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Psychology

Book Review-DBT Explained: An Introduction to Essential Dialectical Behavior Therapy Concepts, Practices, and Skills

It never made sense to me, DBT – dialectical behavior therapy.  Where was the conflict?  That and many other mysteries were solved by DBT Explained: An Introduction to Essential Dialectical Behavior Therapy Concepts, Practices, and Skills.  Marsha Linehan’s discovery in DBT is well validated as a treatment.  But what makes it special?

A Tale of Two Approaches

Cognitive behavioral therapy (CBT) has been well validated for a while, but its focus on changing the way one thinks sometimes left Linehan’s patients feeling invalidated for who they were at that moment.  The insight was the introduction of an acceptance-based approach with meditation and mindfulness.  In this way, DBT validates where the person is – and provides them with the skills and motivation to change.  This is the essential, two-in-one conflict that is represented by the word “dialectical.”  On the one hand, we accept the person for where they are, and on the other, we hope that they can change to better and healthier approaches.

It’s important to note that Motivational Interviewing solved the same dual nature differently.  It focuses on understanding the person and accepting their current reality before moving on to focusing on the core challenges, evoking a desire to change, and planning for that change.  It solves the acceptance problem by introducing the concept of understanding with acceptance.

Acceptance

Most people know the short version of the serenity prayer by Reinhold Staudinger.  Most don’t know that it continues with, “Living one day at a time, Enjoying one moment at a time, Accepting hardship as the pathway to peace, Taking, as He did, this sinful world as it is, not as I would have it…”  Here, the word “accepting” is used in conjunction with hardship, but the concept is included in a broader sense when we consider that we must accept the world the way it is.

Embedded are the concepts of willfulness, when we refuse to accept reality, and willingness, when we’re able to accept “the cards we’re dealt.”  There’s a place for willfulness as we’re seeking to change the world, but in the present moment, denying reality does nothing to change it.

Acceptance of a person and their current reality is the essential first step to coming into alignment with them.  You can’t tell someone how to achieve changes in their life without knowing where they’re starting from.  (See also Richo’s How to Be an Adult in Relationships for more on acceptance.)

Emotional Regulation

Core to DBT is the improvement of emotional regulation.  I struggle here, because “emotional regulation” isn’t quite the right language.  It’s not that we prevent emotions from happening.  It’s that we can learn to let them control us less.

In Daniel Goleman’s immensely popular Emotional Intelligence, he characterizes emotional intelligence along two axes splitting into four quadrants.  On the first axis, we have awareness on one side and management on the other.  The other axis is self and other.  For both, awareness is required before management can begin.  (See also Emotional Intelligence 2.0 and Primal Leadership.)

Beyond awareness comes the management piece, which is as much a negotiating process where emotions are evaluated for their utility by cognitive processes.  This is at the heart of CBT as well.

The awareness step can be difficult for people, because they’ve learned that their emotions are scary and uncontrollable.  Thus, they’ve blocked out all sense of emotions and live without conscious awareness of them – even though they’re silently controlling situations.  (See Switch and The Happiness Hypothesis for Elephant-Rider-Path.)  Often, once people can accept and acknowledge their emotions, the management of the emotions becomes a relatively easy set of skills to be taught.

Follow Your Heart

Many people in many different contexts offer the advice to follow your heart.  Mostly, this means to follow your emotions and intuition towards your goals.  “Following your heart” uncouples you from the realities that tend to hold you back and make it difficult to take big risks.  This has its place and can be a powerful way to realize your dreams.  It’s also dangerous to radically decouple from reality.  It makes you susceptible to your feelings leading you astray.

I trained as a pilot decades ago.  They taught us that when your instruments and your feelings differ, trust your instruments.  Instruments all have backups to verify with, and if they’re telling you the same thing, then that’s what is happening – regardless of how you feel.  It’s okay to fly by feel for a little bit, but you’ve got to remember to periodically check your instruments.  You’ve got to check in with reality and make sure that what you feel is what’s really happening.

It’s like the Stockdale paradox that Jim Collins discusses in Good to Great.  You need to follow your heart – have unwavering confidence – and you need to check things against reality – accept input when the situation dictates it.

In the end, if you want to navigate these sorts of paradoxes, it might be good to start by getting DBT Explained.

Book Review-Stigma: Notes on the Management of Spoiled Identity

It wasn’t what I expected, but it was good.  I picked up Stigma: Notes on the Management of Spoiled Identity to understand the issue from a societal perspective and what could be done to address the challenges that so many people face as they’re stereotyped and stigmatized.  I was expecting a discussion on how to change society to be more accepting, like After the Ball.  I picked it up due to a reference in Suicide Among Gifted Children and Adolescents. I didn’t pay attention to the fact that Stigma was published initially in 1963 and that the author, Erving Goffman, is one of the most influential sociologists of the twentieth century.  What I found in his work was a personal playbook for managing your identity when you believe you’ve been stigmatized.

The Attribute

When someone is stigmatized, there is some attribute – normally an attribute that has some level of observability by others – upon which that the stigma is based.  The attribute can be physical, as in the color of skin – or it can be something like mental illness.

In A Class Divided, William Peters explains the experiment that Jane Elliott did to teach the impact of stereotyping and stigmatizing to her class after the assassination of Dr. Martin Luther King, Jr.  She divided her students on the basis of eye color and treated them differently based on the day.  Even though it was just a classroom exercise lasting a few days, her students quickly identified people based on their eye color – even calling her out for being one of the “lesser” eye colors on days when her eye color was treated as lesser.

The profound realizations from this experiment included the fact that these stigmas could be created very quickly and easily – and that they can be based on completely irrelevant attributes.  It doesn’t really matter.

Obtrusiveness

The words to explain the relationship between the degree of stigmatization and the attribute include obtrusiveness – how obvious the attribute is.  The other words that are used to describe the attribute are perceptibility and evidentness.  For someone to be stigmatized, there must be some awareness of the attribute, and that relies on the degree to which it’s observable to others – or the degree to which they’ve been informed.  On the completely, non-evident end of the spectrum, we have the woman who has lost her virginity outside of wedlock.  There is no outward visible change.  On the other end are attributes that can’t be missed.  Consider someone with a facial birthmark.  It’s nearly impossible for another person to miss.

In between are situations where upbringing might be subtly betrayed by choice of word or language.  For instance, saying that something is “so ghetto” might betray having grown up in poverty.  Something as simple as saying that the chili you had growing up had noodles in it also portrays a certain sense of lower income.  For someone to have a stigma for those who grew up in or near poverty, they may not know until something has been said.

Subhuman

One of the greatest tragedies of our experience with others is when we make others subhuman.  Hitler made the Nazis view Jews as subhuman and the genocide that followed is an indelible mark on humanity.  In America, slaves were counted as 3/5ths of a person – an inexcusable representation of a human.  In moderate to extreme forms, stigma is the devaluing of other humans.  In their otherness, they are somehow less worthy of the birthright of the rest of humanity.  In this, we disengage our morality as is explained in Moral Disengagement and The Lucifer Effect.  While this external condemnation is unacceptable in any form, too many people experience it inside their own minds, berating themselves as not worthy of the kindness and respect deserved by every human.

The internal view of oneself is driven in ways that we’re not cognizant of.  If we’re attached to one stigma/stereotype, we experience better results; pick another, equally relevant, stigma/stereotype, and we’ll do worse.  We subtly pick up on the environment and how we’re treated by others and start to believe those things about ourselves.  All of a sudden, we don’t need others to tell us that we’re inferior, we’ll do it ourselves in voices that we cannot consciously hear.

Overrides

When Al Campanis was the manager of the Los Angeles Dodgers, he punched a bigoted player who insulted Jackie Robinson.  The result ushered in the addition of black players to Major League Baseball.  At a time when racism was firmly entrenched, and there was great personal risk to protect Robinson, Campanis did it anyway.  He did it, because he knew Jackie personally and knew him to be more than what the stigma associated with his race said he should be.  (See Mistakes Were Made (But Not by Me) for more on the story.)

Similarly, we can avoid stigma with people who we’ve known personally prior to their stigmatizing attribute being known.  Consider people whose relative poverty growing up isn’t discovered for years, until after a friendship has formed.  The awareness of their poverty, while being quite impactful for others, will likely not apply to the friend.

There are, however, many limits to this, as Al Campanis’ full story illustrates.  While Campanis was able to override the stigma of Robinson’s skin color for the purposes of playing baseball, he still thought that Robinson wasn’t fit to be a manager.  He was wrong – but in part because the stigma leaked through, past his relationship with Robinson.

The most effective way to work past stigma is to develop meaningful relationships with individuals in the stigmatized groups – and allow them to expose where the stigma may still remain, even with them.

Concealment

There comes a question for those whose attribute can be hidden: should it?  The answer is complicated.  Obviously, exposing it too early may prevent the ability to form the very kind of relationship that can reduce the impact of the stigma personally and potentially unfasten the moorings on which it’s based.  However, it may be that hiding this attribute may come at great personal difficulty – and as such, one must make an informed decision about whether they can “keep up the ruse.”

Ultimately, concealment is a psychically draining situation that should be minimized where possible.  The best advice is always to be yourself.  (See How to Be Yourself.)

Concealing the stigmatizing attribute from others may focus your attention on it and make it more prevalent in your thinking.  Stigma is a hard thing to avoid.

Book Review-Suicide Among Gifted Children and Adolescents: Understanding the Suicidal Mind

It’s a concerning question for parents of children who are considered “gifted” intellectually.  Suicide Among Gifted Children and Adolescents: Understanding the Suicidal Mind doesn’t answer the question about whether these children are more or less likely to die by suicide.  Citing conflicting research, no conclusion is drawn.  However, there is work to surface the factors that lead to these conflicting results.

Theory of Suicide – Suicide Trajectory Model

One serious limitation to the book is the choice of primary model.  They chose the suicide trajectory model put forth by Stillion and McDowell.  This isn’t a popular model, rarely appearing even in the child development context under which it’s borne.  It has some similarities to Rudd et al.’s fluid vulnerability model (see Brief Cognitive-Behavioral Therapy for Suicide Prevention), and it seems to map out Pathways to Suicide, like Ron Maris’ book.  However, while predisposing, contributing, precipitating, and protective factors are reviewed, they don’t form a pathway as much as they represent a set of factors at the individual, family, peer, school, community, and sociopolitical levels.

The problem is that these aren’t discriminating factors.  While citing articles of M. David Rudd and his colleagues, it seems as if Cross misses the central point that we don’t have discriminating factors, and we need to find them.  More recently, Craig Bryan explains why our capacity to predict suicide is unlikely to get specific.  (See Rethinking Suicide.)  This is consistent with research showing that many attempters (who survived) didn’t think about suicide for more than an hour.  Commonly, around 70% of attempters hadn’t considered it more than an hour or two before the act.  It’s hard to build a prediction framework with these kinds of timeframes.

The Myths

Like many others, Cross falls into the trap of describing “myths” about suicide.  The first “myth” is that “Suicide occurs without warning.”  Clearly, that’s true for some people (≥70%).  “Myth” four is, “If a gifted young person wants to commit [sic] suicide, very little can stop him or her.”  Here, nuance is important.  Certainly, if they are determined to die, they will.  They’ll lie, or they’ll find lethal means that you wouldn’t think to protect them from.  (See Suicide: Inside and Out for more.)  However, the nuance is whether or not they’ll have an honest conversation about their suicidal ideation with you.  Techniques like Motivational Interviewing can help open people up to the idea – as long as the coercive forces aren’t too strong.

The “myths” reflect historical thinking about suicide.  While many continue to believe the myths as stated, we’re beginning to realize that the old ideas aren’t necessarily true.

Perfectionism

The most consistent finding for impact in suicidality is perfectionism.  This occurs among the gifted and the normal.  However, perfectionism flows through the sense of agency or growth mindset that Carol Dweck explains in Mindset.  It’s consistent with Harris’ work in No Two Alike.  In short, a small amount of dispositional difference – even among twins – will result in tendencies towards and away from things, like academic excellence.  (See Perfectionism for more on the topic.)

The Meaning of Gifted

Cross’ work is challenged by the lack of a consistent definition of what “gifted” means.  Is it high IQ or mental aptitude in a certain way?  (See Howard Gardner’s Extraordinary Minds for more.)  Is it performing above the required standard?

One relatively common understanding is the experience of being gifted.  The experience is often described as “feeling different.”  I certainly felt – and feel – that.  To be clear, for most, it’s not necessarily better – it’s different.  It’s a curiosity about what is wrong with me, or why am I different?

Psychache

Cross ends with a call back to Shneidman’s work on psychache and the need to eliminate it if we want to take care of others.  (See The Suicidal Mind for more on psychache.)  The need to increase feelings of a life worth living in the person and eliminate their pain is, however, universal to all humans.  It’s not specific to either gifted or youth.  It can be that if we want to prevent Suicide Among Gifted Children and Adolescents, we’ll need to just prevent it among all children and adolescents.

Book Review-Compassion and Self-Hate: An Alternative to Despair

While compassion is the subject of many books, self-hate is not frequently discussed.  Compassion and Self-Hate: An Alternative to Despair seeks to map the relationship between the two and how compassion can heal self-hate.  I came to the book because of self-hate’s role in suicide.  I came to understand how someone could hate themselves so much that they thought they and the world would be better off without them in it.  (This interest was focused while reading Managing Suicidal Risk, 2e.)

Self-Hate Machinations

Sometimes, the mental machinery of our mind gets stuck.  (See Capture for more.)  It can get stuck replaying a time when we were frightened and vulnerable or when we did something that wasn’t nice.  Stuck in this state, it is easy to see how self-hate can develop.  The problem with this is that self-hate is problematic from both a physical and mental health perspective.

Self-hate can also be borne by external or internal perfectionism.  (See Perfectionism.)  With impossible standards, you’re always falling short, and that falling short leads to condemnation from others or yourself.

Self-Punishment

If you know you did wrong – or didn’t measure up – you can take matters into your own hands and punish yourself by denying yourself grace, compassion, or, more tangibly, the hobbies and activities that you enjoy.  This self-punishment makes you your own enemy and sets up a further fracturing of identity that places parts of yourself into the dangerous category.

The logic of self-punishment is either the desire to motivate ourselves to better behavior or to “balance the scales.”  In other words, if there is enough self-punishment, then I should deserve to succeed.  The scales should be slanted towards good things for us – even if that’s not realistic.

Rejection of Praise

When one’s internal image doesn’t match the image that others are sharing with you, you may reject it.  Because what they’re saying is inconsistent with your internal perspective, the discrepancy must be resolved, and it’s easier to resolve it in a way that points to your negative, internal view being right.  It’s easier, but it’s probably not correct.

Sometimes, we outright dismiss the comment.  “That’s not me.”  Other times, we discount it.  “I only did a good job because it was easy.”  Another way that we discount it is by removing the uniqueness.  “Anyone could have done it.”  These approaches prevent us from letting in the light that other people are trying to shine to us.

If someone else is the arbitrator of good or bad, and they say good, believe them.  (If they say something negative, you should evaluate it more carefully to understand their motivations.)

Secretly Suspicious of Good

Whether it’s someone saying good things or simply feeling good, some people are suspicious.  They don’t believe they deserve to feel good or to have happiness.  When it happens, they feel ashamed, as if they have stolen something that doesn’t belong to them.

Value as an Economic Engine

From a chemical composition perspective, the human body is worth less than $100 in chemicals.  Of course, that’s not the standard by which we measure a life, much less a human life.  The value of human body parts has a much higher value – and a much higher moral rejection factor.  (See Moral Disengagement and How Good People Make Tough Choices.)  More commonly, people see themselves as economic engines that generate value through their work.  It’s not surprising, then, that the stock market crash and the Great Depression, with so many out of work, led to a surge in suicides.  Without money or a job, they saw themselves as without value and were willing to throw away their lives.

Most people believe, intuitively, that human life is intrinsically valuable, but too frequently, that value is dismissed.

Early Warning Signals

One of the keys to ongoing maintenance of an attitude of self-esteem rather than self-hate is identifying the earliest signs that our internal talk track is moving towards self-hate.  Learning to identify these early warning signs may prevent the downward spiral before it begins.  The problem isn’t in the idea that we should be looking for early warning signs.  The problem is identifying them.

Early warning signs aren’t universal.  There’s not a cookbook or checklist.  Everyone will have to learn their own unique, personal early warning signs – and choose to react to them.  However, this can be one of the most powerful ways to bring more joy to life.

Learning to Live with Rejection

One of the hardest things for our ego to accept is the reality that we will be rejected.  There will be times when the other person isn’t capable of the thing that we’re asking for.  It may have something to do with us or what we’re offering them – but it may not.  In either case, we will still experience the rejection, and it will still sting.

People who have the most robust mental health have developed a resilience in the face of rejection.  They know that one rejection isn’t the only path between success and failure and that the rejection will not be the last.  They’ve divorced the rejection from their worth and value.  However, those that struggle with self-hate can’t do that.

Instead, each rejection is seen as a fatal failure.  They think that every rejection is a statement about their value and worth.  They become convinced that they’re fundamentally flawed and unworthy of acceptance when this is not the case.

Compassion is the Antidote

In the broadest view, compassion – and particularly self-compassion – is the antidote to self-hate.  Another way of stating compassion is loving-kindness.  If we can learn to be kind to ourselves, we can realize that self-hate isn’t right.  Compassion itself is built upon empathy – “I understand this about you.”  Compassion directly is about understanding the suffering of another and desiring to do something to make it better.  (See Sympathy, Empathy, Compassion, and Altruism for more on empathy and compassion.)  Self-compassion, then, is understanding ourselves and our suffering and making a decision to make it better.

When we start to treat ourselves with compassion, we can see both the help and the helper in ourselves, and self-hate is incompatible with that.  We know that we’re fundamentally wired for cooperation and compassion.  Being compassionate is built-in, we just need to accept it.  (See SuperCooperators and Does Altruism Exist? for more.)

Moods Are Not Permanent

One of the challenges of self-hate is the moods that we arrive in that fuel it.  We find ourselves in depressed moods that seem as if they’ll last forever.  While emotions may be brief, it feels that a mood will be permanent.  Logically, we know that to not be truth, but that doesn’t help our emotions.  Our emotions drive our thinking – and are frequently in control.  (See Switch and The Happiness Hypothesis for more.)

Constant self-reassurance is required to overcome the powerful force of emotions and the perception that negative moods are permanent.  Recalling when you had negative moods before that have passed and good moods that have persisted for a while is a good way to break free of the perception of permanence.

The Surrendering Skill

There are two kinds of surrender – surrender accept and surrender defeat.  (See Conflict: Surrender Accept vs. Surrender Defeat.)  Too frequently, we confuse the two.  We get stuck in the belief that things should be different – that we should never feel bad (or good) – and we find that reality lets us down when it doesn’t conform to our expectations.  If we are willing to let go of our preconceived notions and insistence on our perfect or ideal, we can find more compassion and less frustration.  In fact, if we’re willing to openly surrender and accept reality, we may find that we can see the difference between Compassion and Self-Hate.

Book Review-New Models of Bereavement Theory and Treatment: New Mourning

People are funny about death, grief, and bereavement.  We continue to stick our heads in the sand and pretend that death doesn’t exist – or at least that it won’t happen to us.  New Models of Bereavement Theory and Treatment: New Mourning seeks to share what we’ve learned – and how what we’ve learned doesn’t match what we’re doing.  Grief, mourning, and bereavement aren’t new topics.  I’ve read the classic On Death and Dying as well as The Grief Recovery Handbook, which provide perspectives into death, dying, and grief.  I’ve also read Top Five Regrets of the Dying to understand what people regret most before they die and The Denial of Death to learn how we avoid the thought of death in general.  However, New Models of Bereavement Theory and Treatment does offer a perspective that the other resources do not: a new way of thinking about the process.

Definitions

Before getting into the meat of the work, it’s important to frame the perspective with some definitions.  We start that all death is loss.  That loss means something we had – like our relationship with the deceased – is gone.  The internal response to loss is grief.  It’s the way that we feel the loss.  The outward expression of that grief is mourning.  Suffering is the process of grief.  This is particularly true when the grief is unnecessarily extended, as in cases where people aren’t given the proper support.

These aren’t necessarily the definitions used by the book.  I use these definitions here, because they are most likely aligned to the definitions that others have and are more consistent with other literature.

It’s also important to recognize that the grieving process will differ by person and by situation.  We cannot force the process towards a natural end; however, we can support people in the process and reduce the suffering.

Detachment and Reattachment

Traditional models of grief are focused around Freud’s work and the need for the individual to detach from the loved one they’ve lost.  While this is a part of the process, it neglects an often critical aspect of grieving, which is preserving the other person as well.  Instead of completely severing connections with the deceased, the goal is to redefine the relationship with them.  In grief, we’re disconnecting the old relationship and replacing it with a new relationship.

This new relationship acknowledges that the person is no longer with us in a physical sense, but rather they remain with us in our memories and in our imaginations.  We can maintain a relationship with them by recalling previous memories and by simulating conversations with them.

It’s the critical process of redefining the relationship and creating a new attachment based on that new relationship that seems to have a healing and protective effect for people.

Radically Reorienting World Views

A common, but not universal, experience with people who experience a loss is the radical reorientation of world views.  We all use world views to define how we see the world.  We consider the world a generally helpful or generally harmful place.  We have a belief that the Sun will rise in the East and set in the West.  It would be incredibly disorienting if the opposite were suddenly true.  This is, in essence, what happens when someone whom you expected to be with for the rest of your life – or at least longer than the time you’ve had with them – dies.  This is particularly true when the loss is that of a child.

Children are supposed to bury their parents – not the other way around.  When a parent is forced to confront the loss of a child, they must also realize that the grand clockwork of the universe isn’t exactly the way they saw it.  When a parent buries a child, there is something profoundly wrong with the order of things.

It’s these world views – the things that are so woven into the fabric of life that we cannot directly see them – that must change when confronting the reality of death and that can be its own pain.

Frozen Feelings

One of the traps that people can fall into is the complete lack of feelings.  Because of conditioning while growing up, societal expectations, or our own sense of perfectionism, we can find that we don’t allow ourselves the inward expression of grief or the outward expression of mourning.  Instead, we bottle up the feelings.  We contain them so they don’t get expressed, and we don’t have to fear what others will think of us – or fear that we’ll never stop crying.

Unfortunately, this approach leads to two problems.  The first is that you can’t block out the bad feelings – the sorrow, the grief, and the fear – without also blocking out the good feelings like joy, love, and happiness.  While freezing our feelings off into their own space may be appropriate for a time, eventually the ice must thaw, and we must experience our emotions – bad and good.

The other challenge is worse.  If these feelings do remain bottled up for too long, the pressure will build, and eventually they’ll come out.  It may be as anger or resentment.  It might be an explosive outburst.  More tragically, it may be a psychotic break that leaves someone disconnected from reality and the love of the world.

The Story

In Trauma and Memory, Peter Levine explains how our implicit memories of an event – including being notified of the death of a loved one – exists outside of time.  It’s the process of converting these memories into explicit memories that places them into a time context.  Without that, we’re subject to flashbacks and other intrusive thoughts.  More broadly, we need to make sense of the trauma.

In The Righteous Mind, Jonathan Haidt explains how prediction is a core part of consciousness.  Inside Jokes explains that we’ve got mechanisms in our brain that detect errors in our predictions, and the reward cycle for detecting them is what kicks off laughter.  For the prediction engine of our consciousness to continue to run, it needs a new model of prediction, and that means integrating the events into a cohesive story that can make sense.  Without this, we’ll be stuck, unable to trust our ability to predict the future, and the world will necessarily become a much scarier, unstable place.

It was James Pennebaker’s work in Opening Up that made me aware of the healing power of writing down a trauma.  Writing down the narrative of trauma allows us to weave it into a story that makes sense as well as an opportunity to take a step back and see the potential benefits that can come from a tragedy.

Expectations

We’ve got these expectations about death and loss that aren’t grounded in reality.  Ideas like we’re going to completely resolve any bereavement that we have and move on aren’t real.  Certainly, it gets better, different, and less painful at times, but anyone who says that it will end isn’t being truthful.

Similarly, we can’t prescribe a flow that all bereavement must go through.  There’s no amount of gnashing of teeth or wailing that is mandated for a given type of loss.  Instead, we must recognize that everyone will grieve in their own way.  A failure to express outward morning or acknowledge inward grief doesn’t mean that the person isn’t going through the bereavement process “correctly.”

It’s similarly not necessary that someone experience a great deal of pain in the loss.  It’s quite possible that the loss represents the other person being freed of their burdens in a way that brings them peace.  That isn’t to minimize the loss or indicate a lack of attachment but rather is an acceptance of things and how the world really is.

Who Cares for Whom?

Option B shares a model of circles of proximity to the deceased.  You provide support for those closer and seek support from those further out.  As a general model, it’s fine.  However, it breaks down inside of the nuclear family, like Newtonian physics breaks down at a subatomic level.  When a parent is lost, both the spouse and the children occupy the closest circle, and both need support from the outside.  However, inside the circle, things are not even.

Parents are expected to provide support to their children and not vice versa.  The hierarchy of the family unit suggests that this should be the order of things.  However, often, the spouse is unable to function at a level that allows them to support the children.  Instead of having reserves that allow them to get support for their needs and invest in the children, more frequently, the children must fend for themselves – and sometimes take care of the parent.  This causes long-term harm to the children as they’re forced into a parental, caregiving role before they’re supposed to.

Secrets and Security

You’re only as sick as your secrets.  Yet, in some families, it seems that secrets are all that there are.  Siblings who die at an early age are never spoken of.  Grandparents are just “away” with no expectation of return.  Even tragic illnesses that everyone knows about are just not discussed.

The problem is that, from a stability and predictability standpoint, children and adults learn that there’s always another shoe that can drop at any time.  We can’t feel safe and secure enough to share our feelings, because we can’t see what tragedy is coming around the next bend.  We can’t trust that the people we love and those that we depend on to care for us will tell us the truth so that we can predict some sense of stability in our lives.

The New Models of Bereavement Theory and Treatment accepts our need for safety, sense-making, and reconnection.

Book Review-Who Do We Choose to Be?: Facing Reality, Claiming Leadership, and Restoring Sanity

Margaret Wheatley’s work was a recommendation from a friend.  In a chance part of our conversations, he shared his reverence for her and her work.  That’s why I picked up Who Do We Choose to Be?: Facing Reality, Claiming Leadership, and Restoring Sanity.  There’s the slightest hint of fatalism in how the world will disintegrate and our societies will crumble.  However, through it all, there’s a sense that we have the capacity to grow and learn as a living system.

The Fate of Empires

Wheatley explains that her work builds on the works of Joseph Tainter from The Collapse of Complex Societies and Sir John Glubb in The Fate of Empires and Search for Survival.  She directly shares Glubb’s ages:

  1. Pioneers – In the age of pioneers, fearless, courageous people form the new empire.
  2. Conquest – In the age of conquest, they take control of others, organizing their might for the good of the empire.
  3. Commerce – In the age of commerce, with borders secured, they turn towards material wealth and comfort.
  4. Affluence – In the age of affluence, service ethics begin to wane and are replaced with a new degree of selfishness.
  5. Intellect – In the age of intellect, intelligence increases and spends endless time debating rather than acting while the empire declines around them.
  6. Decadence – The end age of decadence worships the idols of celebrity and descends into behaviors including narcissism, consumerism, materialism, nihilism, fanaticism, and high levels of frivolity.

Living Systems

Wheatley calls it the “arrow of time.”  It’s the tendency towards entropy.  It’s chaos ultimately unwinding the clock of creation.  However, she explains that this is only one view of things.  Another view is of living systems that continue to move in the direction of order and of converting information through an energy process.

Living systems is a way of viewing the universe.  Images of Organization invited us to view organizations as organisms – living organisms.  Wheatley suggests that we apply this thinking to everything.  There’s reason to believe that this is a reasonable approach.  When we went to revisit Darwin’s survival of the fittest through Dawkin’s Selfish Gene, we discovered Robert Axelrod’s Evolution of Cooperation and stumbled upon SuperCooperators putting an end to the question of Does Altruism Exist?.  We discovered that the only way for cooperation and altruism to have evolved is for higher-and-higher levels of organization to generate them.

Even inside living systems, there are higher levels of systems that evolve to create structures where there were none.  While there is this natural tendency to greater organization, we cannot ignore the challenges that we’re creating in the world.  We can’t blindly believe that we’ll find a new technology or approach that will undo all the damage that has been done.  Ronald Wright labeled this “The Progress Trap,” and Wheatley asserts that this is a major factor in accelerating decline.

Change to Preserve

People, organizations, and societies resist change.  In fact, organizations and societies are designed to resist change.  Given this, how is it that changes ever happen?  The answer seems to be that the motivators line up such that the organism or society – or person – perceives they have no choice.  Thomas Gilovich explains in How We Know What Isn’t So how we’ll deny what we don’t have to accept.  However, at some point, we must accept that what we believe or what we’re doing is no longer working.  It’s at that point that the system will accept changes – begrudgingly.

When Facts are Fiction

Perhaps the most concerning observation that Wheatley shares is the one that there comes a time when we’re no longer concerned with facts but are instead more focused on personal beliefs.  Going to Extremes begins exposing the process by which this can start to happen; however, there aren’t complete answers.

There’s a group of people who believe the Earth is flat.  The Flat Earth Society is a real association with members around the globe.  (I couldn’t help it.)  They’ve steadfastly refused to believe other scientists, pictures, and any other evidence that the world was not, in fact, flat.  In the documentary, Behind the Curve, they decided to set up their own experiment.  The short version was to fire a beam of light parallel to the Earth along water, so they knew there wasn’t a change in elevation.  The documentary ends with them proving the Earth is not flat.  And yet, the Flat Earth Society still exists.  They have, themselves, disproven their premise, and they continue.  How and why?  It’s one thing to distrust others and to believe that they’ve got ulterior motives, but what’s it like to discount your own members?

The problem isn’t one group of fringe people at one point in time.  The problem is this same pattern repeats over and over again.  We see it in cults and their failures.  Koresh’s Branch Davidians in Waco, TX, Heaven’s Gate in California, and Jim Jones’ Peoples Temple are all examples of cult followers who died because of their beliefs in the leaders of these cults.

How would I know for sure that this is true?  What’s true-ish?  We see distortion in the media and the messaging from politicians, and we don’t know what to believe.  (See Why We’re Polarized for more.)  We have a greater capacity now than at any time in history to verify facts – and we’re less likely to try.  The internet brings us unimaginable opportunities for verification of information – and an overwhelming amount of false information.  (See The Information Diet and The Organized Mind for more about the overwhelming amount of information we face.)

The simple fact of the matter is that we have no capacity left to verify the amount of information confronting us.  We’re constantly taking shortcuts – we must if we want to pretend to keep up.  This is a frequent concern of psychology, neurology, and marketing – The Hidden Brain, The Signal and the Noise, How We Know What Isn’t So, Mistakes Were Made (But Not by Me), and many other books speak of rules of thumb.  Rules of thumb are the positive spin on these shortcuts.  The negative path uses stereotypes, which is also a popular topic: White Bears and Other Unwanted Thoughts, The Mind Club, No Two Alike, On Dialogue, and particularly A Class Divided speak of stereotypes.  It’s not that we occasionally take a cognitive processing shortcut, it’s the way we think.

More problematic is that we’re too exhausted to test to see when the rules of thumb and stereotypes that we’ve created are wrong.  The Wason selection task was designed to see how much people would seek to disprove their theories instead of confirm them.  The problem is that we’re generally bad when we must disprove our own theories.  (See The Righteous Mind and The Black Swan for more.)

No Longer Hate Crimes

“Don’t feed the trolls.”  It was a warning sign shared with people in the early days of the internet.  In the archaic equivalent of social media channels in the form of Internet Relay Chat and America Online (AOL), people intentionally tried to get a rise out of someone by making outrageous comments.  Moderators were taught that if the “trolls,” as they were called, were not responded to, they’d stop talking.  They would be deprived of what they’re looking for.  The trickiest trolls would post anonymously.  They’d be too ashamed to make their comments with their name attached.  However, by 2015, it was no longer socially unacceptable to say hateful things with your name attached.

No longer were people concerned about whether people knew who they were – even someone’s real name versus a username.  We’d lost our concern for how people would react to us if we connected ourselves to hateful speech.  The trolls are easier to find – but they’re also harder to remove.

Weaponized Information

We live in the information age, where information can make the difference between success and failure.  The old cliché that the “pen is mightier than the sword” is truer now than at any time in history.  Of course, it’s the phone or the computer not the pen – but the point is the same.  Virtually anyone can create information – true or not – that is seen across the globe by millions (and billions) of people.

Information can bring down regimes, like we saw in Arab Spring.  Information can shape perception, including misperception.  False claims about hydroxychloroquine and ivermectin caused countless people to use these drugs incorrectly – and resulted in untold deaths.

Information can now be clipped out of context and applied to situations which it was never intended to be used for.  Clipping out the part of the fight where the defender is hitting back can – and does – create the wrong impression.

Clear Theory of Action

Public health professionals are well intended.  They want to make the world a better place through better public health.  If they didn’t believe this, they wouldn’t have chosen public health as their profession.  It’s not glamorous, nor does it come with huge salaries.  It is a profession that you have to want to love – or you won’t even get started.  That being said, too many public health professionals are in the copycat business.  They look for a pattern that has claimed to work in another locale and they apply it to their population.  The problem is they don’t look for or evaluate the theory of action that led to its success.

A theory of action is a narrative about why the activity gets the results.  It starts with “We think…” and it ends with a causal chain from the action to the result.  The chain doesn’t have to be intuitively obvious.  It needs only to be a reasonably plausible pathway.

Too many public health professionals don’t stop to question how an intervention leads to results – or to verify the previous efficacy claims.  Take the Gun Shop Project.  It introduces the task of assessing mental health – and relative degree of suicide risk – to gun shop employees.  Given that even mental health professionals fail to identify people who are suicidal at rates much better than chance, it’s hard to believe that an employee of a gun shop with minimal training could possibly accurately predict the suicidal intent of a patron.  (See Assessment and Prediction of Suicide for more on our ability to predict suicide.)

The argument from public health professionals is “At least it’s something.”  The problem is while this makes us feel better – it doesn’t necessarily result in better outcomes.  (See Change for the problems with bias towards action.)  The real problem with this thinking is that it can block other, more effective strategies.  Even if it doesn’t directly block a different approach, the lack of efficacy leads to greater change resistance.  Effective programs make it easier to do more programs; ineffective programs block progress.

One Good Conversation

Relationships are at the heart of being human.  We are social creatures.  (See Loneliness for more.)  How does one build a relationship?  It all starts with one good conversation.  One good conversation is all it takes to reintroduce us to what it feels like to be in a satisfying human relationship.  One good conversation allows us to be known – and to know someone else.  Sometimes, it can feel like the people we want to be are in some far off and elusive state.  We forget, however, that we can take steps to be the people we want to be in small and immediate ways.

Knowing Ourselves to Help Others

Brene Brown explains that some of the most wholehearted people she knows are good at boundaries.  Behind this is a great deal of work on themselves.  They know who they are – and who they are not.  People who are in helping professions frequently focus on others and solving their needs – after all, they’re so much larger than theirs.  However, the problem is that you cannot give what you do not have.  You can’t give peace if you don’t feel it yourself.  You can’t help people feel safe if you don’t feel safe yourself.

It’s hard work to choose to work on yourself.  Facing other demons isn’t the same as facing your own.  It’s easier to tell others to be strong than to stand in the face of the oppressive weight.  When we learn more about who we are, what we believe, and how we will behave, we’re preparing to be able to give gifts to others.

Making Meaning

“Humans cannot live without meaning.  The greater the uncertainty, the more our desperate grasp for a handhold, a shred of meaning.”  As we struggle to predict the future to protect ourselves, we seek to find meaning in everything that we do.  However, it’s more than that.  Many of us have to find a way to positively impact humanity.  We need to find that way that we’ll leave our small mark in the sands of time.

Being a leader who bends the arc of humanity in a positive direction is a good meaning.  It’s this thirst for meaning that has us asking and hopefully answering the question, Who Do We Choose to Be?

Book Review-Why We’re Polarized

In America, we’ve become more divisive and more polarized in our politics, but why?  In Why We’re Polarized, Ezra Klein seeks to explain the progression of polarization and the factors that drive it.  Short on solutions, Klein is content to describe a problem of polarization and its causes with the hope that others will be able to help in the identification of solutions.

While Klein’s focus is squarely on politics and how we’ve changed the way that we view political parties over the decades, other researchers have been looking more broadly at how we end up in extreme positions.  Cass Sunstein examines polarization in Going to Extremes.  Alexandra Stein in Terror, Love, and Brainwashing explains how cults create alternate realities and separate people from the rest of society.  Buster Benson for his contribution seeks to help us find ways to bridge the gap and have productive disagreements in Why Are We Yelling?  In Resolving Conflicts at Work, Kenneth Coke and Joan Goldsmith provide tips targeted at resolving conflict at work but end up with a useful framework of ideas for any kind of conflict.

The Pull of Polarization

There’s no doubt that we’re more polarized.  It’s not just the news or noticing – there’s a measurable pull towards polarization that’s driven by the forces of the two-party political system.  For a candidate to be viable, they must be the most extreme version of the ideals that the party holds.  It’s like what draws us to art – it’s the extreme form that we find most interesting.  (See The Tell-Tale Brain for more.)  Candidates become leaders, and leaders’ positions pull us to more extreme positions.  This isn’t unlike what Cass Sunstein observed in Going to Extremes.

Bedrock Identities

We all have multiple identities.  We’re husbands and wives, fathers and mothers, professionals and more.  Our identities are generally fluid and work together to form a coherent self-image.  However, some identities are more powerful than others.  When two identities are in conflict, we’ll lean towards one that seems more important.  These are bedrock identities – the ones that we’ll go back to in times of crisis and concern.  There’s been an evolution with our bedrock identities.  No longer do we consider religion a bedrock identity.  (See Spiritual Evolution.)  We no longer identify with the groups we belong to – because we don’t really belong to any groups.  (See Bowling Alone.)

In the absence of these historical, powerful bedrock identities, we’ve substituted our political affiliations, and we protect them with the same veracity.  We feel as if people who have different perspectives than those held by our core identities are wrong, misguided, or evil.  Bedrock identities aren’t bad – but our need to protect them (because if they’re not right, then somehow we’re not right) is bad.  It separates us from others with different views, prevents us from learning, and leaves us even more polarized.

Shortcuts

The challenge with bedrock identities defined by political parties is that these identities are too amorphous and changing.  What the party stands for may appear to be consistent, but it’s clear that not everyone in the party holds the same view.  A review of positions over time shows that the parties do change their positions at a much faster rate than the change in religious groups.  In short, we’ve defined a shortcut – but the shortcut keeps changing.

We need shortcuts to live.  Daniel Kahneman in Thinking, Fast and Slow explains how we need to make simple decisions where we can, because we need to conserve glucose.  The Rise of Superman affirms that our brains are glucose hungry.  In fact, they’ve got more need for glucose than our bodies can steadily supply.  The Organized Mind makes the same point differently – we’re in an era of information overload, and we’re filtering information to cope.  We malign stereotypes – which have their faults – but we need them.  The Signal and the Noise explains that “rules of thumb” are both error-ridden and necessary.  Kahneman and colleagues revisit the problem in Noise.  We need shortcuts to cope – but we need to minimize the damage caused by using those shortcuts inappropriately.

We can’t mitigate the damage of shortcuts when the shortcuts are changing underneath us.

Negative Partisanship

However, the problem is more complicated than just the shortcuts that we use to identify ourselves.  The research finds that we don’t vote for people as much as we vote against the other guy.  The other party, the other views, and the other people are so repugnant to us that we’ll take anyone with our own party just to avoid them.  There’s no secret to our negative bias.  (See The Resilience Factor and Hardwiring Happiness for more.)  There’s an evolutionary reason for this bias.

It’s sort of the opposite of Pascal’s wager, which argues that the wins and losses for not believing in God are far worse than the wins and losses of believing in God.  (See The Mind Club for more.)  If we err on the side of believing that a threat isn’t a threat – but it is – we may wind up dead.  We can either be unnecessarily concerned about a lion in the grass – or we ignore the lion and we’re dead.

Policy Views

Those who don’t follow politics are more likely to view political decisions in terms of their own best interest, while those who do follow politics are more inclined to view political decisions from the lens of their identity.  For those of us who are only peripherally interested because we neither have a professional reason nor consider it a hobby or area of expertise, we make the decisions because they seem to be best suited for positive outcomes.  However, as people focus more attention on politics, they start to believe that the meaning behind the decisions – rather than the actual outcomes – are more important.

The truth is that most of the public won’t – and can’t – have a strong position on a policy issue or a political appointment.  Most people don’t have the time or capacity to process the issue that deeply.

Agrees with Me

The definition of expert seems to be “a credentialed person who agrees with me.”  Like many things in politics, everything stops mattering except if they’re “for me or against me.”  Thomas Gilovich explained in How We Know What Isn’t So how we believe things until we can’t any longer.  We seek confirming evidence while eschewing evidence that doesn’t agree with us.

If you provide the actual evidence on gun control efficacy to those that believe strongly in gun control and ask them to do the math, they’ll suddenly be bad at math.  Similarly, if you ask gun advocates why people “need” their guns, they’re likely to make slightly – or completely – illogical arguments.  We are more compelled to protect our beliefs – and, more importantly, our identities – than we are to seek the truth.  Amy Edmondson in Right Kind of Wrong explains that we don’t like being wrong – and we’ll resist it.

The Fiction that We All Believe

There’s an idealized image of colleges and universities that they are places of unrestricted thought.  People can explore any line of thinking that is important to them.  They’re places of debate and civil disagreements.  However, as Jonathan Haidt and Greg Lukianoff explain in The Coddling of the American Mind, this is no longer the case.  Instructors now must warn students that what they’re about to be exposed to may be offensive, shocking, or triggering to them.  Klein questions whether this concern for decorum is any different than in previous generations.

The answer is probably both.  Certainly, speech and thought are freer inside the relative safety of a university – but those walls have always been permeable, and people needed to consider what others might think.  But our polarization leads us to find even less safety in universities.  The idea that we can explore ideas inside of a university is likely fiction today – and it may always have been.  Yet most people would say that universities are full of free thinkers.

Interests and Identities

Marketers figured it out a long time ago.  They figured out that they had to find the identities of people to craft messages that resonate.  They weren’t looking for the person who was interested in a dog.  They were speaking to the dog owner who viewed that dog as a part of their identity.  They were looking for the person who wanted to feel happy – and that’s why advertisements almost universally feature people who are smiling.

What we believe are the interests of others are aspects of their identity – and those aspects, when activated, have the power to unite or divide.  When stated generally, “cat people” aren’t activated by conversations about dogs.  Similarly, “dog people” aren’t activated by conversations about cats.  However, frame the conversations about the relative benefits of a canine or a feline, and the fur will fly.  Positioned as a competition or as a single “right” answer, our identities have us arguing that we’re right.

Politicians realized, too, that they needed not to just get people to support them but rather get activated people, people who will campaign and canvas for them if they’re going to win elections – and that means getting people angry.  It means engaging the emotion.  (See The Happiness Hypothesis for more about engaging emotion.)

Our polarization is a natural result of the forces that reinforce extreme positions – yet we still ask Why We’re Polarized.

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.

Unworthy

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.

Demarcation

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.

Burnout

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.

Inadequacy

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.

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