Multiple sclerosis (MS) is a progressive autoimmune disease that results in neurological impairment due to lesions on the myelin sheaths that cover nerve fibers and axons. About 400,000 people in the United States and 2.3 million worldwide have MS.

At this time, we do not know what causes MS. There are many theories, but no concrete explanation to date.

Here are some things you may not know about MS. All data presented are from the National MS Society.

1. MS has four types.

Most people (85%) with MS have relapsing-remitting MS (RRMS) type. With RRMS, people may have one or more symptoms during an exacerbation/relapse, then be symptom free for weeks, months, years, or even decades. When the next exacerbation of the disease occurs, the same person may have a different symptom or set of symptoms from previous exacerbations. Exacerbations are caused by inflammation, known as active lesions.

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Secondary progressive MS (SPMS) occurs in some people with RRMS. For those people, SPMS is considered the second stage of the disease. With SPMS, the remission between flare-ups is no longer present, and people with this type of MS generally have some symptoms at all times. The number of people who will progress to this stage is hard to determine because of the unpredictability of the disease.

Primary progressive MS (PPMS) is the most debilitating type of MS. About 10% of people with MS are diagnosed with PPMS initially. With PPMS, the disease progresses steadily, with no remission. The chronic nature of symptoms in those with PPMS is believed to be related to permanent nerve damage.

Progressive relapsing MS (PRMS) is diagnosed in only 5% of people with MS. With this type of MS, the disease progresses steadily, with some brief remission in the early stage.

2. MS has no cure or treatment, but the progression can be slowed for some with disease-modifying drugs.

Although there is no cure or treatment for MS, those with the relapsing-remitting, secondary progressive and progressive relapsing types often find that intervention with disease-modifying drugs prevents new lesions from forming, thus slowing disease progression and altering the course of the disease. Some drugs on the market can be used to help treat symptoms during a relapse/exacerbation.

There are now 10 disease- modifying drugs for MS, many that have been approved within the past few years. These drugs are very expensive, but patient assistance programs through the pharmaceutical companies can help those who qualify access the medication.

3. MS affects mostly Caucasian women of northern European descent.

For reasons we do not clearly understand, MS is diagnosed in women 2.5 to four times more than in men. It is also found primarily in people far from the equator. People of northern European ancestry, particularly from Scotland, have the greatest risk.

In general, one person out of 750 in the United States has a chance of being diagnosed. Among those with first-degree relatives who have the disease, the risks increase to one in 40. Those who have an identical twin with MS have a one-in-four chance of diagnosis. Some combination of genetics, geography, ethnicity, and possibly an infectious trigger are believed to be responsible for MS, according to current data from the National MS Society.

4. Only about one-third of people with MS use wheelchairs 20 years after diagnosis.

When we think of MS, most of us imagine a person who is unable to walk. MS does affect gait, mobility, muscle strength, and flexibility, but not for everyone. Research shows that only one in three people with MS use wheelchairs two decades following diagnosis. Some use canes or other devices for walking assistance.

An active lifestyle is important for people with MS to maintain their strength and mobility. Adaptive recreation, yoga, hydrotherapy, hippotherapy (horses), and other activities can make a real difference. Many years ago, people with MS were told not to exercise. However,

Jimmie Heuga, an Olympic medalist who was later diagnosed with MS, changed the mind-set in the field of MS treatment about exercise.

One issue to be considered with regard to exercise for those with MS is heat sensitivity. Becoming overheated often triggers a pseudo-exacerbation in which the person experiences symptoms for several hours or days. For this reason, people may need to use cooling equipment when exercising or outside on hot or humid days. MS fatigue is also an issue to be considered, as most people with MS experience this symptom most of the time. Physical therapy can be helpful for people with MS who have muscle spasms, stiffness, mobility, balance, gait, or other problems.

5. People with MS often experience mental health or cognitive impairment.

About 50% of people with MS will experience cognitive impairment. This is most often a problem with executive functioning, such as planning, spatial relations, following directions, working memory, prioritizing, and making decisions. People may one day simply forget how to drive home from work, or get lost going to a grocery store where they have shopped for years. It may take people longer to think of words that they normally use, or respond to questions. These changes can be very frightening.

Depression can be a symptom of MS or secondary to the disease due to lifestyle changes and losses. Depression is not related to the degree of disability. Anxiety is also reported frequently by people with MS due to the unpredictability of the disease. Suicide rates are higher among people with MS than in the general population and among people with other chronic illnesses.

If you know or work with someone with MS, be aware that every person experiences MS differently.

Do you live in fear and anxiety? Do you think they protect you? They may—to a degree.

The startle reflex is protective; if we happen to step in front of a moving car, we immediately jump back, and that is a good thing. This reflex originates in the brain stem.

The fight, flight, or freeze response originates in the amygdala in the mid-brain. It is triggered when we sense danger. When we do not feel safe, we react instinctively without being aware of what we just perceived. The amygdala can be compared to a scanner on a submarine that is always on alert for danger. We are mostly unaware that this is happening. If we perceive a threat to our survival or emotional well-being, we generally respond by fighting back, fleeing, or freezing.

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The third level of fear is irrational beliefs and unreasonable expectations. These beliefs are located in our higher brain, the cortex, which is the seat of judgment and executive functioning. Many of our beliefs were formed so early in childhood that they seem like facts that are a part of who we are. Others were adopted later through cultural influences. Challenging or changing these beliefs may bring up more fears and resistance. We are familiar with the way we think and experience and do not know what our world would be like if we changed our beliefs. We can ask ourselves, “Would I rather be right about my way of thinking and collect evidence to prove and validate my beliefs? Or am I willing to challenge my beliefs in a way that would allow me to be happier?”

Anxiety and stress can take a toll on our mental and physical health. At the same time, they can serve us. If we view stress as bad and try to get rid of it, it has a more negative effect. But if we understand it as serving us, the detrimental effects are negated. The degree of fear, stress, or anxiety, and the effect on us, has to do with our beliefs about it. If you’re about to step on stage in front of a few thousand people, do you experience exhilaration, terror, or panic? How you define the event and what you say to yourself about it will determine your stress or relaxation level. Being a little scared but having a lot more excitement may be the best combination for peak performance.

Worry is frequently based on irrational or unreasonable expectations about the future. You may worry about not having enough money. Or you may worry about not being liked, saying or doing the wrong thing, or doubting that you are worthy and valuable. Specific fears or phobias—for example, snakes, bugs, and storms—may also worry you. All of these can haunt you until you find a way to release them. Notice how much you say to yourself, “What if (fill in the blank)?”

Ask yourself, “Do my beliefs protect me or just cause me to feel miserable? Are they beliefs I have chosen or ones I have taken on because that is what others have told me?” Since you decide what to believe, you also decide what not to believe. It is your choice.

Make a list of the things you think you are afraid of or worry about and challenge them. Ask if these are beliefs you chose or ones you just grew up believing because your parents, teachers, church, peers, or media told you it’s what you should think.

Be honest with yourself. It is the only way you are going to get to having more rational, reasonable expectations that bring you more peace and happiness.

The ongoing dispute in Congress over a recent pay equality bill has reignited discussions about discrimination in the workplace. As political pundits debate the causes of discrimination, minority groups who live with unfair treatment experience the consequences. Disparate treatment isn’t just a moral problem, though. It can also lead to serious individual and societal consequences.

No. 1: Poor Performance

People who are exposed to stereotypes about their group tend to live up to those stereotypes, often leading to poor performance. A concept called “stereotype threat” explains this phenomenon. Numerous studies have found that, when a member of a minority group is reminded of a stereotype about his or her group, that person is more likely to under-perform. A woman who reads a book claiming that women are innately bad at math immediately prior to taking a standardized test, for example, will likely do worse on the test than she otherwise would.

Stereotype threat is so strong that sometimes minorities do not even need to be reminded of a stereotype. Simply drawing attention to group membership—by asking them to check the sex or race box on a test—can trigger stereotype threat.

No. 2: Physical Health Problems

It should come as no surprise that discrimination is stressful to those who experience it. Doctors already know that stress increases the lifetime risk of heart attack, stroke, cancer, diabetes, and a host of other health and medical issues. New research suggests that discrimination-related stress may be even more dangerous.

A 2008 study found that, among African-Americans, race-related stress was a stronger predictor of health problems than other sources of stress. Such research may help shed light on ongoing health disparities between whites and blacks. On average, white men live about seven years longer than black men, and racial minorities are more vulnerable to chronic health problems and terminal illnesses. Perhaps such disparities are the direct result of a lifetime of stress.

[fat_widget_right]No. 3: Mental Health Problems

Discrimination is inherently stressful, and stress increases a person’s risk for developing depression, anxiety, and similar mental health challenges. The rates of anxiety issues are significantly higher among women than men, and women are more than twice as likely as men to develop posttraumatic stress.

While a variety of factors play a role in these differences, discrimination could be one. Women are significantly more likely to suffer abuse than men, with one in three women experiencing a sexual assault at some point in her life. Such abuse is a significant risk factor for posttraumatic stress, and may also play a role in other mental health challenges.

No. 4: Drug Use

The U.S. Substance Abuse and Mental Health Services Administration estimates that drug abuse costs in excess of $500 billion annually. Discrimination may be one factor that helps inflate this number. A 2010 study found that the experience of gender discrimination increased a woman’s likelihood of using hard drugs, even when a woman didn’t report experiencing stress as a result of such discrimination.

No. 5: Self-Sabotage

When people doubt their ability to perform well, they may develop explanations to explain poor performance that don’t harm their self-esteem. One common mechanism is self-sabotage. For example, a student who worries about his ability to do well on a math test might go out drinking the night before so that he can blame his poor performance on a hangover. Several recent studies have shown that the experience of discrimination increases the likelihood of self-sabotage.

One of the most unfortunate consequences of of discrimination is that they may serve to increase discrimination. A minority student who repeatedly sabotages himself may be blamed for his under-performance, even when such self-sabotage is his way of coping with racism. A woman who experiences sexual violence might develop posttraumatic stress or turn to drugs.

Such mental health consequences could then be used to justify denying the woman resources or opportunities. By becoming more aware of the risks of discrimination, it’s possible to minimize its effects and steadily work toward a world free of oppression.

References:

1. Chakraborty, A. (2002). Does racial discrimination cause mental illness? The British Journal of Psychiatry, 180(6), 475-477. doi: 10.1192/bjp.180.6.475
2. Discrimination may harm your health. (2012, January 16). Retrieved from http://www.sciencedaily.com/releases/2012/01/120112134332.htm
3. Fox, M. (2012, April 17). Study shows why US blacks die younger. Retrieved from http://www.nationaljournal.com/healthcare/study-shows-why-us-blacks-die-younger-20120417
4. Physiological & psychological impact of racism and discrimination for African-Americans. (n.d.). Retrieved from http://www.apa.org/pi/oema/resources/ethnicity-health/racism-stress.aspx
5. Ro, A., & Choi, K. (2010). Effects of gender discrimination and reported stress on drug use among racially/ethnically diverse women in Northern California. Women’s Health Issues, 20(3), 211-218. doi: 10.1016/j.whi.2010.02.002
6. Substance abuse prevention dollars and cents: A cost-benefit analysis [PDF]. (2008). Washington, D.C.: Substance Abuse and Mental Health Services Administration.
7. What are the consequences of stereotype threat? (n.d.). Retrieved from http://www.reducingstereotypethreat.org/consequences.html
8. Women, trauma, and PTSD. (n.d.). Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp

In many families, the belief that children must honor their parents is a given. It may be seen as a tenet of the family’s culture, religion, or may be so fundamental that it is experienced as a rule of nature. In any particular family, the meaning of honoring one’s parents can vary from total obedience to respectfully listening to the wishes, perspectives, requests, etc., that parents express. In any particular family, the consequences of dishonoring a parent can range from mild feelings of anger, hurt, and sadness to intense anger, disappointment, extreme hurt, and disownment. (I am not considering the kinds of families which go to extremes which could result in honor killings.

In families with intense and powerful beliefs that children must honor their parents by sharing their points of view and behaving accordingly, children learn that any attempt to differentiate themselves from their parents by having separate, diverse perspectives or needs is unacceptable. Growing up, they learn what consequences to expect should they express their separate, differentiated selves when they are in conflict with family values. For children who struggle with these feelings, the dilemma of how to honor one’s parents and still be “true” to oneself is not easily resolved.

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It is hard to imagine, even in families and cultures with strict admonitions not to depart from parental ways, that children don’t have thoughts that differ from what parents want. To protect themselves and preserve the parent-child relationship, children develop ways of coping. Some unconsciously dissociate (not be consciously aware of) their conflicting wishes, needs, and thoughts. Others suffer quietly and internally with the conflicts between what they think and desire for themselves and their wishes not to hurt, anger, disappoint, or shame their parents.

In my work as a therapist, I often encounter people who seek therapy when they can no longer contain these conflicts and feel that any choice they make between what their parents wish for them and what they want for themselves is unbearable. (Here I am not considering people who dissociate.) Most of these people express loving feelings toward their parents. They are vulnerable to feelings of selfishness, self-betrayal, fear of angering or disappointing parents, and pain about hurting parents. There may be intense shame that their thoughts and feelings are not those of a good child and that their choices could dishonor and shame the parent in the family or community.

As a therapist who values self-determination, individuation, and agency, it is essential that I recognize and respect the value systems that people have internalized. There are no rights and wrongs here. Each person I work with needs to be helped to understand, as much as possible, what his or her conflicts are about, and which choices result in the most tolerable consequences. Therapy has to facilitate the process of making the intolerable feelings more tolerable.

“Lucy” is a 26-year-old Asian woman who came to my office racked with conflict. She and her 29-year-old brother were born in the United States; her parents were born in Asia, where they met and married. They came to the U.S. before the children were born. Most of Lucy’s aunts and uncles emigrated around the same time as her parents and she now has a large extended family, mostly in the Northwest. Lucy came to New York to go to graduate school for fine arts. She met Peter, who is not Asian, in one of her classes two years ago, and Peter has asked her to marry him.

Lucy told me, “I love him so much, but I think it will kill my parents. I haven’t told them about him. When I’ve gone home for vacations, they always want to fix me up with someone from my culture, but I’ve managed to get around it. I also haven’t let Peter know how much of a problem it is for me. I don’t think I can keep up this charade. I keep thinking maybe I should just marry him and never tell them. I don’t know how Peter would feel about that. I can’t imagine giving him up, and I feel so selfish. But if I tell them, I can imagine my mother sobbing hysterically and never getting over the hurt. I can see my Aunt Lynn saying something mean to my mother about how she has such a dishonorable and disrespectful daughter. My mother will die of shame. What am I going to do?”

“Wow,” I said. “You are up against a lot of powerful forces that are tearing you apart and making the possibility of coming to a decision a horrible proposition. You can’t win. But you obviously can’t continue to stay in what must feel like a terrible war going on inside you.”

“Yes, that’s it!” Lucy said. “How can I possibly make any choice and be OK with it?”

“I don’t know that you will ever be fully OK with any choice you come to, but I’d like to help you be OK enough with how to proceed with your life,” I said.

Lucy and I used our sessions to explore her understanding of her family, her culture, and their values. We clarified the powerful nature of respect and honor for the wishes of the elders in the family and the importance of tradition. Lucy acknowledged that her wanting to marry someone from another culture was especially threatening. It not only was going against what her parents wanted, but this particular act—marrying a non-Asian man—would be seen as a public announcement of going against parental wishes.

“I didn’t have the words for it before,” Lucy said. “It seems this is not a private conflict between me and my parents. It is there for all to see. I am such a bad daughter. My brother and all my cousins have married within our culture. It will bring such shame to my family. I don’t know if I could do this to them.”

I asked Lucy if she was worried about anything other than the impact on her parents and family if she were to marry Peter. She thought for a while and started to cry softly. “I love them so much,” she said. “I worry that they will never forgive me, that they will hate me. I’ll be all alone.”

Lucy began to sob. “What if they refuse to be my children’s grandparents? What kind of family will I bring my children into? How can I do this?”

It was apparent that Lucy had kept her family totally in the dark about Peter. I wondered if they were as clueless as she thought. I also began to wonder with Lucy about some theoretical possibilities (not suggestions): What would she guess would happen if she casually mentioned that she had a date with this man Peter to her mother? Her father? Brother? A cousin? Would there be different responses? Would anybody seem interested or excited for her? These questions created some thoughts that surprised both Lucy and me. She realized that there would probably be different responses. She was pretty sure her cousin Cindy would be really into it and it wouldn’t be a big deal. Then she thought her brother might be OK with it, too. She felt her father would get cold and withdrawn to express his anger, and she was certain that her mother would be inconsolable, hurt, and ashamed.

As Lucy and I continue to examine the issues and explore them from all angles, it doesn’t feel as hopeless as when we first began talking. Lucy is planning to talk to her brother. This is an opening up by including a family member in the secret of Lucy and Peter. Perhaps Lucy will find an ally in the family. She has a fantasy of introducing Peter to her brother. Another breakthrough has been that Lucy has told Peter about her conflicts and her worries. His comforting response and willingness to let her find her way through this dilemma has strengthened her resolve to find some emotionally acceptable resolution for herself.

In our explorations, it was clear that growing up, Lucy had been successful hiding differences with her parents. When she felt strongly that she wanted or thought something that they would disapprove of, she kept it a secret. She had never really disobeyed them in any serious way. She had always been able to contain her conflict and struggle internally.

Considering marrying Peter was the first time she could not keep her conflict inside. Now that her struggle is more out in the open, she is in the process of determining how and if to keep it private or if it is safe enough to make it more external. Her consideration of including her brother, for example, could lead to a conflict between the two. The fact this is a consideration for Lucy moves the conflict resolution process to a new arena.

It is hard to imagine that Lucy’s family will come to fully embrace Peter and/or that Lucy will feel totally untroubled by a choice to marry Peter. Although it seems that Lucy is trying to find a way to be OK with marrying Peter, at any time in Lucy’s struggle to decide what and who to honor, she could choose her parents. For example, Lucy has told me that she could never marry Peter and not tell. She also could never tolerate her parents disowning her. So there is still work for Lucy to do to as she focuses on resolving her conflict. Hopefully, it will result in an outcome that feels acceptable.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

At least once a week, we get a call from someone who says, “I know our relationship needs work, but my partner won’t go to therapy with me. What can I do?”

More often than not, when one partner (not always the guy) suggests going to couples therapy, the other partner hears an alarm. Danger! Danger! A tsunami of anxiety floods the mind. Fear abounds. Automatic thoughts start racing: “I’m not talking about our relationship with a stranger. How are they going to fix our problems? What could they possibly say that would make a difference? If you would just (fill in the blank), our relationship would be fine. Who is this therapist? What are they going to think of me? Will they like me? What if they tell me I’m wrong? We can fix this ourselves.”

In response to this resistance, the first partner either escalates the conversation, resulting in an argument, or stops talking and walks away feeling frustrated and hopeless.

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So how can you convince your partner to go to therapy with you? Here are five suggestions:

1. Address the objection or fear. Beneath the surface of defensiveness is fear. If it’s not obvious, you might ask your partner, “What concerns you about us going to therapy?” Once you identify that fear, you can address it. A sample conversation:

Him: “I don’t want someone telling me what to do. We can fix this ourselves.”

Her: “I wish we could, but we have been trying to do that with no success. An objective point of view would be helpful.”

Him: “How is a stranger going to fix our problems?”

Her: “I read about the therapist on her website, and she works with other couples just like us. Let me send you the link.”

Him: “If you would just (fill in the blank), our problems would be solved.”

Her: “I know I have a big part in resolving our differences, but it takes two people to have a conflict and two people to solve it. It’s important for each of us to look at our part and how we can improve our partnership.”

2. Describe the benefit to your partner. Think from your partner’s perspective. What would he or she get out of going to therapy? For example: “If you went, it would make me very happy; it would show me you are making an effort; it would make me feel like we’re truly partners; it would help us understand each other better; we would learn some new skills/techniques that would decrease our arguing so we would feel closer and be able to have more fun; if we felt intimate more of the time, I would feel like having sex more.”

3. Pique his or her interest. Find an article, podcast, or YouTube video and ask your partner to read, watch, or listen. You can use this as a conversation starter. Ask your partner what he or she thought about it or what part he or she related to. Then share your thoughts. Make your partner the expert on the topic and ask if he or she thinks most men/women feel that way.

4. Use a “coaching” model. Often, people think couples therapy is only for people who are deeply troubled. Describe going to the sessions as “relationship coaching,” putting the focus on learning skills and techniques, not changing him/her or his/her personality. Many men in particular often can relate to a coaching metaphor, as sports teams need a good coach to be their best.

5. Ask your partner to go just once and try it. Assure your partner that it is fine if he or she doesn’t want to go back after the first visit. He or she may resist less if it’s understood that he/she doesn’t have to commit to the therapeutic process. After the first session, he or she may see the value and want to continue. Also, this moves the fear of the unknown out of the way.

You might want to use one or several of these ideas when you approach your partner. The bottom line is that one person can work on his or her part of relationship issues, but there is much more that can be accomplished when both partners avail themselves of the process.

For more information about helping a loved one who needs therapy, click here.

Editor’s note: This story contains sensitive material and descriptions of childhood abuse and trauma that may be triggering to some readers.

My story focuses on two areas of trauma: childhood sexual abuse and the lasting effects of working in the field of law enforcement and rescue work. I am, for all intents and purposes, a normal adult—a college educated mother and grandmother. You wouldn’t know it to look at me, but I am a survivor of trauma for many decades.

In my family, I was known as the “spooky smart” child. As soon as I could talk, it became apparent that I had an intellect unlike other children my age. I seemed much older than my chronology would attest. It’s true that I did understand a lot; the saying about little pitchers having big ears was spot on. I could listen to those around me and because I was a little person; no one thought too much about what they said around me.

It didn’t take long for me to figure out that my father was emotionally distant—trying, but often failing not to repeat the abuse he received as a child. He never hit like his father before him, but the words were weapon enough against us. My mother was a black-out alcoholic who, for all of the good in her, spent her life slowly committing suicide by drinking herself to death. She would rather drink than face her demons and get help.

It began when I was about four years old. A family “relative,” the boyfriend of my great-grandmother, began sexually assaulting me and my sister, who was two years younger than I. When I learned he had touched my sister, I decided I needed to stop him.

I could not tell anyone about the abuse, as my dad was in the process of divorcing my mother. Any reports of any type could threaten his ability to maintain custody of us; something I understood, even at such a tender age. So instead of telling another adult, I made a deal.

I told him that he could do whatever he wanted to do, but only to me; he had to leave my sister alone from now on. I told him I would never tell, never yell—nothing. He could do anything to me as long as my sister was free of him. He accepted.

[fat_widget_trauma_ptsd_right]Over the course of the next 10 years he raped me repeatedly; always just outside my sister’s door so she could hear everything. I tried to stay as quiet as possible; even when he made me get on my knees and beg him to rape me. I cannot forget his greasy hair or the alcoholic sweat stink of his body and his breath on me while he used his adult-sized body against me.

As I grew up, around the age of 7 or so, I became involved in rescue work. My father was a cop on a specialized team sent to major accident scenes where someone must be extricated from the vehicle. He also assisted in other areas including search and rescue, looking for the lost, working in the local jail, and ordinary day-to-day beat cop duties.

Because he was a single parent, called out at all hours of the day or night, he sometimes had to scoop up my sister and me, taking us with him to the crime scenes. We stayed in his truck and I would try to occupy my sister so she didn’t look out the windshield at the crash. No child should see the death, grief, anger, and confusion we witnessed. Even though I thought of my dad as a hero for saving others, these are still scenes to which no child should be privy.

I too began learning these fields, taking an interest first in ambulance rescue work and later on to law enforcement. Since then, I have been involved in these areas. I worked with an ambulance crew at 11, becoming one of the youngest people ever to complete the EMT certification at 13. I would later become a police dispatcher, marry a man who became an officer, and have a son who decided to become Military Police officer in the Army.

My life has been spent helping others—being their protector, their advocate, a voice on the phone to help, to instruct them how to breathe life back into the lifeless body of their infant grandchild, trying to talk someone out of committing suicide or homicide. Sometimes I succeeded, but sometimes I failed. Needless to say, I have a somewhat overinflated sense of protecting others, often to my own detriment.

As an adult, I can now say I typically fell for men who would treat me abusively. I know now that I was searching for what I knew was familiar. Even if it’s wrong, familiar is comfortable. It wasn’t until just last year that I realized I needed help. In 2012, I began a relationship with a man I had known for a number of years before; we were friends and co-workers.

He is the first person to be in a relationship with me who was not abusive to me. I didn’t know how to handle it. The whole idea of a life with this man was at once both terrifying and desirable. I knew that while I’m okay overall, when I get angry about something I really overreact. I have thrown things in anger—never toward anyone, though; I have given up on relationships way too quickly, been too ready to believe I don’t deserve to be treated reasonably, all of the things which go hand in hand with abuse.

I couldn’t see any of that until I lived in a nonabusive household. Not being abused freaked me out. He and I discussed it many times and it was then that I decided to find a therapist and a therapy style which would work for me.

I contacted our employee assistance program. They gave a preliminary diagnosis of posttraumatic stress (PTSD) due to sexual and other abuse. They recommended eye movement desensitization and reprocessing (EMDR) therapy for me and gave me the name of a therapist. She did not work out at all. She was truly only worried about the money, not the people she treated. Her half-hearted attempts at helping me did worse than nothing —I was full of uncertainty, emotions, and questions to which she had no real answers.

So I decided to look around on my own. I did some searching and found a therapist who was specifically trained in first responder trauma, a type of trauma that affects those personnel who first respond to crime scenes. He also treated sexual abuse trauma.

Another nice addition was that he was familiar with the trauma of chronic pain and disease. I have rheumatoid arthritis and fibromyalgia, as well as issues related to the removal of my thyroid gland. I am in pain constantly and will be for the rest of my life. My health is overall sound and I have great doctors, but even that can’t compensate for the physical and emotional trauma these diseases offer. I contacted him about my situation and he agreed to let me interview him and vice versa as a potential patient. This invitation was to become the beginning of the rest of my life.

I have been in therapy for only a few months. In that time, I can say I have never felt better overall about myself, my health, and my place in this world. Yes, I am scared. I am scared of what will happen when I begin to feel things again, about traveling back in time to those places, about the idea of bringing up and reprocessing these memories—all of it.

Some days I feel like I can take over the world; other days I can cry at the drop of a hat. I am nervous about the type of person I will become over time and whether I am strong enough to live with it. I am nervous about trusting anyone with my mind and allowing them to help me change. It is a good struggle; I can feel it is worth it.

To anyone with trauma or involved in the treatment of it, I offer my story. My life was filled with visions of unimaginable horror. I have seen more death, destruction, and hate than anyone ever should. But I know I will survive and thrive in the future. To do that, I must deal with the demons of my past and decide that they will no longer direct that future. I have removed control from them. Now I’m practicing keeping that control.

With the help of my therapist and the support of my mate, I look with a cautious smile toward my future. If you are troubled, I hope you will soon be able to do the same. Your situation is unique, but that doesn’t mean you are alone.

Last month I wrote about avoidance, one component of trauma-related struggles for many people. Another one of the primary things therapists consider when exploring trauma-related problems is what we call “re-experiencing.” When the natural healing process after a traumatic experience does not go smoothly, one of the things that many people will find themselves struggling with is the fact the memories of the traumatic event won’t seem to settle in and fade into the background, instead remaining very charged and intruding frequently into day-to-day life—re-experiencing.

Re-experiencing happens in a few ways. Some people find that they have unavoidable nightmares related to the event. This can be so distressing that some people find they avoid going to sleep at all. Others find that thoughts about the event and its aftermath trespass unbidden in their minds during their waking hours; we call these “intrusive thoughts.” Some find that memories from the event pop up and that they cannot control when and how these memories occur, sometimes in response to specific environmental cues and sometimes seemingly at random.

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When these types of memories begin to plague a person, they can be quite distressing. This is because the way our brains form memories during a critical incident is physiologically different than the way they form the more pedestrian memories of our day-to-day lives. When the memories associated with a traumatic event are formed, they tend to be stored as sensory memories: we remember the sights, the smells, and the sounds the way we experienced them during the event. The part of our brains that stores these memories does not comprehend language and it does not read clocks—there is no sense of orderliness or reason about the memories, and there is no sense of relative distance in time. When the memories occur, our brains interpret it as an urgent sense of danger and distress in the present moment, and the sensory nature of the memories adds to the sense of urgency associated with them.

While our logical brains recognize that the memories don’t make sense and are not rational, they cannot communicate this to that part of the brain reacting to the sense of urgency created by the memories, since they do not comprehend the orderly, reasonable input of language created by our rational brain. This dilemma—understanding that there is no comprehensible or logical reason to feel distressed, yet feeling extremely distressed and trapped by the memories that won’t stop intruding—can itself be extremely distressing to the trauma survivor, who may feel like he or she is “going crazy” or “losing it” when the memories and distress they engender won’t abate.

If this overwhelming cycle of re-experiencing, distress, and confusion about what’s happening is causing difficulty for you or a loved one, it’s important to know this: you AREN’T crazy and you AREN’T losing it. You are experiencing a normal response to an abnormal event. However, if after a few weeks have passed the memories still intrude with urgency, it may be that your normal healing process has become stuck. In this case, speaking with an experienced therapist skilled in this area may be a good choice for you.

Moving forward from this place can feel overwhelming for some, but know that it most certainly is possible. It won’t always be easy, and confronting those memories requires courage. However, doing so in the safe and contained therapeutic environment can be very effective in helping the brain get the memories sorted out and “put away” in an adaptive and functional way so that they no longer intrude on and disrupt day-to-day functioning. It is worth the investment of time and energy it will take to move on to a place of healing and put the past where it belongs—in the past.

Grief after any death can raise a lot of questions. For a person of faith who has beliefs about the afterlife, a loved one taking their own life can raise specific questions that can be hard to deal with.

During these early stages of grief, a person can wrestle with their own sense of spirituality as well as external voices. These other voices may echo from the past and carry historical validity, or may still be present within specific faith communities. This article was prompted not only by the struggle of some with whom I have worked, but also by my perception that some in the mental health community are quick to lift up viewpoints of what is less helpful and more historic as the only Christian views on suicide that they have heard of. My hope is to provide several alternate views and encourage people to work within their spirit to find how they feel and believe.

Some stances may make it easier to move forward with the grieving process after a suicide, but if the person believes a different stance, working with a therapist who is sensitive to their spirituality may be helpful. The paragraphs that follow will intentionally focus on a Christian framework, although similar explorations could be made for those whose spirituality is rooted in other traditions.

Suicide as the Unforgivable Sin

A traditional viewpoint on suicide is that attempting and succeeding at ending your life is a gross affront to God, as you take into your own hands what is rightly God’s decision and action. From this perspective, a person who attempts suicide is making a choice to disallow God to play God’s role and to deny God basic control over their life. This denial of God is considered blasphemous, as it is a choice to place the human into the role of God. For this reason, suicide is seen as the unforgivable sin.

[fat_widget_right]The complication that this perspective brings is that if a loved one dies by suicide, you must come to terms with the idea thatthey have distanced from God for eternity. From this perspective, the comfort that there will be another time and place (heaven) where you will be reunited with your loved one is no longer a hope that can be helpful in your grieving process.

An additional struggle that you might enter into is that the only way to reunite with this person is to also distance yourself from God for eternity. This line of thinking has led some to attempt suicide to be able to be with the one who first died by suicide.

Suicide as a Mortal Sin

There are people for whom spirituality does not allow to label something as the unforgivable sin because they do not feel that scripture clearly identifies which act is unforgivable. However, suicide is seen as a serious sin that is intentionally carried out with full knowledge of both the sin and the gravity of that sin. Some people following this line will consider only those who died by suicide as having made the choice to carry out this mortal sin, while the failure of an attempt means it was not really being pursued.

Seeing suicide as a mortal sin means that you look at the person who (attempts or) dies by suicide as rejecting God’s perfect love and justice in such a way that the relationship with God is shattered and the person’s soul becomes “dead” until there is repentance and restoration. Given the timing of the sin and the ending of a person’s life, someone who believes this may have to think about whether the person had a chance to repent before they died.

Suicide as a Nonmortal Sin

The weakest way of looking at attempting or completing suicide as a sin is to believe it is a sin because it affects the relationship between the person and God. In contrast to the previous ways of seeing it as a sin, this belief allows for more of an understanding of the pain and lack of clear thinking on the part of the person who attempts suicide. This lack of clarity of thought means that the person cannot be held accountable for dealing with this as a severe, mortal, or unforgivable sin.

Within this way of looking at sin, one’s spirituality may project the sin associated with suicide as something that does not “kill” the person’s soul, and which leaves open the possibility that God will forgive the sin, even from God’s initiative. In contrast to the mortal sin concept, whether the person is forgiven for suicide is no longer dependent on whether they had the opportunity to repent before death and used it; rather, the grace of God provides an opportunity for the person to experience forgiveness and salvation.

Suicide Does Not Relate to Sin

All of the above approaches require that a person has the rational ability at least to choose to take their life. Generally, therapists understand that when suicide is seriously entertained, most people are operating out of a mental health condition rather than out of rational and conscious consideration of what is going on. Thus, if a person does die by suicide, the real fault lies in the mental health issue and not in a conscious, free choice. From this perspective, the faith community is called to embrace the one who is experiencing pain and whose capacity is limited rather than condemning that person for an act they were not fully in control of.

This way of looking at things encourages the movement toward wholeness and peace earlier in the process. It guides those who are around the person. It shows how God would have compassionate feelings toward the person rather than judgment. Of course, there are some examples that fall outside of this range—the rationally thinking person who dies by suicide as part of a murder-suicide, as part of a terrorism act, and other situations where the person is rationally choosing suicide—but these are not the norm.

Viewing suicide as a symptom of pain and torment is a pastoral way of looking at it rather than a legalistic way. If this is where your spirituality is, you can have an understanding of the problems the person was experiencing and the grace they may now be experiencing from God. It may be hard, however, to look closely and recognize what your loved one was facing. This may even involve you facing your role, if any, in the situation.

Understanding Your Spiritual Orientation to Suicide

As you think through how you relate to suicide and how you believe God relates to suicide, you will have another way of connecting with your sense of loss and grief. Your spirituality will influence your grief process. Having an understanding of your belief about these issues will help you to have a framework as you go through your grief process. This will help you to gain a sense of peace and wholeness, even in the face of tragedy.

Despite decades of work to educate the public about the nature of mental health conditions, mental health issues are still accompanied by stigma. Many people perceive that mental health issues happen to people they never see and certainly never care about.

The reality is that almost everyone knows someone with a mental health diagnosis, and such a diagnosis does not in any way mean that a person cannot live a normal, healthy, happy life. About 26% of Americans experience a mental health diagnosis in any given year. Most of these diagnoses are highly treatable conditions.

Anxiety Issues

Anxiety issues make up the most common group of mental health conditions in the United States, with 40 million American adults—or about 18% of the population—experiencing anxiety in any given year. Obsessive compulsion, panic, posttraumatic stress, generalized anxiety, and social phobia are all examples of anxiety disorders. Among people who experience such a disorder, social phobia is the most common, with 15 million people experiencing this condition each year.

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Mood Issues

Mood issues undermine a person’s ability to regulate mood. About 9% of the adult population, or 21 million people, experiences a mood disorder such as depression, bipolar, or dysthymia each year. Depression is the most common mood disorder, affecting almost 15 million people every year. It is also the leading cause of disability among adults.

Attention Deficit

About 11% of children have been diagnosed with attention deficit disorder or attention deficit hyperactivity. This diagnosis isn’t limited to children, though; ADHD affects 4% of adults every year.

Personality Issues

While many therapists and mental health practitioners do not support diagnoses of personality disorders of any kind, the Diagnostic and Statistical Manual (DSM) lists several types of personality diagnoses, and they are still frequently used. Rather than changing the way a person behaves in a specific context, personality disorders fundamentally alter a person’s thoughts, feelings, and behavior. Avoidant personality, which leads to avoidance of social situations and chronic feelings of inadequacy, is the most common personality issue, affecting 5% of adults every year. Overall, personality issues affect 9% of adults every year.

Substance Abuse

Substance abuse can lead to addiction to substances ranging from alcohol to illicit drugs. About 23 million Americans experience an addiction each year, with only about 10% receiving proper psychological and medical treatment.

If you or someone you know is experiencing any of these common mental health issues, help is available. Find a therapist near you on by searching the GoodTherapy.org Directory.

References:

1. Attention deficit/hyperactivity disorder data & statistics. (2013, November 13). Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html

2. The numbers count: Mental disorders in America. (n.d.). Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

3. The science of addiction: Drugs, brains, and behavior. (2007). Retrieved from http://www.nlm.nih.gov/medlineplus/magazine/issues/spring07/articles/spring07pg14-17.html

In my introductory article on anger management, I introduced you to the notion that anger management per se often misses the mark. Spending all our time and energy handling our anger in more productive, pro-social ways can get tiring if we constantly have anger bubbling up that needs to be managed. Wouldn’t it be nice, for once, to be able to sit back and enjoy yourself rather than constantly spin inside your managerial role? It’s not too good to be true, but you must know going in that getting to this place will take considerable effort at first. Perseverance, patience, and kindness will serve you well in this endeavor.

To begin, we must understand the nature of anger. When not experienced as a secondary emotion (more on this shortly), anger occurs as a result of being a part of or witnessing a wrong. If we or a loved one are in harm’s way, the energy we call anger wells up, leading to two things: (1) an often laser-like focus on the wrong occurring and (2) increased energy to do something about it. We can view anger in this sense as organically pro-social. It occurs in relation to harm that we think must be prevented or averted. Barring any illegal, immoral, or self-harming act, expression of this type of anger can generally be viewed favorably. Sometimes called “righteous anger,” imagine Jesus routing out the bankers from the temple to get an image of what I’m referring to here.

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As you may have already guessed, the vast majority of the anger we experience on a regular basis does not fit into the first category described above. Rather, the anger we generally need to “manage” falls into the category described as a secondary emotion. In brief, a secondary emotion is one that emanates from a judgment about a primary emotion. They generally occur due to our unwillingness to fully accept and feel the primary emotion. The primary emotion is usually one that feels physically uncomfortable and might also have a social stigma attached that reinforces the tendency to keep it held in. Sadness, guilt, anxiety, and fear are most often the primary emotions that get transformed into anger. As a result of judging and therefore suppressing their full expression, their energy “becomes” anger.

In my next article, I will cover in greater detail how to work with fear and anxiety. In this article, I wish to focus on sadness. Sadness occurs when we have lost something significant. Losing a job or the death of a loved one are obvious causes of sadness, but all too often we do not catch the more subtle triggers. At its core, we experience sadness when we’ve lost something that supports our self-identity. The reason sadness hurts is because we’re experiencing the absence of a psychological part of ourselves, not unlike losing a limb.

Feeling our sadness is important because it sanctifies the thing lost. Sadness fully expressed allows us to honor the missing aspect in our lives. This process reinforces the importance of reengaging in life so that we may begin cultivating the missing value. Not feeling our sadness prevents us from accessing the importance of the thing lost. Once we inquire into our sadness with kind curiosity, we will find that some value or quality is missing.

So how do you put all of this information into practical use? We’re all fond of steps, and I’m not here to disappoint:

1. When you get angry, sit down and begin to feel the energy in your body. Rather than ranting and raving, start taking stock of your bodily tension. (Yes, this is very difficult at first. With practice you’ll get better, I promise.) Once some of the energy has subsided, ask yourself what you’re sad about. Usually something specific—and quite often completely unrelated to the thing that caused you to be angry in the first place—pops in.
2. Once you’ve accessed the trigger of your sadness, it’s time to feel sad. I can already hear you grumbling. I know, feeling sadness isn’t pleasant, and that’s why so many of us avoid the sensation. A little trick I learned, and teach, is to say “yes” or nod your head when the sensation of sadness is felt. Acknowledging our emotion in this way makes it easier to access. Now, fully feel the sadness without judging or commenting. (This part is a bit difficult as well. It takes much practice to learn to feel our physical sensations without any accompanying thoughts.)
3. Once the sadness has subsided—and it will subside—you can begin the process of inquiry. Ask yourself what was lost. If it’s not obvious, look to core values that you prize, such as kindness, fairness, support, etc. Often, we get angry when these core values aren’t experienced in ourselves or in our relationships.
4. Patience and honesty in this process will often lead you to the missing value. Now that you’ve found it, it’s simply a matter of going out into the world and cultivating the very quality that went missing in the first place. This might look like being kind to coworkers, patience with your children, or being gentle with yourself when you make a mistake. Regardless of the quality expressed, your sense of power and accomplishment will increase.

Although the above steps are simply laid out, it will take you a few goes before you really get a handle on the entire process. We’ve come a long way from talking about anger. To bring that aspect back, recognize now that underneath much of our anger is a sense of powerlessness in the face of losing something sacred. When we re-access that missing component, we reclaim our power and, ultimately, our sense of peace.

Every smoker knows that smoking poses serious health risks, but the prospect of quitting can be daunting. Nicotine withdrawals can last between three and 14 days, and some smokers find the depression and anxiety that may be associated with quitting smoking unbearable.

If you can ride out the first week or two of misery, though, it really does get better. Within a few weeks, you may be wondering why you ever craved a cigarette at all.

For smokers desperately craving just one more puff, these five tips can help quell the nicotine thirst.

Change Your Routine 

Nicotine is highly addictive, but it leaves your body within three days. By the fifth or sixth day, any cravings you feel are psychological, not physical. Changing your daily routine to remove common triggers for smoking can help you cope with these cravings. Try taking a day or two off of work, changing your working hours, or even going on a vacation. When you don’t have constant reminders that you used to smoke, you’re much less likely to miss puffing away your life.

[fat_widget_right]Get Moving

Even the healthiest smokers suffer cardiovascular consequences from their decision to smoke. But within a few hours of quitting, your body begins to repair itself. This makes exercise easier, and exercising without coughing and becoming exhausted can be a powerful reminder that quitting has immediate health benefits. Even better, though, aerobic exercise can help silence even the worst cravings. Try doing a few jumping jacks every time you get a nicotine pang, and aim for a slightly longer workout every day or every other day.

Drink Some Water

The desire to put a cigarette in your mouth can be overwhelming, but try replacing that habit with a healthier one. Sipping cold water through a straw can combat nicotine cravings. Try taking a few deep breaths as you drink, and visualize yourself as a happy, healthy nonsmoker.

Accept the Cravings

When a craving strikes and you need to be doing something else, the energy you need to fight the craving can undermine your ability to work, concentrate, or maintain a decent mood. Rather than fighting cravings, try accepting them. When you feel a craving, tell yourself you’re going to take five minutes to fully experience the craving. Breathe through it while thinking about all the reasons you want to be a nonsmoker. Then get back to what you were doing before the craving came on.

Make Cigarettes Your Enemy

Most smokers conceive of quitting smoking as a time of epic deprivation. If you think of cigarettes as your friend, though, you’ll miss them more when they’re not around. Before you quit smoking, concentrate on every problem cigarettes have caused you—from smoker’s cough to the inability to enjoy a meal without lighting up. When you smoke a cigarette that you don’t enjoy or that gives you a headache, dwell on it. Then, when you give up smoking for good, think of your cravings as nasty reminders of what cigarettes used to do to you.

The cravings aren’t a longing for a friend who helped you through tough times; they’re the voice of harmful nicotine trying to convince you to do something that’s terrible for your body. When you miss cigarettes, think to yourself, “Cigarettes have harmed me so much that I have managed to convince myself that something that tastes bad and is terrible for me is good.” When cigarettes become your enemy, you have little reason to smoke them—even when you get a craving.

Are you working on quitting smoking? You’re not alone—more and more people are getting help with nicotine addiction. Smoking isn’t just a physical habit; it’s a mental health issue. Finding a therapist who works with smoking cessation may help. You can look for a therapist for yourself or a loved one in the GoodTherapy.org directory.

References:

1. Withdrawals. (n.d.). Retrieved from http://www.quit.ie/en/inner/withdrawals
2. Withdrawal symptoms and how to cope. (n.d.). Retrieved from http://www.lung.ca/protect-protegez/tobacco-tabagisme/quitting-cesser/withdrawal-sevrage_e.php

We know that certain functions of the body shut down when a person is faced with a threatening situation. This allows other parts to become more active. Larger sets of muscles receive more blood as heart rate increases, allowing for the well-documented “fight-or-flight” response. While the body tenses and readies to “respond,” some areas of the brain become less active. Hence, the ability to process emotional responses and store memories during a traumatic event can be impaired while pre-programmed survival mechanisms kick in.

Posttraumatic Stress

For some, this will lead to a condition known as PTSD (posttraumatic stress). The intense emotions associated with an unintegrated traumatic memory can impair normal functioning in daily life for those experiencing PTSD. Read more about this here.

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Not everyone experiencing a traumatic event will go on to develop PTSD. However, for those that do, PTSD is treatable. Eventually, there can actually be benefits that result from a well-integrated traumatic event. This is called posttraumatic growth.

Posttraumatic Growth

Many people experience a meaningful improvement in their psychological outlook on life after a traumatic or life-altering event. For example, after a near-death experience, some report a renewed zest for living, an intense wonder at the beauty of the natural world that surrounds them, and a deeply felt sense of purpose not previously recognized.

In one study, Robert James Miller II and David Read Johnson noted an increased capacity for symbolic thinking in a group of 56 Vietnam War veterans who experienced PTSD. From the abstract: “Unexpectedly, subjects with PTSD in comparison to subjects without PTSD showed greater capacity for symbolic representation, and no difference in lexical capacity, raising new questions as to the mechanism by which trauma could increase the capacity for mental imagery.”

It’s possible that in order to avoid re-experiencing a traumatic event (because memories of the event have not been properly stored), some people unknowingly strengthen their ability to think symbolically as a coping mechanism. Since we know that symbolic thinking is a cornerstone of the creative process, can an unexpected benefit of trauma be an increase in creativity?

Surges in Creativity

There is compelling evidence that suggests surges in creativity could be linked to the experience of trauma. Dr. Marie Forgeard conducted an online study to investigate this idea. An online questionnaire was filled out by participants, whose answers were used to measure posttraumatic growth, rumination related to the event, and growth of creativity. Forgeard used two measures in the study: (1) scores on a measure of posttraumatic growth and depreciation and (2) scores on self-reported measures of creativity in the aftermath of adversity.

She found that “… adversity-induced distress predicted self-reported creative growth and breadth in a sample of online participants. Cognitive processing [intrusive/deliberative rumination] as well as domains of posttraumatic growth/depreciation—in particular, self-reported changes in interpersonal relationships and in the perception of new possibilities for one’s life—mediated the link between self-reported distress and creativity outcomes.”

It is important to note that intrusive rumination describes a process where the individual is primarily focused on the symptoms of the distress being experienced as opposed to solutions for these symptoms. On the other hand, deliberate rumination is a process by which an individual turns inward and engages in reflection along with contemplation about various problem-solving possibilities.

Creative Therapy and Deliberate Rumination

Given the links between trauma and creativity that are being uncovered, creative therapies such as art therapy or expressive writing, coupled with supported deliberate rumination practice, could be beneficial in the recovery process for individuals wishing to deal with the aftermath of traumatic, life-altering events and/or full-blown PTSD.

References:

1. Miller II, Robert James, and Johnson, David Read. Psychological Trauma: Theory, Research, Practice, and Policy. Vol. 4(1), Jan 2012, 112-116. doi: 10.1037/a0021580. Retrieved 3/21/14 from: http://psycnet.apa.org/journals/tra/4/1/112/
2. Thompson, Paula. The Traumatized Imagination: Creativity, Trauma, and the Neurobiology of the Resilient Spirit. Retrieved 3/21/14 from: http://www.healingresources.info/article_thomson1.htm
3. Forgeard, Marie J. C. Perceiving Benefits after Adversity: The Relationship Between Self-Reported Posttraumatic Growth and Creativity. Psychology of Aesthetics, Creativity, and the Arts. Vol. 7(3), Aug 2013, 245-264. doi: 10.1037/a0031223. Abstract retrieved on 3/21/14.