Category: Trauma

What’s “Normal” In the Slow Fade of a Pandemic?

What’s “Normal” In the Slow Fade of a Pandemic?

Even as the pandemic begins a slow fade, the mental health crisis that the pandemic ignited in kids, teens grownups, and caregivers for elders is sticking around. In my therapy office of late, I’ve heard clients name rumination, depression, grief, more alcohol and marijuana, new existential questions about meaning and purpose, relationship challenges, parenting stress, exhaustion, preoccupation about weight, intrusive thoughts, and lots and lots and lots of anxiety (social anxiety, health anxiety, traveling anxiety, etc.) In fact, we now have a name for all the inner debris that the pandemic has left in us: Post Pandemic Stress Disorder. This is on top of all the stress, anxiety, depression, and relationship stuff many of us carry around even in non-pandemic days.

So here are a few points I wish we could all keep track of:

1: Sometimes my clients think that if an event is over, they should be over it. But our brains, nervous systems, and bodies don’t work like light switches. Rather our nervous systems are like cars — needing time to rev up and time to slow down. So it’s normal to not feel normal right now. It’s normal to be experiencing residual exhaustion, more sensitivity to stressors, and to generally feel on edge and like you don’t quite have your social sea legs. Does this mean it’s fun? No. But is having a disrupted nervous system normal given the completely abnormal last 16 months? Yes. Absolutely, yes.

2: During the last year plus, we’ve all been taking stock of our lives: what we like, what we don’t like, what we want more of, and what we want less of in our lives. If you are still looking around trying to figure out what you want your new normal to include and exclude, you are doing something important – and normal. Many of us have had a break from friends, commutes, social obligations, work travel, etc. and now, to some extent, we have some choices in front of us. Do we want to socialize more, less, or differently than before the pandemic? Do we want to advocate for different hours or different amounts of times at our jobs? Do we want to set different boundaries with our families or around our time? These questions are normal. And it’s normal to re-evaluate our priorities following a big, terrible event.

3: If you have gained weight during the last 16 months, congrats on being normal. As far as coping strategies go, eating a bit more than we need is not the worst thing ever. We’ve been going through an ongoing trauma, and our bodies naturally crave sugar and salt when we’re stressed. I hope you can give yourself a break over the weight gain. And maybe even learn about the Health At Every Size movement. Or if you can’t be kind to yourself about your body, please come see me and and let me give you a break.

4: Finally, if you’re feeling bad for feeling bad (as in “I have so much privilege, I don’t deserve to be having a hard time”) then congrats – also normal. Think of this like survivor’s guilt. There’s a guilty feeling that’s hard to shake. But guess what – this too is normal. And while I know it’s hard to stop guilt once it’s ramped up, your guilt does not help anyone.

So – what to do? Consider self-compassion. Surround yourself with people who will be supportive and not make you feel like a weirdo (unless you’re a weirdo in all the good ways). Remind yourself that your experience can be normal AND still be really, really hard. And help your nervous system know it’s now safe to calm down: through regular sleep, nourishing food and relationships, movement, time outside, and – the hardest for many of us – not pushing yourself too hard. Does all that sound impossible? If so, no worries… that’s normal too (and why we therapists are here).

Courtesy of Rahul Jail on Unsplash.com

“COVID is (Almost) Over: Why Don’t I feel OK?”

This past 15-plus months of pandemic life has been a crash course in tolerating uncertainty. Remember when we weren’t sure how COVID spread? Remember when we weren’t sure if we should be wiping down our newly-purchased cereal boxes and bananas? Remember when we weren’t sure what school was going to look like in the months ahead? (Oh, wait… I think that last one about school is STILL true. Yikes.)

Living with the uncertainty brought on by COVID has been no joke. And the stress is still impacting our bodies even as life returns to some semblance of pre-COVID normalcy. Every week I see clients describing difficulties with concentration and focus and irritability and motivation and – last but not least – exhaustion. Is it possible that these clients are anxious or depressed or have ADHD? Yes, of course. But it’s also true that we’re still reeling from a catastrophe most of us couldn’t have imagined two years ago. We all just experienced – and are still experiencing – an ongoing trauma. Our lives were just turned upside down – and stayed that way for more than a year. Of course we’re not going to feel great. Of course we’re going to be struggling.

This relates to an insidious kind of suffering that I see a lot (and that I’m not immune to myself). It happens when we have an unpleasant experience (like “ugh, I’m exhausted”) and then judge ourselves for that experience (like “I shouldn’t be exhausted”). It has variations: I’m grieving a death or break up, but I should be over it by now. Or: I just had a promotion fall through, and something’s wrong with me because I can’t let it go yet. Or: I am struggling but I have so much, so therefore I am wrong to be struggling. (See: privilege syndrome.)

I find that it’s always useful to help clients set realistic expectations for the time and effort it can take to recover from a difficult experience or a trauma. And just because COVID is almost over, that doesn’t mean your body has gotten the message. Our stress is not, unfortunately, a switch that we can just turn on and off. That’s why – if you go on vacation – you don’t automatically feel relaxed. Your body and mind can be in stress-mode even if you’re wearing a swimsuit drinking a mojito.

Think about it like this: your nervous system has likely been on overdrive for more than a year straight at this point, with many more “fight and flight” moments (complete with the release of stress hormones like cortisol and adrenaline) and many fewer “rest and digest” moments. At this point, your body has developed a stressed-out baseline rather than a baseline that’s neutral or even relaxed. So it can take some intentional effort to reset and to re-teach our bodies that we are safe with no imminent threat to ourselves or the people we love.

BUT YOU ARE NOT A LOST CAUSE. YOU DON’T HAVE TO LIVE LIKE THIS FOREVER. There are some things we need to learn to accept in life (the need for sleep; the reality of pollen; the deliciousness of pizza). But feeling agitated, panicky, and anxious ALL THE TIME is NOT something we need to accept.

The brain is beautiful, and complicated, and capable of changing. So is your body. So are you, as a person who has survived long enough to be able to find and read this blog post. You deserve to feel okay, no matter your privilege or lack of privilege. You deserve to feel okay, no matter who you are.

It doesn’t have to be like this. Photo by Aarón Blanco Tejedor on Unsplash.
We Are STILL In A Pandemic

We Are STILL In A Pandemic

We Are STILL In A Pandemic

I say these words multiple times a day, multiple times a week: We are STILL in a pandemic. I say these words when a client with depression can’t figure out why they aren’t feeling better, despite their best efforts: We are still in a pandemic. I say these words when a client with anxiety can’t figure out why therapy and exercise aren’t making them feel zen: We are still in a pandemic. I say these to people suffering from loneliness and grief as well as from chronic professional and financial and relationship uncertainty. We are still in a pandemic.

I say these words because it’s easy to dismiss the effort it takes to act normal – and perform normally – in hugely abnormal times. We think, Oh, it’s been a year, so I should have acclimated. This should be easier. But we are still in a pandemic. We believe, Well, I still have my job/home/health/privilege, so I shouldn’t be struggling. To you I say: We are still in a pandemic.

It doesn’t matter how much privilege we have and how much we have been spared. Chronic stress is real, and we are still existing within an extended period of trauma. This trauma affects not just those who have been sick with COVID, but also those of us (and it’s most of us) who have watched the slow-moving epic disaster of COVID wreak havoc on our communities, neighbors, families, economy, schools, the U.S., and the world.

When we beat ourselves up for feeling stress, loneliness, sadness, or worry, we make ourselves feel worse. When people with financial security wallow in guilt about what we have – when so many others live in scarcity – this does not help. Our self-flagellation serves no one and gets in the way of harnessing the energy to figure out how we can be useful to those around us.

So, in the words of the great Bob Newhart in the skit below: STOP IT. (And sheesh – if only it was that easy!)

White clients, it’s time to talk about whiteness

I have been thinking lots about what psychologist and writer Natasha Stovall wrote almost a year ago, before the police killing of George Floyd, before the COVID pandemic exposed (yet again) racial disparities in our country. Stovall wrote this:

The couch in my therapy office is occupied mostly by white people. Anxious white people and depressed white people. Obsessive white people and compulsive white people. White people who hurt people and white people who hurt themselves. White people who eat too much, drink too much, work too much, shop too much. White people who are bored, envious, guilty, numb. Racist white people and antiracist white people. White people who look across the room and see a white therapist listening. We talk about everything. Except being white.

Stovall goes on to make the point (and this is a gross simplification; the article is worth reading in full) that white therapists need to support white clients to explore racial identity, including the negative ways white culture impacts all of us—even those of us who also benefit from it due to our whiteness.

I’ve been exploring my own white identity for the last few years, primarily through the workbook Me and White Supremacy, through regular meetings with other white therapists wanting to dismantle our own roles in systemic racism, and through expanding my reading list so it does less to center whiteness. I keep coming back to this checklist about white supremacy culture only to cringe as a recognize myself and many of my attitudes and behaviors on this list.

I am committed to doing my best to support all clients. That means continuing to work to become as anti-racist as possible, and, when clients are ready, helping them unpack the ways their challenges may reflect and result from our problematic culture. This is our work right now. This is my work right now.

If I got a dollar every time…

Say I got a dollar every time I heard the following words:

  • “But other people have it worse.”
  • “Yeah I’m depressed and anxious, but I have privilege so I shouldn’t feel this way.”
  • “I’m not sure I deserve to be in counseling.”
  • “I’m worried I’m taking your time away from people who need help more than me.”

How much $$$ would I have at the end of a year if I faithfully put a dollar in a jar each time I heard a variation of these words?

Enough to go out to a great dinner. A really great dinner.

We often wish we could decrease stress and depression and anxiety by reminding ourselves of the hard stuff that other people face. But that’s not how it works.

I’ve written on this blog before about what I call “privilege syndrome” — the belief that if we have privilege in some way, it can be easy to feel guilty or judgmental about the ways in which we struggle. And this is common.

I wish that privilege could buffer us from anxiety. I wish that knowing about climate change or homelessness would mean that people with secure housing and middle class incomes could be immune or invisible from stress or depression or trauma.

But the brain and body don’t work like that. While those of us with stable housing or relationships may be less likely to experience trauma or stress, our nervous systems aren’t designed to tease out nuances of privilege. The body just experiences a flood of stress hormones like cortisol or adrenaline. The body just knows we’re depressed or anxious. The body knows we don’t feel okay, even if we try to use our intellect to convince ourselves we should feel differently.

And the research shows that judging ourselves for our responses and reactions don’t actually do much help.

Instead, I try to help clients cultivate neutrality or even self-compassion for our experience. It’s only by accepting what’s here – the pain, the suffering, the fear, the sadness – that we can begin to move through these difficult feelings. It’s only by acknowledging what’s true for us – whether we like the truth or not – that we can begin to move forward.

Hi, I’m Dana – She/Hers/Her (Gender, Gender, Gender!)

I led a workshop yesterday on mental health for parents of high school seniors. Introducing myself, I said, “I’m Dana, and my pronouns are she/her/hers.” Those same pronouns are at the bottom of my email signature. Were the workshop attendees confused by my sharing of pronouns? I couldn’t tell. But for lots of reasons, saying my pronouns is something I’m trying to do more often.

For many cisgender people (cisgender: people who’s gender identity matches what they were assigned at birth) the movement toward saying pronouns has been a bit baffling. Isn’t it obvious when someone’s male or female, man or woman? Not always. I was excited to go to a great workshop recently all about gender with multilingual Atlanta therapist Irene Celcer (her website’s in Spanish), hosted by the Georgia Society for Clinical Social Work. We talked about the difference between sex and gender (“sex is biology; gender is society”; “sexuality is who you go to bed with; gender is who you go to bed as”), gender incongruence (often known as gender dysphoria) and best practices for therapists working with LGBTQIA+ clients.

Especially given Atlanta’s big-big-big population of gender-nonconforming queer people, and the continuing discrimination and abuse they face – and often resulting trauma – it’s important to me that I and other cisgender therapists and counselors do our best to be respectful and helpful to these clients.

For lots of us who are no longer young adults, it’s a bit jarring to re-think our old ideas of gender, ideas we took for granted as reality. But one of the things I love about being a therapist is that I get to rethink old ideas and learn new ways of seeing and being. I am so grateful for this work.

I love the creativity of all the different affirming bathroom signs popping up around Atlanta.

“We’ve got to tell the unvarnished truth.”

I spent the weekend immersed in suffering. It’s a weird thing to say, but I’m not sure what else is there to say after a long weekend in Washington D.C. spent at the National Museum of African American History and Culture, the United States Holocaust Memorial Museum, and the National Museum of the American Indian.

I’m grateful for the time at these museums, the time to learn and to remember and to witness. It’s so easy to think that we alone have suffered and are suffering, that our suffering is context-less, that this moment will last forever.

But these museums provide an urgent reminder of not just atrocity and genocide and collective trauma, but that times change (for worse and for better) and that people can survive hardship and fight for dignity and impact the world in positive, beautiful ways. These sites remind me that we must not forget our shared humanity and the ways that our suffering is all connected. We suffer when we act in ways that strip the humanity from others or from ourselves. We suffer when we can’t see ourselves or others as fully human. (And yet, so often, it can takereal effort to see one another as fully human!)

I’m reminded, too, of the 1987 slogan of gay activists in the midst of the AIDS crisis: Silence = death. I saw that echoed in a quote from historian John Hope Franklin on the wall at the African American History and Culture Museum: “We’ve got to tell the unvarnished truth.” 

So much of counseling is learning to speak outloud the unvarnished truth – as painful and difficult as it sometimes may be. The unvarnished truth can be freeing, and powerful, and can guide us into discovering what’s next. Speaking the unvarnished truth about our experiences and life in therapy can be a brave, life-saving act – an act that protects our humanity and the humanity of others.

 

 

The Hardest Things To Talk About Are Sometimes the Most Important

It’s easy to circle around the hard things: Death, shame, our heart’s disappointments. They can feel too intense to name directly: abuse histories, experiences with sexual assault and harassment, death and loss, abortions and miscarriages. They hover at the edge of our consciousness, where we try to push them away and distract ourselves: the ways we’ve messed up or been let down, our regrets and fears, our shame and sense of unworthiness. They hover at the edge of our consciousness, where we try to push them away and distract ourselves. They can be overwhelming. We worry that if we let ourselves feel the feelings, we may get too immersed in them to find our way through.

I’ve been thinking about this a lot with the #metoo movement and #whyIdidn’treport. I’ve been asking the question: How is that I haven’t known until now that some of my beloved friends and family members have been assaulted? How is it that even in intimate relationships, these things go unspoken – and unasked about?

Asking takes courage, though of course it takes more courage to name outloud, to ourselves and others, the hardest things we’ve experienced. That’s why I have so much respect for all who continue to share their stories of surviving trauma, including assault and abuse.

We need these stories to be out in the open. The hardest things to talk about are sometimes the most important. For healing, we need to be able to hold each other with compassion and support – and to hold perpetrators accountable for their actions. For a more just society, we need to call out abuse and abuse of power. We need to address barriers to naming these difficult truths out loud – barriers that are significant to all people, and barriers that are often most profound for women of color.

I am continuing to work to make workspace a safe space, for all stories, for all aspects of self, for all experiences that have led us to this moment. I am working to ask and to listen to your stories, even the ones that are hardest to tell.

 

 

 

 

Blog Hodgepodge: ACE Scores, Bias, Lived Experiences, and A Radio Interview

Blog Hodgepodge: ACE Scores, Bias, Lived Experiences, and A Radio Interview

I got to talk on the radio recently about depression, suicide, and teenagers. I’m glad to continue to spread the message about adolescent mental health concerns, even though it’s always sobering to consider how mental and physical health issues can be created or exacerbated by so many preventable factors.

I’m a big fan of the Adverse Childhood Experiences (ACE) Scale as a quick way to look at what sorts of factors may have been present – or absent – in my clients’ lives that may impact them to this day. None of us exist in a bubble. There’s good research on how trauma, neglect, race, class, immigration status, gender and gender identity, and so much else plays into how others treat us, brain function, and how we end up feeling about ourselves. (Here’s a recent reminder of racial bias affecting views toward young black girls.)

In my work as a therapist, I continue to be committed to seeing my clients as individuals whose own stories and experiences are a part of a larger social and cultural framework.

Some helpful stats about the importance of ACEs.

 

Beyond Upset? 8 Small Things To Do Right Now

  1. First Things FirstFirst: Don’t make major life decisions in the middle of a crisis. If you’re feeling an impulse to make a big change right now, notice that impulse and then do yo
    ur best to sit on it for a few weeks.
  2. Undercommit. During times of challenge, you’re allowed to be a little flaky. I recommend sentences like “I’m a tentative yes for this” or “I’d like to, but I need to think about whether I can do this.”
  3. Limit your exposure to information you may find upsetting. Set a timer to remind you to stop compulsively reading whatever is making you panic. There will be plenty of time to read and learn later on. It’s not selfish to choose to opt out for a while.
  4. Get outside. Once there, move your body. Slowly is fine. Less slowly is also fine.
  5. Eat. At regular intervals. The best you can.
  6. Sleep. At regular intervals. The best you can.
  7. Find comfort. Take comfort. Give comfort. Cookies, TV, books, friends, and food are all good starts.
  8. Figure out a small way to use the power you have in a tangible way. That may mean doing something kind for someone else. That may mean volunteering. That may mean writing a letter to the editor. Be careful not to overextend yourself! Refer back to #2.