat them accordingly.

As a result, children of enmeshed family systems often develop emotional ties that elicit confusion, and they may fail to develop autonomy. An underdeveloped sense of autonomy may make it difficult for the child to act on desires that differ from the parent’s or lead a child to feel guilty when attempting to act on their own feelings. The enmeshed parent may also take it personally when a child attempts to demonstrate autonomy or independence, which can have a harmful impact on the child and the family dynamic overall. [fat_widget_right]

Enmeshment between a parent and child makes it difficult for the emotions of the child to be separated from the emotions of the parent. It can be said, then, that a child may take on emotional pain the parent carries from enmeshment in their own family of origin. This is not uncommon and is often done unconsciously—a child does not realize they are taking on the parent’s emotional pain or that it is not theirs to carry.

Another way of looking at it is to think in terms of “absorbing” the emotional pain of the parent. A parent who is projecting emotional pain is likely not consciously aware they are doing it but simply repeating the cycle that played out in their childhood.

Avoiding Enmeshment

To avoid becoming enmeshed with their children, parents must have their own sense of purpose in life, their own hobbies and passions separate from their children. A parent’s self-worth cannot rely a child’s behavior or accomplishments.

To avoid becoming enmeshed with their children, parents must have their own sense of purpose in life, their own hobbies and passions separate from their children. A parent’s self-worth cannot rely a child’s behavior or accomplishments. When one’s self-worth is defined by the actions or choices of one’s child, the pressure on the child to perform, to fulfill expectations, becomes heavy and burdensome. A parent’s self-worth is not the child’s responsibility, and children who take on this charge, consciously or unconsciously, often fail to develop self-esteem and/or a sense of personal identity.

Children generally rely on their parents for support. But before a child can expect to receive this support, they generally need to know the parent is emotionally strong and that the parent will support the child as they are, not only as who the parent wants them to be. When a child is secure in this knowledge, they will typically feel free to be themselves and to follow their own passions without feeling responsible for a parent’s emotional pain or disappointment.

In families affected by enmeshment, children may avoid seeking help when they experience difficulty or dilemma in life, fearing that the parent will impose their own agenda rather than offer guidance and support. When parents model good self-care habits, appropriate boundaries, and regulated emotions, on the other hand, children are more likely to desire to spend time with them, as opposed to when a child simply feels obligated to take care of their parent or manage their parent’s emotions. (Experiencing difficulty with dysregulated emotions? A therapist can help.)

Addressing Enmeshment

What can parents do to address enmeshment? Seek the help of a qualified family therapist or counselor if you recognize any of the following signs in your parent-child dynamic:

What can an older child or adult child do to remedy the impact of an enmeshed relationship with a parent?

Children in enmeshed families may view the parent-child relationship as an obligation or burden and, when they reach adulthood, seek out relationships that perpetuate this dynamic. Parents who take responsibility for their own self-worth and emotional pain, however, are likely to have healthier relationships with their children, where the children make the choice to be involved in their parents’ lives and are able to establish their own healthy, independent relationships.

Reference: 

  1. Heru, A. M. (2015). Families in psychiatry: Unpacking enmeshment issues. Clinical Psychiatry News, 43(5). Retrieved from https://www.questia.com/magazine/1G1-417736319/families-in-psychiatry-unpacking-enmeshment-issues
  2. Lewis, C. (2013, July 8). The enmeshed family: What it is and how to “unmesh.” Retrieved from http://www.mariadroste.org/2013/07/the-enmeshed-family-what-it-is-and-how-to-unmesh

Person in gray skirt suit stands under spotlight, head bowed, in red-toned roomIn biblical lore, Aaron selected a goat on behalf of the entire tribe, cast upon it the sins of all members, and then banished it alone to the wild. The members of the tribe were then at great ease, having been freed from their cast-off sins—whatever those sins may have been.

Everyone felt better, though they had neither identified their specific sins nor atoned for them. They had simply agreed to hang them on the goat. If this spurious logic was obvious to anyone, it was not discussed. Why question an agreed-upon means of making everyone feel better?

Now about that goat. It was selected from the herd and sent forth into the wilderness for reasons having to do with the sins of others. The goat had done nothing to merit banishment. But once the ashes were cold on the rituals of dispatching it, the goat found itself alone in the wilderness, isolated from its herd, in unknown territory, suddenly forced to fend for itself. It faced dangers from predators; difficulty finding food, sustenance, and shelter; and it lived the constantly woeful insecurity of a herd animal without a herd.

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This is the story of the scapegoat.

In dysfunctional families, for reasons similar to those Aaron devised, there can also be a designated person selected for the role of scapegoat. In a family system, the selection process is less overt than Aaron’s. It is done more by consensual and habitual shunning that becomes an unspoken code of behavior: one person is chosen to bear the brunt of any psychological discomfort experienced by the family as a whole. It is justified by repeating the stories that create and then reinforce the image of the scapegoat as being a person who is worthy of disdain and disparagement.

Like the strong goat Aaron selected, the target of family scapegoating is also often the strongest and healthiest member of the family. At first blush, this may sound counterintuitive. But think about it a little more. In Aaron’s case, there would be no group pleasure derived from banishing a weak animal who might easily die anyway, because that would not gratify the needs of the tribe to send off their sins on a robust vehicle, a strong goat who was up to the task of bearing the burden. So it is in families: the targeted individual is often the most accomplished. She—and for the purposes of narrative cohesion, our scapegoat is a female here—must be strong enough to withstand the weight of the shunning voices which might easily and quickly topple a weaker person. The scapegoating would fail if the weight of the sins killed the goat before it could even get chased out of town. Catharsis is the goal. The goat needs to be strong enough to suffer in order that the tribe members do not.

Just as the goat was blameless despite being sent to its lonely death, so is the human scapegoat innocent of all charges. She may not be a perfect human being, but she is no different from anyone else in her range of faults. It is not her character or her actions that have directly caused her banishment. It is the way her character and her actions, and often her accomplishments, have been experienced by the dysfunctional family members, who for their own unexamined reasons need to dispel this person from the family realm in order to avoid looking into their own consciences. They need to punish the scapegoat for provoking by her very existence the discomfort family members are feeling that is actually a result of their own unresolved issues.

If you are being scapegoated in your family, please seek professional help. You are not likely to be able to intervene in a dysfunctional system that treats one of its own members in this way. You may continue to experience the futile attempts at explaining yourself. You may fail to understand the way you are being treated. You may begin to doubt your own version of your life story. The price is too high.

Can a human scapegoat die like the goat of yore? Maybe. If not physically, certainly emotionally. It is difficult for the scapegoat to believe that her family would treat her in this unconscionable manner if she were not guilty of some grave sin. She wracks her brain and her heart to understand, but she cannot. The reasons she is given for being mistreated seem shallow, petty, and incomplete. It is difficult for her to believe these small transgressions could warrant such heavy condemnation.

She begins to doubt her own version of reality, since consensus in her own family supports a narrative different from her own about who she is and what she does or has done. She learns that if she tries to sort this out, she will be accused of “playing the victim” or being selfish, or being a “drama queen.” She is able to hold to her knowledge that this assessment and treatment are not right, until one day, utterly discouraged, she gives up. The full weight of the banishment settles upon her. She is alone. She doesn’t try to understand or explain anything anymore. She has moved into accepting a fate that makes no sense to her.

Good mental health at this point suggests she make her peace with leaving behind the family that fails her so completely. And if she is strong and well-supported with friends, she may be able to do this. She will pay a lifelong price for sins she did not commit, however, because it is difficult and painful to extract oneself from one’s family. It is counter to the most basic of human needs for home, shelter, affiliation. It is a cruel and inexcusable undertaking for a family to scapegoat a member.

If you look at the research regarding the fate of individuals who have been relentlessly bullied, you can draw conclusions about what happens to scapegoated family members, for scapegoating is bullying with focused and long-term intensity. Some bullied children go on to become bullies themselves. Some develop social skills to divert and challenge bullying, though the scars of having been bullied may insert themselves into their lives in many ways for many years to come. Others, however, do not survive, driven to suicide.

If you are being scapegoated in your family, please seek professional help. You are not likely to be able to intervene in a dysfunctional system that treats one of its own members in this way. You may continue to experience the futile attempts at explaining yourself. You may fail to understand the way you are being treated. You may begin to doubt your own version of your life story. The price is too high. Please find a counselor who can help you unravel the fictions that subvert the truth about your life and about who you are. Good counseling support can help free you from the binding ties of pain, guilt, and shame that you did not create and which are not justified.

You were not born to bear the sins of others any more than Aaron’s goat was born for such a fate.

Hands in group huddleCommunity-based mental health services can improve outcomes in people with mental health diagnoses, several studies have found. Deinstitutionalization—the push to keep people out of long-term mental health institutions—increasingly means people with mental health conditions are living in their communities rather than treatment facilities. The Olmstead decision, a United States Supreme Court ruling on mental health treatment, enshrined the right to the least restrictive treatment available.

The number of available psychiatric beds dropped from 558,922 in 1995 to 37,679 in 2016. This is good news for those with mental health conditions, most of whom lead more fulfilling lives in their communities than in institutions. Inadequate funding for outpatient, community-based resources, however, has driven the number of homeless people with mental health diagnoses to more than 100,000.

When available and funded, court-ordered treatment programs—known as assisted outpatient treatment (AOT)—can help integrate people with mental health conditions back into their communities. The 21st Century Cures Act, which former President Barack Obama signed into law in December 2016, includes additional funding for AOT. Research in several states points to the efficacy of these programs. In New York, for example, researchers looked at more than 3,000 people with access to AOT. AOT reduced mental health hospitalizations by 77% and homelessness by 74%.

Stop Smoking Services May Boost Mental Health of People With Depression

[fat_widget_right]Smoking cessation services may improve overall mental health, according to a study published in the journal Annals of Behavioural Medicine. Researchers found 66.3% of smokers who had moderate to severe depression when they used quit-smoking services experienced no symptoms a year later.

Good Outcomes With ‘Telepsychiatry’ in Medical Treatment of Opioid Use Disorder

Telepsychiatry, which offers remote therapeutic services via video conferencing, may be a good option for people with an addiction to opioids. According to a study published in the Journal of Addiction Medicine, for people using buprenorphine to treat their addiction, telepsychiatry offered similar results to in-person therapy. Participants in the telepsychiatry group were more likely to live in rural areas, making telepsychiatry a more accessible option.

Nicotine May Help Schizophrenia, Study Finds

According to a study published in Nature Medicine, nicotine may treat hypofrontality, one of the symptoms of schizophrenia. Hypofrontality denotes low activity in the prefrontal cortex during cognitive tasks. This leads to cognitive issues in people with schizophrenia. When exposed to nicotine, the prefrontal cortex of people with schizophrenia appears to work better. Smoking, which releases nicotine to the brain, is more prevalent among people with schizophrenia. One study estimated 88% of people with the diagnosis smoke.

Phyllis Harrison-Ross, Mental Health Pioneer, Dies at 80

Phyllis Harrison-Ross, who pioneered mental health treatments for children with disabilities, died of lung cancer January 16. Many public schools use Harrison-Ross’s programs, which were designed to keep children with disabilities out of institutional settings.

Trapped by the Game: Why Professional Footballers Don’t Talk About Their Mental Health

According to interviews with seven male football players, footballers do not feel safe discussing mental health issues. The interviews point to struggle as a common theme among players. They viewed the football field as a battlefield where they felt they had to struggle to “survive.” Shame and stigma often kept them from expressing any sense of vulnerability or emotional difficulties. Many also found it hard to integrate into the real world after careers in professional football.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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