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Book Review

Book Review-Invisible Heroes: Survivors of Trauma and How They Heal

Trauma survivors aren’t heroes in the same sense that a first responder is.  We see the first responder at the scene of an accident, like a house fire, and see how their actions are protecting all of us.  We don’t get to see the hard work that trauma survivors do, because their work is internal.  That’s why the title Invisible Heroes: Survivors of Trauma and How They Heal makes so much sense.  The work is invisible on the outside – until the trauma victim reemerges transformed by the trauma.  (See Transformed by Trauma for examples.)

Predictable Pacification

Too frequently after a trauma, a person blames themselves.  They think that they somehow – often magically – should have avoided the situation.  Of course, in many cases, there is no way to see or avoid the situation.  It’s one of the random things that happen in life.  Even in those cases where we could have made different choices – and likely will in the future – there’s little reason to ruminate over the choices that were made.

This need for a sense of control – innate to all humans – drives us to take too much accountability for the things that have happened and how we might have made things turn out differently if only we had done something differently.  We fail to accept that we may not have done anything wrong or incorrectly.  We believe we had to have done something wrong, so that we can maintain our belief that the world isn’t random and that we’re able to predict it.

The degree to which we believe we can predict the situation influences the degree to which we feel peaceful.


One of the challenges with the unnecessary attribution of blame to ourselves from the randomness of life is that we can take on ourselves a sense of unworthiness.  That is, we believe that not only did we make a mistake (guilt) but that we’re unable to do the right things (shame).  We start with shame, but eventually we start self-punishing and self-isolating, perhaps progressing even to a place where we believe we’re irredeemable.  There’s nothing that can happen to make us worthy of interacting with other mortals.

Sometimes, this thinking style becomes so pervasive because of continued trauma and abuse that the idea of returning to what others would consider normal is uncomfortable.  It can feel weird and uncomfortable for people to treat you as a fellow human instead of someone beneath them.

The truth is that no one is irredeemable.  Everyone deserves to be treated as a human – even if that’s not their norm.


Substantial traumas often create a division in a person’s lifeline.  There’s a time before the trauma and a time after the trauma.  Often, traumas cause a major change of course.  One of the ways you can recognize that someone acknowledges their experience was one of trauma is that they’re able to acknowledge their life is different – in more than a tactical and mechanical kind of way.

With smaller traumas, or traumas that persist over a longer time, it’s harder to see this demarcation point, but it’s rare that trauma doesn’t cause us to change in some way or another.

Something that Happened to Me

With time, in the post-trauma space, it’s possible to recount the trauma without reexperiencing it.  Until we can establish an explicit memory of the trauma and come to some terms with what it does – and does not – mean, many victims reexperience the event while retelling the story.  With new traumas, it’s important to not push them to recount the events, because doing so may accidentally amplify and anchor the trauma in their mind.  Rather, we should let people share at the speed, detail, and level that they’re able to.  If we can create a safe space for them to process the trauma, they can move it to something that happened in the past.

It is even better when we can recognize that one trauma or even multiple traumas don’t define us.  Yes, there is that demarcation line where things changed, but it’s not the entirety of who we are.

Work is Hard and Necessary

I’ve never found anyone who would dare to say that overcoming and moving past trauma is easy.  Even those who are grateful for where they are today would neither recommend their trauma nor relish the work they had to get to their place of healing.  Victor Frankl in Man’s Search for Meaning explains his time at a concentration camp.  While he exposes some of the things that helped him and others survive, he doesn’t recommend it.

There’s a delicate balance of experiencing the event while replaying it at a level that’s safe enough but vulnerable and raw enough that it’s possible to make sense of the event.  Sometimes, the only sense of control you can get in a trauma is the extent to which you allow yourself to experience it and your insistence that it won’t define you.

Mastering the Waves

Trauma survivors will tell you that you’ll always experience triggers that connect you to the traumatic experience, but they change.  It can be likened to riding an emotional wave on a surfboard.  You are still moved by it, and you’ll likely end up in the water at some point.  In the meantime, you can stay above it, using the energy to propel you forward.  Surfers, even professional surfers, fall off their board, but until they do, they’re able to do some amazing things.

One way to make trauma better is to learn the skills that allow you to spend more time above the wave and less time being pummeled by it.

Internal Perception of Danger

One step is recognizing that, often, the danger and fear associated with the event are in the past.  It’s quite likely that the fear of that moment doesn’t continue into the current moment – or shouldn’t.  What we come to realize is that it’s our internal perception of danger that matters more than the objective measure of risk.

We can use a set of well-known techniques to shift our perception away from momentary and current danger to a sense of relative safety.  Some of those techniques are below.

Play Acting a Different Ending

It’s magical thinking.  It’s the domain of the two-year-old – but it works.  For Victor Frankl, it was imagining his wife.  He knew she might be dead, but hearing her speak to him transcended that actuality.  He was able to create a scene in his mind that he knew to be reassuring but also false.

One way that we can reduce the suffering associated with trauma is to replay the event in our mind with different endings.  We can know they’re not real but at the same time be comforted with alternate endings.

An Army of Heroes

One alternate ending that can be valuable is to call in for a hero you can trust – real or imaginary.  These heroes can stand with us in our mind’s eye of the moment.  For some, they have a single hero who can stand with them.  For others, it’s a cadre of heroes, each with their own special skills and protections to offer.

This stands in the fantasy land of the child and at the same time offers us healing.  The real heroes aren’t the Invisible Heroes of our imagination but are those who fight their way out of the wake of trauma.

Book Review-Reducing Secondary Traumatic Stress: Skills for Sustaining a Career in the Helping Professions

When you think about it, there are dozens of professions that are focused on improving society.  We think of first responders in terms of firefighters, law enforcement, emergency medical personnel, and 911 dispatchers.  However, we forget about our mental health professionals, teachers, child protective services, and dozens of other professions that are exposed to the traumas others are coping with.  Reducing Secondary Traumatic Stress: Skills for Sustaining a Career in the Helping Professions is designed to serve those who serve others by helping them learn to address the hardest parts of their jobs.


Early on, Miller speaks about burnout harking back to Freudenberger’s Burn-Out.  He incorrectly associates Maslach’s work with Freudenberger’s, perhaps because that’s the narrative that has been spun.  (I should say that Freudenberger’s book isn’t the oldest book on burnout: that distinction belongs to Professional Burn-Out.)

Miller, however, correctly identifies the key to burnout as feelings of inefficacy.  He challenges the notion that you’re burned out at the end of a long career and explains that burnout happens more frequently at the beginning of a career – not the end.  Of course, this is consistent with the research we did when building Extinguish Burnout.

Compassion Fatigue

Miller similarly pushes back against compassion fatigue.  He argues that it’s not that you’ve expressed too much compassion, but rather that you’ve closed yourself off to all feelings and empathy with the result of failing to express compassion for those you’re there to serve.  In Is It Compassion Fatigue or Burnout?, we speak about it from the perspective that professionals have failed to do their self-care.  The result is the same: you shut down, and it’s this shutdown that’s perceived as compassion fatigue.

Systemic Stress

Too many mental wellness programs are little more than herbal tea, soft lighting, and a once-a-month yoga session.  While these practices have some value, they’re often crushed by the onslaught of 50-minute sessions, crisis calls, and complex cases.  The physician that can’t find time for a bathroom break between 15-minute patient appointments won’t find what they need at the bottom of a teacup.  The paramedic whose sleep was just interrupted to respond to an accident doesn’t need soft lighting.

We can’t assume that we can put a band-aid on a gaping wound, and it will all be okay.  We have to match the care that we give to the need.

Feel or No Feel – There Is No Try

My apologies to Yoda.  You can’t selectively let in some feelings and dampen others.  You can’t decide to let joy through but block depression.  When we numb – either naturally or with pharmaceutical assistance – we block both the good and the bad.  This is part of Miller’s point: when we try to block out the struggles of empathy, we necessarily prevent the development of compassion.  We can either choose to open ourselves to experiences and live, or we can wall ourselves off from the world and from others.  If we choose that option, we disconnect ourselves from the broader community and their support for when we’re feeling low.

No Feeling is Final

What we know about feelings is that they change.  Even moods change over the longer course of time.  (See Emotion and Adaptation.)  It is hard to remember in the moment that the feeling will pass.  (See Capture.)  However, the only thing constant about feelings is that they do change.

There is something to be said for actively shaping your thoughts while accepting them.  One can work to hardwire happiness without preventing acceptance of other emotions.  (See Hardwiring Happiness.)  Too many people believe that feelings happen to you – and it can certainly feel that way.  However, we know that you can consciously influence your feelings by focusing attention on the emotions that you want to have.  Caution is appropriate here so that we don’t over emphasize what can be done, as Bright-sided and Happier? Are concerned about.

Removing Rumination

Rumination is the opposite.  It’s focusing on the same situation and the challenges associated with it without finding ways to resolve the problem.  Instead of problem solving, rumination catches us in a net of repetition.  (See Capture.)  If we want to break free from rumination, we must either seek to solve the problem, or we must learn to let go.

Miller proposes an ACES (Action, Concrete, Experiential, and Specific) model for problem solving.  You know it’s not rumination when you’re coming up with specific, concrete actions that are doable.  Problem solving doesn’t mean that you must solve the end problem yourself.  Even identifying the specific set of actions you’re going to do to ask for help is enough to allow your mind to let go of it.

It used to be that I’d be caught in a loop of trying to not forget something that I needed to do in the morning.  Now, I grab my phone, send myself a quick one-line email, and go back to sleep.  Knowing that I’ll see it in the morning allows me to let it go and move on to the important need for sleep.

Letting go of something is the other option.  It’s easier when you’re deferring it, but for some things that we ruminate on, we need to accept that we have no control of.  We can’t prevent something from happening or cause it to happen.  No amount of rumination will change the outcome.  As uncomfortable as it can be, sometimes we just must let the cards play out the way they’re going to play.

Energy Management

The narratives around burnout, compassion fatigue, and secondary traumatic stress are collectively focused on a false dichotomy.  They generally believe that your energy is drained or consumed at work and refilled at home.  The expectation is that work grinds you down, and your home life is fulfilling and life-giving.  However, for many people, this isn’t the case.

At work, they feel effective and fulfilled in their role.  They know what to do and how to get good results.  At home, they’re in a constant struggle with their spouse.  Their teenage kids don’t listen to them and are downright hostile.  They don’t know what they did wrong or what it will take to fix it – but they know they don’t like it.

More often, it’s in the middle, where some things at work build and renew a person – but there are times of exposure to trauma and tragedy.  At home, they find both love and challenge.  It’s not about the place but rather about the moment-to-moment environment that defines whether someone is receiving more energy than they’re giving.

Driving with the Brakes On

If you’ve ever had the experience of having a car brake caliper freeze up, you quickly have discovered what it’s like to drive with the brakes on.  (Hint: it doesn’t end well.)  A less eventful situation might be what happens when you forget and leave a parking brake on.  Unfortunately, that’s what happens with too many people.  Their sympathetic and parasympathetic systems get locked into a fight, and they get stuck or oscillate.  If we want better results, we’ll find a way to either have the brakes on or put our foot on the accelerator.

Generally, when the parasympathetic system (brakes) is engaged, the sympathetic system shuts down – but not always immediately.  With patience and practice, it becomes easier to downregulate and recover more quickly when we do become triggered.

Blessin’ or Lesson

Miller quotes a Southern saying that “everyone you meet is a blessin’ or a lesson.”  In other words, they’ll either attempt to bring you good or bad.  Either way, you must learn to work with them.  Knowing ahead of time which one they are is one step towards Reducing Secondary Trauma Stress.

Book Review-Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal from It

When Paul Conti’s brother, Jonathan, killed himself with the handgun that his father had been issued in the Korean War, his life changed.  It wasn’t simply that he experienced the loss of his brother, but it also caused his desire to focus on understanding trauma and why he couldn’t see the struggles his brother was facing.  In Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It, Conti tries to expose the internals of how we process trauma so that we can learn to see it and process it.

For Generations

One of the often overlooked aspects of trauma is that it has a ripple effect that expresses itself across generations.  In Why Zebras Don’t Get Ulcers, Robert Sapolsky shares not only the research from the adverse childhood experiences (ACEs) study but also the work on fetal onset of adult disease (FOAD).  To clarify, the stress of the mother can have a negative impact on the health of the fetus.  More broadly, we’ve begun to learn that it’s more than genetics that leads to health outcomes, it’s epigenetics.

That is, our genes are activated and deactivated by our environments.  While two identical twins start out with an identical set of genes and gene expression, through different experiences, they can end up with different gene expressions – and therefore different outcomes.

The implications of this are that a traumatic event or set of traumatic events can send ripples across time into future generations.

Marshmallows of the Future

In the person themselves, trauma changes things.  It makes the world a bit less stable.  It causes us to believe that our dreams and aspirations aren’t possible.  They’re not real.  Irrespective of the facts, we insist on staying in the here and now so that we aren’t disappointed when the future disappears.  This has a negative impact on our ability to hope.  (See The Psychology of Hope.)

When Walter Mischel tested preschoolers to see how they could handle delayed gratification, he didn’t realize what he was measuring.  (See The Marshmallow Test for a full explanation.)  Ultimately, the test was about whether children would sit with a sweet in front of them for a short time without eating it, with the promise of more if they did wait.  (It wasn’t always a marshmallow that Mischel used.)  Retrospectively, it seemed that those who could delay longer did better in life.  However, what’s more interesting are the strategies that the preschoolers used.  Some could clearly see the value despite the future, discounting what Daniel Kahneman explains in Thinking, Fast and Slow.  Other research, including Paul Tough’s in The Years that Matter Most, leads us to understand that those who have the most trauma have the hardest time trusting in future gains.

More tragically, trauma can leave us questioning our self-worth and our gifts.  We begin to consider life in terms of some sort of grand karma.  If we’re really good and worthy, then trauma wouldn’t happen to us.  Of course, that’s not fair, but it doesn’t stop the evaluation.  As The Halo Effect explains, life is probabilistic, not deterministic.  Bad things do, in fact, happen to good people.  While Thomas Gilovich explains in How We Know What Isn’t So that we have a bias towards believing better of ourselves than we should, trauma can reverse that wiring, so we believe we’re not as good as we are.

Presumed Control

If you speak with an abused child before they’re removed from the abusive situation, you’ll often hear that they believe the abuse they receive is their fault.  They believe that if they’re just a better child, their mommy or daddy won’t hurt them.  This illogical conclusion is the one that their minds are forced into, because the alternative is more painful and tragic than believing that they can, with their behavior, prevent the abuse.

If the abuse has nothing to do with how good or bad they are (or their behavior at all), then it’s unpredictable and unstoppable.  They must believe that the abuse and pain will continue forever – and that’s not something they’re prepared to do.

We all do this throughout our lives, not just in childhood.  We try to take control of the situation, so that we don’t have to fear it.  (See Compelled to Control for more.)

Inciting Illness

One way that we see this same dynamic in adults is when they believe that the trauma they experienced is their fault.  From the automobile accident that they blame themselves for to the cancer that couldn’t have been prevented, people believe that it’s their fault.  The result is shame – “I am bad” – driving the sense that they need to punish themselves.  Somehow in the punishment, they’ll equal out the scales of justice.  There are two key problems with this.  First, the sources of the traumas are almost universally external to the person.  Second, no amount of self-flagellation will even the scales.


Brene Brown calls it “enough.” (See I Thought It Was Just Me (But It Isn’t).)  It is the feeling that we’re not “good enough.”  We’re not “doing enough.”  We’re not worthy of what we have or even of being on the planet.  It’s the less extreme form of impostor syndrome that too many people routinely feel.  While inadequacy can be a powerful drive to cause people to strive to do more and be more, it comes at a cost.  The cost is both the happiness of the person and, sometimes, their life.  In Perfectionism, we learned the psychic toll that perfectionism – or inadequacy – brings.  When we believe we’re not enough, we can never get a break from ourselves.

The Costs of Survival

We celebrate the survivors of trauma of all kinds.  We admire their strength and their courage.  However, we never ask ourselves what it took to get there.  We celebrate the war hero who walked his team out of the firefight, and we don’t ask what he had to do.  We don’t want to know about the prisoner or little kid he had to kill to survive.  We don’t want to know how deep that trauma goes.  We fail to notice when we try to celebrate them, and they squirm away.  It’s more than being shy.  It’s a deep sense that if people knew what they had to do, they wouldn’t celebrate their return home in the same way.

Computers and Chainsaws

Both computers and chainsaws are tools with immense positive potential.  They’re also tools through which someone can inflict suffering.  With both, if we learn how to operate them safely, we can prevent trauma.  The unfortunate reality is that anonymous forums lead to mob-like or gang-like behavior where people become worse than they’d be on their own.  (See Going to Extremes and Delinquent Boys for more.)

Protecting people from unsafe spaces is, in part, requiring that individuals be held accountable for their comments – or, at the very least, having their name attached to them.

Not Mine

Whenever there’s a negative outcome, it’s appropriate to ask to what degree your behaviors influenced the outcome.  What could you have done differently?  What should you do next time?  These are healthy questions that can take an unhealthy turn we if decide that we need to not only own our own dysfunction in the situation but the dysfunction of others as well.  A wise friend once explained that “that’s not my shit.”  She explained that sometimes you’re not responsible for the negative outcome – or certainly not responsible for all of it.

It’s important to take responsibility for your part – but equally important that you not take responsibility that’s not yours.

Facts and Fallout

The law is concerned (ostensibly) with the facts.  They want to assign guilt and blame.  They are not equipped to help trauma victims cope with the fallout.  The penalties that are assigned to criminals are used as a deterrent to prevent their own and others perpetrating the crime in the future.  There as some crimes – like murder – for which there is no compensation.  Criminal trials aren’t concerned with that.  Civil trials are, but only a small fraction of trauma-inflicting events are the subject of a civil suit.

Criminal trials are themselves sometimes more trauma-inflicting than healing.  It can be hard to confront the person who injured you and hard to defend yourself against the questions and implications of their attorney.

Pre- and Post-Trauma

When people have a single, defining trauma, there seems to be a bright line between the before and the after.  The trauma created a change in the person (that may still be evolving).  That change can be seen in the pre- and post-worlds.  Sometimes, people speak of recovering or returning to the place before the trauma, but the place no longer exists.  We must build a new place with new awareness – and that isn’t always easy.

Given that it’s estimated that 90% of us will experience trauma in our lives, it makes Trauma: The Invisible Epidemic.

Book Review-Fighting Fires: How Emotional Trauma Sparks an Inferno

For many first responders, firefighters included, the idea of mental health is for the other guy.  It’s a tough job and you’ve got to “man up” and be tough.  However, at the same time, the things that first responders see, hear, do, and not do, are unforgettable.  They’re confronted with the worst that humanity has to offer.  It’s the most suffering, the most cruelty.  It’s also times of greatest compassion.  Fighting Fires: How Emotional Trauma Sparks an Inferno is David Lewis’ journey through trauma that he experienced outside of the job, inside the job, and through life.  No question he experienced trauma through his work as a firefighter, but that wasn’t the only trauma he experienced in his life.

Fire and Smoke

Lewis describes mental health as the pillar upon which life is built.  It’s a sound argument, since the life we experience is the one that we create.  Incognito shows us just how much of our lives and what we think is reality is made up.  Life is really what we make of it – and it can be filled with fire and smoke, or it can be fresh air.

Lewis uses the analogy that fire is the traumatic events that you see, hear, do, or experience.  Smoke is the problems as a result of that fire.  He properly places the focus on the fire portion, recognizing that smoke is a result of fire.

The Charlatans

Early on in Lewis’ attempts to get better, he describes running across an “internet guru” that claimed to have the elixir that Lewis needed to be “fixed.”  All it would take is a credit card.  The free materials seemed good, so Lewis parted with hard-earned money only to realize that the content behind the pay wall wasn’t really worth it.

The real problem is it’s easy to make things look like they’re good when it’s shallow; it’s hard to make sense of it when it’s deep and it matters.  I cannot count the number of burnout books that I’ve read where the authors had no breadth or depth in what they’re saying.  They saw the opportunity to make a buck selling some books and consulting, and they dropped right in.  (Even Maslach’s latest book, The Burnout Challenge, is woefully under-researched.)

Even professional mental health providers rarely read research or use evidence-based techniques.  Too frequently, they just do what they think works, leading to Science and Pseudoscience in Clinical Psychology and The Cult of Personality Testing.  Even in an area where the public is supposed to be protected through licensure, we’re confronted with the need to carefully screen people, as Lewis points out later in the book.

Coloring in unicorns may be fine for an eight year old, but it’s not appropriate for a professional firefighter – or most other adults, for that matter.

Buffalos and Cows

For the most part, cows and buffalo seem like similar animals.  They’re both mammals.  The buffalo burger is leaner but is similar in taste to a hamburger.  (Why “hamburgers” come from cows not pigs is a mystery.)  However, they have some different behaviors.  One is how they cope with the stress of a storm.  They react like people react.  Buffalo charge into the storm, while cows walk away from it – even when they’re in the midst of the storm.

The subtle change of moving into or away from the storm has a profound effect on how long the animal is in the storm.  The buffalo will spend much less time in the storm than the cow, because the storm passes over quicker.

As humans, we often turn away from our challenges expecting that we can escape them – but rarely is that effective.  Sometimes, the right answer is to face the storm and walk into it.


When the mental anguish becomes so strong that you’re fighting intrusive thoughts, there are many strategies that one may employ in an attempt to retain balance.  Unconsciously, there may develop a tendency towards obsessive compulsive disorder (OCD), including ritualized approaches to common activities.  We can deceive ourselves into believing that these activities protect ourselves and our families, when in reality they deprive us of the resources that we need to heal.

A more common and more socially acceptable approach is to become a workaholic.  (See The Globalization of Addiction for more.)  After all, being a workaholic means that you’re providing for your family.  However, the dark side is that work becomes all-encompassing, leaving little of the person for themselves or their families.  It’s common to believe that if you just work harder, you can block out the feelings and memories.  However, doing so deprives you of the very resources you need to live – and to recover from the pain and trauma.


As Compelled to Control clearly points out, we all love the illusion of control.  The illusion protects us in a random and ultimately unpredictable world.  It calms our consciousness as we confront the challenges of the world.  If we’re in control, then we don’t need to fear the world.  We can feel safe.

Some would say that we can control ourselves but not others.  However, in some ways, we’re so influenced by our environment, and we respond so instinctively at times, that it’s hard to convincingly say we’re even in complete control of our own reactions.  (See Thinking, Fast and Slow for more about how we lie to ourselves.)

Defined by Our Responses

It’s not the tragedies and struggles we’ve faced that define us.  What defines us is how we respond to them.  Problems, struggles, and challenges are the substance of life.  We can’t escape life without problems.  In fact, sometimes when we believe we’re helping animals, we’re dooming them, because they need the struggle.  (See Beyond the Wisdom of Walt for more.)

There’s no shame in being injured – if we can heal.  If we need help to be able to heal, then we should ask for it.

Worst Case Scenario

Sometimes, we’re so afraid of playing the worst-case scenario game that we won’t play it at all.  Other times, we won’t play the game fairly.  In a bit from a comedian friend, he speaks how his mother moves from how he isn’t overly responsible through owning dogs to having a child that dies of neglect.  This wholly illogical chain of thinking is the way that too many people think about worst-case scenario.

Instead of looking to the things that can happen and reasonably evaluating their probability and impact, we focus on the case where the Earth is impacted by an asteroid – something that’s both always a possibility and something that we have no ability to prevent or mitigate.

By avoiding the game, we trap ourselves into a set of beliefs about a threat or stressor that aren’t realistic.  Like a large shadow from a small person or animal, we magnify the size of the problem, because we refuse to look at it directly.

The Balance of Life

In a state of suicidal crisis, it’s possible to lose all sense of scale.  Lewis explains how buying a toy for his son and dying by suicide seemed to be of the same magnitude.  Somehow, he thought that the scales of justice would be even.  Reflecting on it, Lewis can see how “jacked up” his thinking was – but in the moment, the evaluation of the balance of life was such that it had no special meaning.

The research and reflections seem to validate Lewis’ experience that life and the possibility of hope aren’t given their due significance.

Focus Forward

Trauma, whether acute or chronic, is a tragedy.  It’s something that each of us must learn to process, to come to terms with.  We can’t run from our challenges, and we can’t pretend they don’t exist.  Eventually, they’ll add up to a point where they compel us to address them – and by that time, they’ve grown fearsome.  If we get the choice, we should want to pick smaller fires when we’re Fighting Fires.

Book Review-Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body

A common experience in trauma is dissociation.  One of the clinical therapies most focused on grounding and being present – the opposite of dissociation – is Gestalt.  The intersection of these two opposites is an interesting space for healing.  Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body walks in the middle of the experiences and shows how one might connect the two.

If you need a definition of psychological trauma, please see Trauma and Recovery.

Living in an Uncertain World

The heart of the problem with trauma is some event that shatters our beliefs about the world.  Psychological trauma is an event – something you’ve experienced or done – which cannot be integrated into your beliefs.  Too often, the belief that’s called into question is the one about the world being predictable.

Many people see the universe as a big clock with gears spinning and whirring.  Everything has the mechanical precision of cause and effect.  There’s no room for chaos theory or Lorenz’ tornado-causing butterfly.  (See Facilitating Organization Change.)  It is this predictable world that we live in, because it’s a place of safety.  If we believe the world is probabilistic, then we’ve got to accept that bad things can happen to good people, and that’s not okay.

Still, we know that probabilities exist.  We watch batters swing and miss at the baseball plate.  We play the lottery and expect to win – knowing that the probability is very small.  We spin the wheel and roll the dice but keep for ourselves a separate thought about the safety of our world.

The first thing to accept about our world is that it’s random and impermanent.

The Disconnect

Central to Gestalt is being in contact with oneself.  This is a conscious, and non-judgmental, assessment of the body and mind.  This includes feeling our breathing, our heartbeat, the state of our muscles, and so on.  It also includes an assessment of our emotions and whether they appear to be influencing bodily processes.

In some cases, trauma victims believe that exploring these sensations is dangerous, because it will bring back the traumatic event or that, once experienced fully, they’ll not be able to contain them.

Expanded Choices

A sign of trauma is constricted thinking.  Some things are, quite literally, unthinkable.  So, one sign that someone is recovering from – or healing from – traumas is the capacity to consider other options.  Capture explains how thoughts can sometimes enter downward spirals.  In Trauma Therapy and Clinical Practice, the statement is about the barriers to escaping those cycles.

The reality is that we always have choices.  Instead of the tightly coupled idea that someone or something “made you” do something, the more accurate statement is that you reacted to their action.  Emotion and Adaptation explains there’s a gap between stimulus and response, and that gap allows us to respond rather than react.  We can, in fact, choose our responses, if we decide we want to and we practice it.

Regulated Arousal

Much of the work on psychological trauma resolution is on increasing our capacity to process the event.  This can mean increasing our resources or decreasing the impact of the event.  Much of that is finding ways to regulate our arousal as we consider the event.  If we can reduce the emotional responses, including fear, to a more manageable level, we can better process the event.

On the surface, it sounds simple, but it requires a set of techniques like desensitization, building safety, and the core work of Gestalt, grounding.  These tools and others allow traumas to be processed and thereby stop their intrusive nature.  (See Trauma and Memory for more.)

Between Too Ordered and Too Disordered

Live is about making decisions.  It’s selecting the right choice or option for us at the current moment.  Much has been written about how we make decisions – and the consensus seems to be that there’s an optimal range for people to operate.  (See Decision Making and Sources of Power for more on how we make decisions.)

Gestalt views this from the lens of being too ordered – or too disordered.  You wouldn’t expect that even creativity is helped by some bounds, but that’s what Creative Confidence says about how to be creative.  So, despite getting a bad reputation, constraints can be helpful.  Simultaneously, they can be too restrictive and can choke off both creativity and joy.

Sometimes the traumatized person has added constraints to their world (by themselves).  It’s important for them to determine whether those constraints are too much – or if they need to add some healthy boundaries and limits.

Hovering at the Thresholds of Tolerance

Flow is a highly productive state that lives in the narrow band between challenge and capability.  (See Flow, Finding Flow, and The Rise of Superman for more.)  In this gap, research finds 5x performance gains and real growth.  It’s not hard to imagine how hovering around the edge of our tolerance might be a powerful way to learn to process trauma.  In fact, this is the core of desensitization: keeping people safe while moving them progressively closer to something that triggers them.

By hovering at the edge of tolerance, at the edge of safety and our capacity, we expand that capacity and make it more likely that we can process trauma at some point.  It’s critical here to celebrate the progress, because it can seem painfully slow when you want a solution now.

They Can’t Hurt Me, I’m Not There

Dissociation is a natural response to an overwhelming event.  When the event is very close to the threshold for processing, it may be that it’s only compartmentalized.  That is, we’re aware of it, and we can’t process it, but we’re still present and connected.  At the other end of the continuum, there’s severe, clinical dissociation.  Dissociation is a process of distancing ourselves from an event to protect ourselves from it and its impacts.

Obviously, if there’s physical trauma, dissociation doesn’t prevent that physical trauma from happening.  It does, however, separate the processing of physical trauma.  For instance, someone in an accident may see the scene from outside (and often above) their body.  They don’t feel the pain associated with physical trauma, because their consciousness is separate from their body.  It’s this dissociation that led more than one trauma victim to say, “They can’t hurt me, I’m not there.”

A technique recommended in the book when speaking with people who may be dissociating is to ask them what percent “in the room” they are.  It’s a continuum between wholly present and not present at all.  Often, the person you are speaking with – when prompted – can judge the degree to which they are currently dissociated, providing clues about whether it’s time to add more safety to the conversation or whether it’s safe to press on.

Relationships for Healing

Healing happens in relationships.  When you look at the factors that most impact outcomes in psychological care, the number one answer is called the “therapeutic alliance.”  (See The Heart and Soul of Change for more.)  It is the relationship between the therapist and the patient.  It’s much more important than the actual techniques in use.

In difficult work with substance use disorder (SUD) patients, Motivational Interviewing starts with engaging the patient, because without a relationship – even a professional relationship – nothing else matters.

While this book is focused on clinical applications, we know that we are most likely to influence the people with whom we have a relationship.  In fact, Everett Rogers in Diffusion of Innovations believes that it’s the only thing that can change someone’s attitude – and ultimately their behaviors.

Disorganized Attachments, Trauma, and Cults

Perhaps the most disturbing thought from Trauma Therapy and Clinical Practice is the way that trauma creates a disordered attachment style where none existed before.  Terror, Love, and Brainwashing explains that it’s disordered attachment that makes cults possible.  Often, the cult leader induces the trauma – but it’s also possible that a recent trauma could make people more susceptible to cult leaders, because they’re already partially or completely in a disordered attachment style.

I don’t believe you need to be a clinician to find ways to help people who have experienced trauma reconnect, and Trauma Therapy and Clinical Practice may have the tips to make that easier and faster.

Book Review-Managing Suicidal Risk: A Collaborative Approach, 2e

The first highlight is “helping people find their way out of suicidal despair.”  That is a wonderful testimony and summary of Managing Suicidal Risk: A Collaborative Approach.  Sometimes when you read a book, you get a real sense for the heart of the author, and this is the heart of David Jobes: to reduce the pain and suffering that leads to suicidal despair.

(It’s important to note that this review is about the second edition of the book, and a third edition has recently been released with substantial revisions.)

Throughout this review, I’ll frequently simplify interactions as clinician and patient interactions, as Jobes targets a clinician audience for his book.  However, I strongly believe that the approaches and techniques that he teaches through the book are appropriate and applicable to anyone who is committed to helping others.  Suicide prevention is an odd space of behavioral health where there is no diagnosis.  There’s no need to diagnose someone with suicidal ideation, because they directly state it.  There’s no need to compare a set of symptoms against a syndrome listed in DSM-V.  Rather suicide risk is seen as a side effect or symptom of other listed disorders.  Caring individuals would want to steer clear of providing psychotherapy – but supportive human contact would be appropriate for everyone.

Carl Rogers

Though Jobes only refers to Carl Rogers a few times, there are echoes of his influence throughout.  I was introduced to Carl Rogers’ work through Motivational Interviewing.  Words like acceptance, worth, autonomy, empathy, and affirmation pervade Rogers’ work.  The hallmark that summarizes his perspective is “unconditional positive regard.”  This is in stark contrast to the traditional way that people who struggle with suicidal ideation are treated by clinicians.

To be fair, clinicians themselves are fearful.  As clinicians, they’re concerned for their license and their livelihood in the event that someone under their care dies by suicide.  Jobes addresses this concern later in the book.  More importantly, from a human perspective, they care.  You don’t go into a profession that requires so much work and exposes you to so much trauma if you don’t have a heart for helping others.  The fear of connecting with someone deeply and losing them is a fear that we all share as humans and one that too frequently creates a distance and difference.  These natural tendencies in service of the patients is one of the things that Rogers saw and called on his colleagues to fight against.

Sometimes, this shows up as simple courtesy of not interrupting; other times, it shows up as acceptance that the patient’s perspective is real and correct to them at the current moment.  Whether the clinician agrees or not isn’t the point, and directly disagreeing with a patient about their perspective won’t be helpful.  Jobes uses other words to describe the same sense of empowerment, support, and care and the need for clinicians to accept the limits of their control.


The truth is that if a patient wants to die by suicide, they can.  No clinician is going to stop them if they make the decision.  What the clinician – and human helper – needs to recognize is that no matter how well intended, trained, or skilled they are, it’s not their life.  We can support others through their difficult times and encourage other choices, but, ultimately, the choices are not ours to make.

Clinicians should seek agreement that suicide is an option for later – not now – without pushing for a “no suicide contract.”  The thought is that the clinician and patient are collaboratively looking for other alternatives and ways to change the patient’s life such that suicide no longer appears to be a viable option.  The agreement is not coercive but rather a statement of shared commitment that life should be the preferable option to death – if the important problems in life are resolved.

Understanding the Suicidal Struggle

Whether the person is a patient pursuing clinical treatment or they’re a someone who has disclosed their suicidal thoughts to another human, there is an inner conflict transpiring.  The person doesn’t want to die, but they don’t want to continue living the way that they’re living today.  Simply understanding the reasons why life seems unbearable is a good foundation for the work on perspective-taking and problem-solving that will lead someone away from the idea of suicide as an option.

Shneidman called it “psychache” – that psychic pain that pushes people towards the precipice of pursuing suicide.  (See The Suicidal Mind.)  The enlightened workers in substance use disorder (SUD) realize that SUD starts as the numbing of some psychic pain, and, progressively, the person becomes trapped by the behavior.  (See Chasing the Scream, The Globalization of Addiction, and Dreamland for more on SUD.)  While we focus on SUD from a drug addiction perspective, other addictions like eating, sex, and gambling share the same roots.  We’re avoiding a painful psychic reality.  These may – or may not – be less urgent and life threatening, though they’re more socially accepted.  Even more socially accepted is the idea of being a workaholic.  However, all of these expose an underlying pain that is trying to be suppressed – and that can only happen for so long.  Eventually, the object of numbing becomes ineffective or overpowering.

Techniques like Motivational Interviewing are effective at managing SUD.  It shares similarities in the suggestions of Jobes, and it’s based on Rogers’ work and perspectives.  It’s fundamentally a listening process that focuses on what is the most important to the patient – and it helps them address the circumstances (or, more often, perspectives) that are causing them pain.

Stress, Press, Overwhelmed, and Trauma

Conceptually, we all think we know what stress is – right up to the point where we’re asked to form a formal definition.  (Trust is the same way, as Robert Solomon and Fernando Flores explain in Building Trust.)  Stress is something inside – an evaluation, as Richard Lazarus explains in Emotion and Adaptation.  Stressors exist in the environment, but stress is evaluation of the potential impacts of that stressor.  (See also How Emotions Are Made.)  Stress is bad, as is thoroughly explored in Robert Sapolsky’s excellent book, Why Zebras Don’t Get Ulcers.

What Shneidman connected to stress was Henry Murray’s “press,” which is the stressor.  I struggle with Murray, because much of his professional work seems as much built on fancy as fact, as I explain in my reviews of The Cult of Personality Testing and Love’s Story Told.  However, that doesn’t remove the validity of the basic concept of “press.”  So, press – the stressor – is invariably connected to stress, but not without the mediating factor of internal assessment.  Unfortunately, we know from Superforecasting, Predictably Irrational, Noise, The Signal and the Noise, and other works that our perceptions are notoriously warped by seemingly innumerable biases.  Capture takes this further into a personal spiral that can lead us to despair.  It’s the personal equivalent of what Cass Sunstein describes in Going to Extremes.

In short, the precipitating factor, whether called a stressor or press, is mediated by our assessment, and that assessment is frequently distorted.

Trauma, psychological trauma, is often poorly understood as well.  Psychological trauma is simply being briefly overwhelmed.  (See Trauma and Recovery.)  Thus, being overwhelmed is trauma, and we frequently evaluate stressors in ways that are at least temporarily overwhelming.

Sidebar: Being overwhelmed can be more long-term and connected with burnout (see Extinguish Burnout) or can be of a shorter-term duration that is more of a traumatic event or moment.


The SSF-4, the Suicide Status Form, is at the heart of the Collaborative and Management of Suicidality (CAMS).  The form is eight pages long, with the first four pages being dedicated to assessment and treatment planning.  A second section helps to track risk through the process, and the final two pages track outcomes and disposition.

It’s important to note that integrated into the form is the core principle of collaboration.  In places, it encourages the patient to fill out the form.  In places, it’s explicitly collaborative.  In places, it’s also clinician-led.  This, along with strategic repositioning of the clinician during the process of completing the form, conveys a sense of partnership that’s often missing in clinical settings – and one of which Rogers would likely approve.

There’s a substantial amount of research and wisdom packed into the form as a framework for guiding interactions.  From a learning perspective, it’s a sidekick productivity aid.  (See Job Aids and Performance Support.)  Its consistent use allows clinicians to focus on their clinical treatment approach while being supported and guided in the CAMS framework.

The SSF-4 also serves another important purpose for clinicians.  It encourages the proper documentation that limits malpractice exposure.  People will be upset when their loved one is lost due to suicide, but the form encourages the documentation that appropriate care was given.

For non-clinicians, understanding the components can help shape the kinds of support that can be offered to others.  Jobes selected some of the most important indicators of risk for inclusion from a list of hundreds if not thousands of possibilities.

The Big Five Variables

The SSF-4 starts with asking the patient to evaluate their psychological pain, stress, agitation, hopelessness, and self-hate.  This is followed by an overall summary rating of risk.  Psychological pain is the psychache discussed above from Shneidman’s work.  Stress is, as we also saw above, a frequently misunderstood phenomenon; here, it’s combined with being overwhelmed.  The remaining three factors are addressed separately in the following sections.


A child blows air into a wand, forming a bubble of water and soap.  The bubble floats aimlessly along until a moment of weakness causes a single spot on the bubble to fail before the entire bubble collapses in an instant.  The failure isn’t subtle or slow. The child can themselves accelerate the collapse by disturbing the bubble, like poking it.  Agitation, which Shneidman calls “perturbation” after the word’s use in the physical sciences, doesn’t itself cause suicide, but it hastens the path towards it if a person is already so inclined.


To understand hopelessness, one must first recognize that hope itself isn’t an emotion but rather a cognitive process, as Rick Snyder explains in The Psychology of Hope.  He explains that it builds on both waypower – knowing how to do something – and willpower – the desire or energy to do it.  A dimension often missed in Snyder’s work is the possibility that these can come from outside the person through their relationships or society in general.  For instance, in Trust, Fukuyama explains that different cultures focus their trust on the individual, family, and society, and the greater degree that trust is focused externally, the greater the degree that hope has seeds outside one’s own capacity.

For willpower, we find that Roy Baumeister has a work with the same name.  In short, it’s an exhaustible and regenerative resource that can be strengthened like a muscle.  (See also Antifragile for more on strengthening.)  Baumeister’s work is also represented directly by Jobes in the concept of self-hate.


Understanding how people can become self-destructive rather than having self-esteem is a challenge.  Self-hate leads to self-destructive behaviors – which is obviously a concern for suicide.  In Delinquent Boys, Albert Cohen explores the need for status and the inevitable disappointment that sometimes leads people to a path of self-hate and delinquency.  Albert Bandura’s work on Moral Disengagement creates an opportunity to see how people can do reprehensible acts based on structure and how they might come to develop self-hate as a result of their acceptance that they have done bad things.

A stop nearer on the path to self-hate is shame.  Brené Brown has described herself as a shame researcher at times, and her library of authored works is extensive – see Daring Greatly, Rising Strong, The Gifts of Imperfection, Braving the Wilderness, and more.  The key to understanding the difference between guilt and shame is that guilt is about “I’ve done wrong” and shame is that “I am wrong.”  Left unchecked, shame can easily develop into self-hate.  If people with shame aren’t able to separate what they’ve done from who they are and accept their good attributes, they’ll land in a place of self-hatred – and therefore vulnerability to suicide.


Before continuing, it’s important to note that the antidote to shame and self-hate is acceptance.  As Richo explains in How to Be an Adult in Relationships, acceptance is critical for our relationships with others and ourselves.  No one is perfect.  We cannot expect to be successful if our goal is constant perfection.  In The Paradox of Choice, Schwartz explains how maximizers – those who have to have perfection – are less happy with their lives.

For those with high standards, the immediate pushback is that perfection is possible.  This is true in the short term but is necessarily incorrect across long periods of time.  The goal for anyone should be the best they can do – excellence.  Carol Dweck’s work on Mindset and Mihaly Csikszentmihalyi’s work on Flow make that clear.  We can grow, change, and be incredibly productive.  However, we cannot do that if we’re focused on blaming ourselves.

Another, more fundamental, perspective is to recognize that one of the key tenets of meditation and mindfulness is the acceptance of thoughts as they pass followed by a release.  Instead of judging our thoughts, we simply observe them.  We accept them as a natural and normal part of consciousness.  (See Altered Traits.)  The more we can accept that even good people do bad things, the more we can release self-hate.

Preoccupied with Others

One of the observations about suicidal people is that they can become overly concerned or even obsessed with others’ perceptions of them.  Reiss might describe this as someone who is high on status or acceptance (inclusion, in this context).  (See Who Am I? for more.)  Some are motivated by the perceptions of people around them and, as a result, are particularly sensitive to bullying and other forms of social discrimination.

There has been good and credible criticism of social media and the rise of both depression and anxiety.  (See Alone Together for more.)  However, so, too, has there been research showing that technology and our always-on, always-connected world can help people find connections with others that wouldn’t have been possible before.  So, while our technological world has the potential for harm, it has the capacity to help as well.

It’s important to note that it’s the preoccupation that’s the challenge.  The tendency to ignore other perspectives – whether external or internal – is problematic.

Preoccupied with Thoughts

Another type of person is “in their own world.”  They’re consumed by their own thoughts and perceptions.  While there’s a validation of some objective – if potentially cruel – facts with those preoccupied with what others think, there’s no objectivity when someone is preoccupied with their own thoughts.  There is no automatic mechanism that leads to an accurate and grounded sense of the world.  While focusing on oneself and improvement can allow for the kind of advances that are discussed in The Rise of Superman, so, too, does the disconnection from external signals represent a risk.  This is the sort of problem that Capture is concerned with.

Reasons for Living and Reasons for Dying

When you see suicide as the fight between reasons for living and reasons for dying – rather than a binary sense of a desire to die – one can see how there is a constant internal battle.  In Principles of Topological Psychology, Kurt Lewin explains force fields and the forces that move people from one state to another or tend to keep them in the current state.  Some research implies that the reasons for dying are more powerful than the reasons for living.  That may be the case.  It may also be the case that the reasons for living in suicidal people aren’t as strong as reasons for dying.

Research seems to indicate that suicidal people have less aspirational and inspirational reasons for living.  They’re less inclined to follow themes of hope, future, plans, and goals compared to those who are not suicidal.  In short, the reasons for living are hollow – and they’re also the same reasons people would give for dying.

Prohibition of Self-Harm

Thomas Joiner’s Myths About Suicide catalogs a set of myths.  The first one is that “Suicide is an easy escape, that cowards use.”  In Why People Die by Suicide, his interpersonal theory of suicide explains that people who die by suicide develop a capacity for self-harm.  They somehow override the biological imperative to live.  Managing Suicidal Risk shares, “The eye-blink response data show that multiple attempers were extremely reactive to the unpleasant images.”

We don’t know whether this is a result of causing them to recall their own attempt or if it’s just a particularly strong natural aversion to harm, including self-harm.  However, it is interesting how it may be that there may be some visceral, intrinsic, and immovable aversion to self-harm that keeps these multiple attempters alive.  To be clear, I feel sorrow that their lives are such that they’ve been forced to come against this barrier.


A hallmark of Buddhism is the need for detachment.  It’s not disengagement.  It’s still doing the best you can – but recognizing that you don’t control the outcomes.  (See The Happiness Hypothesis and Resilient for more.)  Therapists confronted with a suicidal patient feel the humanistic pull to save the other person’s life, but the problem is that they can’t.  They can influence – and should.  They can care – and they should.  However, it’s always the person’s decision to live or die.

One of the hardest things for new therapists to accept is that they can’t accept responsibility for the behaviors of their patients.  They’re there to support, but the choices are ultimately the other person’s to make.  If a therapist can’t detach, then their emotions will become entangled in the situation.  They’ll change their responses to defend their own feelings – whether or not that’s in the best interest of the patient.

Legitimate Pain

Consider this statement: “I have never talked to a suicidal person who did not have legitimate needs behind his or her suicidal words, thoughts, and behaviors.”  This direct quote leads us to the most important and appropriate path.  Rather than simply prohibiting the option of death by suicide, perhaps we should focus on understanding the factors in the person’s life that lead them to consider it – or want it.  We can remain focused on measures to prevent suicide, but shouldn’t we focus on the items that would remove the burdens, barriers, and pain that make them want suicide in the first place?  Instead of trapping them in a living hell, shouldn’t we fix the things that are, to them, making it a living hell?

John Milton said, “The mind is a universe and can make a heaven of hell, a hell of heaven.”  While it’s often not appropriate to change the objective circumstances that a patient (or friend) is in, it can be that we can help them change their perspective on things that are relatively neutral.  There’s a fine line here.  It’s not the idea of polishing a turd.  Instead, it’s about finding ways to accept the reality and make the best of it.  (Acceptance is another of Richo’s “Five As” in How to Be an Adult in Relationships.)

Managing Means

Whether it’s a firearm or a stash of medications, having means available to someone is not ideal.  We know that most people who have suicidal ideation and plans won’t change their means.  If they’ve already expressed “the” method that they’ve chosen, it’s appropriate to prioritize focus on (at least temporarily) reducing access to that method.  If it’s a firearm that’s the chosen method, finding strategies to reduce access, from locking it up to removing it from the home, are appropriate.  If medications can be safely locked up by other members of the home, that should be pursued.  It’s possible to leave a small quantity unlocked for legitimate needs and keep the larger quantities off limits.

Some methods are relatively impossible to restrict means for.  If someone decides to die by suffocation (hanging), there’s almost always something around that can accomplish that goal.  If they decide they’re going to crash their automobile into something, you can look for ways to limit access to their automobile, but if they need to live, this may be impractical.

In short, while means restriction is a good idea, it may not always be as practical as we’d like it to be.  Jobes makes the point that, as a clinician, it’s your decision whether to continue treating if they’re unwilling to restrict access to means – and he’s clear this is a tricky issue.

Observationally, I’d say that there will be some people who you won’t find a way to reduce their chosen means.  However, I believe there are strategies that can be employed that will signal you understand the reasons for not limiting means – like I feel I need my gun for protection – and simultaneously engage them in strategies that will have a protective effect.

Consider someone who says that they’ll die by firearm – but it will be a specific one, and they have multiple.  In this case, perhaps this firearm can be locked up in their home in a way that they don’t have immediate access – like having a friend change the combination and keep it, or keep the keys to a key-based lock.  They can keep another gun for protection, but the one they’d use for suicide isn’t available while everyone is working on keeping them alive.

Gun owners are very resistive to the guns leaving their homes in most cases.  Strategies that leave the guns in their home but locked in ways they must ask for access from another person can sometimes navigate this space.

Coping Ideas

The development of a coping idea list is a part of the recommended practice.  It’s simply a list of suggestions for things that someone can do when they feel particularly suicidal.  It can be simple, like take a walk or phone a friend.  Jobes makes the point that he’ll sometimes flip over his business card and write these ideas on it so that they have these ideas – and access to resources when these ideas aren’t enough.


Key in understanding suicide is that suicide is often episodic.  It’s something that comes and goes in waves.  Intense suicidal ideation may last an hour or less.  We need to make sure that we enable people with skills and resources that they can access during these times of intensity.  It’s important to understand and plan, but it’s equally important to encourage and enable people to be successful as partners in Managing Suicidal Risk.

Book Review-The Anatomy of Suicide

With an initial publication date of 1840, The Anatomy of Suicide is perhaps the oldest book I’ve ever reviewed.  A fair question would be what such an old text could teach us today.  The answer is both universal truths that haven’t changed in nearly two centuries and the things that have changed.  It’s good to know what was believed so we can see how we’ve made progress in our understanding and acceptance of suicide over time.


Since antiquity, there have been three “causes” for suicide:

  1. Avoiding pain or personal suffering
  2. Vindication of one’s honor
  3. To provide an example for others

The first is perhaps the most common and the heart of Shneidman’s psychache (see The Suicidal Mind).  In more recent times, less has been said about honor.  In America’s Generations, I summarized a progression of honor over time – and it’s not moving in a positive direction.  The idea of suicide as an example for others is definitely an extreme case of the protection against people taking advantage of others that is often exposed in the ultimatum game.  (See The Evolution of Cooperation and SuperCooperators.)

Justifiable Suicide?

While most people would agree with a general prohibition of suicide, many recognize that it’s not absolute.  In historical times, suicide was justifiable if one expected to fall into enemy hands and therefore to be tortured and murdered.  The water gets murkier when we speak of people who believed that they could no longer contribute to society or who were completely destitute and therefore decided to end their own life.

Today, in some countries, there is the concept – often well regulated – of suicide when a person is afflicted with a terminal illness.  So, while we share a general aversion to suicide, in some countries for some limited circumstances, we do accept that it should remain an option.

Compelled to Live

No one can be compelled to live.  Suicide: Inside and Out demonstrates how it’s impossible – even in an inpatient setting – to compel someone to live.  They must want to live.  You can reduce means.  You can try to remove every harm.  But in the end, you can’t prevent someone from suicide if they want to do it.

There’s a consensus that people who are suicidal learn what to say to inpatient doctors to allow them to get out.  (See How Not to Kill Yourself as one example.)  While the illusion of control is comforting (see Compelled to Control), it’s not reality.

Law and Consequences

No law can be made without the threat of some consequences.  The most dangerous situation is when the other person has nothing to lose.  Laws prohibiting suicide are problematic because the consequences must mean something to someone for whom not even life means something.  Threats of exposing the bodies to public display or some form of humiliation is one avenue that has been tried – with limited or no apparent success.  Being prevented from being buried on church grounds or even requiring burial at a crossroads has not made a measurable impact.  So, too, have penalties and forfeitures been levied upon the families of those who die by their own hand.  The result of these strategies has provided strong disincentive for coroners to accurately report suicides because of the repercussions.

Suicide is something that remains largely beyond the reach of the law.  Perhaps that’s just one reason why it’s not against the law in most parts of the world – the consequences don’t work.


What if you “knew” that nothing that you could possibly do would ever make up for the pain, hardship, and sorrow that you had caused others?  What if nothing that you could do could get you back to having at least a neutral impact on the world?  Being hopeless, self-loathing, or irredeemable would seem to lead to a sense that suicide is the right option.  After all, if you can’t make it better, you can at least exit the situation.

Of course, it’s not possible to say that you’re irredeemable, but in the throes of cognitive constriction and suicidal crisis, it may seem that way.  (See Capture for more.)  Rick Snyder in The Psychology of Hope explains that hope is a cognitive construct that relies both on waypower – or know-how – and willpower – the desire and drive to do.  Roy Baumeister explains in Willpower how willpower itself is an exhaustible resource.  In most cases, not knowing how to compensate for past harms (real and imagined) leads to an exhaustion of willpower.

How He Lives

It’s not how a man dies that matters, it’s how he lives.  It’s a simple cliché with a deeper meaning.  Often, suicide is evaluated as the final and ultimate act of a person’s life.  In doing so, it invalidates all the other good that they have done and minimizes them to a single moment.  Too often, suicide is the result of people believing that they’ve not lived well.  Whether that’s because of unrealistic expectations or the belief that living well means a life without struggle and loss doesn’t matter.  What matters is that those that choose suicide have judged themselves and their circumstances harshly.

False Medicine

Before ending, I should say that one must overlook the quasi-medical practices of the past that we’ve long since discovered did more harm than good.  There are references to bleeding people to let out the bad humors.  Similarly, there are references to disproven theories about phrenology.  It would be irresponsible to take medical advice from a text that is nearly two centuries old – but also irresponsible to discard the entire text because of some errors.  The truth is that every work has some errors.  Some are larger and some are smaller.  Our goal should be to take what’s valuable and leave the rest.

When Life Is Unbearable, Death Is Desirable, and Suicide Justifiable

Too often, the brief and momentary troubles are perceived as persistent, personal, and pervasive.  (See The Suicidal Mind).  Our goal in preventing suicide shouldn’t be the absolute prohibition or punishment of those who consider it.  Instead, we should endeavor to reduce suffering, to make life more bearable, and to make death undesirable.  Instead of removing the scales between reasons for living and reasons for death, we should find ways to pile on more reasons for living.

Maybe if we can look deeply at how people see themselves and how they’ve seen themselves over time, we’ll finally find a way to reduce suffering through a better understanding of The Anatomy of Suicide.

Book Review-Unsafe at Any Speed

I don’t have a particular passion for automobiles.  That’s not why I picked up Unsafe at Any SpeedRalph Nader may not have been successful in his presidential bids, but what he did do is disrupt industries that were harming consumers.  He’s lauded for creating the change in the automobile industry that caused a shift from accidents and outcomes being “all because of the nut behind the wheel” and moving towards building safety into automobiles.  I wanted to understand how – not because the automobile industry needed disrupted again, but because of something else equally important.

Craig Bryan uses the analogy between automobile accidents and suicide in Rethinking Suicide.  We can’t prevent accidents.  There’s no way to know which individual will or won’t be in an accident.  However, we can make accidents safer when they happen.  Though Bryan doesn’t explicitly mention Unsafe at Any Speed in his work, I recognized that the parallels might go deeper than the analogy as he shared it.  As I suspected, there’s more to learn than just how to design cars.


“But the true mark of a humane society must be what it does about prevention of accident injuries, not the cleaning up of them afterwards.”  Even in the preface, Nader begins the assault on the prevailing perspective of tolerating the trauma created by accidents.  Instead of looking for every opportunity to prevent and to protect, the automobile industry looked for ways to deflect blame from the balance of practices that prioritized style over safety.

The tragedies revealed by Unsafe at Any Speed explain that many – though not all – automobile accidents were the result of poor designs that left the vehicles uncontrollable after minor and common disturbances.  Imagine if every time you went to turn left or right you were fighting against the car’s attempt to turn too far.  Imagine what it would take to counter the forces that wanted to roll a car over because a wheel rim caught the roadway instead of the tires.  The Corvair drivers of the 1950s didn’t have to imagine; they had to develop high degrees of driving skill simply to keep the car from creating an accident.

What we needed were different approaches and designs that prioritized a human’s ability to prevent accidents by reducing workload, decreasing critical conditions, and making the car more responsive to driver controls.

Human Factors

Aviation had already solved many of the problems that automobile drivers had to face.  Shiny surfaces that caused windshield glare had been eliminated.  Controls and gauges were standardized.  The information being conveyed to a pilot, while seemingly overwhelming at first, were carefully designed to reduce errors and ensure that the pilot was able to quickly determine a situation.  In fact, even private pilots are taught unusual attitude recovery where they must quickly assess an aircraft’s orientation and take immediate corrective actions.  It’s not the training that’s important here – its that the whole system is designed to allow the pilot to safely control the aircraft.

When it comes to human factors in automobile design, “They did not forget the driver; they ignored him.”  In other words, the lack of human factors work was intentional.  They wanted to not be bothered with that troublesome driver who caused all the accidents with their beautiful machine.  If it weren’t for the driver, there would be no accidents.  They are, of course, right on one level: if no one used their machines, they’d never end up in an accident – or do anything useful, either.


While the industry was admonishing the driver, telling them to “never take your eye off the road,” they continued to change configurations of controls that made it impossible for a driver to determine by feel which control they had their hand on.  They’d tell you never to take your eye off the road, and then require that you do to operate the controls in the car.

The tragedy is that, while making it impossible to follow the advice, they’d blame the driver when accidents would happen, because they were looking at the controls to figure out how to make a change.  However, the most challenging problem with controls wasn’t the radio, wiper, or other accessory.  The most challenging problem was the automatic transmission.


It’s been years since manual transmissions were common.  “Three on the tree” indicated that the shifter was on the steering column.  “Four on the floor” was an indication that the manual shifter was on the floorboard.  Despite their differences, the manual shifter patterns were notably consistent.  Even today, I could hop in a car with a manual transmission and know how to get it into reverse.

The same couldn’t be said for automatic transmission shifters.  There was no standard.  There are two problems with this.  The first problem is that consistency reduces errors.  The second is related to the ordering of the shift locations themselves.  Numerous needless accidents were reported because people expected they were in reverse but were in drive – or vice-versa.  People were being harmed.  The solution was simple.  Put a non-drive space between forward (drive) and reverse.  However, General Motors was having none of it.  They already had a pattern they preferred and weren’t going to bow to anyone telling them how to change their shifter.

The pattern they adopted, which was Park, Neutral, Reverse, Drive, and Low, put the reverse and drive adjacent.  This pattern was linked to accidents, but rather than voluntarily agree to a better pattern, they resisted – until the government stepped in and made it mandatory.

Maintaining the Illusion

The auto industry was adept at “voluntarily” adopting standards when threatened with legislation.  They’d announce their desire to continue to enhance the safety of the general public while narrowly avoiding the government mandate.  Sometimes, the government would back down – and the industry would back away from their promises.  They’d introduce a safety feature – as standard equipment – during a year of pressure and then drop those features from the next model year.

It was all a part of the carefully cultivated illusion that the cars were safe and well-engineered – without the need for government oversight.

Excellence of Automotive Engineering

The real problem is that the public doesn’t have the knowledge to know when something is or isn’t well engineered.  It’s not a specialized skill that they’ve developed.  Remember that the Nazis convinced a complacent German people that Jews (as well as Russians and others) were inferior.  It was wrong.  However, the message was sent so relentlessly that the German people learned to believe something that is so transparently false.  So, too, were the claims of the automotive industry that they were following best practices engineering.  The public was kept far away from the truth.  In April 1963, the journal of the National Society of Professional Engineers opened an article with “It would be hard to imagine anything on such a large scale that seems quite as badly engineered as the American automobile.  It is, in fact, probably a classic example of what engineering should not be.”

The illusion of excellence in engineering was seemingly more valuable than the actual engineering quality.  We’d come to find out that the industry’s lauded safety and engineering initiatives didn’t produce much, and when it did, it was either not implemented or sold as a luxury.

Safety as a Luxury

Chrysler’s industry-leading safety engineer, Roy Haeusler, admitted that vehicles could be safer without increasing costs if only the engineering is done right in the first place.  Said differently, the industry’s primary push-back against enhancing safety was without merit.  It was possible to build safer vehicles, they were just choosing not to.

Sure, as a technical matter, a seatbelt would cost a little more than not having one – but not in a material way.  Other design changes, like removing the hood ornaments that impaled pedestrians and retooling the dashboards so that they didn’t cause substantial injury to the passengers, cost nothing on a per-unit basis.  They just required that the auto industry was concerned about its consumers.  They’d provide safety – but only if you paid for it.  They cared about your money, not your safety.

Seatbelts that Cause Head Injury

The argument against seatbelts reached comic proportions.  When harnesses and safety belts were introduced, racing drivers were criticized for using them – they were told that they lacked courage.  Certainly, the public was aware of this – they may have been the ones who were, in part, criticizing the drivers.  Today, with decades of racing research on survivability, seatbelts and harnesses aren’t optional.  Dozens of innovations have helped racecar drivers walk away from horrendous crashes that would have been lethal just a few decades ago – including folks I call friends.

The non-economic argument against seatbelts was that if passengers weren’t thrown from the vehicles, they might be more harmed by impacting the dashboard.  So rather than resolving the secondary impacts, the public was being sold on the idea that being thrown from the vehicle was safer.  While this seems ludicrous on the surface, it was one of the things that was said sufficiently it began to be believed.

More than that, by 1958, the automobile industry had the technology to make airbags and install them in vehicles, dramatically addressing their own concerns.  It would be the 1970s before cars began to come equipped with them and not until 1998 that they became required.  In other words, it took 40 years for life-saving technology to be standard equipment – and then only after federal mandate.  While Nader helped make progress, he didn’t fully eradicate the problems with the industry.

Which Came First, the Demand or the Offer

The argument that allowed for safety to be a luxury rather than standard equipment was that people weren’t paying for it, so obviously it didn’t need to be a standard feature.  The problems with this argument are many, but two key issues are expectation and awareness.

First, the public had been sold on the idea that cars were well engineered and safe – to acknowledge anything else meant that the carefully crafted illusion would fail.  That’s not something that the industry wanted.  The second issue is that dealers were often not aware of the additional features or their importance and thus car buyers weren’t sold on the add-on safety features.

The result was low demand.  That would be excusable if, at the same time, the auto industry wasn’t bundling in useless styling features that consumers couldn’t remove.  They had to have features that added to the allure but provided no protection.  It wasn’t that the industry ignored the need for safety, they worked against it, because acknowledging it would hurt sales.

Wish Fulfillment

The auto industry in America had a problem.  The problem was that they wanted to produce cars at a rate greater than the actual need of the consumer.  If the car had a five-year lifespan, they wanted the consumers buying a new car every three years – or, ideally, every year.  To get them back in the show room, they had to sell more than features, because there weren’t that many new features.  They had to sell people on a lifestyle, on fulfilling their wishes to be different people than they were.  Somehow cars had to make you more fun, smarter, and every other desirable attribute that a consumer could think of.

The trend towards selling wish fulfillment didn’t stop with automobiles.  Vance Packard in The Hidden Persuaders explains how marketing began to overtake us, how we stopped buying products and started buying happiness.  However, this was in stark contrast to the admonishment we’d receive once we had purchased the vehicle.

Enforcement, Education, and Engineering

In 1924 and 1926, two traffic safety conferences were convened by Herbert Hoover, then Secretary of Commerce.  At these conferences, the resonating message was “The Three E’s.”  Enforcement, education, and engineering would safeguard the public from the hazards of automobile accidents.  Engineering meant highway engineering – not automobile engineering, which we’ve already discussed wouldn’t even meet the bar of sub-par.  Enforcement and education were carrying the heavy load, and they were heaped on the backs of the motorist.

The problem is that enforcement didn’t work.  According to Unsafe at Any Speed, “In Connecticut, during Governor Ribicoff’s well-known crackdown on speeders, the number of accidents and injuries increased and so did the injury rate per vehicle miles traveled.”  Similarly, in the article, “The Effects of Enforcement on Traffic Behavior,” Dr. Michaels concluded that the different amounts of highway police patrol showed no reliable difference in the number of accidents on the roads.  In short, enforcement didn’t work – even if it did make drivers occasionally feel like criminals.

Education, then, should carry the heavy burden.  They’d teach drivers to drive carefully.  They’d be sold with scare and shame tactics to improve their driving.  We’ve already explained how human factors often put safe driving outside of the reach of the normal driver.  Our more recent experiences with scare tactic programs illustrate how ineffective these approaches are.  The US Surgeon General declared Drug Abuse Resistance Education (D.A.R.E.) a potentially harmful treatment approach for substance use disorder (SUD).  Its fear-based approach didn’t, doesn’t, and never will work.  (See Chasing the Scream, The Globalization of Addiction, and Dreamland for more on SUD.)

Failure to Stop

The citation is called “Failure to stop.”  It’s given to the driver.  The presumption is that if a driver failed to stop when appropriately signaled by a sign or traffic light, it must be their fault.  A failure of the braking system isn’t often considered.  If they overrun the distance, they were speeding or failed to react quickly enough.  If they don’t appear to slow at all, they must have failed to apply the brakes.

Even in the event of a failure of the breaking system, the driver is often still blamed for a failure to properly maintain the vehicle.  Even for vehicles built in the early 2000s, sometimes, brake lines were constructed of oxidizing (that is, capable of rusting) materials.  The result is often a catastrophic failure of the line and resulting loss of brake efficacy.  For me, this isn’t a hypothetical example.  A 2002 Chevy Suburban that we owned suffered a failure of brake lines during a long-distance trip.  Of course, the replacement lines that you paid to have installed were a stainless steel that wouldn’t rust.

There are two important components here.  First, why would manufacturers use materials that could oxidize on the bottom of the car, which is in contact with salt and road spray, in a critical system?  Second, how could a consumer know that their brake lines were compromised before the critical failure?  The answers are unknown but troubling.

In the end, the law recognizes the driver as the agent.  (See The Mind Club for more on agency.)  They’re to blame for a failure to stop whether the design of the car itself was or wasn’t a significant contributing factor.

Where Rubber Meets the Road

The problems for the auto industry didn’t end at the end of the manufacturing line.  Cars left the line dangerously overloaded.  The tires on the vehicles weren’t rated to carry the amount of weight when the passengers and useful capacity of the car was considered.  They would roll off the line with no one in them, but when fully loaded with passengers and luggage, they often exceeded the tire ratings.

That’s the tires’ official ratings.  The industry wasn’t regulated or self-controlled to a degree where there was consistency in testing and marketing of tires in a way that a consumer could recognize the problems with their new car or purchase new tires when they needed to.  The options were too complex, opaque, and inconsistent for the consumer to be successful in getting the tires they needed.


Today, things are different – but, as noted, not perfect.  What’s terrifying is how many other industries are working in their self interest rather than working towards the kinds of standards, control, and consideration for humans that leaves the world better.

As I ponder suicide and the programs that operate without either a theory of action or any scientific basis, I wonder how many other ways that we proceed blindly accepting what we’re told rather than recognizing that we’ve been sold a lie.  I’m beginning to wonder how many of our programs and advances are Unsafe at Any Speed.

Book Review-Parental Alienation: An Evidence-Based Approach

Kids should be first.  When parents get a divorce or separate, the primary concern should be that of the wellbeing of the children.  However, too frequently, parents are more interested in “winning” the popularity contest and ensuring that their ex doesn’t have a better relationship with the kids than they do, so much so that they’re willing to sabotage the relationship.  Parental Alienation: An Evidence-Based Approach reviews the psychological and legal research on the topic and creates a framework for evaluating the presence of parental alienation as well as informing responses.


Parents don’t typically set out to alienate their children from the other parent.  There’s a conversion of their hurt and disappointment with the other parent that led them to overt and covert behaviors that create alienation.  In my post, The Progression of Parental Alienation, I explained how parents can alienate children through a normal progression and in ways that may not be completely transparent.


One of the criticisms leveled against parental alienation’s legitimacy is that the APA refused to include it explicitly in DSM-V.  The DSM-V is the diagnostic manual used to code patient concerns for billing.  There are two issues with this.  First, is that DSM does not primarily include relational diagnoses.  It’s focused almost exclusively on individual diagnoses.  The few relational diagnoses that exist are correlated to individual diagnoses.

Second, “parental alienation” as a name isn’t called out, but there are the codes V995.51 for “Child Psychological Abuse” and V61.29 for “Child Affected by Parental Relationship Distress.”  Both of these are applicable.  Given that we know children are better off with relationships with both parents, depriving the child of the relationship of the other parent is abuse.

In short, a surface look at the DSM-V would lead someone to believe that parental alienation should be called out but isn’t – but a deeper look reveals why it doesn’t meet the criteria for inclusion.

Frequently, the ICD codes published by the World Health Organization correspond to the DSM for behavioral health issues.  ICD codes are for all medical issues, including both physical and mental health issues.  However, there are some differences.  ICD includes a code for burnout where DSM-V does not.  ICD calls it an “occupational issue” to avoid it being something related to a person that should be included in DSM-V.

An argument could be made that ICD should include a separate code for parental alienation.  There is a precedent for including codes not listed in the DSM-V.  So why not in this case?  While there’s no clear answer, having appropriate codes that can be used, the lack of explicit call out in DSM-V (despite a petition), and the relational nature of parental alienation may all play into it.  Given that there is a code QE52.0, “Caregiver Relationship Problem,” which covers many of the associated problems with parental alienation, it may also be that the World Health Organization believes they have it appropriately covered.

Would it be ideal for parental alienation to have codes in both DSM-VI and ICD 12?  Yes.  However, the lack of inclusion hasn’t stopped parental alienation from being used and accepted in progressively more court cases over the past several decades.  It seems that the courts are accepting the premise without an explicit mention – because there’s sufficient research to demonstrate validity.

Digging Deeper

McCartan makes the point in Parental Alienation that it seemed impossible to write about the topic without checking every detail.  Numerous accounts were distorted to fit the narrative that authors wanted to portray – that there’s no such thing.  Her comment and the discrepancies that she discovered had a striking resemblance to the denial that occurred when Sigmund Freud first identified childhood sexual abuse and then recanted to save his career.  (See The Assault on Truth.)

Even in the previous section while discussing DSM-VI and ICD-12, it’s easy to search for “parental alienation” and not find it, then decide it’s not addressed.  It’s only by looking deeper into what is available can you recognize that searching for “silver maple” won’t tell you if a book contains knowledge about trees.  (See Pervasive Information Architecture for more about specificity of terms and why experts use more specific terms.)


One of the factors that pushes towards parental alienation is when one of the parents becomes enmeshed with the child.  This enmeshment creates a challenge in the beliefs about the other parent.  If the parent in the enmeshment doesn’t like the other parent, then the child shouldn’t either.  This can cause the enmeshed parent to try to shape the child’s perception to match their own.

Enmeshment isn’t healthy, particularly in a parent-child relationship because of the long-term relational damage it can do to the child and the way that they express their relationships.  (See The Gift of Failure for more on enmeshment.)

Parents Are Parents Not Friends

“Fish are friends, not food” is the famous refrain from the shark, Bruce, in Finding Nemo.  There’s not a similar refrain about parents being parents, not friends – but there should be.  In today’s world, we find that parents crave friendship and often place their children into the role of a friend.  This necessarily breaks the power dynamics of a parent-child relationship and deprives the child of the discipline and correction they need to grow.

Parents have a responsibility to shape and correct their children towards societal norms.  That is an entirely different relationship than two friends who should support and accept each other rather than shape them.


Worse are the cases where the parent isn’t capable of being a parent and requires that the child be the parent in the relationship.  While this is obviously not literally true, the roles and responsibilities are reversed to a substantial degree.  The child may be responsible for remembering important things, like paying the bills, or doing the tasks that are normally the responsibility of the parent, like cooking dinner.  In these cases, children are adapting to unstable environments and using their personal agency – no matter how small – to increase the degree of predictability in their environment.

Adult Information

Sometimes, alienation comes in the form of information that is shared – that shouldn’t be.  It can be information about court cases or other issues that aren’t something the child should need to be concerned about.  Often, the intent of sharing this information is to manipulate the perceptions of the child.  “Your father is taking me back to court” seems innocuous enough, but it leaves the perception that the father is “attacking” the mother.  What’s worse is when the reality is that the father is not the petitioner – both parents are just responding to another round of court appearances.

False Memories

An evaluator enters into the home and begins the work of assessing the situation.  Before long, the child asks if they can go ask the parent what they were supposed to say.  It’s a clear indication that the child has been coached into what they should say to make the parent appear in the way that they desire the evaluator to see them.

Other times, the clues are more subtle.  The child claims to remember events that happened to them before memories are reliable.  (Generally, memories before about age 2 aren’t reliable because of the neural pruning that happens around this time.)  Perhaps the child describes the situation using adult language – language they shouldn’t know.  Other times, they may describe the situation from a perspective that they couldn’t have possibly had.

It’s a tricky thing to determine the truth of the situation.  Research indicates that adults are only capable of identifying children lying 54% of the time – with professionals only doing slightly better.  On the one hand, we don’t want to discount a child who is telling the truth, and on the other hand, we don’t want to propagate false accusations against innocent parents.

The Blurring of Facts and Feelings

There’s plenty of research and work to support the understanding that our memories aren’t infallible.  However, we continue to believe that what we remember is the “truth.”  Without an irrefutable record of the event – like video recordings from multiple angles – we’re forced to accept what we remember as truth.  (For more on the fallibility of memory, see Mistakes Were Made (But Not by Me).)

The distortion of memory is particularly prevalent when strong emotions are in place.  People believe what they believe because it justifies their beliefs or behaviors.  There have been cases in my life where it was necessary to share video evidence to shift people’s beliefs.  They believed one thing because it made them look good, yet the reality of the situation was quite different.

Perceived Abandonment

One of the outcomes of distorted memories is that the child can believe the other parent abandoned them.  This may be amplified by the alienating parent failing to deliver presents or messages to the child or fabricating appointments – but never telling the targeted parent.  The strategy of controlling communications can be quite effective at manipulating the perception of the impressionable child.

Luckily, with the advent of child phones and court requirements to allow contact, some of the strategies are less effective – however, they’re not completely out of the question, even in today’s world.

Ten Fallacies

The book lays out ten fallacies about parental alienation:

  • A child will not unreasonably reject a parent with whom they spend most of their time.
  • A child will not unreasonably reject their mother.
  • Parents contribute equally to alienation.
  • Alienation is a temporary response to parental separation.
  • Parental rejection can be a healthy coping strategy after separation.
  • A young child living with an alienating parent does not require intervention.
  • Alienated adolescents should be permitted to make decisions about their contact.
  • An alienated child who is functioning well in other areas of life does not require intervention.
  • Therapeutic intervention will be successful even if the child lives with their alienating parent.
  • Separating the child from the alienating parent is traumatic.


The question is, once alienation has been identified, what is to be done?  The answer depends on the situation, the willingness, and the patience.  The unfortunate truth is that by the time that alienation is discovered, it may be too far gone.  It may not be possible to repair the relationship in the short term.  Perhaps the issue will resolve itself over time – but it may not.

In an ideal world, the alienating parent would acknowledge their behavior and work towards reunification.  Unfortunately, even after court orders, many alienating parents continue their bad behaviors – perhaps unconsciously.

With the right cooperation between all of the parties, reunification is possible – and it is in the best interests of the child.  Tragically, too few situations end this way.

Truth or Lies

With parental alienation, it’s hard to tell what is and isn’t alienation.  It’s hard to separate the fact from the fiction.  Even well-meaning people are unaware of how their children are impacted by their responses.  I hope that neither you nor any of the people you know have to experience Parental Alienation.

Book Review-The Assault on Truth

It’s a tragedy when the truth is discovered but, because of the desire to protect egos and keep secrets, that truth is then buried.  That’s The Assault on Truth that J. Moussaieff Masson is writing about.  His claim is that Freud discovered that children were being sexually abused and made the claim publicly, but because of his ostracization retreated from his position.  If true, Freud traded protecting children for his community and fame.  He may not have known he was doing it at the time, but it may have been the result.


Before I move on to the tragic claims, it’s important to surface whether these claims are supported in fact or the kind of fantasy published by tabloid newspapers.  The criticisms of Masson’s work largely focus on his character rather than the validity of his claims.  That’s a serious reason to ignore them.  Mastering Logical Fallacies calls this approach abusive – and I agree.  Rather than explaining how Masson’s conclusions aren’t correct, the focus is on him as a person.

Observationally, Masson is clear about the places that he’s “reaching” to draw conclusions.  He presents the facts that lead to the conclusion and, in at least a few places, some facts that lead away from the position he’s taking.  While I don’t anticipate that anyone is completely unbiased, his writing in this place has the characteristics of a reasonably well-balanced argument.

In the Morgue

The suspicions that Freud developed, that his patients were suffering due to the abuses they suffered as children, may have originated in a Paris morgue.  Freud studied with Ambroise Tardieu, who was a professor of legal medicine at the University of Paris.  Tardieu’s position had him performing autopsies on children who had died, and he was tasked with either validating their accidental death or determining the more sinister situations that led to the death.

Tardieu’s investigations began to uncover the frightening frequency with which sexual assaults were being perpetrated against children, particularly young girls.  Despite the claims that would come later that the children were “making up stories” about their assaults, the physical evidence of the deceased didn’t lie.  The assessment was that there were real assaults that had occurred.  The physical trauma was consistent with the kinds of trauma from a sexual assault.

Tardieu wasn’t alone.  In 1886, Paul Bernard published a book with the English-translated title, Sexual Assaults on Young Girls.  Paul Brouardel published a book on the rape of children, which was published posthumously.  The point isn’t to catalog the list of professionals and researchers who were elevating this real societal problem.  The point is to clarify that Freud’s voice wasn’t the only voice.  His ideas likely were drawn from the work of his medical mentors.  But Freud’s interest was slightly different.

His focus wasn’t on the physical trauma or the brutality.  His focus was on what happens to children who are sexually abused.


At this time in history, it was believed that only women got hysteria.  Hysteria was extreme – and often uncontrollable – emotions.  To the outside world, it didn’t make logical sense.  There weren’t conditions that should have warranted the kind of response that these women were experiencing.  We know today that these experiences aren’t confined to women.  They’re trauma responses that can happen to any human who has experienced trauma and hasn’t been able to deal with it.  (See Trauma and Recovery for more.)

However, for Freud, the behaviors were a mystery.  He was trying to sort out the root cause, and he stumbled across the secret of childhood abuse and its potential relationship.  As researchers came after Freud, they would ultimately dismantle psychotherapy but, in the process, validated the core tenet of the relationship between the past and the present.  It would be decades before John Bowlby and others would observe and explain the vulnerability of the young and how seemingly insignificant behaviors may have overwhelming impacts later in life.

Attaching Bowlby

John Bowlby isn’t mentioned in the text.  However, it’s important to assemble the puzzle that Freud couldn’t fully see.  His initial claims were that the disturbances that occurred later in life were caused by the abuse, and therefore trauma, of their lives as children.  To understand the connection, we need to understand trauma and understand how attachment plays into the ways that we respond.

Michael Meaney observed odd behaviors with rats.  Some would confidently leave their safe harbors and explore.  Others would cower and go nowhere.  The defining difference, Meaney’s observations confirmed, was that some pups were licked and groomed by their mothers more than others.  In short, the behavioral support conveyed by licking and grooming made them more confident.  Believing that they’ll be comforted and supported made them more likely to see what they were capable of.  This was consistent with Bowlby’s belief that young children need a secure attachment to feel confident later in life.

Harry Harlow discovered something similar with rhesus macaques (monkeys).  He placed monkeys in cages with two surrogate, inanimate, mothers.  One had a bottle holder where the monkeys would feed, and the other had a terrycloth covering that provided physical comfort but no milk.  He found that the monkeys would go and feed but then return to their terry cloth comfort.  They ate enough to live but craved the comfort the terrycloth mother provided.  This, too, was consistent with Bowlby’s belief that we need more than material needs: we need to feel nurtured.

Meaney’s work with rats was a part of the discovery that it was more than genetics that influenced growth.  It was the experiences animals had that altered the gene expression (activation or deactivation), which played a part in an organism’s future.  While Freud didn’t have the benefit of these experiments, he intuited that something was wrong with the adults he encountered.  They were behaving in odd ways that seemed inconsistent with the way that other adults behaved – just as the animal analogs would prove later.

Disordered Attachment

The disordered attachment, in Bowlby’s attachment theory, comes from the idea that an abusive childhood results in behaviors that are observable.  To understand why, we need to understand how much our internal sense of safety plays into our behaviors.

Our overall safety has three basic factors: our situational assessment, our mood, and our traits.  Very few people have a good understanding of their perceptions of safety.  We know that our responses and behaviors are shaped by numerous things well below the threshold of consciousness.  (See Predictably Irrational, Influence, and Pre-Suasion.)  Our perception of safety is one of those things that often is subconscious.

State and Trait (with Mood in the Middle)

Richard Lazarus in Emotion and Adaptation explains that our sense of fear or safety is based on our assessment of the impact and probability of the potentials that our environment – including stressors – may bring.  This is divided by our capacity to cope.  When we assess the probability as very low, the impact as very low, or our ability to cope very high, we’re likely to feel safe.

This moment-by-moment assessment is our state.  It’s the degree to which we perceive safety in our environment.  While we believe these assessments are made without bias, we know that our mood and our traits can be invisibly influencing our sense of probability and our belief about our ability to cope.

If we’re in a foul mood, we won’t realize that we over-estimate the probability and impact while simultaneously underplaying our coping capacity.  The factors that cause us to assess impact are varied but generally rely on our mood and our traits.  Our mood is the most short-lived but influential factor in our assessment of the situation.  Of course, sustained negative evaluations can reinforce a foul mood and ultimately create a reinforcing loop.

At the other end of the spectrum is our overall disposition.  Largely, we expect that there’s some degree of the way that we see the world that comes from our genes.  Some of us are blessed with less reactive genes and others are cursed with overactive genes that want to find concern in everything.  While trait effects from our genes make up just less than half of the impact, for most people, cultivating moods can make a big difference in the way that the current state is evaluated.

The Coming of Cults

We each have images in our head of what a cult is.  In most cases, we see the people in the cult as very “other.”  That is, we believe that they’re not like us.  For the most part, this isn’t correct.  Mostly people in cults got caught up in a system designed to transform them to a disordered attachment so that they can be manipulated.  The techniques that are used are both subtle and powerful.  (See Terror, Love, and Brainwashing.)

By changing normal attachment to disordered attachment, it’s easier to manipulate people.  Cult leaders do this by sending conflicting messages of love and punishment.  The messages muddle care and concern with exploitation.  Their safety can be threatened more easily, and they’re more susceptible to suggestions.  The cult puts people in the very vulnerable state that Freud discovered and discussed, where their future behaviors don’t conform to norms because their attachment was disrupted.  Instead of by a cult leader as an adult, it’s disrupted by a family member or acquaintance as a child.

Psychological Trauma

As Trauma and Recovery explains, psychological trauma is simply that we’re momentarily overwhelmed.  This means that we have some sense of inherent coping capacity.  This coping capacity is severely diminished in the presence of disordered attachment.  The evaluation of the potential for harm is substantially larger in disordered attachment than in a securely attached individual.  If we want to prevent psychological trauma, we reduce the stressors and make them safer.  If we want to create disordered attachment and trauma, we can do that by sending mixed signals.

Tonic Immobility

Freud and his contemporaries didn’t have the benefit of Peter Levine’s work or the researchers who discovered tonic immobility.  They didn’t know that, in cases of extreme fear, it’s possible to lose the ability to voluntarily control motor neurons and therefore muscles.  They didn’t understand that even strong people who are sufficiently scared can freeze in ways that they can’t immediately self-resolve.

The result was that sometimes it was decided that rape victims weren’t actually raped, because they had the strength to resist their attacker.  They didn’t know that, if tonic immobility sets in, strength doesn’t matter, because there is a gap between the brain’s instructions and what the muscles will do.

Some people experience a brief glimpse of this as they wake up.  They’re conscious but are also aware that they can’t move their muscles.  This is a normal brain process that occurs during sleep where muscle control is disconnected to prevent you from harming yourself.  In some people, the effects extend until after conscious thought, resulting in a very concerning and disorienting period.

During a rape, tonic immobility isn’t disorienting.  It’s terrifying.  The dynamics of the situation sometimes cause the victim to act as if it were their fault.  They’ll say to themselves, “If I only fought back.”  They say this not realizing that it wasn’t an option.  It wasn’t a matter of lack of will.  It’s a matter of brain chemistry.

Sometimes accusations of rape are dismissed because the victim didn’t fight back or, occasionally, because they had previously had sex.  Hopefully, we’re beyond these conclusions; unfortunately, I’m not so sure.

Sexual Gratification at Any Price

Adults who believe that they can and should pursue their desires without regard to the cost victimize children who seek protection and tenderness.  The price the child pays is problems with relationships and love for the rest of their lives.  Even those who have recovered through hard work and therapy will feel the lingering effects.  They’ll have to fight for normal relationships that should come naturally.  All of this happens while the adult inflicts their desire for sexual gratification on someone who can’t say no.

They can’t overpower the adult.  They can’t say no because of the relational power structures – and their physical power.  If the adult cares more about their sexual gratification, they’ll harm the child in the act, in the disordered attachment they create, and in the sense of powerlessness that they’ll leave the child with.

It would be appropriate to classify these acts as hatred for the child rather than love that some adults hope to contort them into.


On the surface, the fact that many of the children grow to be hypersexualized makes little sense.  It’s only when you realize that they’ve coupled the sexual act as being worthy and desirable that you can see how the grown child might interpret sex as a way for them to restore their value.

The paradox is that the premature sexual contact often leaves the children believing there’s something wrong with them – that it’s their fault – and they seek the same thing to relieve them of their burden.  We must realize that, in the face of uncontrollable abuse, children often choose to believe that it is about them.  This allows them a sense of control – even if it means they must believe they are bad to make this work.  They believe that they can become good enough, so the problems don’t happen any longer.  (See The Myth of Normal for more.)

Ferenczi Follows

While Anna Freud was growing, there was a protégé of Sigmund Freud’s who he called “dear son.”  Sándor Ferenczi was Freud’s closest analytical friend.  Perhaps it was the friendship that caused Freud to discourage and block Ferenczi’s publication of nearly identical to the claims that Freud made and then retracted.  It seems that Ferenczi reached the same conclusion – despite Freud’s objection.

Maybe there was some bit of Freud that Ferenczi detected that still harbored the knowledge that his disavowed theory was right.  The record, as edited by Anna Freud, doesn’t contain evidence of her father’s contemplation about whether he did the right thing to retract the theory.  Maybe he never lost the question – he just became more adept at hiding it from the record.

Ferenczi’s paper in 1932 was almost an echo of Freud’s 1896 paper.  It validated the belief that something was happening to these children, and it’s the result of this psychic trauma that was being studied all this time.  It wasn’t fantasies.  It was a fact.  Despite his mentor’s objections, Ferenczi persisted and accepted the ostracism to ensure that those whose voices had been silenced would once again be able to speak.

The fact that it keeps coming up, that individuals keep coming to the same conclusion, is evidence that it’s the truth, and that Freud, for the benefit of his career, played his part in The Assault on Truth.

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