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Good Grief: Part I Is It Mourning or Is It Depression?
As a training contractor for
Fairfax County Government (in Northern Virginia; home of America Online and the "Software
Valley") I’ve been leading bimonthly "Dealing with Stress, Loss and Change through Humor" and "Managing
Anger and Conflict" workshops.
Over the last two years, I’ve
interacted with hundreds and hundreds of individuals who have been terminated, downsized and outsourced. Some of these folks
have been dislodged for just cause, some because of management malice or mismanagement; some with severance pay and some with
a half-day notice. The process of layoffs seems to be especially volatile in the new economy -- here today, gone tomorrow
– Information Technology (IT) world.
For most folks, when the dislocation
from a job and a career is sudden, unexpected and/or unwanted, there’s a period of shock, fear or rage, as well as sadness or helplessness. And when unemployment drags on from weeks to months and a feeling of self-doubt and despair spirals unabated…are
we talking:
a) grief process,
b) situational depression or, as we’ve seen,
c) prolonged stress effecting biochemical and mood disorder
consequences?
It’s a vital and confusing
question because:
1) grief and depression have complex overlap along with marked
differences as bio-psychosocial states of experience and action and
2) depression needs to be differentiated between situational
or exogenous, that is, external and environmental forces (like losing a job)
and the clinical, the internal or endogenous (that is genetic, family history and biochemical
factors or predisposition).
Let’s begin the conceptual
differentiation through word association. What comes to mind when you read the word, "depression?":
- emptiness
- exhaustion
- darkness
- heaviness
- black hole
- mood disorder
- food disorder
- sleeplessness
- agitation
- mania
- paralysis
- helpless
- hopeless
- endless
- suicide
- Prozac!!
Perhaps not so extreme. How
about:
- melancholy
- inertia
- apathy
- sorrow
- sadness
- joyless
- loneliness
- pessimism
- deprivation
- abandonment
- bereft
- bereavement
- grief
Quite a depression spectrum
-- depression to grief but also grief to depression. What is cause, what is effect? Is this a chicken and egg issue? It’s
clearly not black or white; many shades and intensities of grayness and darkness.
Drawing on the above-mentioned
experience, let’s see if a scenario involving an unemployed individual can shed light on some of the diagnostic conundrums.
Clearly, the unexpected and/or unwanted termination of a job so often triggers a profound sense of disruption and loss.
Very quickly the person is
thrust into a grief process and, initially, the person literally may not know what has hit him or her. So to clarify the many
levels of confusion – from conceptual to emotional – let me outline the stages of grief.
Clearly, what follows is an
ideal type as grief stage engagement rarely marches in precisely aligned and sequential steps. The bereaved may bypass a phase
or rapidly morph from one stage to another. A person may waver -- two stages forward, one stage back, or vice versa.
Anniversary losses, such as
a death or divorce dates, can easily trigger a feeling of regression, of being thrown back to the vicious beginnings or the
whirlpoolish depths of a grief (or depression) cycle. Fortunately, much
of the time the regression is temporary and the person with sufficient support and stamina will continue his or her hard-fought,
"Rocky" evolution and personal growth through "Good Grief!"
Stages of Grief
1. Shock
and Denial or "It Can’t Happen Here!" It’s no big surprise when given a days notice that an employee may
experience a state of shock. There’s such total confusion and disbelief that a person often goes numb; the mind-body
system has to shut down. Sometimes shock follows the downplaying or denial of bad news.
For example, in the early
‘90s, there was talk of significant restructuring in the US Postal Service. A number of employees took the early attitude:
"We’re always dealing with change here…No big deal." Alas, these folks didn’t count on Carvin Marvin Runyon
becoming the Postmaster General. Talk about a shocker...Within a year 50,000 employees were restructured out of the service!
2. Fear,
Panic and Shame or "Oh God, What Do I Do Now?" Once the shock wears off, you are no longer numb, there are some predictable next steps,
such as profound anxiety and vulnerability:
how will I survive this loss
of income, identity, my daily routine, my social standing, etc.?
There’s a mounting sense
of being out of control, which for many also evokes feelings of shame and inadequacy. And lack of control, not surprisingly, can stir up childhood memories of the same, being or feeling tormented, rejected or humiliated by family, peers, teachers, etc.
I vividly recall the lamentation
of a postal supervisor on a management fast-track, quickly derailed by reorganization: "I once had a career path. Then this
boulder fell from the sky and crushed it! Is it only a career path that’s been crushed? How about the human psyche and
spirit? Has it too been burnt up or burned out?
3. Rage
and/or Helplessness or "How Dare They!" or "Oh No, How Could They!" Do you think
our once fast-tracked supervisor is feeling abandoned and betrayed? Most likely. Often people in this phase swing between
rage and profound sadness. Both states can be induced by deep underlying vulnerability or helplessness. You’ve been wounded, feel exposed and just want to lash out.
Or you turn the rage inward
in depression and self-condemnation. Now it’s crawling under the covers escapism, or going through the motions of living
or, even, straining as hard as you can to reign victorious over your basic unworthiness; to battle a fear of failure and lurking
dread of being sucked into that compelling black hole of helplessness.
Consider this: in the Random
House Dictionary: The Unabridged Edition, the first six definitions of the word "failure" describe it as an act or an instance.
It’s not until the seventh and last definition that "failure" takes a personal direction. So losing a job or being confronted
with other losses and separations are often more events or individual episodes than a judgment upon you.
Also, please consider, that
individuals predisposed to a depressive mindset are likely to over attribute self-responsibility, that is, to blame themselves
for "negative" events. These folks minimize the impact of external factors or environmental stressors. Which is why the next
phase, while often maddening, is also essential for moving through the grief process.
4. Guilt
and Ambivalence or "Damned If You Do or If You Don’t!" The feelings and old voices of guilt (not living up to
an important other’s expectations or standards) and shame (violating or compromising an internalized core value or essential
part of your self-identity, integrity and esteem) can become louder and more incessant Self-directed rage keeps taunting you
for shortcomings, unworthiness, lost dreams, etc., and can ultimately drain you. If some energy returns or remains the battle
may continue in other arenas. First, the classic approach-avoidance conflict: "Damned if I do, damned if I don’t; damned
if I stay, damned if I leave." Take the paltry severance or not; leave the faulty marriage or not. And while the uncertainty
is terribly frustrating, at least there’s a struggle.
Some may turn to a spiritual
source for relief or rescue: "Higher Power, just tell me what to do" or "Higher Power, I turn it over to you." And, of course,
some in desperation will proclaim newfound or "born again" allegiance if they are only saved. Yet, in the end, with or without
your HP, one must get focused and cut the entangling emotional cord.
5. Focused
Anger and Letting Go or "Turning a Lemon into Lemonade" and "Freedom’s Just Another Word…" This phase truly
reveals the complexity and potential creative energy built into the grief process. To reach that powerful, purposeful and
passionate state of focused anger one must often blend rage and sadness. Some rage can propel us out of a shocked, paralyzed
or ambivalent state. Yet, you must also face your sadness and loss and struggle with uncertainty to temper uncontrollable aggression, to make sadder yet wiser assessments and decisions. Remember, rage unchecked much more often leads to self-destructive behavior than it does to "Going
Postal!"
If you’ve worked hard
to integrate the previous stages then the reward is "focused anger": "I really don’t like what’s happened…but
how do I make the best of it?" You’re ready to loosen – if not untie – the knot of hurt and humiliation.
And best of all, you’re getting ready to knock on (maybe even knock down)
doors again.
6.
Exploration and New Identity or "Now You’re Ready to 'Just Do It!’" (even if scared). Letting go is often
unnerving. It’s not just the financial security that’s at stake. But losing a job or a vital relationship also
profoundly shakes our personal/professional identity. We’ve invested so much time, ego, energy, money in this position
or partner…Who am I without the job, without my mate or significant other?
However, this vulnerable yet
fluid state provides unprecedented opportunities to get to know yourself, to assess your true individuality – strengths
and warts – and not only as it relates to financial dependence, job skills or career paths. Now is the time for a full
scale person-in-situation life inventory. How healthy or toxic are seemingly vital relationships and friendships? What about
your health? During this transitional window, do dysfunctional coping patterns -- habits of drinking, smoking, drugging, eating,
lack of exercise and limited socializing or spiritual support -- need to be challenged?
Even with the most dear and
painful loss or separation, the words of Albert Camus, Nobel Prize-winning author and philosopher have the crystalline ring
of essential truth:
"Once we have accepted the
fact of loss we understand that the loved one [or loved position] obstructed a whole corner of the possible, pure now as a
sky washed by rain."
A Mid-life Maelstrom or Father Finally Knows Best
Camus’ words remind me of an existential crisis faced
by my father in his late-40s. It’s a morality and morale-ity tale about how his corporate world went from cutthroat
cocoon to just cutthroat. For over twenty years, my father had been working as a salesmen for a large manufacturer in New
York City's garment center and fashion industry. As I mentioned, the competition was cutthroat, but still only figuratively.
And through aggressive and tenacious persistence, he had carved out a legitimate and fairly successful niche. He had sales
turf, some financial security and hard-earned pride.
Then, almost overnight, my father realizes that organized crime
is infiltrating the company big time. (Perhaps some of dad's capacity for denial was at play.) Now he's going to have to report
to one of these new executive slimeballs. His whole world is at risk; cutthroat is no longer symbolic. This isn't just downsizing...it's
downright "frightsizing!" Dad's existential crisis is in high gear. From this experience I first learned there can be a fine
line between homicidal and suicidal tendencies. Day to day, I didn't know if he'd go to work and punch someone out or not
get off the couch, immobilized by an explosive psychic cocktail of rage, fear and depression. (Good thing he was in group
therapy at the time.)
He was caught in the classic reorganizational bind: "damned
if I stay, damned if I leave." Fortunately, my old man realized "discretion is a better part than...'A Death of a Salesman.'"
He resigned. Economic fears had him precipitously joining another large manufacturer. After a month, he knew it was the wrong
move. What crystallized was his need for genuine control and autonomy, and a playing field in which he could aggressively
compete. And he eventually found it as an independent sales rep for a small manufacturer. Of course, the owner of this garment
center business was a "goniff" (Yiddish for thief) in his own right, and would often drive my father up the wall. But crazy
we have practice with and can handle in my family. It's when people take cutthroat literally that we usually draw the line.
And in fact, my father went on to have his most successful years in business.
As Camus understood, a whole new corner of the possible can
emerge when you accept loss and take time and heart for genuine grieving and exploring.
7. Acceptance
or "The Glass is Half Empty and Half Full." While submerging yourself in the stages of grief for a time will feel hellish,
there truly is an opportunity for rebirth. Getting out of the black box is a distinct possibility if you can ride on and ride
out this acutely emotional learning roller coaster. The grief encounter is definitely more than a learning curve. And there’s
no absolute or fixed period of time for your movement through the stages. My blood starts percolating when I hear "well-intentioned"
family members, colleagues or friends say to the grieved, "Hey, it’s been three months (or even six months) already.
Don’t you think you’re stretching out this grief thing (or unemployment status) a bit too much." The implication,
of course, is that you’re indulging in self-pity. Or, sometimes the verbal sting comes in a seemingly more innocuous
message: "Gee, someone with your skills, talents, experience…I can’t understand why it’s taking you so long
to find a job."
The most important thing we
can do after experiencing a major break – whether break up or break down, social, physical or psychological –
is to take time to heal. Now some after a loss of a job or a relationship feel compelled to jump right back into the fray.
And getting back in the saddle is a cultural icon and wise strategy for a thrown cowboy or cowgirl. However, for a major loss
it’s wise to retreat and regroup, at least temporarily. For example, those folks who are participating in the Fairfax
County Government reeducation and training program are getting career counseling and job search coaching, taking job training
classes (for many students, leading to computer skills certifications) as well as the Stress Doc workshops. Perhaps most important,
they realize they are not alone. Also, folks are encouraged to grieve and to gradually recover and discover: Who am I? What
genuinely feels like me? What works for me and my family? What seems to kindle (or rekindle) my passion?
So remember, there’s
a real difference between "feeling sorry for yourself" and "feeling your sorrow." When you are feeling sorry for yourself
you are mostly blaming others. When you are feeling your sorrow you are demonstrating the courage to face your fears and pain.
There are poignant moments in life when we all must take time to embrace our sorrow.
As I once penned, reflecting
on more than one soul shaking grief process: "Whether the loss is a key person, a desired position or a powerful illusion
each deserves the respect of a mourning. The pit in the stomach, the clenched fists and quivering jaw, the anguished sobs
prove catalytic in time. In mystical fashion, like spring upon winter, the seeds of dissolution bear fruitful renewal."
When It’s No Longer Just Grief
While many grapple productively
with the ebb and flow of grief gradually, if not grudgingly, working their way through the stages for other folks it’s
not uncommon to get stuck in "the big muddy" of mourning. Mourning becomes melancholia. How do you know the difference? My
first therapist gave me a handle; actually a heavy lid. She likened the state of depression to a heavy lid that often covers
up or tries to hold down underlying bubbling and boiling, conscious and unconscious thoughts and emotions – fear, rage,
obsessive ideation, panic, helplessness, suspicions if not paranoia, etc. So much energy is used in suppression and repression
of this raw psychic tension that exhaustion and apathy often result. Also, some of the tension can manifest as an amorphous
agitation. A number of classic depressive symptoms may appear:
1. Fatigue, sadness, heaviness
and listlessness, 2. Loss of appetite (though sometimes there’s compulsive eating) or using escapist substitutes –
alcohol, tobacco, drugs, etc. to numb one’s pain, 3. Difficulty concentrating and starting and completing tasks; general
diminishment in role functioning, 4. Feelings of shame and worthlessness and incompetence and inadequacy, 5. Restless and
interrupted sleeping, 6. Difficulty getting active and focused especially in the morning, 7. Loss of interest in activities
once seen as enjoyable or meaningful, 8. Withdrawing from friends, colleagues and family members, 9. Engaging in a variety
of reckless and potentially dangerous – active or passive -- undertakings, e.g., drinking and driving, drinking while
taking medication, etc., 10. Communicating directly and indirectly a desire to harm oneself (or others) that is, expressing
or demonstrating suicidal or homicidal impulses, gestures and/or actions.
As for the grief process,
my analogy has a mythical bent. Unlike depression’s tendency to bottle up and stuff down emotions, for me, grief work
is like removing the cover of Pandora’s Box. As was recently illustrated, grief opens you to a whole range of harbored
fears and furies – past and present. Ultimately, grieving releases and integrates a range of emotions and energies that
enables you to regain psychic equilibrium, helps evolve a new or renewed sense of purpose and direction. Vital mourning is
also the wellspring of passion and determination for exploring new roles and identities.
However, key components of
the grief process do overlap with key depression dynamics such as deep sadness, agitation or anxiety along with helplessness
and rage (often inverted). So when is it grief and not depression? Or, how do we know that a difficult and possibly prolonged
grief process is not being weighed down by or turned into situational or (unrecognized) clinical depression. (Remember, chronic
low-grade clinical depression is difficult to recognize and acknowledge. Over the years, the individual, as if living in a
constant smog environment has adapted, albeit not without disruptive mind-body consequences, to this (mostly) moderately depressive
and slowly degenerative condition. "It’s just how life is," cough, cough.)
Closing
Next time, seven bio-psychosocial
dynamics and role contexts that may help differentiate natural grief from morbid melancholy, including warning signs of grief
morphing into depression. And finally, some inspiring "F"s for mastering loss and change. Until then, of course...Practice
Safe Stress!
Stressful Contexts for Turning Grief into Depression: Part
II
Part I of this series, "Good Grief: Is it Mourning or Is It
Depression?" (Stress Doc Newsletter, APR 2000, No. 1, Sect. 2) examined the fine line and conceptual confusions between grief
and mood disorder. The essay also outlined the stages of grief. In the past two years, based on my workshops with reorganized
and unemployed professionals in career transition, here are seven bio-psychosocial dynamics and role contexts that may help
differentiate natural grief from morbid melancholy. While mostly compiled with workshop students in mind -- many of whom are
refugees from the volatile engineering and high tech fields -- it’s clear the distinguishing factors deepen and darken
an array of loss and grief encounters. This listing also provides depression warning signs; more than just grief clouds are
in the picture.
1. Sleeping on the Job. One vulnerable group are high tech employees
caught up in the mercurial, "24/7" IT work environment, especially those who literally stay at work around the clock. Not
only are these folks exhausted from the hours and demands, but too many truly don’t have a life. Friends and family,
relaxation and recreation are forever on the back burner. And when suddenly informed that their contract is over or the project
is completed and services are no longer needed…talk about an implosion. Now exposed on the front burner is the beleaguered
employee’s burnout process which has been simmering and eroding from within. There’s no spare energy and emotional
resources to withstand the termination blow. Not to mention the sense of injustice and outrage: "How can you make me a sacrificial
lamb after all I’ve given to the company, after all I’ve sacrificed in my life for you." (As we indicated earlier,
burnout is less a sign of failure and more that you have given yourself away.)
Often the most important lesson of this burnout-depression trauma
is that, "Life Is Not Fair." Ultimately, we must learn to stand up for our psychological integrity and physical health. If
we don't, the risk is predictable: the line between grief and depression can be too readily burnt into oblivion.
2. Breakup of a Marriage. Being confronted with an additional
major trauma, for example, both losing a job and the dissolution of a key relationship, will also grease the grief to depression
track. For years research has shown that the more change-related stressors experienced in a time-limited period, the greater
likelihood of some physical illness or mental disturbance. Not just a layoff or downsizing but even positive changes such
as a promotion can heighten stress: higher performance expectations, new authority roles or collegial relations, etc. Too
much change, too fast can induce a feeling of being overwhelmed, a feeling of being out of control – "future shock."
And if these vulnerable feelings persist, the shaky/quicksand ground can quickly turn from "The Big Muddy" to having you trapped
in "The Big Moody."
3. Past Traumatic Loss Experiences. One of the consequences
of prolonged or sharply acute stress is a wearing down or the sudden snapping of our psychological defenses. These defenses
keep memories of painful events and the concomitant disturbing emotions out of everyday consciousness. When cracks develop
in your defensive armor brought on by the stress of loss or separation (such as losing a job or mate) then past associations
to previous losses, abandonments, rejections get stirred. Now a judgmental boss in the present starts more consciously reminding
you of a former harsh supervisor, or perhaps a critical parent or a devaluing spouse. Especially if these past hurts and humiliations
have not been sufficiently and successfully grappled with and grieved emotionally the result, again, is a depression predisposing
mourning process.
4. Battered Employee/Spouse Syndrome. Sometimes an employee
(or spouse) who has been subjected to a pattern of verbal and emotional trauma (not to mention physical abuse) does not know
how to set limits and fight back, or does not believe that leaving the abusive scene is an option. This person is definitely
vulnerable to helplessness, worthlessness and passivity. In the work setting, when management does not believe they can force
out an employee, or they don’t want to directly fire the person for fear of legal consequences…an insidious game
may ensue. The targeted individual may be subjected to subtle forms of hostility by management or by a management surrogate.
Perhaps management tolerates or ignores the baiting of the employee by colleagues. Even when the harassment seemingly isn't
blatant it can be a legal issue if management should have known about the harassment and interceded. However, taking companies
to court still can be another "holy grail" quest. Any of the above scenarios can break down an individual’s will, spirit
and health.
And when an embattled employee hangs on trying to fight the
system without sufficient financial and legal resources, the result, too often, is a greater deterioration of his or her physical
and mental states. Once the proverbial backbreaking straw event occurs through trumped up dismissal, outsourcing or from the
employee finally giving up the fight the endgame is predictable. Grief is overwhelmed by "battle fatigue" or the individual
collapses in a heap of depression.
5. Illusion of Security and Age Anxiety. In a rapidly changing,
paradigmatic shifting economy – from the industrial to the informational/high technical – all folks but, ironically,
many early computer trained or science degreed professionals may find themselves frighteningly out of date. Having created
a seemingly secure position, for example, evolving mainframe expertise, once laid off these professionals suddenly feel like
they’ve been dropped off on the moon. Compared to when they were last doing job exploration, the current IT field, gravity
and atmosphere is so profoundly different. It literally is a shock. First there are the unanswered telephone calls and resumes
mysteriously lost in the job listings black hole. Then there’s the constant refrain: "You need to upgrade your skills
and certifications."
Of course, this scenario is a bit less daunting than the one
for a basically middle aged computer virgin; just the thought of becoming computer literate can throw such an individual in
a phobic or panic state. And, not surprisingly, age is a significant job/career factor even for those not technophobic. Frequently,
a number of old timers in the computer field or (or post-40 year old newbies to IT) bemoan age discrimination in what’s
increasingly perceived as a Gen X run world. Once again, when psychological, educational and socioeconomic forces are conspiring
against you (or are perceived as such) the boundary line quickly dissolves between grief and depression.
6. Multiply Downsized. A particularly at-risk individual is
the member of the increasingly large horde known as the "Multiply Downsized." This creature is fen found in the engineering,
aerospace and rapid startup-rapid fold IT industries, as well as in an array of government agencies. After awhile it appears
this employee’s main mission is as a statistical artifact in a restructuring process. Of course, some folks who have
survived several layoffs or downsizings develop a thick skin – "been there, done that." Their transitional radar is
finely honed and now the battle veterans know to jump ship before it crashes into the restructuring iceberg.
However, the almost universally vulnerable employee is the one
who has left a hometown, sold the house, said good-bye to family and friends, moved alone or with family to a new section
of the country for a "great opportunity"…and within six months the promised land/position has disappeared once again
in the disorganizational black hole. This hole is more than unsettling; it's particularly dark and bleak. In fact, the person
may not have fully grieved a previous downsizing (whether as organizational outcast or survivor) and may have been on the
edge of depression before the latest transitional trigger.
7. Addictive Patterns and Depressive Propensities. Finally,
two other susceptible classes of individuals for pathological grief are people who: a) routinely use addictive behavior –
drinking, drugging, smoking, eating, cybersexing or "romantasy" obsessing," gambling, etc. – to avoid or numb painful
emotions and difficult problems. This medical illness and/or escapist defense mechanism not only can be inherently toxic (for
example, when abusing substances) but it impedes the chance for developing and shaping cognitive-affective muscles. Psychosocial
maturation is retarded by a pattern of avoiding analytic, emotional and interpersonal problem-solving.
Invariably, an addiction process which may have blocked out
existing depressive signs and bottled-up rage, or numbed low self-esteem, etc., is no longer able to shut out or deny the
"no exit" separation trauma. You have to deal somehow with the loss crisis. (I suppose a deadly overdose is a tragic exception.)
Psychological defenses and addictive escapes, as well as the grief process itself, are overwhelmed. Massive depression, psychiatric
breakdown or withdrawal may quickly ensue, and
b) people with a genetic/family predisposition to clinical depression
who are not receiving proper medical/psychiatric treatment. These folks tend to be acutely sensitive to loss, emptiness and
abandonment, to shame, humiliation and rejection. A history of having difficulty directing and sustaining energy and attention,
seemingly a lifetime of self-doubt, feeling like an impostor, procrastinating, not completing projects or meeting goals, running
from commitments, etc., all obviously shed light on the aforementioned sensitivity and vulnerability. Again, the boundary
between grief and depression most likely has rarely been demarcated.
So for significant numbers there’s a progression from
grief to depression and, finally, with enough adversity and unending stress, the possibility of further descent into overt
clinical depression. Obviously, when there is a genetic predisposition, the contributing factor to a mood disorder is not
just external or environmental. However, it’s also true that chronic stress, untreated burnout or a prolonged and morbid
grief process can either: a) bring out a latent genetic predisposition to depression or b) can adversely impact the workings
of our biochemical and hormonal systems so that even as adults, without clear family history, a clinical depressive disorder
can gradually build then "suddenly" emerge full blown.
Clearly, a multi-pronged bio-psychosocial intervention is necessary
for confronting major loss, for tackling comprehensively situational or clinical depression. The intervention goal is to help
the wounded individual gain the emotional stamina to embrace and evolve through the natural grief process. Some combination
of individual grief counseling, support group, couple counseling or family therapy, medication, exercise, relaxation or meditation,
diet, assertiveness training and career counseling or retraining may well be needed. My personal recovery motto is not for
the faint of heart:
For the phoenix to rise from the ashes One must know the pain
To transform the fire to burning desire!
Finally, a closing strategy for confronting loss and grief as
well as situational and/or clinical depression. And the source of the inspiration shifts from the poetic to the alphabetic.
By understanding the dynamics of distress, burnout, grief and depression and by applying "Practice Safe Stress" tools and
techniques every day you will, for once, be proud to have earned an "F"...actually, six of them. May you successfully engage
the path of "The Six 'F's of Loss and Change":
1. Shaking or breaking up life's puzzle; letting go of a familiar
past, 2. Confronting and channeling the anxiety of an unpredictable future, 3. Grappling with a loss of identity and integrity,
with a loss of self-esteem and pride...with a loss of face, 4. Exploring and generating new resources -- environmental, informational
and psychological -- for evolving a new focus, 5. Seeking and being open to feedback, both challenging and affirming, such
as a variety of TLC -- "tough loving care" and "tender loving criticism" -- throughout the grief and rejuvenation process,
and 6. Trusting in higher power faith, from a belief in a transcendental power to the synergy and confidence instilled by
participating in a vital support group or counseling/coaching relationship.
source site: click here
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Compulsive Overeating
Definition
Compulsive overeating is characterized by uncontrollable eating
and consequent weight gain. Compulsive overeaters use food as a way to cope with stress, emotional conflicts and daily problems.
The food can block out feelings and emotions. Compulsive overeaters usually feel out of control and are aware their eating
patterns are abnormal. Like bulimics, compulsive overeaters do recognize they have a problem.
Compulsive overeating usually starts in early childhood when
eating patterns are formed. Most people who become compulsive eaters are people who never learned the proper way to deal with
stressful situations and used food instead as a way of coping. Fat can also serve as a protective function for them, especially
in people that have been victims of sexual abuse. They sometimes feel that being overweight will keep others at a distance
and make them less attractive. Unlike anorexia and bulimia, there is a high proportion of male overeaters.
The more weight that is gained, the harder they try to diet
and dieting is usually what leads to the next binge, which can be followed by feelings of powerlessness, guilt, shame and
failure. Dieting and bingeing can go on forever if the emotional reasons for the bingeing is not dealt with.
In today's society, compulsive overeating is not
yet taken seriously enough. Instead of being treated for the serious problem they have, they are instead directed to diet
centers and health spas. Like anorexia and bulimia, compulsive overeating is a serious problem and can result in death. With
the proper treatment, which should include therapy, medical and nutritional counseling, it can be overcome.
Signs and Symptoms
- Binge eating
- Fear of not being able to stop eating voluntarily
- Depression
- Self-deprecating thoughts following binges
- Withdrawing from activities because of embarrassment about
weight
- Going on many different diets
- Eating little in public, while maintaining a high weight
- Believing they will be a better person when thin
- Feelings about self based on weight
- Social and professional failures attributed to weight
- Feeling tormented by eating habits
- Weight is focus of life
Physical/Medical Complications
- Weight gain
- Hypertension or fatigue
- Heart ailments
- Mobility problems
- Diabetes
- Arthritis
- Sciatica
- Varicose veins
- Hiatal hernia
- Embolism
- Sleep depravation
- Toxemia during pregnancy
- High blood pressure
- Shortness of breath
- High Cholesterol levels
- Cardiac arrest and death
source site: click here
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Below are signs and symptoms that are frequently identified with eating
disorders (Anorexia, Bulimia, Compulsive Overeating, and Food Addiction). DO NOT use these lists as a self-diagnostic tool.
If you believe that you, or someone you care about, is suffering from an eating disorder, contact your doctor or Turning Point
for a free evaluation.
Warning signs of an Eating Disorder:
» A preoccupation with food and weight (i.e. counting calories, excessive
dieting, frequent weighing of self) » "Feels fat" when weight is normal or even below normal » Perceives body shape
of being different than it really is » Guilt and shame about eating (not wanting to eat in front of others) » Hoarding
food » Use of laxatives, diuretics, purging » Evidence of binge-eating » Excessive exercise » Emotional changes
(irritability, social withdrawal, depression) » Extreme concern about appearance » Over sensitivity to criticism of
any kind » A need for perfection
Specific signs of Anorexia Nervosa:
» Significant weight loss without medical illness » Significant
reduction in eating along with a denial of hunger » Dieting (even though at or below normal weight level) » Restricting
food » Loss of menstrual cycle » Unusual food rituals » Social withdrawal » Fatigue » Dry, brittle hair »
Feeling of being constantly cold » Obsession with calorie and fat content of food » Cooking for others but not eating
themselves » Depression, irritability, mood swings » Wearing baggy clothes to hide weight » Frequently checking weight
on scale » Fainting spells and/or dizziness » Headaches » Pale (pasty) complexion » Evidence of vomiting, laxative
abuse, diet pills, or diuretics to control weight » Intense fear of gaining weight » Constipation » Hair loss »
Growth of fine body hair on arm, legs, and other body parts » Dry, brittle skin » Shortness of breath
Specific signs of Bulimia Nervosa:
» Evidence of binge-eating » Hoarding or stealing of food » Frequent
weight fluctuations » Evidence of purging (laxatives, diuretics, Ipecac, etc) » Swelling of parotid glands under jaw
(caused by frequent vomiting) » Frequent dental problems; tooth decay » Irregular heartbeat » Avoidance of restaurants
and planned meals » Complaints of sore throat » Frequently visits bathroom after meals » Broken capillaries in face »
Fasting or extreme diets » Severe self-criticism » Fatigue » Feeling out of control » Bloodshot eyes » Irregular
menstrual cycle » Preoccupation with weight
Specific signs of Compulsive Overeating/Food Addiction:
» Binge eating » Fear of not being able to stop eating » Depression »
Withdrawing from activities because of shame re: weight » Going on many different diets » Eating little in public yet
maintaining a high weight » Believing they will be a better person when thin » Feelings of self based on weight »
Social and professional failures attributed to weight » Feeling tormented by weight »
Weight is the focus of life » Eats when not hungry » Awareness that eating patterns are self-destructive but does not
stop » Feelings of shame and resentment around weight » Obesity » Antisocial behavior |
To feel or not to feel -- that's the coping question.
Wed, 02/06/2008 - 20:04
— Ronald Brill
In our society children are
sometimes encouraged by parents and educators to "toughen up" and stop being so sensitive when their feelings are hurt by what others do or say to upset them. Of course we want our children or those kids in our
care to be strong and able to weather daily upsets and stress. But the question is whether "toughening up" or developing emotional coping skills
are better long term strategies to deal with stress without suffering the serious side effects from our course of action.
Neuroscientists and emotional
health professional tell us that emotional pain is real and registers deep within our emotional and reptilian coping brains.
(See Coping Skills for Kids website "Coping Brain" section.) What happens
when we "toughen up" so we ignore and don't attend to pain arising from emotionally wounding experiences?
In effect we are signaling
our brain to not deal with our real feelings. Our brain comes with strong instincts to avoid pain of any kind. However, because physical and emotional pain register in the same location of our brain,
we can convince the brain to "pretend" that emotional pain isn't real.
And in the short run that
brain disconnect often does work. Our brain even blocks physical pain the instant we're hurt by a serious accident.
This instinctive brain response protects us by putting us into a state of shock that masks the pain of our injury until
we surivive the crisis. It's only after the shock wears off that we truly begin to experience our pain and fear for our life.
But what happens when we choose
to desensitize our awareness of emotional brain pain when we're stressed and upset? We cam temporarily avoid the
emotional truth and not actually feel anything when we're emotionally wounded.
But if we adopt this way of
avoiding pain we may later pay a big price for this false sense of security. In the process we may sacrifice our ability to access positive feelings of love, joy and connectedness with
others.
A major indicator that we
are emotionally healthy is the ability to employ healthy and effective coping skills that allow us to "own"
and get over our pain without losing positive feelings about ourself and others.
We may convince neocortex
and emotional coping brains to ignore emotional pain impulses, but painful experiences are often stored so deeply unless we
directly deal with them they may never leave us. The danger then is feeling tormented by
the very experience we never learned to honestly deal with in the first place.
Some kids and adults try to
convince themselves that "I don't care," but functional brain imaging (fMRI) scans actually show that our
emotional and survival (reptilian) instinctive brains still remember that the pain is still there.
Emotional brain is involved with
our long term memory. The more we learn about our brain we realize it is programmed to avoid
danger and painful experiences. If we choose to cope with distressing experiences and emotional wounds by pretending they
don't exist, we may get some temporary relief.
But often repeated
use of the "toughen up" coping strategy can impair the human capability of experiencing real love or deep emotional connection
with others.
Whenever you hear a defiant
kid say "I don't care," think of it as code for "I don't feel." Kids may not realize the consequences of choosing to not
recognize or feel their pain. But they need to understand that our decision to not feel can lead to a lifetime
of troublesome coping patterns:
- aggression
- depression
- high risk behavior including alcohol or drug abuse
Those who choose not to feel
(or care) take a high risk coping road that may quell emotional pain they cannot deal with, but leave them with with an emotional
disability.
source site: click here
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Some Tormented by Homosexuality Look to a Controversial Therapy
Corey Larsen spent years hiding the feelings that drew him to
other men, at first refusing to acknowledge them and then praying daily for them to be taken away.
As a teenager in Clearfield, Utah, he tried to banish the thoughts.
As he grew older, the attractions grew stronger, but so did his religious convictions as a Mormon.
The contradiction tormented him. After moving to Manhattan several
years ago, he remained a respected young leader in his church ward. Behind closed doors, though, he sank into despair. “I
was either going to stay in the church, in what I believe and what I love, or choose this different path that I felt was just
knocking on my door,” he said.
Last May, Mr. Larsen, 28, began seeing a therapist in Jersey
City, joining others across the country making similar attempts to eliminate their gay desires through therapy or religious
ministries dedicated to that end. Most are caught in similarly anguishing crises of faith and identity, searching for a way
out through a murky world of intense dispute and warring political agendas.
Efforts by religious conservatives to “treat” homosexuality
received renewed attention last week with news that the Rev. Ted
Haggard, an evangelical pastor dismissed from his Colorado
megachurch in a gay-sex scandal, had undergone three weeks of intense therapy and then reportedly concluded that he was “completely
heterosexual.”
Although the scientific community cannot say definitively what
determines sexual orientation — whether it is nature or nurture — most mainstream mental health professionals
dismiss attempts to eradicate homosexual desires or to change someone’s sexual orientation as quackery that is potentially
harmful.
Gay rights advocates say the efforts only provide additional
fodder for homophobia. Mental health experts say there is no proof that sexual reorientation therapy, as it is often called,
works. Meanwhile, they argue, the damage it can inflict on self-esteem, triggering depression and even suicide, is well documented.
“There’s not a debate in the profession on this
issue,” said Dr. Jack Drescher, a New York psychiatrist and former chairman of the Committee on Gay, Lesbian and Bisexual
Issues of the American Psychiatric Association. “This is like creationism. You create the impression to the public
as if there was a debate in the profession, which there is not.”
Nevertheless, these efforts, commonly called the “ex-gay”
movement, have become increasingly visible across the country, where the battle over gay marriage and sex scandals in the
Roman Catholic Church
have brought the divisive issue of homosexuality to the forefront in recent years.
The efforts to rein in homosexual desires run the gamut from
those that take a completely secular counseling approach to others that are completely spiritual. Some proclaim complete change
is available, while others focus simply on helping gays and lesbians live celibately. Men seem to predominate in them, but
women also seek them out.
Despite the skepticism about whether ex-gay programs can work,
there is no denying the struggle of those involved. Among them are evangelical Protestants, Orthodox Jews, Mormons, Roman
Catholics and others often driven by deeply held religious beliefs that run counter to societal voices that encourage them
to embrace being gay. It is unclear how many people participate in these programs, but a leading Christian organization in
the movement, Exodus International, estimated in 2003 it had 11,000 in its affiliated ministries.
Mr. Larsen, a soft-spoken middle-school teacher in the Bronx,
grew up in a small town north of Salt Lake City. He tried to ignore his feelings for other boys back then, he said.
“I had a hard time even acknowledging it in my own mind,
or in my prayers to God,” he said. “I would say, ‘Just help me with that thing.’ ”
Later, he dated women briefly but invariably broke up with them
out of fear that they would learn the truth. He fell into a deep depression.
Early last year, he learned about a special weekend program
in Pennsylvania run by a secular group called People Can Change. He signed up right away.
The weekend focused on addressing his feelings of inadequacy
as a man, which Mr. Larsen now believes is what shapes his attractions to other men. But just meeting others like him, he
said, was healing.
Afterward, he made an appointment with David A. Matheson, one
of the organizers of the weekend and a state-licensed counselor in Jersey City who runs the Center for Gender Affirming Processes.
The center is one of several such organizations that dot even
the greater New York area, where gay men and lesbians are more widely accepted than in many other sections of the country.
On Friday and Saturday evenings in Manhattan, as many as 30
men and women gather in the Midtown offices of another group, called LIFE — Living in Freedom Eternally — Ministry.
An evangelical Christian organization that has been around for several decades, it combines counseling and emotional work
with biblical teaching and prayer.
In Morristown, N.J., the Vineyard Christian Fellowship of Morris
County began running a Bible study program two years ago called Living Waters that is geared toward people wrestling with
homosexuality and other forms of what evangelicals term “sexual brokenness.” The program, led by lay people and
conducted on Friday nights, originated in California.
On Monday evenings on the West Side of Manhattan, about a dozen
members of the nationwide Roman Catholic organization Courage go through a 12-step program that helps them try to live chastely.
For Jews, there is JONAH — Jews Offering New Alternatives
to Homosexuality — based in Jersey City. It runs online and in-person support groups for “strugglers” and
organizes special immersion weekends focused on family dynamics and emotional healing for people dealing with what they call
“same-sex attraction.” They also hold a support group for parents of gay children.
Mr. Matheson, who holds a master’s in counseling and guidance
from Brigham Young University, began full-time practice in New Jersey in 2004 and juggles an active roster of some
50 clients. He charges $240 for a 90-minute session.
Mr. Matheson trained under the psychologist Joseph Nicolosi,
president of the National Association for Research and Therapy of Homosexuality, a prominent secular organization in the ex-gay
movement.
The emphasis in Mr. Matheson’s counseling is on helping
men — all his clients are male — develop “gender wholeness” by addressing emotional issues and building
healthy connections with other men. He said he believed that helped reduce homosexual desires.
“The therapy I do really just uses standard, normal therapeutic
principles,” he said. “Cognitive therapy and emotion-based therapy, standard therapeutic approaches, with an emphasis
on helping them feel more comfortable in their masculinity.”
Defenders of sexual reorientation programs point to a 2001 study
by Dr. Robert L. Spitzer, a psychiatrist at Columbia University, who interviewed 200 people who said they had successfully changed their
orientation and concluded that many of their accounts seemed credible.
But after enduring an avalanche of criticism from peers who
said he had given too much credence to the accounts of his subjects, many of whom were leaders of ex-gay ministries, Dr. Spitzer
now says many advocates of sexual reorientation have misrepresented his views.
“Although I suspect change occurs, I suspect it’s
very rare,” he said. “Is it 1 percent, 2 percent? I don’t think it’s 10 percent.”
Conversations with more than a dozen participants in programs
in the New York area revealed a range of wrenching stories and outcomes. Some told of years of struggle with little to show.
Others said their gay feelings had clearly diminished. Several insisted they had experienced a complete turn to heterosexuality.
But even Kevin Dickson, 37, who leads the Living Waters program
at the Vineyard church in Morristown, said he was cautious about promoting change. “If someone says, ‘Go to this
ministry and you’re going to come out straight,’ if you don’t, then how are you going to feel about yourself?”
said Mr. Dickson, who was openly gay until three years ago and now lives celibately.
He says his attraction to men still exists, but is greatly diminished.
“I’m resolved to the fact that’s always going to be a temptation, but who’s not tempted by something?”
he said.
But leaders of LIFE Ministry boldly declare that complete “freedom”
is available for anyone willing to put in the emotional and spiritual work.
Robert Schaeffer, 44, one of the group’s facilitators,
is a former pastor who spent years secretly having sex with hundreds of men. After he discovered he was H.I.V.-positive,
he divulged his secret to his Pennsylvania church and his denomination sent him to LIFE Ministry. He began dating a woman
after two years of counseling and eventually married her. He now proclaims himself to be completely free of homosexual desires.
“This ministry pointed me toward the emotional roots of
homosexual desire,” he said. “The ungodly reactions to pain in my early formative years are really what I had
to look at to get free of this.”
But for every ostensible success story, there are many other
stories of people who have concluded they were deluding themselves, including some who used to be among the movement’s
most visible leaders.
Peterson Toscano, 41, spent years in ex-gay ministries, including
LIFE, during the 1980s and 1990s and eventually got married, only to see his marriage fall apart after he was unable to keep
his homosexual urges in check.
He finally decided: “If you keep trying this, you’re
fooling no one.” Now openly gay, Mr. Toscano lives in Hartford, attends a gay-friendly Quaker meetinghouse and performs
solo comedy sketches around the country, including one that pokes fun at his experiences in the ex-gay movement.
As for Mr. Larsen, he feels positive about his progress. He
called his attraction to other men now more like merely “noticing” them, as opposed to “this super-strong
urge.”
“It doesn’t take me into a bad place,” he
said.
But, significantly, he no longer says that completely eliminating
his attraction to men is his final goal. He has come to see his temptations as a trial and an opportunity for growth. He cited
a verse from the Gospel of Matthew that urges followers of Jesus to take his yoke upon them and they will find the burden
light.
For him, he said, the burden is beginning to lift.
source site: click here
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