PTSD Awareness Month

Did you know June is national PTSD awareness month? It is also Pride Month! And Men’s Health Month! And National Safety Month! (and probably more that I don’t know about!)

The one I want to talk about today is PTSD awareness, not because it is more important than any of the others, but because PTSD (or at least trauma) is part of almost all of my work.

Actually, there is tons of overlap between PTSD and LGTBQ folk, men, and safety.  For example, LGBTQ youth experience higher rates of trauma (such as bullying, harassment, traumatic loss, physical and sexual abuse, and societal stigma, bias, and rejection) than their peers. And while women are more likely to be diagnosed with PTSD, men are more likely to experience a trauma and are less likely to get counseling in general. Also, trauma seriously impacts our ability to feel safe.

So what is PTSD? Good question, since I keep using that acronym, let’s start there - the long term for it is Posttraumatic Stress Disorder.

People might develop PTSD after experiencing something awful or tragic, where their life or someone else’s life or well-being is threatened; we call this a trauma. Sadly, trauma is super common in our world. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives according to the VA. Some examples of trauma are sexual assault, child sexual abuse, serious accidents, physical assault, combat, disaster, or witnessing death or injury. Others that are less physical in nature still have a strong impact, and I would argue the impact is often deeper or more complex; examples include things like childhood neglect (not getting your basic physical, emotional, or social needs met), verbal abuse, stalking, social rejection (of yourself or your community), and hearing about the details of trauma that happen to others.

Experiencing a trauma does not automatically mean you will have PTSD. Although you might still have some reactions that relate to what you experienced, and those reactions might pop up at any time. If you have PTSD you will have symptoms across multiple categories in addition to having witnessed or experienced a trauma.

The easiest way to explain PTSD it to describe it as a disorder of being stuck in the trauma.

People have different ways of being stuck in bad experiences. It can look like frequently reliving or re-experiencing things related to the trauma. You might be avoiding memories and reminders of what happened. You may notice changes in your thoughts and feelings that are directly related to what you experienced. And you might find yourself being highly reactive or on-guard. If this paragraphs sounds familiar to you, you probably have been feeling lonely too. Please know that you aren’t, 70% of adults in the U.S. have experienced trauma and up to 20% of those people go on to develop PTSD; that means literally millions of people are experiencing this. The good news is there is effective counseling for PTSD such as cognitive processing therapy (CPT) and trauma-focused cognitive behavioral therapy (tf-cbt). There is also growing evidence for EMDR.

Discovering if you have PTSD is the first step towards getting getting over it (and yes, research supports effective treatment for both adults and kids!) A psychologist can diagnose PTSD - if you are worried you might have it, schedule a free 15 minute chat with me to see if testing or counseling might be right for you. You don’t have to be stuck forever!

Mental Health and Mass Shootings

It happened again today, at a school again too.

I want to be surprised, but I think at this point I would be more surprised if it did not happen.

I am going to need to take care of my mental health today, and you might too. I will be posting more resources about that on my Facebook page. But for now, since it is mental health awareness month, I'd like to focus on that.

We like to think we know a lot about gun violence. But the truth is that what we know is limited because research on gun violence has been limited for a long time. And the information we do have depends on how people define "mental illness" and "mass shooting."

I am not going to say that a mass shooter is someone who is mentally well. I think we can agree that someone who is mentally healthy does not see mass shooting as the best plan of action. However, I do want to clearly state that being mentally healthy and not having any mental health diagnosis are not the same thing.

A person can have a mental health diagnosis such as Major Depressive Disorder, Schizophrenia, Bipolar Disorder, etc. and be mentally healthy. They can be taking good care of themselves, seeing a therapist, taking prescribed medication, have a good support system, know their personal signs of worsening and have a plan to follow, purposefully keep themselves away from weapons if that has been a concern. A person can also have no mental health diagnosis and not be mentally healthy. They might misuse substances, have anger issues, not learn how to manage their emotions, not be taking care of themselves, or simply have never sought treatment. 

We do know a couple things about gun violence and mental health that seem pretty clear. One is that death by gun by suicide is actually more common than death by gun by homicide. But again, a diagnosis does not mean suicide and no diagnosis does not mean no suicide. We also know that there is a relationship between domestic violence and gun violence.

So today, think about how you are going to take care of yourself or others, and make a commitment to think critically when you see people "taking sides" between if it is a gun problem or a mental health problem - there is a lot of grey in between and the truth is, the answer is rarely black or white in the real world.


Cure Stigma

Mental health awareness continues this month! My last post got you thinking about how we define mental health. Now, let's talk about stigma. NAMI (the National Alliance on Mental Illness) is taking on stigma this month with their Cure Stigma campaign. NAMI also has some wonderful suggestions on how to help reduce stigma here. Unfortunately, we create and reinforce stigma daily. When we don't understand a person's behavior we say they are "psycho" or when someone's mood changes we call them 'bipolar." Then, we avoid talking about it when a person actually has mental health concerns and needs help. The truth is that the words we use (and don't use) matter because of the meaning behind them. In this case we are sending the message "there is something wrong with you" and "if there really is something 'wrong' with you, don't talk about it." We are building stigma in a BIG way by using words and diagnoses when they don't apply to the person and by sending the message that those words and diagnoses are bad. We are building stigma when we refuse to talk about mental health. Let's start talking and thinking about the message we are sending! I try to do a lot of things to keep my table level - talk to friends, practice yoga, sing, read, bike, sit in the sun, listen to happy music, build my "tribe." What are you doing to support your mental health? 

How do you think about mental health?

Take a moment and look at a table near you - how level is it? Mental health, especially that of children, is like the levelness of a table. I learned this analogy years ago from Frameworks Institute at a conference. They write

One way to think about mental health for children is that it’s like the levelness of a piece of furniture, such as a table. And that levelness can depend on the table, the floor it’s on, or both. Just as levelness allows a table to function properly, the mental health of a child enables them to function in many different areas. When children’s brain architecture develops in an environment of toxic stress, it’s like a table on an uneven floor. And tables can’t make themselves level; they need attention from experts who understand levelness and stability and who can work on the table, the floor, or even both.

Many people think about mental health only in terms of if you have a diagnosis or not; if not you are considered "healthy." What I have learned from doing evaluations and counseling is that the truth is we are ALL somewhere on a spectrum of mental health, and it is not just a diagnoses or lack of one that places you on the spectrum.



Empathy only unlocks the door

Recently, I wrote about empathy being the key. But we still have to turn the knob, open the door, walk through, and deal with what is on the other side of the door.

Sometimes just having empathy and not knowing what to do with it can make us feel strong emotions. Vulnerable, weak, scared, sad, angry, the list goes on. No matter what the situation is, there are two steps that you can almost always fall back on (there are always exceptions!).

First, manage your own reaction

This step is extremely important for us to be able to take any other steps. If we are overwhelmed with emotion, that emotion is going to drive our behavior. If we are angry, we are going to yell. If we are vulnerable or weak, we are probably going to get defensive. If we are sad, we are burdening the one we want to help with our sadness. Sometimes those intense emotions can shut us down and cause inaction. Acknowledge how you are feeling, accept your feelings in that moment, and take steps to manage your reaction to your feelings. Managing your own emotions might mean taking some deep breaths, going for a walk, doing an enjoyable activity, listening to some calming music, or another strategy you have found that works for you.

Then, validate the emotions of the other person

How many times have you wanted someone to know that someone else "gets it" or to feel like someone truly sees you? If you are using empathy correctly to really understand how someone might be feeling, remember that the intensity of what they are feeling is probably more intense than what you are feeling. Sometimes we really aren't able to imagine what the other person might be feeling, but we can validate that too. The easiest thing to say is often "I can't even imagine what you are feeling right now." I remember years ago a client saying they disliked a previous therapist because the therapist had said "I understand what you are feeling" when there is truly NO WAY the therapist could possibly have felt the intensity of what that person felt. The truth is sometimes we really cannot understand unless we have experienced it ourselves, especially if it involves something extremely traumatic. In other situations, you might try to label the emotion and add something like "and my guess might be wrong or only scratching the surface" another option is "I am here to listen if you want to talk." It can be easier with young children to simply label the emotion "you look angry right now, it is okay to be angry." Regardless of which message you pick, the goal is letting the person know that emotions, as intense as they may be, are okay to experience.


Stay tuned for more!

Is empathy the key?

YES - Empathy is the key to solving many problems. First, let me explain a bit about what empathy is. Then we can get to the fun part of looking at an example in action.

So what is empathy?

Many people mistake empathy for sympathy. Empathy is not merely feeling pity or sorrow for someone else; it requires going beyond thinking of yourself in their situation. To practice empathy we must take what we know about a person so we can try to understand what they must feel and think about their situation from their perspective. As you might imagine, this can be a tricky thing to do. 

Empathy is about standing in someone else’s shoes, feeling with his or her heart, seeing with his or her eyes. Not only is empathy hard to outsource and automate, but it makes the world a better place.
— Daniel H. Pink

Here's an example. A three year old is throwing the world's most embarrassing tantrum in the middle of the grocery store, the parent is screaming and yelling at the child to stop and it is not helping the situation at all. Everyone is giving them that look, you know the one. You wonder why the child can't just behave, or why the parent doesn't try something else seeing this isn't working, or why everybody is just judging? 

If we try to see things from each person's perspective, we will gain some insight into how to manage the problem. Pretend for a moment that you are the parent (maybe you've been in this situation at some point, it happens to the  best of us!). Now, see things from your child's perspective - you've already gone to two other boring places today with your parent, you got woken up from a brief car nap, you are hungry and tired. All your three year old brain knows is you want that cupcake and you want it now!

As the parent, you get hangry (hungry + angry), but not like this. When you take the child's perspective you see alternative solutions - validate their feelings, buy a less sugary snack or grab one from your bag, leave and let them get that nap, or maybe just let them have the cupcake this time and make a plan for how to avoid or solve the problem next time.

You can also pretend that you are an onlooker. Try seeing things from the parent's perspective - you are exhausted from running around with a 3 year old all day and waking up early because your child does not understand sleeping in, skipped breakfast, grabbed a granola bar for lunch, feel frustrated and angry, and are worried about money so don't want to buy anything unnecessary. Let's not forget this parent is probably embarrassed too at this point. An onlooker who can empathize with this might see some solutions - validate the parent's experience and feelings, ask how you can help and offer potential solutions such as "could I buy a small snack for your child or coffee for you" or "let me help you get through the check-out line and out to your vehicle," or maybe offer a kind smile and "I've been there."

The opposite of anger is not calmness, its empathy.
— Mehmet Oz

Can I learn to be more empathic?

YES - A quick google search can give you many ideas for both adults and children. Research indicates that empathy is not a fixed trait, meaning that we can increase empathy in ourselves and others. To increase our empathy we have to genuinely be motivated to actually do it. It can be helpful to seek out activities or settings that are different than what is typical or comfortable for you. We can also increase empathy through experiencing the arts such as books, music, and movies - have you ever been able to put yourself in a character or singer's perspective? In real life, practice listening for understanding, instead of listening to plan your response. If you prefer to read, below you will find my top picks for a children's and adult's book for learning empathy. (Full disclosure - I get a very small commission from Amazon if you make a purchase through the links, but I would recommend these books even without that!) Tackle it on your own, with a partner, or with friends! Most therapists are also skilled at helping people increase their empathy if you are looking for more help. 

Book recommendations

The top book for adults I would recommend is Born for Love by Bruce Perry and Maia Szalavitz. Bruce Perry is an expert in trauma and I work a lot with trauma; taking a trauma-informed approach to empathy just makes good sense. It also gets positive reviews from most readers.  

The top book for children I would recommend is The Invisible Boy by Trudy Ludwig. While it does not advertise itself to be about empathy, it really is. The content is engaging for children and even though is says it is for 6+ I have read it to my almost-4 year old with no issues.

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