Tuesday, March 3, 2015

At What Cost?

Why do the people think so little of death?
Because the rulers demand too much of life.
Therefore the people take death lightly.
Tao Te Ching

The reported numbers of American service men and women who are taking their own lives is both staggering and heart-wrenching.  As someone who has worked in the mental health field for three decades, I have seen firsthand how the suicidal impulse takes root and grows stronger as the suffering individual sinks further into depression.

As the nation takes on the challenge of understanding why so many military personnel are choosing to end their lives, those of us on the front lines of mental health treatment are trying to find ways to both respond to those in need and prevent future episodes. 

While there is obviously no one factor that determines whether or not any individual would choose death over life, it seems clear that one of the primary elements is that the perceived cost of continuing on is too high.  It is often said that the ultimate fear is that of death. I have found that this fear is often trumped by the fear of a life lived in unending pain; whether that pain is physical, emotional, or mental.  

I have to confess that as someone who has never worn a military uniform, I cannot imagine the sacrifice that one makes when deciding to serve one’s country.  I can, however, imagine that the reward for that service often comes in the form of feelings of pride, honor and duty.  I can’t help but wonder if wars that lack of an easily identifiable enemy, have no clear-cut delineation of winning versus losing, and are based on the inherent clash of ideals, diminishes these rewards. Instead of feeling victorious, we now have men and women left with PTSD, redeployments, separation from loved ones, and fighting in alien territories devoid of the grounding mechanisms of normalcy. 

It’s known that often before taking their lives people will try other methods to cope with the burdens of daily life. Alcohol, drugs, sex and other compulsions are methods of self-medicating the growing darkness within.  Others will turn to self-improvement techniques and even seek professional assistance.  In the absence of any meaningful relief, the desperate seeker begins to see suicide as a reasonable alternative that, ironically, returns a sense of control.  

As a psychotherapist sitting with people who have either attempted to end their lives or are giving serious consideration to the possibility, I know that it is next to impossible to instill in another person the will to live.  When confronted with absolute hopelessness and intense pain, the casual list of reasons to live often falls inadequately short.  The isolation that accompanies deep states of depression is so powerful that those experiencing it can have a sense of detachment even when surrounded by caring individuals eager to help. Paradoxically, the very concerns of trusted others can further deepen the growing darkness as there is a feeling of letting down these helpers by not getting better.

 It seems far too simplistic a solution to heed the advice of the ancient text of the Tao Te Ching and stop asking so much from our service men and women.  “War is hell,” we are told and those that enter into its circles are surely going to be forever changed.  But does this mean that they also have to surrender the hopes, dreams and aspirations that drive most people through rough times?  Is it reasonable to expect that depersonalization that if often a prerequisite for the battlefield will be left behind and not come home with those who have been trained to see the world in terms of black and white and to  become “an army of one?”

While research demonstrates that early intervention, hospitalization and medication can save lives, we need to consider methods beyond crisis management.  The bigger question is how to help our military personnel recover from wounds that are largely invisible, deeply psychological and inherently corrosive to their sense of humanity.

The basis of most trauma work begins with the supposition that returning one to an emotional and mental state that existed prior to the trauma is unattainable.  Instead, efforts are focused on helping the person move from victim to survivor and on to thriving through the process of reframing the traumatic experience. This is done through molding a new life that both honors past experiences while at the same time breaking free from one’s personal history.  While much of this work takes place on an individual basis, making it a lasting experience requires weaving this experience back into the fabric of society.

According to Dr. Judith Herman, in her book Trauma and Recovery, the final stage of recovery from trauma involves “Restoring the connection between the survivor and his/her community.”  The loss of this connectedness is what leaves many people feeling like they have been sentenced to a life of solitary confinement, imprisoned by emotions beyond their control. 

In order to free those being held hostage to traumatic experiences, we need to become the bridge that brings them back to a social network that provides a protective barrier from the death and destruction that was their reality.  This effort has to be more than banners, ribbons and parades and instead have all the intensity of the front end of service.  What is called for is a basic retraining; a boot camp mentality to help warriors rejoin the fabric of society that nurtures compassion, cooperation and connection.  What better way to pay tribute to those who serve than to return to them their personal sense of decency, dignity and self-worth?

Tuesday, July 15, 2014

The Gratitude Attitude: Finding Grace in Everyday Life

Gratitude bestows reverence, allowing us to encounter everyday epiphanies, those transcendent moments of awe that change forever how we experience life and the world.

John Milton

Even those of us far removed from childhood can remember the subtle, and not so subtle, reminders from the adults in our lives to be grateful.  The often asked, “What do you say?” was followed by the obligatory “Thank you,” before running off with whatever gift, treat, or act of kindness given to us. 

When not being encouraged to reflexively give thanks, more dramatic methods were employed.  Perhaps you remember the frightening little phrase, “I complained of having no shoes until I saw a man with no feet.” Or, maybe like me, on more than one occasion you found yourself staring at a plate of a disagreeable food offering and being told “There are starving children in China (the location seems to vary based on generational and cultural factors) that would love to eat this."  And, maybe like me, you thought, “If a starving child in China wants this, let’s wrap it up and send it on its way.”
The intention, of course, was to foster a sense of gratitude in us.  The unintended consequence of the guilt-ridden, “Do it or else” approach, is that it takes a spontaneous experience and turns it into something we must do on command.  This seems to follow many of us into adulthood and, despite learning to appreciate the taste of broccoli, (the disagreeable food substance of my youth) many of us have a hard time swallowing the concept that gratitude is anything more than just good manners.
Interestingly, the word gratitude comes from the Latin root gratia, which is also the root for grace.  Both mean "to be pleased," or "thankful."  It’s an irony  that many families say grace before sitting down to a plate of food that, in some cases, children in some far off country would be more grateful to have.  On a much deeper level, however, grace and gratitude are intrinsically woven into the fabric of life; the warp and woof of existence.  Their arrival adds the sweet fragrance of wonder to everyday happenings. They simaltaneously steer us through, and transform, the struggles, challenges, and sufferings of everyday life.
Gratitude seems to be going through a renaissance of late.  The current selling point is that it can turn otherwise painful situations into opportunities for growth.  This has even shown up in my professional field of psychotherapy where clients are encouraged to “practice” gratitude with the understanding that when they focus on what’s good about their day they will feel better.  The trap door, however, lies in that the prescription to practice gratitude may be seen as just another version of something one ought to do.  With the echoes of, “Because it’s good for you,” ringing in their ears, many are still left staring ata plate of limp broccoli that is the world and all of its challenges. (My humble apologies to broccoli, which I have, on my own, come to love and appreciate.)
How does one find the healing power of gratitude when it’s all too obvious that life includes suffering; when our knee-jerk reaction is “Thanks, but no thanks”?  Does a list of “What went right today” really trump the painful hands many feel they have been dealt?  How do we keep gratitude from becoming just a more dressed up version of the optimist’s doctrine of “Don’t worry be happy”? 
As someone who has gone through the cancer experience, fully convinced that if cancer did not take me out of this world then its treatment would, I can tell you that even that experience does not move one permanently into a state of gratitude.   I find this to be the case with many of the client’s I've seen who’ve gone through traumatic experiences, to include life threatening illnesses.  Many emerged with a profound sense of gratitude for still being alive, only to find that it faded like a summer tan; leaving them, once again, pale and tired of life’s minutia.  
Gratitude, it seems, is not something one can will into one’s life.  Like its counterpart grace, it seems to arrive on its own accord.  The good news is that it is a vital element of our true nature. The even better news is that rather than having to be taught to appreciate life, we can unlearn those things that blind us to life’s wonders.
We can begin by refusing to feed gratitude’s opposite.  Let’s be honest, the more we take things for granted the less pleasing life seems. Additionally, when we begin to expect the worst in an attempt to avoid disappointment, we step into a trap of our own making.  We become ensnared in the twisted logic that there's something to gain in having our belief that “Life sucks and then you die” confirmed.   As a result, if the awful thing does not come about, gratitude is replaced by the terrible twins pessimism and cynicism. 

In order to open the door to gratitude, it helps to see that all life moves towards happiness and the universe provides endless gifts just waiting to be opened.  And while a polite, and even heart-felt, “Thank you” is the mannerly thing to do, we should heed the words of the writer Richard Bach who wrote “The best way to pay for a lovely moment is to enjoy it.”  Isn’t this the ultimate expression of gratitude?  Once we break free the bonds of guilt, unworthiness, or whatever other psychological mechanisms stand between ourselves and our enjoyment, we will find the awe in everyday life.  This, in turn, will alter our experience and change our very existence into one great “Thank you.” 
Additional tips for creating an opening for gratitude to flow freely include: 
1. Say “yes” to offers from others for help, assistance or support.  
2. Practice saying “I don’t know” more often.  Rather than a sign of a lack of commitment, it’s a sign that you’re committed to keeping an open mind. 
3. Have you cake and eat it too.  Deprivation leads to desperation and it’s hard to feel pleased when frantically try to get our needs met. 
4. Avoid the expectation trap.  Nothing spoils a feel-good moment like wanting, needing or craving its return.  Live in the now as it's the playground of grace and gratitude.
5. Forget “Give until it hurts” and “Give until it feels good.” If you’re not finding joy in your giving then all of your gifts carry the stain of suffering.

Monday, June 16, 2014


Artwork by Ralph Verano

Looking back over some of my recent posts, I was astounded by the lack of humor in some of them. The serious tone and, dare I say, preachiness, made me pause and reflect. When did I confuse pacifist with weightiness? I don't feel that one has to take on a solemn tone when walking a more peaceful path through life. As a matter of fact, I have always believed that a sense of humor was a key element when trying to dodge the slings and arrows of the path of most resistance. What gives?

Upon further reflection I realized I had fallen prey to one of the lesser known side effects of going through major life events. This side effect, unlike the ones that come along with chemotherapy, arises solely from the mind and has only one full-proof remedy. The effect is to look at life way too deeply and the cure is to simply knock it off.

Let's be honest, when I say the word pacifist the image that most likely pops into your head it one of a peacenik, sticking flowers into instruments of death, and chanting, "We are the world." Where's the fun in that? Who says that one cannot strive for a higher cause while taking the low road of slapstick comedy? Where is it written that we can't take the "mean" out of meaningful and just have a good laugh now and then?

It was Oscar Wilde who said, "Life is far too important a thing ever to talk seriously about" and he wasn't kidding. Or maybe he was? Who knows? Who cares? It's a great quote.

We are repeatedly told that laughter is the best medicine. Current neuroscience research even indicates that simply smiling is good for the brain. Of course there are times when the joke not only is lost on us, it seems that we are the very brunt of the joke.  It's the feeling that the punchline has hit us right in the solar plexus, or, in my case of cancer, right in the thymus gland, which is just a little higher. It's ironic that this profound sense of laughter would leave us just when we needed it most.

The problem lies with confusing serious with important, and funny with trivial. When strength of conviction hardens it loses its flexibility and can no longer smile. In rigid fashion it poo poos the free-spirited, spontaneous, "Take life as it comes," approach (poo, now there's a funny word).

I've seldom heard a cancer survivor, or survivor of other traumas, for that matter, exclaim, "You know, I find that I'm a lot funnier now for what I've been through." Maybe that means it's time to take on a viewpoint best expressed by an old Robin Williams joke that goes, "I'm not laughing at you, I'm laughing near you." Tragedies can bring a heavy-hardheartedness to our lives so why not counter with a lighter heart? If we're going to head into the deep waters of the meaning of life after a close call, why not strap on the laughing gas instead of the oxygen tank? 

It is most likely some innate wisdom, and not so subtle reminder, that tears accompany both a good cry and good laugh. Surely, in both cases they spring from the same profound source of . . . thought I was going to get all deep on you there, didn't you? Seriously? : )