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It’s a Solution and a Problem

I didn’t know it at the time, but what started as a service opportunity for me became the most important learning moment of my life.  I was helping with a twelve-step-based program when I was introduced to a very wise young man.  He taught me about addiction – and about life in ways that I both marvel at and cherish.

The man explained to me that substance use wasn’t the problem, it was the solution.


“How can something that is so problematic be a solution?” I wondered out loud.  I heard the heart of a man who had experienced deeply troubling pain.  He was debilitated by the pain.  That’s when he first started using drugs.  He wanted a brief escape from the constant, unrelenting pain of life.  It wasn’t like he had been in an automobile accident and faced chronic pain as a result.  His pain was different.

His pain was internally based.  He never thought he was good “enough.”  He felt like a failure, a letdown, and an imposter.  He believed with every fiber of his being that he was “wrong.”  His drug of choice made it all go away for a while.  He was the life of the party.  The voices of judgement in his head were suddenly stupefied into submission.  No longer could they harass him.

As with all addictions, the coping skill became an addiction.  He wanted a moment of relief and then another, until the drugs had control and he didn’t.

Fundamentally, for him, the drugs represented a solution to the problem of the relentless pain.  They offered a way out – even if it extracted a high price.


I encountered him well after his sobriety was cemented into his being.  I had no sense that the addiction was in control of his life or that he was at risk.  However, as we spoke, I heard stories about how others had consistently treated the drugs as a problem and how he didn’t see them that way.  We hear stories about how drug users – including alcohol users – are defensive about their use.  “It’s not that bad,” “I can stop at any time,” and “I am in control,” are such common answers they’re cliché.  The more that people tried to convince him that the drugs were a problem, the more convinced he became that they didn’t understand.

They were selling a message that drugs were the problem, and he was pursuing them as a solution.  The perspectives couldn’t have been more incompatible.

Suicide Prevention

I came to the topic again not because of personal conversations but the continuing research on what we can do for suicide prevention.  Thoughts of suicide come when people are dissatisfied with their life as it is, and suicide becomes the consideration to make it better.  It’s a solution to the pain they’re feeling – it may be a bad one, but it is still a solution.

Instantly, when most folks hear that another person is considering suicide, they leap to tell them that things aren’t that bad or that they’ll get better.  It’s called the “righting reflex.”  It’s an attempt to bring the other person’s perspective of reality in alignment with ours.  The problem is that, as a result, we end up invalidating the other person’s perspective.

An alternative response is fear on the part of the listener and an instant problem that they believe they must solve – after all, suicide is irreversible.  It’s permanent.  Like the game of hot potato, they don’t want to be the last person that talked with another who died by suicide.  They’d rather get emergency medicine, psychiatric care, or someone else involved, so that they don’t have to accept responsibility for a tragic outcome.

Certainly, I’m not saying to validate that suicide is a good idea.  However, until we can see that suicidal thoughts are a solution to the problem of life’s circumstances, we can’t connect with the person and help them see other solutions and other options.

The first step for us as listeners is to realize that sometimes things are problems, and sometimes they are solutions.

Book Review-Feeling Good: The New Mood Therapy

It’s a classic, a 1980 classic.  Feeling Good: The New Mood Therapy by David Burns has come up a few times as a reference over the years.  Some have described it as cognitive behavioral therapy for the masses.  Despite being easy to read, it’s long at 700 pages long.  However, it’s packed with good information that can help people find a way to accept and process their problems.

My Problems Are Real

At the heart of cognitive behavioral therapy (CBT) is the idea that the drivers for many people are the way they think about their problems. That is that the is problem – not whatever they’re thinking about.  Some who come to the precipice of CBT declare that their problems aren’t their thoughts.  Those are fine.  Their problems are real.  It’s hard to argue that someone who is unemployed without any prospects, homeless, and hungry doesn’t have real problems.  There are real problems.  However, many of the problems we face aren’t those sorts of problems.  The kinds of problems most of us lament are how much we like our job – or whether we have a stable romantic relationship.  They’re concerns to be sure, but they are the kinds of things where our perception really matters.

Pick your favorite author.  In Paradise Lost, Milton said, “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.”  Shakespeare, in Hamlet (Act 2, Scene 2), said, “for there is nothing either good or bad, but thinking makes it so.”  Mark Twain said, “I am an old man and have known a great many troubles, most of which never happened.”  In short, what we think about life and our circumstances is of critical importance.

Depression Signals

There’s no doubt that depression is a problem.  It’s incredibly common.  (See The Noonday Demon.)  It’s also implicated for suicide risk.  (See Suicide Over the Life Cycle.)  Certainly, there are pharmaceuticals for depression – any many people are on them – but, as Warning: Psychiatry May Be Hazardous to Your Health explains, they’re not without risks.  Other strategies, like CBT, may not seem like much, but the impact of CBT is much longer lasting than medications, which need to be continued to see the effects.

Burns argues that people with depression are suffering from a problem with processing the signals that are coming to them.  He makes the analogy of a radio that isn’t tuned well and is picking up static.  (This is unfortunate, because it both dates the reference and limits the audience, since too few people today have ever listened to an analog radio that’s slightly out of tune.)  However, Burns’ analogy has a different meaning that people today struggle with.

The short version is they spend too much time listening to negative thoughts and not enough time focusing on the positive things that are happening in their world.  In Hardwiring Happiness, Rick Hanson has a methodology for changing how much time we think about positive versus negative thoughts.  You need that, because once you get sucked into the depression vortex, it starts minimizing your desire to listen to the positive and literally biases you towards thinking more things are negative.  (See Capture.)

Emotional Reasoning

It starts with the belief that you can read minds.  You believe you know what others are thinking – about you.  (See Mindreading for the reality of our abilities.)  Added to this is the belief that you’re a fortune teller.  You can foresee the future – a future of misery for you.  It extends into the belief that if you feel it, it must be true.  As Lisa Feldman Barrett argues in How Emotions Are Made, we don’t always put the pieces of emotion together well.  From a neurological standpoint, the difference between thought and emotion is indistinguishable.  Our emotions are based on our thoughts (cognitions).  (See Emotion and Adaptation for more.)  In short, our emotions aren’t credible witnesses to what is really happening.

We somehow slip into the magical thinking of a child who fears that, because they thought something should happen, their thoughts were somehow made manifest in reality.  There’s a Twilight Zone episode with this theme from decades ago.  It’s been a common belief following a loss.  A parent is killed in an accident, and the child believes that it’s because they were angry and thought that they’d be better off without the parent.  It, too often, can make grief malignant.

As adults, we recognize that our thoughts and our emotions don’t have the power to transform reality.  This is painfully obvious as you watch a mourning mother or father beside the coffin of their child.  Both are unified in their strong desire – even wish – that their child will live again, but the most powerful of emotions and desires cannot change the reality of the situation.

Inherent Value

A common misconception and perspective is that you’re only as good as what you can do for others.  Instead of being an heir to the inherent value of human life, you’re somehow excluded and must earn your worthiness by your works.  This is, of course, false.  Every human life is valuable, and this remains true for all humans – regardless of the things that they do.

The lack of worth is sometimes used as a justification for suffering.  You don’t deserve suffering.  It’s not some karmic consequence for your lack of value.  It happens.  Life isn’t fair.  Good people suffer.  However, there’s no need for you to inflict additional suffering on yourself by taking the suffering on.

A different way to think about this is what a beloved friend might say about you and to you in your suffering.  Instead of “you deserve it,” you’re likely to hear that they’re sorry, you’ll get through it, and they’ll be here to help.

Believe in Yourself

Your beloved friend believes in you – and you should, too.  We become burned out (see Extinguish Burnout) and hopeless (see The Psychology of Hope) when we can’t believe in ourselves or our capacity to get things done.  We forget that we’ve made it to this point in our lives.  We’ve encountered and conquered innumerable challenges.  We may have the scars to prove it but we’re also here.

Too often, we believe that “anyone could have done it” or “it wasn’t that special.”  The problem with this thinking is that it minimizes what we have accomplished and deprives us of the awareness that we can accomplish good work.  But maybe you’ll think that you are “just average.”

The Horrors of Being Average

We dream of being famous or a hero.  Whether it was being an astronaut or a firefighter or a baseball player, our childhoods are filled with dreams of what we can be. Society and our parents reinforce the message that we can be whoever we want to be.  We can, with hard work and determination, accomplish anything.  Part of that is the protestant work ethic – and it doesn’t always work out.  (See The Black Swan.)  Part of it that is the inherent desire to be something special.  It’s something that Chuck Underwood, in America’s Generations, explains that many – particularly Generation X – have lost.

More striking to me in my reading is the story of Ralph told in Work Redesign.  Ralph, after pushing against the system and getting struck down, decided to shut down and stop trying.  He resigned himself to being a part of the system rather than apart from the system.  The decision was irreversible.  Even when given new opportunities to be special and lead, he resisted.  He’d succumbed to the horrors of being average – but that was better than the idea that he could have succeeded but gave up too early.

The truth is that all of us are special in some way, and it may or may not be rewarded by others.  In a town 30 miles away, there is a man who is enamored by trains.  He lives for the model trains he built – and he built a business from it.  If you don’t live close or if you’re not into model trains, you’d never know that one of the largest model train businesses in the US is run from a little nondescript store in Atlanta, IN.  To some, he’s amazing – but for most, he’s average in his own way, and that’s okay.

Love Not Required

For some to be happy, they must have someone with whom they’re in a romantic loving relationship.  It’s the stuff of fairytales.  If you want to be happy, you have to pair off and live happily ever after.  However, as Anatomy of Love points out, the story is more complicated than the fairytales would have you believe.  There’s even room for the idea that you don’t need a romantic relationship to be happy.  It’s possible that you can be happy just as you are.

Dan Richo in How to Be an Adult in Relationships would say that it’s accepting.  In this case, perhaps the best answer is to accept yourself.  Maybe with that, you can look forward to Feeling Good.

Launching: One Place to Learn Myths and Facts about Suicide

Suicide is a tragic problem shrouded in myth and mystery.  It’s a topic that no one wants to speak of for fear that it will visit their family or friends.  However, the way to ward it off is to talk about it, learn about it, and discover how pain leads to it.  We’ve launched a new web site,, designed to tackle the most pervasive myths about suicide and to help you learn what you can do.

We’re asking for your help in two ways.  First, please provide feedback about what we’ve done well and where we’ve missed the mark.  If you’ve got ideas for how to organize the content, additional myths, or what we can do to help people understand the truth about suicide, we want to know.

Second, if you have a crisis or suicide website that you have influence or control over, would you consider linking to  We want people to find this important content, and we know the best way to do that is from other similar websites.  If you have a website that you believe we should link to, please let us know.

Book Review-Secrets of Suicide

It’s not multiple personality disorder (now called “dissociative identity disorder”), but it’s odd when the author of the book refers to the pen name from previous books in the third person.  In Secrets of Suicide, Dr. Ken Tullis reveals that he’s also written books under the pen name of Dr. Kevin Taylor.  He acknowledges that his current book is in “collaboration” with Kevin Taylor.  It’s deeper when you recognize that Ken Tullis was a founder of Suicide Anonymous, a group modeled on Alcoholics Anonymous that seeks to create a space for people who are living with suicidal thoughts.  It makes sense that a professional would want to obscure his identity when revealing his suicidal ideation.


Tullis recounts an early childhood experience and his response to it: “No way I can beat that, I thought, no matter how much I work at it. No way I can jump over a bar that high. Why even to live. No matter what I ever do, I’ll fail.”  Obviously, this is a fatalist attitude that would characterize his life going forward.  He expands the experience with, “I’m going to fail; therefore, I’ll get out by killing myself.”  At an early age, he had decided that suicide was not only an option but the natural course of events.

There’s also an element of perfectionism.  If there’s no way to win, then there’s no reason to play.  (See Perfectionism for more.)  If your father is perfect in your eyes, then you must be, too.  If he got a perfect score, you know you can’t beat him – so what’s the point?

Of course, the answer is that not everything is wrapped up in one aspect of someone’s life, and we’re our own creatures who will be better at some things than others.  We don’t have to compete on every aspect – or even the same aspects.  It’s too bad this wouldn’t be a lesson that he was taught as a child.

Secrets of Booze, Sex, and Suicide

Like many who are believe they’re not good enough and are seeking to numb these feelings, Tullis turned to booze and sex.  (See The Globalization of Addiction and Chasing the Scream for more.)  Booze numbs for a while.  Sex elevates endorphins to fight off despair – for a while.  The secret of suicidal thinking  is different and less widely used.  Though research seems to indicate that somewhere between one-in-three and one-in-six people will seriously consider suicide at some point in their lives, it appears as a less frequent coping tool.

Suicide as a secret was always an option.  If things got bad enough, if there seemed to be no other way out, then it was an option that could be pulled out.  Like the other secret coping mechanisms, it was designed to make things good enough for now – and to relieve the pressure of unrelenting failure to be perfect.

Twelve-step groups say that “you’re only as sick as your secrets,” and Tullis had developed a trifecta.  (See Neurodharma for more.)


Many people’s first suicidal thoughts are rooted in trauma.  Something traumatic happens, and they think that it’s an option for them to end the game of life.  To be clear, trauma – psychological trauma – is temporarily being overwhelmed by a situation.  It relies on the intersection of the person and the event.  Things that are trauma for one may or may not be for another.  It’s important to accept that being told he couldn’t beat his father was, for Tullis, a trauma.

One of the natural defenses in the presence of trauma is dissociation, where the event is made “not me.”  However, when dissociation fades, we cannot help but accept that the event did happen, and it impacted us in some way.  Sometimes, the dissociation sticks, and we wall off parts of our personality, as No Bad Parts explains.

The Narrowing

Years ago, I was taking a comedy course.  (See I am a Comedian for more.)  At that time, I had been speaking in front of crowds for decades.  I was, at times, underpreparing for talks to get a spark of adrenaline when I’d hit the stage.  It was routine.  As a part of the course, I walked on stage in front of a real audience on an open-mic night.  It was at that point that I experienced a massive stress response.  The entire room went dark for me, except for my friend in the front row.  I couldn’t see anyone else – including my instructor, who I knew was standing in the back of the room.  My psychological defenses kicked in and narrowed my vision.

I made it through my set – but I’m not sure how.  I didn’t think anyone laughed at any of my material.  Listening to the recording afterwards helped me realize that wasn’t true.  I just had no capacity to hear it.  While I’ve only experienced this once, many people who fight suicidal thoughts are challenged with these experiences frequently.

Among the most traumatic experiences are the loss of a sibling, spouse, parent, or child.  These events are consistently traumatic for most people.  Often, the narrowing comes after these experiences; disproportionally that narrowing leads to suicide.  I didn’t experience this when I lost my brother, nor when we lost our son.  However, I made decisions fixed in stone for each.  When my brother died, I committed to support his wife and his daughters.  When Alex died, I resolved to learn how he could die by suicide.

Frustrating Attempts

With the persistently suicidal, there are often multiple attempts.  While it would seem like the failure to die would be greeted with love and appreciation, it isn’t always.  The family must live in constant fear that their loved one will decide to attempt suicide again, and that stress can be painful to live with.  It leads to the thought – that isn’t always verbalized – that the person should just “die and get it over with.”  The challenging bit of this is that the person often feels the same way themselves.

As Thomas Joiner explains, burdensomeness is a factor in suicide.  (See Why People Die by Suicide.)  The person who has made an attempt becomes aware of the strain they’re putting on their families.  They realize that, despite their value, they are at least in some ways a burden.

Based on Beliefs

Our lives are not built on reality and facts but are instead built on our beliefs – correct or not.  If someone believes that they’re not worthy of love, then they’ll fail to accept it when it comes.  If they feel as if they’re not good, they’ll resist being told they are.  Most of the time, our beliefs approximate reality enough that there’s no problem.  However, from time to time, we found that our beliefs drift from reality, and rectifying them can be challenging.

I’m not talking about the kind of disconnect from reality that schizophrenics encounter.  (See How Emotions Are Made.)  Rather, I’m talking about the everyday type of distortions that we all have.  (See How We Know What Isn’t So.)  I’m talking about a view of ourselves that is too good or too bad to match reality.

One belief that can be limiting is that emotions are bad or uncontrollable.  This belief prevents the sharing and expression of emotions, and this creates a problem, as they build up internally until they can no longer be contained.  This suppression of emotions can create psychotic breaks that are disturbing to see.

Hopefully, you can find the path to exposing Secrets of Suicide.

Book Review-The Suicide Club: What to Do When Someone You Love Chooses Death

How could you not wonder what you could have done differently when someone you love dies by suicide?  How are you supposed to feel?  How do you cope?  The Suicide Club: What to Do When Someone You Love Chooses Death is Alexandra Wyman’s story of pain, struggling, and recovery.

“The day my husband ended his life was the worst day of mine,” says Wyman.  It’s a common refrain that the pain the suicidal person carries doesn’t evaporate when they die.  Instead, the pain is transferred to those who love them.  Suicide doesn’t make it go away – it spreads it.  It’s like hitting dog poop with the mower.

Immediate Reorientation

Wyman admits that her pre-event perspective on suicide was radically reoriented.  She had to come to terms with her perspective that people who died by suicide were selfish and didn’t have their lives together.  Her judgement of people who were suicidal was colored by society’s portrayals and perspectives on suicide.  Shawn, her husband, died and forced a reevaluation of these beliefs.  While not perfect, he was far from the person that she had in her mind of the suicidal person.

Others have shared that, the moment they lost someone to suicide, they had no choice but to reevaluate their relationship to it.  Some respond with shame and keep the story of suicide quiet.  A friend of mine lost her father.  She shared that the family said it was a hunting accident.  Her candid retort after that was, “but the only thing he was hunting was himself.”  You allow such retorts for those who are grieving and angry.

The Long Reorientation

Some things take longer.  Changing the relationship you have with the deceased isn’t easy.  One moment you’re in a bidirectional relationship, with give and take; the next moment, you’re alone and talking to yourself – maybe even audibly.  Therapeutically, many schools of thought encourage communication with people who aren’t there by writing them letters and through exercises involving two chairs, where you can take the place of the missing person.

While this extreme position isn’t necessary for the long term, the truth is that some part of the other person will stay with you.  At some point, it may even feel like the presence of an old friend with whom you’ve lost touch with.  It can be a warming and affirming voice reminding you that you’re doing well or celebrating your achievements.

One Decision from a Different Life

Mel Robins said, “You are one decision away from a completely different life.”  The intent was to convey that your small decisions – go to college or start working, for instance – can radically change the course of your life.  That’s true in my life.  My world skipped the college experience and then returned to it; in that space, I found technical publishing, which taught me how to learn while working.  My life would have been different had I been able to attend college immediately after high school.

However, those who have tragically lost loved ones due to suicide recognize a second meaning.  The decision isn’t always yours.  Sometimes, the decision that changes your life is one made by your loved one.  Alex’s death radically reoriented the work that we’re doing and the way that I view the world.  The life I have today is radically different from the one I’d have had if he was alive.

Obviously, the life is worse off in the loss, but it’s better, too, as we’ve met amazing people.


Rebuilding a life in the aftermath of death or suicide death is incredibly disorienting.  The moment you believe you’re headed in the right direction, you get turned around – or knocked down.  The theme song to the TV show, Cheers, includes the lyrics, “Making the way in the world today takes everything you’ve got.”  That’s doubly true when you’re trying to navigate the world without a friend.  The chorus includes “Where everybody knows your name and they’re always glad you came.”  When your loved one dies, part of the “everybody” that knows your name dies.

If we’re lucky, we’re left with a compass – a mission.  Whether we’re lucky or not, no one is left with a map of how to move their life forward in the absence of the one they lost.  We’ve got to figure it out, get lost, and try to reorient.

We do have to continue life.  In the case of the loss of a spouse, it’s appropriate to “move on” with a new romantic relationship recognizing that the relationship will include the person who was lost.  There’s no competition.  There’s no replacement.  There must be acceptance that the missing person is a part of the past and the present – even though they are not physically present.

Life Happens for Us

It’s natural to think that life happens “to” us after a tragic loss.  We can feel as if we’re out of control and the world is a hostile place.  However, it’s also possible to relearn that life happens “for” us.  It’s a journey that has both highs and lows.  No one would want the lows of a death by suicide, but at the same time, we cannot have the good without the bad.

In an ideal world, we’d find our way back to the realization that life is a gift.  Then again, it would be better if no one else would have to join The Suicide Club.

Book Review-Deaths of Despair and The Future of Capitalism

Suicide is, unfortunately, not the only death of despair.  In Deaths of Despair and the Future of Capitalism, the argument is made that we’re getting crushed by suicide, drug overdoses, and alcohol related deaths.  These are, the authors assert, the deaths of despair – and that they’re uniquely being amplified by the American system of capitalism.  In fact, they argue that there’s a class difference between those with bachelor’s degrees and those without them.

Education’s Protection

The basic argument – backed by a mountain of data – is that those who have at least a bachelor’s degree are protected from much of the despair.  They’re not immune to problems or even a death of despair, but the prevalence is lower.  Paul Tough in The Years that Matter Most explains that not only does going to college matter, but so does which college you go to.  He’s speaking about the high end of opportunities unlocked by both the education and the network that you develop.  What happens below the line – when you can’t get into any college?  That’s what concerns Anne Case and Angus Deaton.  Why is it that people who don’t get a degree do so poorly?

The answer may be a cascade of factors.  First, jobs have become increasingly more complex and have required greater technical skill.  While there’s an argument that too few people go into the field in which they earned their degree, there’s a belief that a bachelor’s degree proves a general acumen.  In any case, the unemployment numbers indicate that unemployment is higher without a bachelor’s degree than with them.  In short, there’s a greater likelihood of employment with a degree.

Second, the prospects of marriage are much better with a job than without.  There’s an expectation that especially men should be able to support their spouse and ultimately their families.  Without a job, that’s not possible.  So not only does a degree convey better job prospects, where many get their self-worth and socialization, but it conveys better opportunities for marriage.

Third, marriage means, on average, a better economic picture.  Two people working together – both of whom are likely to have a degree – is much better financially than two people working alone.  The result is that the person with a bachelor’s degree is likely to be even better financially than just the degree implies.

Thus, the degree allows for a set of conditions that lead to several protective factors: the belief in self-worth, the engagement of social connections, an intimate partner, and financial resources.  It’s a keystone marker that had a large impact on future outcomes.


What few people realize is that substance use disorder – a drug addiction – isn’t just a problem.  It’s a solution, too.  It’s the way that people have learned to cope with their life’s circumstances.  There is a lot of mythology with drugs that makes it difficult for people to accept that people with substance use disorder aren’t bad people – and it’s not that drugs are so addictive.  Even Bruce Alexander’s work about Rat Park is misrepresented as saying that even rats become addicted to morphine.  (See Chasing the Scream, and The Globalization of Addiction for more.)  We’ve been sold a bill of goods that people who use drugs are bad, and even one attempt at drugs will addict everyone.  It’s just wrong.

The painful truth about drug use is that people use drugs because of some other pain they’re facing that they don’t know how to handle.  There’s something that they don’t know how to resolve, and the drugs make it go away – at least for a while.  That’s why including drug use as a death of despair makes so much sense.

Another tricky aspect of drug use as it pertains to suicide is that it’s very difficult to distinguish a suicide death by drugs from an unintentional one.  Intent to die is the only thing that separates the suicide from the accidental overdose, and there’s no clear, bright line.  Ambivalence and not protecting oneself from overdose death is only a matter of degrees different than intentional overdose.  Even those who survive may not be certain themselves.

There was a real problem that was created by pharmaceutical companies, particularly Purdue Pharma, where powerful opioids were sold as non-addictive.  The result of continued overuse led to addiction.  Oxycontin was massively overprescribed for pain.  When controls started to be placed on opioid prescriptions, and they became both harder and more expensive to get, many people switched to heroin, because it was a similar but cheaper option.  (See the book Dreamland for this transition and the opioid crisis in general.)

The number of deaths due to drug overdose is estimated at 107,000 in 2021.  This is roughly double the number of deaths that are categorized as suicide in the United States.  More than that, these startling numbers are a key indication that many people are suffering.


Drugs are at least illegal.  Deaths by overdose are necessarily criminal when the drugs themselves are outside the law.  However, what about the deaths that center around alcohol?  We tried prohibition in the United States, and it ended quite poorly with the rise of crime.  We won’t attempt eliminate consumption of alcohol again, but it does take a huge toll on us.  The CDC estimates over 140,000 people die through excessive alcohol consumption – that’s roughly three times as many people as die by suicide each year.  It’s appropriate to focus on the mortality associated with alcohol.  However, we can’t ignore that alcohol – like drugs – causes suffering in other ways as well.

Alcohol consumption differs between those with and without a bachelor’s degree.  People without a degree are more likely to drink heavily, less likely to drink in moderation, and less likely to abstain from drinking.  Alcohol is really a drug – a legal one – that people use to help them numb the pain of their daily lives.


The most addictive substance is nicotine.  Decades ago, the tobacco industry’s chokehold on information about the harmful effects of smoking was broken.  Despite this, we still find that 11.4% of adults with bachelor’s degrees smoked – as compared to 19.8% of people without a degree.  It would be practically impossible to smoke without awareness of the long-term health impacts.  If nothing else, the on-package warnings are a solid clue.

This is a powerful indicator that simply having knowledge of something doesn’t mean that we’ll change behavior.  Everett Rogers in Diffusion of Innovations explains that we must change knowledge, then attitudes, to get to a change in practice – or behavior.  (See Knowledge-Attitudes-Practices for more.)  An official strategy for combatting tobacco use is called the Transtheoretical Model – or Stages of Change.  It’s important to recognize that this model accepts that some people aren’t even open to changing their behavior, and engaging them in a discussion about the change may cause them to dig in their heels.

Deaths and the Economy

Though suicides are correlated with economic hardship, deaths generally fall during economic hardship.  The reason for this is that, though suicide deaths increase, other types of deaths fall.  Whether the core of that is because people don’t have the money to do riskier things or they’re not stressed by their jobs, the odd relationship means that there is often more than meets the eye when we’re looking at societal changes.

Unable to Work

One of the difficult parts of addressing deaths of despair is the degree and type of support to offer.  We see that countries that have better social support programs have fewer suicides when unemployment increases, but the concern is that we’re demotivating people from working.  In fact, we’ve seen a general decline in the percentage of men of working age that are in the workforce.  That’s a troubling statistic.

Part of the issue is that there’s a greater participation in higher education, but that’s not enough to explain the decrease.  Investigation of the numbers notes that there is a troubling trend that people exit the employment market during downturns – perhaps through no fault of their own – but they don’t always return to the work force.  This is irrespective of the social supports in place.  They’re just not coming back.

It’s also true that the decline in the rates of working people in the United States involves an increase in reported pain.  Pain makes work less tolerable, particularly for those whose jobs involve manual labor.

Sex and Marriage

Above, I shared that marriage prospects are decreased for those without a bachelor’s degree, but there’s more to this story.  As I mentioned in my review of America’s Generations, the advent of the contraceptive pill and the availability of abortion radically reorganized our views about sex, particularly sex outside of marriage.  No longer was there a real risk that one would face an unwanted pregnancy after sexual relations.  With appropriate precautions and with a failsafe, sex felt safer for casual fun.  It’s a startling revelation that, using the data from 2014 rates, one in four women will have an abortion by forty-five.  The recent Supreme Court decision to overturn Roe v. Wade will certainly have an impact on this – but to what degree isn’t known.

This meant that women no longer needed to marry early to ensure support of a baby.  They were free to be choosier.  More than that, it changed the sense that women had for their careers.  They had more flexibility to decide when they wanted to take a break to have a baby.

Religion and Politics

Marx called religion “the opiate of the masses.”  However, as Churchless, The Great Evangelical Recession, Bowling Alone, and other books have noted, people are attending church less regularly.  We ended up using opioids as religion lost its hold on society.  But what happened to cause the gap is more challenging.  Ezra Klein in Why We’re Polarized explains that we’re more focused on our political identity than we have been in the past.  We’re seeing it in church attendance: instead of people first picking a church community and adapting their politics to suit their friends, they’ve switched it.  Now, it seems people pick their spirituality to fit their politics.

The Assault on Healthcare

The book ends with an assault on healthcare.  It asserts, “Sixteen percent of those in the top 1 percent of incomes in 2015 were physicians; 6 percent among the top tenth of 1 percent.”  The implication is that doctors are soaking up the work of the people through higher than appropriate fees.  However, if we look at Robert Pearl’s work, including Uncaring and Mistreated, we see that there is a problem, but the doctors probably aren’t the core issue.

There is lots of profiteering to be sure.  However, the truth is that our system doesn’t prioritize or reward preventative care.  We know that preventative medicine is good medicine.  Not only do people not suffer, but it’s more effective.  Yet most preventative care isn’t done, because it doesn’t make sense for an insurance plan that is likely to change in the next year.  We don’t fix problems, but instead subject patients to long-term pharmaceutical interventions.  We operate a medical system that is paid to perform services – and so that’s what we get whether those services are needed or not.

Scanners and Scammers

Making it even harder is that the new technologies that are supposed to improve care may not really do that.  For instance, I took Scott Warrick to task for supporting SPECT rather than the more broadly accepted fMRI.  (See Solve Employee Problems Before They Start.)  Both are expensive, but SPECT is less expensive and much less common.  SPECT has some uses, but fMRI provides more robust data.  The tricky part here is that SPECT can be useful – but in a narrower set of circumstances.  Figuring out whether a cheaper scanner will do what you need or whether you need a more expensive scanner with more robust data is a difficult decision that invariably will be wrong.

One of the reasons that our healthcare costs are spiraling upwards is because these expensive pieces of equipment sit idle too frequently.  In the service of faster access, we reduce utilization and therefore must amortize the cost of the unit across fewer procedures.

Sorting out the solution to The Deaths of Despair and the Future of Capitalism isn’t easy – but it’s important.

Book Review-Healing Trauma: Attachment, Mind, Body and Brain

Edited volumes are quite literally a collection of semi-random chapters written by different authors.  The results can be good, bad, or both.  Healing Trauma: Attachment, Mind, Body, and Brain has both good and bad.  It’s an attempt from 2003 to pull together the best of what we knew; in some ways, what we knew then is just as relevant today.  In a few cases, the material and perspectives didn’t age well.  Overall, it’s a good place to get perspective on a vexing problem.

Differentiation and Integration

Navigating the world isn’t always easy.  We’ve got to learn how things are different from one another – and how they’re the same.  These twin processes of our brain are constantly helping us to see better.  Sometimes, as in the case of stigma, it has negative consequences (see Stigma), but much like we’ve learned about altruism, these functions have evolutionary value.  (See Supercooperators and Does Altruism Exist?)

The assertion of Healing Trauma’s editors is that trauma blocks the integration process.  Individuals can see how they’re different, but not how they’re the same as others.  They can see that the trauma was different from their ordinary world but are blocked from integrating that experience with the rest of their lives.  The result is the fragmented, implicit memories that are at the heart of problems with trauma and sometimes develop into post-traumatic stress disorder (PTSD).  (See Trauma and Memory for more.)

Brain Structure

Perhaps one of the most challenging aspects of reviewing older materials is the balance between accepting the reality that different regions of the brain have differentiated functions and rejecting the broad, sweeping statements about the hemispheres of the brain and their function.  The historical perspective of neurobiology was that the left and right hemispheres of the brain had distinct and different purposes.  Our understanding today is more nuanced.

It’s true there are two hemispheres, and they’re connected.  The right hemisphere even develops before the left.  However, often, people overstate both the differences and what can be determined as left or right hemisphere.

As I’ve mentioned in my review of Transforming the Living Legacy of Trauma, we realize today that our thinking is much more distributed and integrated than previously thought.  In fact, therapies like EMDR are theorized to enhance integration between the two hemispheres, thereby relieving distress.

History Is Not Destiny

The power of processing trauma is that, by better processing it, you can change your future.  It’s possible to disable or render inert behavioral habits that lock people into repeating patterns.  While it seems obvious that your history doesn’t set your destiny, when it comes to trauma, many authors seem intent on believing that once you’ve experienced trauma, you are damaged goods.  They ignore the fact that all organisms need stress, challenge, and setbacks.  (See Antifragile and Why Zebras Don’t Get Ulcers.)

More importantly, the estimates are that 80-90% of people will experience a traumatic event in their lifetime.  Effectively, we’ll all be injured by traumatic events – and we’ll all need to figure out how to process those events.

Rather than viewing trauma from the perspective of its unchangeability, we should recognize that the impacts of the trauma are inherently changeable.  The way that we view the traumatic event and how we choose to respond is under our control.


Attachment theory has a big impact on the way that we process trauma.  The more secure our attachment, the more likely we are to integrate the memories and develop adaptive styles of coping.  (See Attached.)  What are the factors that are most likely to influence our attachment style?  Obviously, given the roots of the study, they’re our parents’ ability to meet our needs and to not respond negatively to our needs.

What this really means is that the more integrated our parents’ narratives are, the more likely they’ll be to respond positively to our needs as a child.  Those parents who have a coherent autobiographical story integrate their “parent-ness” into who they are, and they choose parent-like behaviors.

The Difference Between Thoughts and Feelings

In How Emotions Are Made, Lisa Feldman Barrett sought to expose the cognitive processes that underlie our emotions.  She explains how our thoughts fuse with our bodily sensations in ways that form emotions.  How we feel about someone or something has as much to do with indigestion or illness as attraction.

Neuroscientists have not been able to find some clear, defining line between what constitutes a thought and what is an emotion.  While they’re differentiated, it may be possible that thoughts are not all that different from emotions after all.

Storytelling and Press Secretaries

We’re constantly writing and rewriting our autobiographies in our heads.  We’re moving from a set of disjointed experiences and stringing a narrative between them.  Sometimes, we can articulate the narrative – and other times, we can’t.  Either way, we’re constantly writing our stories.  Once we passed our second birthday, we began speaking in stories, and the most important one is ours.

Some of what we see as our story is just a rationalization for what we decided without conscious intervention.  Jonathan Haidt explains that the rider in his elephant-rider-path model is a press secretary.  (See The Righteous Mind.)  The press secretary’s job is to make sense of what has already been decided.  Similarly, our conscious mind often just makes up stories to fill in the gaps in what we’ve already decided or done.  (See Incognito.)

Tolerating Trauma

The general strategy for helping to relieve the negative impacts of a traumatic event is to make processing the event easier, safer, and more tolerable.  It isn’t that the event can be made fear- or anxiety-free, but rather that it is possible to reduce the degree to which recalling an event induces fear or anxiety.  It’s important to realize that this isn’t unique to trauma.  In Find Your Courage, it was rightfully asserted that courage isn’t the absence of fear but a decision to move forward in the presence of fear.  The lower the fear or greater the conviction, the greater the chances we’ll see something we call courage.

Fear is at the heart of Richard Lazarus’ work, Emotion and Adaption.  In it, he explains that fear is an evaluation of the impacts and probabilities of an event – mitigated by our coping capacity.  We can encourage better evaluation of the factors of fear so that they can be reduced.

Rick Snyder in The Psychology of Hope explains that hope too is a cognitive process and that when you increase someone’s sense that they know how to solve a problem it gets bigger.  The other component of hope is willpower.  As explained in Willpower, we can increase our capacity for willpower.  Antifragile points to increasing capacity with appropriate challenging exposures.

In Why We Do What We Do, Edward Deci speaks of our intrinsic motivation and the need for us to feel autonomy.  In the language of Compelled to Control, we want to believe that we control ourselves.  The more we believe that we’re in control of our lives, the more intrinsic motivation we’ll have.  The ability to control one’s destiny is also a factor in preventing burnout.  (See our Extinguish Burnout site.)

In short, we can change the factors that make someone fearful or anxious about remembering a traumatic event.  Through this remembering we can continue to lower the fear and anxiety of the traumatic event until it can be successfully processed – and therefore no longer a traumatic event impacting now.

The Disorganization of Nomads

Most mammals return to a home base when frightened.  There’s a den or hutch somewhere that they return to for protection.  However, humans are different: we seek out protectors rather than places.  This may be a side effect of our initial nomadic life, where there wasn’t a singular place we could feel safety.  Instead, we had to adapt to seeking others for our protection.  This becomes problematic when the protector is the one who is making us feel threatened.  Our instinct to protect ourselves leads us away and towards the person at the same time.

Taking a step back, we find that anxiously attached adults have experienced what they believe to be abandonment.  Therefore, they seek to keep people they’re connected to closer.  Avoidantly attached individuals avoid close personal connections, because they believe they can only be harmed by a close relationship – in short, they’ve experienced some situations where they’ve sought protection, and the protector made them fearful.  For instance, they come crying to a mother or father, and the parent responds with, “That’s nothing – stop crying, or I’ll give you something to cry about.”

The disordered attachment person alternates between anxiety and avoidance seemingly without reason.  They can’t decide whether they need to be close to people – or whether close relationships only cause them pain.  So, when our nomadic parents don’t have the capacity to respond in consistently supportive ways, we’re at risk for some insecure attachment style (anxious, avoidant, or disordered).

Don’t Blame the Parents

It’s natural, particularly in today’s age, to blame the parents for the challenges that children face.  After all, if the parents were fully available to their child, wouldn’t they be securely attached?  As Judith Rich Harris points out in No Two Alike and The Nurture Assumption, it may not be that simple.  It can be that the parents did meet all the needs of the child – from their perspective.  The child may or may not agree, and that may not be the parent’s fault.

Additionally, a tendency to blame the parents ignores the problem of math.  Once parents have more than two children, it’s not literally possible to meet every child’s needs all the time.  Even with fewer children, the demands of life to make money, go grocery shopping, and generally “do life” can interfere with the ability to meet a child’s needs at every moment.  Parents who are struggling at the edge of poverty are particularly challenged, as they must strive to simply provide food and shelter.  The additional emotional needs of children may be beyond their capacity.

Holding Back the Trauma

“I’m still in love with the illusion of this life.”  Rarely is it articulated this well.  People recognize that they need to move forward to change their world and “bring things to a head” but refuse to do so.  They know their marriage isn’t what it should be, and they need to change it or, more likely, get a divorce; but they know that the divorce itself will be traumatic, and they’d like to avoid that, if possible.

It’s easy enough to claim that “it’s not that bad” or believe that magic will happen, and things will get better.  Rarely do people choose to walk into the possibility of trauma despite the awareness that the degree and severity will be lower if it’s confronted directly.  Or they believe they’re incapable of surviving the trauma if they trigger it.  They believe the divorce might break them.

Some of the traumas we need to deal with are the ones that we ourselves initiate – or at least initiate the timing of.  Continuing to believe the illusion that there’s a way to avoid the trauma generally makes things worse, not better.

Get Well or Stay Married

Sometimes, individuals are faced with a trauma-inducing and -reinforcing relationship that was that way from the start.  One of the parties wants to get better, but the other doesn’t want to change.  They believe that their drinking buddies are more important than a healthier lifestyle.  It’s in these situations that one of the partners is faced with the reality that they can either get well or stay married.  They can’t do both.

There’s no doubt that the first stop should be to try to convince your partner to try the change.  Attempts to create desire in the other person must be tried.  There should be ample – but not too much – time to shift thinking.  However, if the partner is unwilling or unable to make the change, then sometimes it will be necessary to get well and accept the trauma of the loss of marriage.  Once you’ve made this tragic decision, you can move forward towards Healing Trauma.

Book Review-Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists

It’s a mixed bag.  Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists has some profound insights – and also some frustrating perspectives that aren’t consistent with other works and without research cited.  It makes it difficult to know which things are true, and which are not.

Thirty Years Ago

“Thirty years ago, it was thought that traumatic experiences could be healed when the secrets were finally revealed and the story of what happened was told to a safe, validating witness.  However, contrary to what we believed then, that process often made the traumatic effects worse instead of better.”  It’s my first highlight from the book – and it’s wrong.  While I understand the intent – and there are aspects of truth to it – it’s not consistent with what we know about trauma today.

First, the truth is that forcing people to relive a trauma, particularly in ways that don’t feel safe (or safe enough), absolutely does do more harm than good.  It tends to reinforce the trauma and make it worse.  It’s one of the big reasons why, I believe, CISM doesn’t work.  (See Opening Up for more on CISD/CISM.)

However, the work of James Pennebaker and others shows that the process of organizing the trauma in our minds (through writing the story) has a healing effect.  (See Opening Up.)  Peter Levine in Trauma and Memory speaks of the processing that converts implicit to explicit memories and essentially how this is a storytelling process.

This is at the heart of my concerns with the book.  Some of the statements have a kernel of truth to them, but they don’t have the clarity necessary for someone to discern what is good and what is bad.

For instance, another challenging statement is, “Doctors, nurses, and EMTs all rely on adrenaline to do their jobs well, as do most peak performers.”  It directly contradicts the work of Anders Ericsson and Robert Pool in Peak and is inconsistent with the high-performance state of flow.  (See Flow and Finding Flow.)  Steven Kotler in The Rise of Superman acknowledges the desire for adrenaline but also is careful to explain that too much is a problem.

Similarly, comments like, “Restricting food intake puts the body into a neurochemical state called ketosis, creating a numbing effect but also a boost of increased energy,” show an ignorance of medical information.  Ketosis is the reduction of carbohydrates, not food.  It causes the body to derive energy by burning fat – which is why most people indicate a loss of energy as they transition into ketosis.  There’s no evidence of “numbing” in the sense it appears to be used here.  Numbness and tingling is a side effect of the transition, as there is lower blood sugar and lower blood pressure (generally).


Fisher acknowledges that MacLean’s triune brain model is mostly considered out of date by scientists but continues to use it for its utility.  I take no issue with that, because it’s a simple model that helps the reader conceptualize three parts of our brain.  It’s useful as a way of understanding our neocortex is often being used to dampen (or amplify) the responses from the more primitive structures of our brain.

However, a bit more concerning is the insistence on using a left-right hemisphere model of describing the brain beyond what is still supported by science – without identifying that it’s a simplification.  There’s hemispheric structure to the brain and the corpus callosum does connect the two sides; however, we’ve learned that various parts of the brain operate in concert to achieve what we believe is a single thing.

For instance, generally people believe that speech comes from Broca’s area.  Broca’s area seems to handle syntactic structure, but Wernicke’s area is more focused on meaning.  Damage to either area impairs the ability to speak.  Wernicke’s area occurs in both hemispheres of the brain with slightly different uses.  Many of the tasks that we take for granted happen in multiple areas of the brain.

Understanding the Process

Fisher explains that her mentor, Judith Herman (who wrote Trauma and Recovery), insisted that what trauma victims needed was education about trauma, including its ramifications and manifestations.  I’d expand this to say that they need to know what to expect.  By knowing what to expect in the processing of trauma, they don’t have to be afraid of it.  They don’t need to be concerned that their trauma will leave a lifelong limitation.  While Herman reportedly wanted patients to make intelligent choices, I believe it’s more than that.  It’s about being able to be calm and feel relatively safe through the process.  When you know what to expect, it’s safer.

Trauma as Being Forced

Fisher proposes a different definition for trauma, which is, “trauma is the experience of being forced to do what others want.”  Certainly, it can be traumatic to do what others want.  In the context of Herman’s work in domestic abuse, this can be true.  However, as a broader statement, it doesn’t define trauma.  At a broader level, the kind of trauma being discussed here impacts the person personally – causing physical injury or at least a constriction of freedom.  It also forces us to confront our belief that we’re in control of ourselves.  (See Who Am I? and The Righteous Mind for more.)

Shame and Self-Blame

“But remember that shame and self-blame shut down the prefrontal cortex and diminish the capacity to learn.”  Yes, but that’s not the primary mechanism.  The primary mechanism is fear.  The spinning neurochemicals cause memory to encode differently – and generally in ways that’s harder to recall consciously.  (See The End of Memory and Trauma and Memory for more about memory encoding and recall.)  Of course, Brene Brown has made a career of studying shame, and it’s certainly a noxious self-concept.  (See Daring Greatly.)  Self-blame, which Brown might call “guilt,” can be instructive when we move from the blame to the behavior change that will prevent the outcomes in the future.

Two Darts

Buddhists speak of the story of two darts.  The first dart is the pain.  The second dart is our, often maladaptive, reactions.  That’s one of the reasons that Buddhists and other contemplative (meditative) practices encourage acknowledging thoughts and then letting them go or getting curious about them.  Rather than being self-punitive for failing to meditate “properly,” we can either release the thought or follow it – if it doesn’t lead to rumination.

Sometimes, the experience we find ourselves in is binding – and sometimes less so.  A person can make belittling comments to their spouse, but unless the spouse accepts these comments (at any level), they’ll have no effect.  It is as if the first dart missed its intended target.  (See my review of Rising Strong (Part 2) for more about catching the darts in mid-air.)

Conversely, someone who is concerned about their ability to support themselves financially may accept abuse from their spouse, because they feel as if they have no other options.  Not only does the first dart hit, but they launch the second dart at themselves by amplifying the impact.  They take it to heart that no one else would love them and they’d be nothing without their spouse.  (See Terror, Love, and Brainwashing for more.)

More than the Trauma

Ultimately, recovery comes in the form of reestablishing ownership of our mind and body – that is, the belief that we’re in control of ourselves.  Fisher incorrectly quotes van der Kolk from The Body Keeps the Score but with a similar meaning.  Van der Kolk’s words are, “The challenge of recovery is to reestablish ownership of your body and your mind—of yourself.”

Practically, this recovery means accepting that you’re more than the trauma and even the outcomes of the trauma, including loneliness and suicidality.  (For loneliness, see the book Loneliness.  For suicidality, see Loving Someone with Suicidal Thoughts.)

In the end, I can’t recommend reading Transforming the Living Legacy of Trauma – unless you’re willing to carefully challenge what you’re reading with the hope of sharpening your understanding.

Book Review-Trauma Treatment: Healing the Whole Person: Meaning-Centered Therapy & Trauma Treatment Foundational Phase-Work Manual

I picked up Trauma Treatment: Healing the Whole Person: Meaning-Centered Therapy & Trauma Treatment Foundational Phase-Work Manual after seeing it as a reference at an anxiety workshop.  I was looking for more perspectives on trauma treatment.  What I didn’t know then is that it’s based on Viktor Frankl’s logotherapy.  You may know that Frankl wrote Man’s Search for Meaning and that he was a concentration camp prisoner.  I deeply respect Frankl’s work and his insights.  Not surprisingly, his work focuses on finding meaning.

Alternate Perspectives

While I favor a definition of trauma that speaks to its temporarily overwhelming nature, other perspectives of what trauma is are interesting.  Trauma Treatment focuses on how it impacts us, saying, “Trauma deconstructs the carefully constructed understanding of life. Trauma disorganizes the prior harmony of our assumptions. Trauma is a loss of pattern.”  When explaining trauma to others, I often speak to both the personal impact and the way that trauma reorganizes our perspectives of the world.  Our consciousness is, at its core, a prediction engine.  (See Mindreading.)  We have consciousness to support our ability to predict, because it confers an evolutionary advantage.  To predict allows us to prepare and thus survive.

As I’ve implied in the preceding, I think the definition provided by Trauma Treatment is incomplete.  It fails to account for how we’re connected to the event in a way that triggers the reevaluation of our beliefs.  It also neglects the dimension of personal impact on future possibilities.

Meaning in the Moment

In addition to the ultimate meaning of one’s life, Frankl believed in the meaning of the moment.  Our consciousness is constantly scanning our environment and trying to make meaning of our perceptions.  We’re constantly trying to find the meaning of the moment – but generally only in a threat management sort of way.  Frankl encourages us to look more deeply to try to understand how the meaning of the moment has meaning to our lives.

Here, I recommend caution.  While I firmly believe in finding the meaning in the moment, I also recognize that, for traumatized people, they can read too much – or the wrong thing – into circumstances.  The woman who was raped walking home from a Christmas party may draw the conclusion that Christmas means rape.  She can also draw the conclusion that it was her fault.  Neither of these conclusions are the best.  (I hesitate to say “wrong.”)

I’d revise this to say that we should be open to discovering meaning in every moment without necessarily insisting that we find it.  When we try to force meaning from a moment, we often come up with answers that aren’t the best.

Suffering to Meaning

Core to Frankl’s beliefs is that, while suffering is universal, the resolution of suffering is finding meaning.  The idea that suffering is universal is a core Buddhist belief.  It’s the expectation that, in life, we’ll have suffering.  Frankl claims (in Man’s Search for Meaning) that the resolution of this suffering is meaning.

I disagree with Trauma Treatment’s assertion that people resist finding meaning because they need time to be in the pain.  This prejudiced perspective implies that they should just get over it and move on.  I prefer to look at it from the perspective that the therapist can see the meaning (or, more precisely, a meaning) more quickly.  Their job is to find meaning in events, and thus they’ve become more adept at it.  Sometimes, it takes people longer to learn from their circumstances.  That doesn’t mean that they need (or deserve) to suffer in pain.

Logotherapy Change

Logotherapy and existential analysis build upon the Transtheoretical Model, often called Stages of Change, to describe a process by which individuals can change and grow.  The problem, as with other parts of the book that called an Indian who lived 500 years BC a logotherapist, is that the timelines don’t work.  The model was first published in 1994 and Frankl died in 1997 – while enough time to develop an extension to the model, it’s more likely something created by his disciples.  This is important, because unlike the original insights regarding the importance of meaning, these changes feel more like an attempt to connect Frankl’s core work to the need for change to make it more relevant.


The book includes a set of what are clearly slides as figures, which contain some diagrams but are mostly walls of text that seek to make an incomprehensible number of acronyms that presumably the reader is expected to remember.  Mnemonics and acronyms can be a helpful tool – but not at the volume they’re being used.  (See Job Aids and Performance Support, How We Learn, and Efficiency in Learning for more.)

It feels as if the book was an adaptation of a workshop, but the slides themselves weren’t fully translated into prose.  For me, the wall of text on most of these slides makes me wonder why the information couldn’t be transformed into book form more readily.

In the end, there are nuggets to get out of Trauma Treatment, but it’s better to skim it than to dedicate time to reading it.

Book Review-Healing Secondary Trauma: Proven Strategies for Caregivers and Professionals to Manage Stress, Anxiety, and Compassion Fatigue

What you see and do changes what you see and do.  It’s a simple statement with profound effects.  It’s a recognition that you can’t see others’ trauma without being changed by it.  You can’t be in the presence of others’ suffering without suffering yourself.  Healing Secondary Trauma: Proven Strategies for Caregivers and Professionals to Manage Stress, Anxiety, and Compassion Fatigue is designed to provide tools that allow us to stay in contact with the trauma longer, to suffer less ourselves, and to help more.

Healthy Tactics

The set of strategies that Healing Secondary Trauma recommends are proven to be useful.  There’s no problem there.  However, the problem is that the recommended strategies are patches.  They don’t address the core problem.  They’re good to help you reduce the suffering to the point that you can do real work on the trauma.  However, they’re not a final solution.

The Symptoms

Gilbert-Eliot shares what she believes are the symptoms of secondary trauma: anger, sadness, exhaustion, and compassion fatigue.  That’s problematic, because while they can be symptoms of secondary trauma, there are also many other causes of these symptoms.

I’ve discussed how anger is disappointment directed.  (See Destructive Emotions and my explanation in Conflict: Anger.)  Disappointment is certainly something that one could experience when we see how humans treat other humans or the destruction that can come from “acts of God.”  So, it’s quite plausible that it would have an impact – but the solutions offered don’t provide a way to work through these disappointments and disable the anger.

Sadness is less frequently discussed than happiness.  In fact, happiness is one of the philosophical ideals that can keep people very busy.  A lack of enjoyment with life and a sense of sadness can be a result of secondary trauma, but here, too, there’s little advice on what to do.  (See Happiness, Hardwiring Happiness, The Dalai Lama’s Big Book of Happiness, and more for more on happiness.)

Exhaustion is hard, because it’s simply exertion.  What’s missed is the reality that people are holding back emotional release, and this consumes energy.  Much like stress is a friction that reduces our efficacy, holding back memories of the trauma can rob us of the energy we need to live.  (See Nurse Burnout for stress as friction.)  So, the problem isn’t so much exhaustion directly, it’s the work that we’re doing to maintain compartmentalization of the trauma long after it should have been released.

Compassion fatigue is trickier to explain, because it’s often confused with burnout.  (See Is It Compassion Fatigue or Burnout?)  However, neither phenomenon is directly related to trauma.  Both seem to have elements of a failure to feel effective or a belief that you’re not enough.

The Tactics

Gilbert-Eliot also identifies, “Healthy tactics for managing anger include assertiveness, problem solving, cognitive restructuring, and acceptance.”  Here, too, Gilbert-Eliot misses the target.

Assertiveness is a good tool to help people take more control of their lives.  Greater degrees of control (or perception of control) are associated with better outcomes across a wide variety of mental maladies.  However, assertiveness does nothing to help someone process a trauma they’ve experienced.

Problem solving is an interesting – but difficult – tool for all sorts of things, but most traumas don’t represent a problem (or puzzle) to be solved.  Problem solving is difficult to teach just as creativity is difficult to teach.  Creative Confidence explains that we’re all born with it, and we just need to recreate situations for our stifled creativity to reemerge.  Problem solving is that, but it’s also the development of greater capacity for mental models.  Gary Klein in Sources of Power explains how mental models allow for the solution of problems, like the best way to deploy firefighters to a fire.  If we were to extend this further, we’d ideally teach people to think in systems, so they can see what kinds of things they might do to solve the problem.  (See Thinking in Systems for more.)  Even people with a high degree of problem solving skills encounter trauma and struggle with it, because it’s not a problem to be solved as much as it is an experience to be processed.

Cognitive restructuring is a solid recommendation.  It’s at the heart of cognitive behavioral therapy (CBT) and is recognized for improved mental health.  What is missing is only that the restructuring often is about accurately perceiving and responding to reality as well as creating a better sense of innate safety.

Acceptance indirectly helps trauma by increasing safety and allowing the trauma to be processed more readily.  Richo explains in How to Be an Adult in Relationships how his five As, including acceptance, can lead to better relationships – and a better life.

False Explanations

One of the tragedies heaped on tragedy is when people have a period of memory loss associated with a trauma, and they believe, in that gap, they did something awful.  Instead of assuming that they behaved consistently with their character in a professional, respectful way, they assume that, for the memory to be missing, it must be because they did something bad.  This is rarely the case.  In most instances, the memory disruption causing amnesia is related to the event itself and not to the person’s reactions.  Even in cases where it was related to their actions, it’s often because of the ethical dilemma or moral injury situation they were placed in.

Ethical dilemmas are where you’re faced with two bad choices, and you’ve got to pick the one that seems least bad to you.  Consider a train barreling down the tracks, with 10 people on board; around a curve (unseen), there are 10 people working on the railroad tracks.  There is a switch you can throw to cause the train to go down another track and miss the workers, but it will almost certainly cause the train to derail and cause injury to the train driver and the passengers.  Do you throw the switch?  In either case, someone is getting injured.

A moral injury goes farther: you behave in ways that you disagree with, because you believe it’s required to keep your job.  Consider a train operator who believes the train can safely travel at 30 miles per hour.  The company insists on 45 miles per hour to keep the schedule.  A person jumps in front of the train – intending to die – and the operator can’t stop.  The operator faces moral injury, because they believe they’re being asked to operate in a way that is immoral.  (See How Good People Make Hard Choices and Moral Disengagement for more on these topics.)

Even in these cases, a missing memory doesn’t indicate something evil or wrong done by the individual but rather protection from the pressures of these situations.


A major concern with trauma is the splitting of personality, which Gilbert-Eliot correctly raises.  To put it in context, it’s believed that people naturally fragment parts of their experience.  No Bad Parts explains the Internal Family Systems (IFS) view, where we have protectors and victims that are all operating semi-autonomously in our heads.  The goal of IFS is to help reintegrate those parts to lead to better mental health and wellbeing.

Dissociation – a natural and normal reaction to trauma – isn’t a problem as a temporary coping mechanism.  However, when it crosses over into a permanent separation from oneself – or a part of oneself – there’s more cause for concern.  Monitoring the degree of splitting of personality and developing a sense for when the splitting may cause problems can be an important part of Healing Secondary Trauma.

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