'The Intersection of COVID-19 and the Legacy of Trauma' by Georgina K Smith, PhD

“In the midst of this catastrophe, 

more than looking in to find serenity 

we need to look out for one another 

to practice humanity” – Abhijit Naskar

We need look no further than social media in this time of fear and uncertainty to be flooded with a stream of advice, coping suggestions, comparisons, judgments, shaming; divergent roads of seeming light and darkness. The lightness of planned days, structure, mindful practices, self-reflection and gratitude, and the ‘making the most of’ mentality veering vastly from the the darkness of despair, panic, loss of income, instability, isolation, sickness, flooded emotions, and grief. And our inevitable tendency toward comparisons doesn’t help matters. For many both the light and dark may co-exist, showing up in varying capacities depending on the hour or the day. 

Here’s the truth – there is no right way to navigate this. We are all swimming in unknown waters, and I am witnessing many people in different contextual stages of grief. There is no right way to show up or to cope. One person’s order is another person’s chaos. Your messy day as compared to someone’s peaceful day is not a measure of failure. Your only immediate task right now is to take care of yourself and get through this the best way you can… a temporary departure from the ideal of thriving versus surviving. Many of us are now navigating a triple threat of working/parenting/schooling all at one time. Many are still working on the front lines of a pandemic. Many have lost jobs, lost businesses, lost loved ones, lost their lives. Many can’t find employment. Ideas of moderate balance and self-care may be out the window. Or some may be able to rest into taking this time as an introspective journey. Conversely, your cup of coffee may be the only part of your day that holds any remnant of normalcy or routine. Many are describing feeling left out at sea without any sense of comfort or feeling led or taken care of, or feeling that they know which information to trust or listen to, and this may ignite another layer of distress for someone who has a history of this very experience. We are in one big storm together, but everyone is in their own individual boat, with their own individual set of stressors and resources. And our boats may all look pretty different. Circumstances are calling us to stay physically distant, when everything we need to get through this right now is support and connection. 

I work extensively with individuals who have endured some form of trauma in their lives, and as I witness various journeys, I am seeing something emerge during these times that has been less spoken about, so much so that I felt moved to write about it in the hopes that it may resonate for more people and perhaps help in some way. For those that have a history of trauma, they may enter this time in a bit of a paradox. There will certainly be a multitude of different responses, many who will be triggered into their past by the current experience of uncertainty, fear, lack of safety, restriction, isolation, lack of control; these experiences perhaps mirroring their childhood. And they may experience an increase in emotional dysregulation and distressing symptoms during these times. Those who struggle with addiction are also at greater risk during this time, with a combination of uncertainty, isolation, and being alone in their head with which to contend. There are other individuals who have traumatic histories who may have a different experience. Their boat may be extremely worn down and weather beaten and it may not navigate storms smoothly, but the internal structure of their boat may have surprising reinforcement and bolstering that holds it together during these times. We might think of this in part as what research has identified as ‘grit’. 

But there’s something else. Individuals who have internal alarm systems stuck at a higher set point due to trauma often experience struggles and symptoms in part as a result of the mismatch of their outer world to their inner world during more ‘normal’ times. For example, they may experience a minor life disruption or conflict as something much greater than it is. Their defense systems are wired to perceive threat and thereby engage protective mechanisms such as flight, fight, or freeze. In a relationship conflict these may look like either running away from or avoiding the argument, becoming more combative and retaliatory, or shutting down completely. Consequently, there can be feelings of guilt and/or shame when they later reflect on their mismatched responses. In coping with these dynamics, patterns of self-medication or other escape mechanisms may develop in attempts to find temporary relief, which of course further reinforces beliefs of badness or failure that may be rooted in their internalized trauma narrative, and perpetuates the inevitable cycle of shame and need for escape. 

However, when a global pandemic arrives on our doorstep, some of these individuals may have a re-lived experience of the circumstances in the outside world once again matching their internal alarm system, matching their history. Their alarm is intricately wired to tune in to exactly these catastrophic circumstances. So for some, they may experience a paradoxical sense of calm even if they also experience moments of triggering and panic and fear. A state of familiarity and knowing in the fear and uncertainty. An odd sense of comfort and aliveness and function in the chaos. Finding function in the need to do something to keep others safe. There may be a sense of control despite everything being completely out of control. They may temporarily reduce certain need seeking behaviors because of feeling a familiar attunement to the crisis, because of the matching of inside and outside that is happening. The past feels once again present. The quarantine and self-isolation may also feel at times calming in the sense of feeling like there is permission to retreat, to have a break from ‘performing’ for the world around them, for them to feel safe in the controlled alone-ness and to have a sense of knowing where everyone is, giving them the experience of less exposed risk. 

The time that may be more challenging for some of these individuals is when they have to anchor their boat once the storm is done. Their internal alarm system may have a hard time letting go and downshifting, even though circumstances will no longer require the same level of emergency response. They may not feel the same level of perceived control, function, aliveness, and self-efficacy outside of this boat and this storm. This is when the flood may hit… the feelings that haven’t yet been felt, expressed, and moved through; the needs that may surface now that there is time and space for them to be reflected on and hopefully met. This may bring a new grief along with a historical grief for developmental longings that still exist, yearning for something that didn’t happen, yearning for attunement and needing to be seen, while watching the world march on in what may feel like a jarring and abandoning normalcy. There will be a call for a recalibration to the new normal, a meeting of the parts of oneself – the young parts, the protectors – and ongoing conversations with those parts in an effort to adapt responses to one’s present self and experiences and needs, to others, to life, and in an effort towards ongoing integration and healing. There will be a need for a tuning in to one’s body and what is being held in tension, needing discharge and relief, so that the brain can receive a message of safety and loosen the grip of the armed guards. 

Once upon a time there may have been a dire need for the proverbial firefighter to blast in to the room, coming to the rescue to put out the fire – the fires of traumas once taking place. And with a global pandemic, the internal firefighters have a job. They are resurrected and purposeful. Once we land and acute crisis passes, the firefighters may still want to blast into the room, only they are not needed now in the same way. And the water they blast when there is no ‘fire’ may create more damage that will need repair. The trauma story will beg to evolve and change to match the ‘you’ today, the one that survived and holds all the resources and strength and courage and grace. And when the old noise revisits and gets too loud, we get to try and reach in and imagine turning down the volume, choosing how we respond to the story being spoken and choosing what we give energy to. 

As we navigate these unprecedented times, it is important that we all create space for the nuances of our own experiences and needs; that we have permission to be just where we are – now and when this ends. When this ends, it may just be the beginning for many people, whether that is coming out of a sense of triage to face the feelings that have been necessarily compartmentalized, or the beginnings of rebuilding a business, surviving financial loss, or experiencing the loss of a loved one to COVID-19. There will be a strange alchemy of relief, hope, and agonizing grief. A reorganization of how we experience and perceive our lives in this world. We all bring different histories and different frameworks of experience and personality that become the lens through which we view and respond to crises and through which we relate to one other. Stay aware of your story and your needs. Let your voice be heard. It doesn’t matter what it sounds like right now – as long as it is yours. Compassion and grace - practicing imperfect humanity for yourself and others - is our way through. 

If you are feeling engulfed by this unknown and by the circumstances you now find yourself in, try and find at least one air pocket, just for today, whatever that looks like for you, and try to focus on the most immediate present moment right in front of you. And if it’s too much to be present in this, imagine a time when you felt safe and happy. Use every one of your senses to go back to that place in your mind. Feel how it felt to be in that moment and feel where it lives in your body. Forget a day at a time, take one step at a time. And for trauma survivors, while the internet is going to be a vital lifeline of social connection for you in so may ways right now, be sure to seek out the healthy online spaces of support that allow you to be seen – as is. Place limits on other spaces that may flood you with triggering news (you can be informed without being flooded), or spaces where parts of you may travel down the social media comparison rabbit holes seeking glimpses of yourself, seeking the reflection and attunement you missed, yet finding and attaching instead to (mis-)interpreted reinforcers of long held negative core beliefs, or more simply put – old ghosts. 

Coping tools of reality-testing (do I have evidence for what I am feeling/saying to myself right now?) and perspective-taking (considering alternative interpretations and possibilities from your initial perception and interpretation of a situation) are going to be your friends here, helping you build corrective experiences around perception, connection, and attunement. There’s a flood of messaging coming at us via social media right now – condemning, informing, applauding, comparing, validating, permitting, educating, inspiring, reflecting, questioning. And we are hearing a lot about opportunities for growth in this crisis. And I believe there are opportunities in crisis. But know this - you don’t have to be there yet. You don’t have to be at the post-traumatic growth, meaning-making part yet. We are still in this. Some people need to make meaning to cope. But some can’t (yet). That’s ok. 

Tune in to your stage of grief and what you need. And what you don’t need. Maybe you’re in denial about all this. Maybe you’re angry. Maybe you’re all over the place emotionally from day to day and everything feels like static and it’s hard to take things in or feel soothed, similar to trying to soothe a colicky baby. Try and be gentle with yourself. Seek out any other sources of input in your day aside from responsibilities. Maybe that’s a nap, a movie, a podcast, a guided meditation, music, art, reading a book, fresh air, talking with a friend or family member, a shower, exercise, screaming in a pillow. Create a framework of structure and routine to your day that works for you – for some that may be minimal bookends to your day and for others it may look more planned by the hour. Honor what feels less pressuring and more adaptive for you. Monitor your mood, your responses, your needs. Name what you are feeling and going through – without judgment or past critical echoes. Meet parts of yourself where they are at with compassion and acceptance. When we move toward something instead of fighting it, our capacity to change it increases. Limit time spent alone wondering down rabbit holes in your mind. Isolation can amplify underlying fears in ways that are not helpful. And as we exist in this new normal, we will need to create new diffusion methods, ways to redirect, distract, regulate, soothe ourselves. Define a comfort zone – internally or externally - for yourself and spend time in it each day, whether it’s for 5 minutes or 1 hour.  Maybe it’s your bed or your couch, sitting outside or playing with a pet, talking with a loved one or visualizing a place or memory internally. And play the ‘What is the first thing I/We are going to do when this is over?’ game. Maybe it’s going back to your favorite restaurant or going to hug the people you have missed the most. It is important to create some space for future plans and goals when the right here/right now feels like too much. For individuals who have lost loved ones while being in lockdown, losing the ability to say goodbye, when this is over it will be important to step into the spaces of mourning and memorializing that were taken from you. And finally, seek professional help if you need it. Therapists are available online during this time. There are also hotlines available if you find yourself in crisis. 

We are in our boats together. We will come ashore from this storm. We will land. And wherever we find ourselves, we will be together in that too. 

RESOURCES

National Suicide Prevention Lifeline

1-800-273-8255

Crisis Text Line (USA)

Text ‘HOME’ to 741741

National Help Line for Substance Abuse
(800) 262-2463

Online Meetings – Alcoholics Anonymous

https://www.aa.org/pages/en_US/options-for-meeting-online

Search for a therapist in your zip code. They have listings based on expertise, telehealth (online/phone options), sliding scale options, and whether they take insurance. 

https://www.psychologytoday.com/us

COVID-19 RESOURCE AND INFORMATION GUIDE – NAMI (NATIONAL ALLIANCE ON MENTAL ILLNESS)

https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf

COVID-19 MENTAL HEALTH RESOURCES

https://dmh.lacounty.gov/covid-19-information/

Fellow Travelers

By Georgina K. Smith, Ph.D.

“You wake up in Chicago, pull back the curtain and you KNOW where you are. You could be nowhere else. You are in a big, brash, muscular, broad shouldered motherfuckin’ city. A metropolis, completely non-neurotic, ever-moving, big hearted but cold blooded machine with millions of moving parts-a beast that will, if disrespected or not taken seriously, roll over you without remorse” -Anthony Bourdain

Mr. Bourdain’s words reach far beyond Chicago. He could have been speaking in part about addiction, depression, the cold blooded machine of suicidality.

Over the past eight days the world lost Kate Spade and Anthony Bourdain. The world also lost many other people to suicide whose names did not make the news. My heart feels heavy and I feel compelled, like many others, to say something, and still what I have to say feels somehow incomplete.

I’ve heard people talk about the selfishness of the act of suicide and their anger about it. There is a devastating, traumatic legacy that suicide leaves behind with a penetrating transmission of pain. The person who dies by suicide, however, is often in such extreme mental suffering, pain and anguish, that suicide may present the only seeming reprieve they are able to give themselves and others, feeling that their existence is too painful to them and all those surrounding them. It can feel like the escape out of a burning building when the building burning is them. This kind of pain often creates a suffering that inhibits the brain’s ability to think rationally, to find hope, to connect to coping and managing. It can create a pain so great mentally and at times physically that living feels like too great a burden to bear. It can create a fight or flight response that meets so imperfectly with an impulse that the result is suicide. So often these individuals want to live. They just want to experience a different life than the skin they are in.

But let’s be clear. It is not only the mentally ill who are vulnerable to suicide. Yes, depression, mood disorders and other forms of mental illness are significant factors and can feel unbearable to live with. But many who die by suicide are not mentally ill. They are grieving or they are traumatized or addicted or they are in such deep loneliness and shame over events in their life or enduring such desperate life circumstances that suicide seems like the only way out. Trauma, grief, shame, disconnection, mental illness can make the acts of daily living, of daily transactions with others, with the world, feel like the person is a live wire navigating torrential rain storms, volcanic eruptions, earthquakes, and violent weather changes. With depression, light stings, gravity crushes, and depression pulls the chains that they are pushing against. The energy to navigate their inner world and its response to the outer world can feel exhausting, like a never ending game of chicken. And the response of the outer world when they can’t understand the person’s struggles and reactions can often reinforce the shame, self-hatred, and hopelessness. And it’s no one’s fault.

Success, like that of Kate Spade and Anthony Bourdain, does not create an immunity to struggle, to depression, to suicide. Rather it can create a suffocating cocoon of isolation and paradox, where there is a violent fracture and conflict between the experience and presentation of inner and outer worlds that cannot be reconciled. A very fragile heart beats inside the superimposed persona of a superhuman. What a lonely place. Success and fame beg for a form of public servitude, are synonymous with luck, fortune and happiness, and the prerequisite for gratitude and a ban of the right to complain or suffer. But from the homeless person on skid row to the individual in their Bel Air mansion to the school teacher to the actress or the janitor or the stay at home dad or the veteran or the blue collar construction worker or the executive working mom or middle school student, mental illness, loneliness, and suffering do not discriminate. Access to resources and to help, however, sadly does. And we have a long way to go. 

The World Health Organization estimates that 1 person dies by suicide every 40 seconds. According to the United States Department of Veterans Affairs, an estimated 22 veterans per day die by suicide. So why are we not talking about them? Why do we seem to come to a stunned halt when we hear the news of Kate Spade and Anthony Bourdain? I imagine it is because we may understand a little more about the anguish and trauma that veterans are enduring. But perhaps we cannot as easily grasp how people who appear to have it all, who appear happy, successful, can suffer the same fate. I believe it triggers an existential dread in us; a fear that if they can’t make it, how will we? And in these days and times, I believe the news hits us on an already pulsing raw nerve. The political divide. The gun violence. The rocked sense of safety in our communities. Never at any time in my past decade of private practice have I seen so many patients consistently coming in speaking about the impact they are experiencing from our country’s current state of affairs and politics and their escalated fears and tensions. So perhaps we hold on to the happy stories when we hear them, perky Kate Spade and her colorful creations – a light. Anthony Bourdain – the best kind of bad boy with an honest voice, who breathed the essence of realness and human connection and purpose. If their lights go out, how do ours stay on?

We have to talk about it and find a way to create connection. We have to talk about our struggles. About our ‘not okay-ness’ behind our social media smiles. About our grief, our depression, our traumas, our desperation, our suicidality. And no, you don’t have to lay your story out for public consumption. You decide. You choose who you tell. You have the right to your boundaries and your privacy. But tell someone. And for those that speak out in any way, anywhere, thank you for your courage. For your presence. For your heart beat. For your bravery.  For still holding on. I know it’s not easy. I’m a fellow traveler.

The weights of all these precursors to suicide can create a tipping point where everything becomes out of balance. Trauma can create defense and coping systems that are completely necessary and rational at the time of the trauma, but over time long-term can tip a person into illness in part because of the stress hormones surging through brain and body. The weight of these precursors may also show up as the crushing burden of depression. And depression will curl up with its host at night, never leaving their side, infusing itself into dreams and nightmares and humming a pulsing undertone of anxiety as a constant reminder of its presence and power. And during the day it may dress up with its host, don a smile, and play right along with what the day needs, what the surround needs, with what the act of living needs, whispering its persistent dread and doubts and questions, telling its old stories, and playing out its old fears, pulling shade over the light. It will make eyes heavy, hands shake, and the normalcy of daily exchanges feel alien and harsh. And it will speak its language of shame, toxicity, brokenness and blame till it becomes the host’s language and identity. It beats and burns and erases its victim till there is no shelter they believe they can escape to anymore. They just want out. Yet still trips are planned, work is attended, relationships exist, hellos and I’m fines are exchanged. And we may never know what lies under the surface because for many, arriving at this end can finally appear like the most possible, rational thing to do and they may seem temporarily more okay in their acceptance of this.

To the people who are suffering and who are still here trying to find a way to hold on and find a way out in waking life: know that it’s okay to not be okay, keep talking to your loved ones, keep going to therapy, keep asking for help, keep taking your medications if that’s something you need or talking to your doctor about changing the medication. Find your community, your people. Focus on any moments of okay-ness and find ways to understand them and expand them, find the things and the people that can be your lifelines and reality tests when the darkness pulls for you. Practice being a voice of compassion and kindness. You are not the violent weather pulsing through you. You matter. You’re loveable. You’re loved. Find that voice inside that will speak back to the voice of shame, blame, anger and hatred, that can find different responses to the weather inside of you. Find purpose and gratitude, even if that is in the fact that you got out of bed today, that you showered, that you smiled at someone, or someone smiled at you, that you felt the sun on your skin or the bite of the cold wind. Keep putting one foot in front of the other because that’s the only way you will ever know what lies around each new corner. Your broken past is not the evidence for your future even though it will try to convince you it is. Find whatever works for you – medication, religion, the gym, music, spirituality, 12 step programs, therapy, comedy, meditation, nature, your dog, your cat. Check in on your most basic needs – are you eating? Hydrated? Sleeping? And when nothing is working, do nothing. Minimize the damage. Go to bed one more night before making the last decision, the final act. Wait. Then wait again. The absence of action is sometimes all you need to do when you are at the lowest point. Not everything will work all the time, but there can still be relief, healing, progress, change. The maintenance of any form of recovery requires a practice and a management and some form of ‘balanced’ lifestyle (whatever that may look like to you…try not to attach to an idea of perfect balance. It does not exist. Navigating our flux within a more manageable range is what I mean by ‘balance’). Recovery needs you to keep showing up.

This isn’t a matter of will. Of fortitude. Of moral choosing. This is life or death. And if death becomes the only choice, then what profound suffering must have preceded. And what profound suffering will continue for all those impacted. Some make it out. Some do not. We have to talk about mental illness. We have to talk about emotional suffering and struggle. But we also have to recognize that certain systems - macro and micro - do not promote openness, communication, acceptance. We have to reduce stigma and fear and educate. We have to stop with minimization and invalidation. If people who are suffering could “just get out of bed and do it” they would. The brain is an organ capable of illness and dysregulation just like any other organ. But we do not bring chicken soup to those with mental illness. We bring judgment and expectation. Until we have walked in their shoes, we simply cannot know the extent of pain in their world.

I have come to believe that those suffering with depression and other forms of mental illness and trauma who are still here are not better or immune to what the future could bring. There may be a darkness that is never too far away, and a sometimes unexplainable impulse towards suicide that may be dormant but ever present. Rather those who are still here are continuing to make difficult choices every day, every moment. It’s not about being better or stronger or less sick. Some find a way to live by going straight towards their trauma and pain. If trauma and pain are your kin, coursing through your veins, many who know them so intimately choose to find their life purpose in them, not by running away from them. And for every fear and every doubt that tells you to take a step away and a step down, take a step towards. And sometimes it will be messy, you’ll overcompensate, or feel too much or not enough, or make mistakes, but you’ll be alive to make another choice. And when shame and failure want to take you out, walk into the swampy mess of it all and own your vulnerability the best you can, trusting that the hellish feelings will pass and that they are not facts. The storm will pass, even if there’s another one right behind it, but then it will pass too. Trusting that somehow things can work out. But they can’t work out if you’re not here.

We are not just the presentation of our social media profiles. We are complex, broken and beautiful and we need connection. We need resources from all spheres – physical, social, emotional, financial, spiritual. We need meaning, purpose, curiosity, hope. We need accountability. We need to feel seen and heard. Many of us are fighting demons that others will never see. Embrace your humanness and imperfection, ask questions, ask even your strongest friend if they’re ok. Make eye contact and don’t look away. Go deeper. Ask for help. Offer help. Get educated about mental illness, get real, be patient, be tolerant, be kind. Please be kind. Don’t brave this world alone.

Resources

National Suicide Prevention Hotline: 1-800-273-8255

Substance Abuse and Mental Health Services Administration Treatment Referral Helpline: 1-800-662-4357

Didi Hirsch (Low Cost) Mental Health Services: 888-807-7250

Psychologytoday.com (therapist, psychiatrist, treatment center locator)

Waging the Battle Against Depression

The loss of Robin Williams hit me harder than I could have imagined.  Maybe it was because I read that he suffered from depression and that the reports were stating suicide.  Maybe it was because he reminded me of my brother and the impossible loss of him that leaves a haunting remnant which may never quite disappear.  Maybe it was because as a little girl my first all time favorite television show was Mork and Mindy.  Our two Siamese cats were named after that show.  And of course Robin Williams is simply a legend who has been a constant companion for us on screen over decades.  His roles in Dead Poets Society and Good Will Hunting will forever move me.  A young teen who is waging their own battle against depression spoke about Mr. Williams and said simply to me, “If only he could have held on for 5 more minutes and made another choice, things might have changed by tomorrow”. 

I realize no one gets out of this life alive, and I realize that the loss of any life by any means can feel so utterly tragic.  Yet upon hearing this today, I feel the need to speak out to the tragedy of depression and suicide.  This is about more than the loss of a celebrity.  In my profession, I watch people wage a brave battle against mental illness everyday... old, young, rich, poor, known, unknown.  It is very real and still very stigmatized.   According to the World Health Organization, “depression is the leading cause of disability and the 4^th leading contributor to the global burden of disease in 2000.  By the year 2020, depression is projected to reach 2^nd place in the ranking of DALY’s (disability adjusted life years, which are measures of overall disease burden, defined as the years lost due to ill health, disability or early death)”.  Approximately 16% of the population is estimated to be affected by major depression, and an additional 1% is affected by bipolar disorder.  And those who suffer from depression live in a darkness that few who have not been there can possibly understand.   Symptoms of depression can include feelings of worthlessness and guilt, hopelessness, long periods of sadness, feelings of emptiness, irritability, changes in sleep or appetite, loss of energy, loss of interest in pleasurable activities, thoughts of suicide, difficulty concentrating, problems with memory, and unexplained physical problems such as back pain or head aches.   Depression symptoms have a major impact on life functioning and can also manifest on many different spectrums.  Certain specifiers for types of depression include: anxious distress, mixed features (simultaneous depression and mania), melancholic features, atypical features, psychotic features, catatonia, peripartum onset (related to pregnancy), and seasonal patterns.  Symptoms may also manifest differently in children and teens and in the geriatric population, and differently in men and women.  Depression can also co-occur with other mental health conditions.   And no matter what your background, your race, your SES, depression does not discriminate

In my work as a therapist and in my collaboration with To Write Love on Her Arms – a nonprofit movement dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury and suicide, we are dedicated to removing the stigma of mental illness and addiction.  I was recently revisiting a radio show I did in 2011.  The host questioned how people could lay in bed for 2 weeks, why can’t they just get up?  He was questioning the governance of our own lives and how we have become so resigned to handing our lives over to therapists and medications?   

Well, imagine this.  The feeling of weights on your chest, ropes around your limbs, restricted breath, heavy air, a bowling ball in your stomach, pain in your body and heart and breath, all smothering you to the point of an endless exhaustion.  Imagine walking out into the brightness of day and feeling blinded and blank and dead, unable to connect to the aliveness in the communities we share, feeling plastic and disconnected.  Your mind tells you to get up, to get happy, to get help, to get better.  But nothing in your body or mind can connect to it or activate.  Sometimes it is numbness.  Sometimes it is a pervasive feeling of dread and debilitating anxiety.  Sometimes it is an endless ocean of tears.  And sometimes all of the above.   You are not supposed to just get over it, and you are not supposed to travel this road alone.  You are not crazy.  It is ok to need help, and there is great courage in asking for help.

The helplessness and hopelessness that often accompany major depressive episodes are symptoms, and sometimes they are contributing factors in the case where someone may have experienced trauma or/and abuse in their lives to the point where they have internalized a sense of worthlessness or helplessness, as their experience likely dictated to them.  Sometimes these environmental experiences trigger genetic vulnerabilities.  Sometimes genetic vulnerabilities are expressed with no environmental trigger.  There are also extensive neurobiological explanations as to the etiology of depression that point to disruptions in the neurotransmitters serotonin, norepinephrine and dopamine. 

Individuals suffering with significant depression or mood disorders that can lead to suicidality are not crazy.  They are often all too sane and are resorting to the consideration of suicide in a desperate, last ditch effort to seek relief in order to deal with their immeasurable pain.   They need help.  They need understanding.  They need to know suicide is a permanent solution to a temporary problem and that there is hope and there are other solutions.   They need to know that if they can hold on just a beat longer, something can change.   Many of these individuals will benefit significantly from seeking out therapy and a medication consult with a psychiatrist.  In some cases medications may not be needed, but in many cases they are life saving in conjunction with talk therapy.   Along with this treatment, many life changes are recommended along a biological-psychological-social-spiritual-nutritional-fitness continuum.   And for many, this is a lifelong battle.  Even with therapy and medication or/and other holistic methods of mood management, depressive episodes can manifest periodically throughout one’s life.  The goal of therapy is often to assist the individual in mindfully observing themselves and being able to identify changes in their life and mood.  This then helps them to reach out for support and make the changes they need to get in front of and manage a depressive episode, and to know that it is temporary and that it does not define them.  Cognitive, behavioral and narrative coping methods are also often taught throughout the individual’s therapy, as well as assisting them in healing from any childhood trauma they may have experienced. 

In closing, here are some quotes that paint a powerful picture from individuals who have suffered from this debilitating illness.   (Names held for anonymity).

“I was a stripped electrical wire and my life was a raging ocean.   I think I died.  I think I am a shell of my old self.  I feel like a refugee.  I feel like a battlefield survivor that just doesn’t know how to make it in this society, in the everyday flow and hum and buzz.  The flow drowns me, the buzz floods me, the hum agitates me.  I am separate.  I am an observer.  I am broken.  I am meant to be more.” – Anonymous

“I’ve seen the line between sanity and madness, and it’s not a thin line.  It’s an invisible fault line.  I’ve seen it in others, and within myself.  I know the madness within me is only one or two choices away, for many of us.  My depression can try to take me to depths of darkness where the world feels like one of Sylvia Plath’s final poems.  Mechanical, emotional, raw, shameful, crude, distorted. It drives me down to the recesses of hell.  The pain is in my body; my head throbs, my heart aches, I want to scream, I want to cry, I shake.  But it’s just another day.  The sun is out, yet today it blinds me, my eyes never adjusting. The air is heavy on my skin, the oxygen thick, the air never cold enough, sleep never long or restful enough. But everyone else is going on with their day. It’s just a day…why have I changed?  I have to push through mud, pull the corners of my lips against gravity into a smile; I have to remind my heart to beat.    These feelings - I have to see them and name them.  And I have to ride them out.  And then I am aware I know so much, have seen so much, I sometimes feel so sane, that the sanity gets to be too much.  I yearn for the luxury of brokenness again, of losing myself into the false promise of suicide’s relief.  Then I remember the flip side.  And I remember that relief and freedom and bliss are in showing up and walking right through the pain and the fear.  I have to keep going.  And I do.  I keep going, and I am bigger than the depression, than the madness.  It speaks to me and I choose whether I listen and how I respond.  I fight to build the muscle of my happiness, and some days are easier than others.” - Anonymous

To all of you out there struggling with depression or suicidal thoughts, this is not the end of your story.  There is hope.  Your life can be beautiful.  You are needed and you are loved.  In many ways we are all weird, beautiful, broken, extraordinary human beings, no matter what our path.  You are not alone.  

Please reach out to a teacher, a pastor, a parent, a friend, a therapist.  Resources can be found in your area via the following links:

This link will take you to mental health and substance abuse treatment resources. It also provides a link to the suicide prevention lifeline. http://findtreatment.samhsa.gov/

You can also search www.psychologytoday.com to locate a therapist in your area.

 If you are in an immediate life-threatening crisis, please call 911.

REST IN PEACE ROBIN WILLIAMS

References

World Health Organization (www.who.int)

Mayo Clinic (www.mayoclinic.org)

To Write Love On Her Arms (www.twloha.com)

The Power of Validation: PART II: The Communication Ingredients

In relationships there are several key things you can do to maintain a sense of wholeness through healthy communication, self and other validation, and setting flexible boundaries. 

1.        Even when you disagree with your partner, consider, acknowledge and validate their experience, their point of view, their feelings.  Not only will this empower you, it can lead to more open communication.  When your partner feels heard, they will feel less defensive, and thereby likely more open to hearing your experience.   

2.       Respond versus react.  Reactivity is impulse and emotion fueled.  It is setting you up for a fight, a power struggle, a threat-based exchange of attack and defense.  If you are feeling angry or upset, take a moment, take a time out.  Pause, breathe, center.  Consider the exchange that just occurred and inform yourself of some things that may be going on for you and your partner.  When you are ready for a responsive versus reactive dialogue, come back and begin with ‘I statements’ of what you are feeling and what you are needing.  Allow the other person to respond without interrupting.  If you reach a stale mate, walk away with the agreement to revisit this later.

3.    Check your perception.  It’s easy to jump to wrong conclusions and make up your own accounts and narratives for which when you check you may just have no evidence.  Be willing to consider another point of view and tell yourself something new and different.  Be willing to let go of what you think you know.  There is strength in vulnerability and it may help you be more open and accessible to the other person.

4.       Consider your reactivity.  What are you reacting to?  Own your ‘stuff’.   When you react, are you being triggered by your fears and insecurities?  If so, you may end up projecting these onto situations where they do not belong.  In doing so, you will often create a self-fulfilling prophecy.  Be aware that you are not reacting based on old negative self-beliefs and self-schemas, or out of personal traumas, fear of rejection, losing control, self-doubt or unwillingness to be wrong. 

5.       It is not all about you, so don’t take it personally.  Remember that each of us has a history, a story, a framework through which we view our lives and others.  Imagine being in the other person’s shoes, consider their story, their intention, and then sometimes the content of what they are saying becomes less important and the emotion and need become more clear.  Be careful not to personalize their ‘stuff’. 

6.       Engage compassion.   This is important at any time, but especially in moments of anger or fear.  If you’re feeling stuck or paralyzed, be kind to yourself and to others.  Being of service to someone or something else may just get you out of your own way for a moment, and open up some new doors for you.

7.       Be willing to be wrong.  There is power in this.  If you’re one of those people who always need to have the last word, or who can’t be wrong, try a little contrary action.   Resist the urge to respond.  Resist the urge to prove a point.  Ask someone else more about their point of view.  Get interested in what they have to say, whether you agree with it or not.  The interest may just be reciprocated.

8.      It can be very empowering to let go of needing to control others’ perceptions of you – no matter what they are.  Own who you are and how you feel.  You can’t control anyone else, only yourself.  And even if you’re a super hero, not everyone’s gonna like you.  Let it go.

9.       Nurture yourself.  If you are only other-focused, you will be running on empty and symptoms of imbalance and ‘dis-ease’ are likely to come up sooner or later.  Fill yourself up and you will have more to give.  Empower yourself and you will empower others. 

10.   Don’t lose yourself to relationships.  You are not just your job, you are not just your hobbies, and you are not just the role you take on in your relationships.  You are a sum of your parts, embrace them all, nurture and value them all.  You cannot expect others to give you what you do not give yourself. 

      

11.    Address codependency.   Codependency is chronic self-neglect.   Do you need someone else to be ok with you in order for you to be ok with you?  Do you need to please, care take or receive validation and praise to feel good and to know who you are?  Can you say no?  Do you live, breathe and feel through other’s experiences and needs?  Do you give up too much for another person or try to control someone else’s feelings and choices?  Do you fear rejection, loss of control?   If any of these things are true, it is time to let go and start getting to know your authentic self, who you really are outside of your fears and what you have learned.  You will need to challenge each of your beliefs and begin telling yourself a new story.   It will be uncomfortable, but hey, that’s where the change happens.12.    In communications ~ Be honest.  Be clear.  Be consistent.  Clarify, don’t guess.  Be direct.  Ask for what you need. Be assertive (not aggressive).  Leave the past in the past.  Avoid aggressive arguing, defending, judging or blaming. 

13.    There is opportunity in crisis.  If a difficult person or situation enters your life, perhaps that is life saying I want you to learn how to deal with this.  We often repeat old patterns and they keep showing up over and over.  The next time an old pattern presents itself, recognize it and begin to engage contrary action.  Love yourself enough to do something different – you will grow through the discomfort.  There is a lesson to be gained, and in gaining it there can be relief from suffering.  Moving through what consumes us, versus avoiding or self-medicating or repressing, can bring liberation and enlightenment. 

14.    Learn to embrace the differences between you and others.  Celebrate your uniqueness.  Know that conflict is a part of life and trust that you can hold onto yourself and be ok. 

15.    And as I mentioned in my prior piece…  Get conscious.  Get intentional.  Shut off your auto pilot and be deliberate.  Listen to your inner voice, that inner dialogue.  Make sure it’s yours, make sure it’s accountable, and make sure it’s kind.