Author: thecopingblog

Note: Mental Illness Trap I was posted on 1.27.2023. Additional discussions of PTSD were posted on 4.20, 4.27, and 5.5 2019.

Many people are eager to blame “mental health” on the rash of killings in schools, and elsewhere – anywhere we go from day to day. Many cases do indeed involve a perpetrator who is unstable, and some show warning signs of being a danger to themselves and others. A number of states have instituted “red flag” laws that allow families, health and social workers, psychologists, and law enforcement to intervene before someone showing signs of dysfunction actually carries out an attack. This strategy is fine, but unfortunately, the mental health argument usually focuses on the perpetrator, and ignores the mental-health consequences for victims and their families and friends after a trauma. Post-traumatic stress disorder (PTSD) can develop in all these people.

Traumatic experiences – whether we’re talking about the direct victim or friends and relatives who experience the trauma vicariously – have the potential to change everyone over the long run; the effects of trauma, to one degree or another, tend to be permanent. No one should expect to eliminate trauma effects. Yes, the effects may be subtle, but they are present nevertheless. We must be sensitive to victims who will carry the emotional baggage of a traumatic event for the rest of their lives.

Are these victims and those close to them mentally ill? They are certainly emotionally distressed but are not likely mentally ill. Unfortunately, when mental-health initiatives are directed at perpetrators, the victims who are troubled do not receive the message that their emotional reactions are quite normal and expected, not signs of mental illness. Instead, victims – especially the young ones – hear the false message that if they experience emotions like shame, anxiety, sadness, confusion, frustration, ambivalence, and fear, then they are mentally ill – not normal. This bogus and dangerous message can trigger despair, depression, and thoughts of suicide, especially in young people who already feel rejected, abandoned, and alone.

The key to coping with post-traumatic emotions is to acquire actions to deal with them in rational and confident ways. Is it not tragic, however, that too many people in our society – especially adolescents and young adults – have been protected from adversity by parents and other adults, with the unfortunate consequence being that they never learn how to deal with negative experiences and emotions? That inability makes them susceptible to the misleading statements about mental illness perpetrated by society.

Are you one of those with a somewhat unrealistic view of the world? Have you lived a relatively sheltered, stress-free life? Do you believe adversity and danger primarily affects others, not you? If so, psychologists know that – even when your trauma is vicarious, such as when a family member is the direct victim – you’re probably ill-prepared for processing stress and trauma, and being able to confront and meet challenges. Before you can deal with the effects of your trauma, you must challenge and modify your unrealistic view of reality.

Bonnie is in her late 20s, and has been briefly hospitalized psychiatrically twice. She would come in demoralized and depressed, and leave feeling somewhat better, but still with flat emotion. Psychotropic medications had little therapeutic benefit. In outpatient therapy, Bonnie was reluctant to offer much about her past, but eventually she described a car accident from years earlier that led to the deaths of others, and put Bonnie in the hospital in a coma. She was 17 at the time, and was tormented by some classmates who bullied her online. She kept herself isolated from her parents and siblings, and fit the profile of a confused, distraught, self-critical, and self-punishing adolescent, lost in a maze of conflicting emotions. One day she drove off in a rage, crying, and that’s when the accident occurred. When she finally came out of the coma, she had no memory of the accident, a deficit that remained years later. She does, however, remember going to jail because there was evidence she was to blame for the accident.

Ten years later, Bonnie remained ravaged with guilt, but failed to see how much so through a haze of denial and shame. She also did not understand that deep down she believed she didn’t deserve to live because she caused the death of others. It was nearly impossible for her to realize that although she could not change the past, that it was within her direct control to become a better person in other important ways. One reason her guilt was difficult to resolve was that she lacked specific memories of the accident, and the guilt was hard to clarify and discuss. Nevertheless, therapy slowly helped her see her self-defeating and self-destructive brought on by the guilt. It took months for her to see the connection between her guilt, shame, and depression. As she did, the motivation to punish herself decreased and she acknowledged it was time to accept what happened and move on with her life in more productive ways. These insights occurred very slowly because her guilt and shame were rooted deep in her mind.

She agreed to join a therapy group. Eventually she was able to talk about her trauma, and she learned that she was not judged for her previous misdeed. Over time, Bonnie’s mood and behavior became more positive, her outlook brightened, and she voiced optimistic and hopeful attitudes. She faced and accepted her guilt over the accident, which helped her reduce her shame about the event. Originally, when her guilt was linked to shame, she amplified, “Look at this terrible thing I did,” to, “I must be a terrible person.” These negative emotional states regularly produced social withdrawal, depression, self-punishment, and low-esteem. By understanding that these emotions were normal given her trauma, and she was not hopelessly “crazy,” she was able to become more sociable, hopeful, and constructive in her behaviors. Finally, she learned that she needed to forgive herself.

How many 16-year-old Bonnie’s are out there, not who have had a car accident but who have suffered other types of trauma: bullying, parental rejection, school shooting, abandonment, drugs – you name it. Post-traumatic stress comes in all sorts of disguises, and these victims of trauma need professional help, especially the ones who have been indulged and overprotected, and are ill-equipped to cope with stress brought on by trauma.

Ever hear of the sandwich generation? This phrase came into vogue in the ‘70s and ‘80s when parents of “war babies” and the baby-boom generation approached retirement age. Their kids began to feel “sandwiched” between two sets of responsibilities: (1) taking care of their own children, careers, and marriages, and (2) taking care of mom and dad as they began to need help navigating the physical, medical, financial, and psychological demands of being old. Pressures on the sandwich generation began to ease as they grew older: their children reached adulthood and became more independent, and their parents eventually died. However, these changes were often replaced by a new source of stress: many had siblings who were now reaching old age, and who often needed support from healthier and more financially-secure siblings.

Being a family caregiver is a challenging role and few people are trained to manage it. From a psychological perspective, the first important step in meeting the challenge is to accept your emotions because they are normal and expected: Anxiety. Can I do this? Will I get support from the rest of the family? Will it require financial support on my part? Anger. I’m angry and resentful for being put in this situation. I’m irritated that other family members don’t support my efforts. Grief. I’m going to lose someone I value.

The second step is getting help from your spouse or an adult child who may live with you. I remember Harry, 68, whose 90-year-old mother was in her final stages of life. He could not bear the thought of putting her in an institution, and he said to Sophie, his wife of 38 years, “I want to move her into the house. We can put a hospital bed in the den and give her a comfortable, final few weeks of life.” Sophie, 67, had recently joined Harry in retirement, and she had been looking forward to several years of a good retired life with him. She envisioned occasional trips to visit their kids and grandchildren, and fun travel for just the two of them. Now Harry wanted to burden them in this way? She loved her mother-in-law, but this was unfair. Sophie was not happy.

Harry was really stressed. He was concerned for his mother’s well-being in her final days, and he knew he was asking a lot of Sophie. So, before discussing the issue further with her, he did some preparation and put it all in writing: He made a detailed list of his mother’s caregiving needs, and pledged to be the one responsible for providing them; he designed a schedule that would minimally disrupt his and Sophie’s lives; he listed areas collateral to her direct care (such as, organization of financial statements, financial planning of mom’s assets, use of online tax packages) in which Sophie had professional skills and could be a big help; mom’s doctors said she was expected to live for about 2 months, and Harry included a promise that if she was still alive after 4 months, he would put her in an institution. He then set aside a specific time to discuss the situation with Sophie uninterrupted, to make sure she understood what he was proposing. Sophie reluctantly agreed to the arrangement. Turned out that mom lived for another 22 months, although Sophie never held Harry to the 4-month deadline.

Harry and Sophie’s outcome may not be typical, but that’s not really the point. Caring for a loved one – either directly as primary caregiver like Harry, or indirectly as a secondary caregiver like Sophie – is stressful, and like any other stress, it can best be handled by following our four coping rules: Acceptance, Accountability, Humility, and Empathy. Both Harry and Sophie accepted the reality of Harry’s mom’s condition; Harry decided to be accountable as primary caregiver, and to do his best to respect Sophie’s reservations; Sophie agreed to be accountable for secondary responsibilities; both of them agreed that their individual needs and wishes would not supplant those of their larger family bond; finally, both of them worked to put themselves in each other’s shoes and see things from the other’s perspective. No real rocket science here, folks; this is how coping successfully with stress works.

Reducing stress in a caregiving context also requires that caregivers remember their own needs. If you are in this situation, as much as possible follow a schedule and stick to your routine, including time to relax. Continue with activities that are enjoyable and important to you, especially those that involve you and your spouse. Stay connected to the one you are caring for, and you will be able to explain and remind them of your needs. Keep your social network active so you can talk with others regularly about your frustrations…and joys. Writing helps many organize their thoughts and feelings, so consider keeping a daily journal not only about activities pertaining to your caring efforts, but also your feelings. Stay vigilant for signs of depression, anxiety, or burnout, and seek professional help if needed. Keep up with your own health care. Finally, keep reminding your spouse and other helpers how much you appreciate and need their efforts. Give them a sense of ownership in the caregiving plan.

I know many people who care for an elderly spouse or sibling. It is quite clear that while they admit to the hardships and sacrifices that are involved, they also experience incredible rewards that bring them satisfaction and a sense of purpose. As Sophie said to me one day, “It’s tough having Harry’s mom here, bedridden, and needing 24-7 care. But we still live our lives and it gives Harry a sense of peace. It’s an unexpected blessing.”

It’s great to be optimistic, unless your optimism is unrealistic. A noted psychologist once told me that growing up, he truly believed he could be a shortstop for the Chicago Cubs. “Sometime in college I realized it wasn’t going to happen. Contrary to what my folks always told me, I came to the realization that living in America did not mean that I could grow up to be anything I wanted to be. No dream was too big, they always said. Well, playing for the Cubbies was too big.”

The power of positive thinking is limited, but the power of positive actions is unlimited. One of the secrets to coping well with stress is to engage in positive actions, behaviors that bring you satisfaction and comfort. Seeing yourself perform these positive actions will give you a sense of empowerment, and will also invest you with optimistic thinking that is based on reality, not on a pipe-dream. If you want to be a positive thinker, then engage in positive actions.

Too much unrealistic thinking can overwhelm you with stress. Irrational thinking can impair day-to-day functioning as your life becomes organized around the central themes of those thoughts. Eventually, irrational thoughts demoralize you, and make you vulnerable to psychological dysfunctions like personality disorders, depression, and generalized anxiety disorder. In this last condition your mind entertains a big package of irrational thoughts, and you constantly add thoughts to the box. The result is that you worry about a huge variety of different things, and at an intensity far above what is normal concern and worry.

Actions that service irrational thoughts are difficult to resolve because they isolate you from situations that need to be challenged, and from people who can potentially help you. Telling yourself, “I’ve got to stop thinking this way” is futile. The pure repetition of irrational thoughts will dispose you to focus on and listen to them more and more. This is why those who want you to accept some idea as real, keep repeating that idea. As you hear it again and again, your actions will be modified around those thoughts, and you will develop dangerous habits of withdrawal and denial of what is really real.  

When dealing with irrational thinking, your best bet is to accept the reality of your irrational thinking, identify your illogical thoughts, and focus on reasonable and sensible actions you can take. Such actions will help you modify your thinking into more levelheaded form. A woman in counseling confessed that she avoided social situations as much as possible because, “I’m afraid I will faint.”

Counselor:       “Afraid you’ll faint? Has that ever happened?”

Woman:           “No, but it’s possible.”

Counselor:       “Yes, that’s true. But can you accept that it’s highly unlikely?”

Woman:           “Yeh, I can go with that.”

Counselor:       “Besides, what if you did faint? What’s the big deal?”

Woman:           “Are you kidding? Everybody would laugh at me and think I was worthless.”

Counselor:       “Worthless? Laugh at you? Would you react that way if you saw someone faint?”

Woman:           “Probably not. I would think they were sick or something like that, and needed some help. I wouldn’t…Oh, I see what you mean. No, maybe they wouldn’t make fun of me.”

The woman thinks unrealistically that she will faint in social situations, even though it has never happened. Her low self-esteem also leads her to believe – quite illogically – that people will think she’s incompetent because she fainted. In the exchange, note how the irrational thinking is identified, and how the counselor helps her challenge such thinking. Eventually, counseling will help her develop an action plan where she can demonstrate her competence and independence to herself.

When you are tormented by irrational thoughts that literally enslave you and force you to withdraw from life, if you focus on positive actions that contradict these senseless ideas, you can acquire some perseverance, self-sufficiency, confidence, and a chance at feeling good about yourself. Such positive possibilities certainly outweigh trying to make yourself the center of attention by inviting others to your personal pity party.

Amanda was in an unsatisfactory marriage. Her husband was often on the internet communicating with others in chat rooms, even with other women. Amanda understandably felt rejected, and she suffered from low self-esteem. She had tried both individual and couples therapy to address her issues, but was unsuccessful. She fell into self-defeating ways of coping with her stress and seeking more attention from her husband. She became very negative, nagging, and complaining, behaviors that were guaranteed to fail. Eventually Amanda decided to take some risky actions. She left her husband, filed for divorce, found a well-paying job she enjoyed, and asserted herself with her parents, who had contributed to her problems over the years. In short, she seized opportunities that had been available to her, but which she had been afraid to pursue.

What changed in Amanda’s life that led her to these decisions? Before answering that question, let’s note that in subtle ways, first her parents – and later on her husband – regularly tried to convince her that her perceptions of them were faulty. By any objective measure, Amanda’s parents were cold, distant, and unsupportive of her emotional needs. Yet, they would always tell her that the rejection she felt was for her own good. They told her that they showed their love for her by preparing her to face a hard world where others would be out to take advantage of her. Only by their insensitive and impersonal treatment could they train her to be vigilant for the malicious intentions of others. Amanda became dependent on her parents and unconsciously tried to perpetuate this destructive dependence by marrying a man who showed the same manipulative control in convincing her that only he could accurately interpret her reality for her.

To borrow a present-day colloquial term, Amanda’s parents and husband were “gaslighting” her. Although the term has no formal standing in psychology, it refers to a psychological process whereby one tries to manipulate and control another’s perception of reality, to the point where the victim literally questions the validity of their own perception. At one level, Amanda sensed that her parents were rejecting her, and her husband was being emotionally unfaithful, but at another level she became self-critical for distorting her perception of them. Her self-loathing developed and led her to helplessness, abandonment anxiety, low self-esteem, and eventually, depression.

OK, back to our earlier question: How did Amanda get out of her emotional nightmare? The change was triggered when her father died. His death spurred her to seek therapy because she experienced tremendous guilt over his death. At her first session with a psychologist, she was surprised when he asked her a pretty simple question that provided the foundation for subsequent sessions: “What are you avoiding?” No mention of anxiety, depression, bipolar, etc. – just, “What are you avoiding?” Before too long she discovered that the answer was not her overt guilt, but anger – anger at her father and her husband. Her guilt was actually a mask for anger because of the distorted reality both those men had created for her. Once she accepted the fact that she really had done nothing to feel guilty about, she was ready to accept her anger and perceive reality as it existed, not how she wanted it to exist, or how others tried to convince it existed. She decided she needed to focus on her thoughts and behaviors, on those things she could control. She became more constructive with her thinking, and took specific actions noted earlier that gave her more empowerment and confidence. She realistically evaluated her abilities and her confidence, and her self-esteem improved. She learned that her issue was not depression or any other dysfunctional label; her problem was avoiding things that she needed to confront. She even put her past aside and decided to develop a more constructive relationship with her mother based on present realities. As she took charge of her actions and thoughts, she lowered her overall life stress that she had tolerated and suffered for many years. When she took independent self-generated actions, she felt more in control of her life, and was able to manage stresses in more healthy and productive ways. She extinguished the flame of the gaslight.

I recently read some remarks by a politician who was ranting about the evils of schools that waste time on “social-emotional” programs. I got the impression that “social-emotional” was code for material related to gender and homosexuality. In any event, the comment made me think about coverage of Child Psychology in a standard college Introduction to Psychology textbook. Generally, child development is considered in three separate sections about development: Cognitive, Emotional, and Social. Of course, the fact that they’re treated in separate sections does not mean that development in these areas proceeds in some linear orderly fashion, such as first kids learn about emotions, then they tackle intellectual pursuits, and finally venture into social development. The fact is, beginning at birth, learning in all three of these areas occurs simultaneously. Even the one-month-old infant is soaking up knowledge about the world, expressing emotions, and socializing with parents, other caregivers, and strangers.

It’s Monday morning and the kids are getting off the bus at Anywhere School. There’s Larry. He’s a bundle of anger, frustration, and jealousy who is abused both physically and emotionally at home. He’s developing into quite a bully and most of the kids steer clear of him. How many Larry’s will show up today? There’s Sally, always smiling and nice. Deep down, however, she’s anxious and scared. Five years ago, her parents and brother were killed in a car accident. She is being raised by her grandparents, and they’re doing a great job, providing Sally with a warm and secure home, and lots of love. But Sally is tormented by anxiety that her grandparents – both in their late 60s – will die and she will be alone. Like Sally, Jennifer is obsessed with anxious concerns about “tomorrow,” but Jennifer’s issues revolve around fear of being shot. Her cousin lives in another state, and his school was attacked by a lone gunman. She and her cousin regularly text, and Jen is convinced her school will be next. Then there’s Pete, a post-pubescent 9-year-old with raging hormones. Pete, however, is attracted to Adam, and he worries about being some sort of weirdo. How many Pete’s are at school today struggling with their self-esteem and identity? Maybe Shawna? She’s wearing her usual long-sleeve blouse to cover up scars on her arms from self-inflicted wounds. She wonders a lot if the world would be better without her around.

There are a lot of good data showing that mental health problems are increasing significantly among young people. That’s not surprising when we think about how many kids – bolstered by social media that amplifies negative emotions and damages connectedness with others – isolate themselves with their problems, and turn emotions like anger, anxiety, sadness, and frustration upon themselves. Over-protective parents add to the problem. They think they are helping their kids feel good about themselves, when in fact their hovering has the opposite effect: “Mom and dad are always there to bail me out of trouble. It’s obvious they don’t trust me and doubt my ability to do the right thing. I guess they’re right – I’m not able to manage my own life.” Well-meaning parents who overly shelter their kids to ensure that they succeed and feel good about themselves seem to forget something important: life, and that includes education, can be hard. It is not always fun and games, and failure is a part of the learning venture. Psychologists have shown that we learn more from failure than from success. The idea behind parenting should not be to make sure kids enjoy regular and uninterrupted success; it should be about teaching kids how to face problems, how to initiate actions, and letting kids discover how to address failure, not avoid it.

The notion expressed by that politician that schools have no business in the “social-emotional” part of kids’ lives is ill-informed, absurd, and dangerous. Psychologists know that kids can be taught coping-enhanced behaviors on a large scale, behaviors that can help them navigate the variety of stressors they experience. Exhibit A is Seligman’s program for preventing depression in children. The program, summarized in the 1995 book, The Optimistic Child, describes an effective strategy for preventing depression in preteenagers that lasts through adolescence into adulthood. The program shows parents and teachers how they can instill resilience and persistence in their children to develop optimism, and use it to prevent depression. The kids come to feel more competent, and collateral effects include better school performance, and improved physical health. These skills provide children with the resilience they need to increase self-esteem and manage their teenage years and adulthood with more confidence. Seligman says, “Teaching optimism is more than I realized than just correcting pessimism…It is the creation of a positive strength, a sunny but solid future-mindedness that can be deployed throughout life – not only to fight depression and come back from failure, but also to be the foundation of success and vitality.”

Unfortunately, society has not taken Seligman’s insights to heart, and we are not winning the war he identified nearly 30 years ago. The recent study by the Centers for Disease Control (CDC) on the status of mental health among youth in 2021 shows that kids are not alright. One in three teen girls have considered suicide; 46% of youth 18-24 say they are emotionally troubled; 12% report having no close friends, and only 22% feel part of a close-knit family; Covid and climate change weigh heavily on youth and half worry that humanity is destined for extinction. While unknowledgeable adults argue about what books to ban, assigning bathrooms, and how to disenfranchise non-Whites and gays, we overlook the fact that our youth are our future, but we are assisting them to become psychological invalids. Shame on us.

Considering professional counseling? If so, we’re sure you want to take steps to increase the likelihood of success. Here are some suggestions: First of all, be willing to take an active role in counseling and work hard to produce needed changes in your behavior. Second, trust and be willing to “open up” to the counselor, and follow recommendations made by the counselor. Third, and perhaps most importantly, the effectiveness of counseling is helped enormously if you believe it will be helpful.

This last item might remind you of the placebo-effect, which means that something works only because you believe it will work. However, we don’t mean to suggest that successful counseling is simply a placebo effect. Notice, for example, that if you believe in a successful outcome, you will also be more likely to work hard, stay optimistic and confident, trust the counselor, and persevere when the going gets tough. It is those qualities and actions that result in successful counseling, not some sort of magical placebo effect. The point here is simple: Counseling is not like taking an aspirin, lying down, and waiting for your headache to subside. Counseling requires you to take an active role in your treatment. If you sincerely believe that it can bring you positive benefits, you will be more likely to engage in actions that will bring you benefits.

Brian and Lee don’t know each other, but they are both clients of psychologist Dr. Wiley, who is treating them for social anxiety. They have each had three sessions with Wiley, and he has suggested to each one that they join his weekly support group of people who are also struggling with social anxiety. Later that day, Brian says to his wife, “I’m really upbeat about this group. I’ll be anxious in a group of strangers, but in the long run I think it’s going to pay off.” Brian is optimistic. Lee, on the other hand, is pessimistic. He says to his wife, “I’m pretty sure this group thing is going to be a big waste of time. But I told Dr. Wiley I’d give it a shot, so what the hell.”

After the first group session, Brian is on his bus when a stranger sits down next to him and starts reading the paper. Brian thinks, “One guy in the group said that having a simple exchange with a stranger helped him. OK, deep breath and let’s go for it.” Brian looks at the stranger and says, “This heat wave has been brutal. Hope it breaks soon.” The man looks over at him and says, “Absolutely! It’s too hot,” and returns to his paper. Brian thinks, “Wow! It worked! I started a conversation and he treated me OK, not like I’m some kind of weird loser! This is the start of a new me.”

Same scene on Lee’s bus. A stranger is next to him, and he thinks, “That guy in the support group said a brief chat with a stranger helped him. It’s nonsense, but I’ll try it.” He looks at the stranger and says, “This heat wave has been brutal. Hope it breaks soon.” The man looks over at him and says, “Absolutely! It’s too hot,” and returns to his paper. Lee is crushed. “My God, I said something and what do I get in return? Two or three words? That’s it? This whole damn counseling thing is a big waste of time and money.”

Brian and Lee have each experienced a self-fulfilling prophesy. Brian the optimist puts a positive spin on the exchange with the stranger, while Lee the pessimist interprets the same experience as worthless. Brian’s positive attitude causes him to interpret his interaction with the stranger in an upbeat way, and he is inspired to work toward improvement. Lee’s negative attitude causes him to interpret the stranger’s response as rejection, and conclude that his sessions are useless. A positive attitude won’t guarantee that counseling will go well, but it helps to believe that counseling is going to work for it to have a reasonable chance of working for you. A negative attitude, on the other hand, greatly increases the chances that counseling will be ineffective.

James Gordon, MD, is author of The Transformation: Discovering Wholeness and Healing After Trauma. He is part of a long tradition in psychology that stresses people’s need for meaning and purpose in their lives. From Maslow’s thinking in the 1940s about self-actualization, to present-day theories on mindfulness, psychology has always recognized the need for people to find ways to “be all I can be.” Gordon believes that empathy and service to others plays an important role in this psychological growth: “I’ve worked with hundreds of kids at Marjorie Stoneman Douglas High School since the shooting. They’re anxious, angry. But when they have a sense of being useful to other kids, their lives change. They want to share what has been helpful to them.”

Mark Leary, PhD, Professor Emeritus of Psychology and Neuroscience at Duke University, adds another element – humility – to the coping equation: “After more than 40 years of research on human nature, I have come to believe that most of the serious problems people create – for themselves and for society – are rooted in excessive self-preoccupation. People think about themselves far too much, selfishly focus on what they want without sufficient regard for other people, believe that they and their group are special, and think that their beliefs are correct.” [Both the Gordon and Leary quotes are from Psychology Today, “Putting Yourself in Perspective,” April 2020.]

In this blog we consider empathy and humility – along with acceptance and accountability – as foundations of the coping process, and try to dispel the notion that empathy means sympathy for others, and that humility means weakness and rejection of praise from others. Let’s briefly review those arguments.

As Leary says, present-day society seems devoted to “Me, me, me, and I, I, I.” Such self-absorption is at the core of many of our present individual and group problems. When you lack humility, and believe that “the world owes me,” you form your own pity parade when things don’t go your way. You wail about the unfairness of it all – “I deserve better!” You talk and think your way into becoming an emotional cripple. Humility helps you admit that you are not the primary ingredient in your life recipe, that there are always others involved. This admission can help release you from your self-pity, give you an uplifting sense of freedom, and instill you with an optimistic spirit – all of which partially inoculate you against despair, helplessness, and depression. Strengthened by this new-found positivity, you will be more likely to “share yourself” with others who are also fighting stress in their lives, and here is where empathy enters the picture.

Empathy – which, along with humility, completes the inoculation against despair, helplessness, and depression – allows you to understand others in the context of their needs, not yours. That understanding allows you to focus your actions around human values and social conscience, and to act in the service of moral principles. Sympathy has nothing to do with it. As Gordon points out, the beauty of empathy is that both giver (you) and taker (the other) reap the psychological benefits. There is no more effective personal therapy than empathetic service to others, making sure you leave no one behind. Whatever your plight, you discover you are not alone, and that you have the ability to help others.  

Jack is 58, on disability and a widower whose wife died from cancer 13 months ago. He is unable to continue working as a longshoreman because of a workplace accident that happened 4 months ago, and damaged his eyes enough to make working on the docks risky. Once a competent, independent, can-do-anything type of guy, Jack is now depressed, plagued with low self-esteem, and on a daily pity parade. He mostly hangs around the house, alone with his thoughts, and often wondering what’s the point of even staying alive. One morning his good friend, Larry – who used to work with Jack and is also a widower and on disability – came to Jack’s home at 8am and announced, “OK, that’s it. Get off your duff. I’m sick and tired of watching you waste away. You’re coming with me to the gym.” The gym was connected to where they used to work, and they enjoyed free membership as an employee perk. Each day for the next week Larry arrived at roughly the same time, and off they went to a couple of hours of treadmill, weights, laps in the pool, and a sauna – anything that could be managed within the limits of their disability. They cooled down at the juice bar and munched on raw veggies. On the first day, after the gym session, Larry dragged Jack to the grocery store and showed him how to shop “healthy,” which meant no junk food.

After a week Jack was hooked and the trip to the gym with Larry became a part of his routine. Then, one day after the workout, Larry said, “You’re not going home yet. We have another stop. We have some people who need our help.” And off they went to a soup kitchen where Larry volunteered. For the next couple of hours they dished out food to anyone who stopped by, mostly homeless folks. After serving was done they helped the staff clean up the room, which took a good 30 minutes even with 8 volunteers present. Once Jack got home, he flopped in a chair, exhausted, but “Feeling better about myself than I had since Sherrie died. My body felt good and strong, I had purpose, I was useful, I was needed. I realized I was a selfish SOB thinking I was deserving of special treatment. Those folks at the soup kitchen needed help a lot more than I did.” Jack picked up the phone and called Larry. “I want to do the soup kitchen again tomorrow, OK?” Larry laughed. “I do it every day buddy. I just didn’t want to pile it on you too soon.”

The power of humility and empathy. Six months later Jack was still doing his gym routine and working at the soup kitchen. Now, however, he was involved in both the food preparation – “Me, a chef,” he laughed – and serving. He was also a volunteer at the state Office of the Blind, doing what he could to help folks whose visual impairment was far worse than his. Just about every day he says to Larry, “You know, we’re both blessed.” Larry smiles and nods in agreement.

Jim works in sales, and most of the time he is away from his office. One Monday morning, after a productive two-week trip that brought three new accounts to the company, Jim was catching up on paperwork in his office. His colleague and friend, Adam, stopped by. “Glad to see you back, Jim. I need to alert you that the new guy in marketing, Ralph, has been spreading some garbage rumors around about you. I swear, I think he wants your job. But don’t worry – I made sure everyone knows he’s full of hot air, and that there’s no truth to what he’s been saying.” Jim was furious. “That b*****d! I’m going to the boss and getting him fired!” Adam said, “Hold on, Jim, hold on. Like I said, everyone knows he’s full of it. It’s going to get to the boss and I think his days are numbered. So don’t take a chance on making yourself look bad. Besides, your day will come. One day he’ll walk into your bullseye and you can nail him. He’s a loose cannon and will hang himself.” Jim accepted his friend’s caution, but every time saw his adversary around the office his blood boiled.

Everyone is likely to get mistreated by others now and then. You’ve probably been bullied, insulted, given a lousy grade, turned down for a job, criticized, dumped romantically, and on and on. When you’re on the receiving end of such actions it’s natural to think negatively about the person responsible. You may carry a grudge or dislike for them in your mind for months, sometimes even years after they’re no longer a part of your life.

Many religions say you should forgive others for their transgressions against you. Even in everyday conversation, others tell you it’s not good to hold a grudge against someone. “Forgive, put it behind you, and move on,” they say. The problem is, forgiveness requires a lot of humble-pie energy. If you had a personal high-school bully who made your life miserable on a daily basis, why bother to forgive this person years later? Plus, you figure holding onto the grudge is harmless and just one of your unpleasant youthful memories. But, is maintaining a grudge harmless?   

In one study psychologists asked participants to think about a person who had done them some personal harm in the past, and whom they still blamed for the action. The participants were asked to rehearse the original negative event, to dwell on the hurt they had felt from this person, and to think about their anger and the unforgiving feelings they had toward the person. But then the participants were asked to switch gears and imagine what they would say to forgive the person. They were told to concentrate on having empathy for the person, to see things from their perspective, and think about various ways to forgive. During these two phases, the participants were asked questions to assess how they felt – their emotions, comfort, tension, etc.

When dwelling on the unforgiveness phase, participants showed increased arousal and discomfort. They felt angry, nervous, and sad when thinking about unforgiveness. In the next phase, however, when imagining comments geared to forgiveness, participants were more relaxed, understanding, and felt good about being able to control their emotions.

            Some psychologists say that holding a grudge can cause considerable stress and weaken your body over time. At best, you could become more vulnerable to episodes of anger and other negative emotions; at worst this strain could negatively affect your immune system and contribute to health problems. So, what can you do to lighten this burden?

For starters, all you have to do is imagine yourself apologizing to the person during a civil conversation with them. That’s right, the forgiveness does not have to be face-to-face; just rehearse in your mind how you would apologize, and then go on with your life. Forgiving (in your mind, at least) is not only good advice, but it’s easy to do.

            You can also try this technique with current antagonists. What do you usually do after you have a conflict or disagreement with someone? We bet you spend time thinking about the confrontation and imagining what you should have said to win the argument or to put your antagonist down. You come up with clever insults, but unfortunately, you didn’t say those clever things in real time, so dwelling on the episode after it’s over just frustrates you, and creates anxiety about your next meeting.

            To cope better, try this: Instead of fantasizing about things you could have said to dominate your tormenter, why not imagine yourself saying something like, “You know, this is not worth getting all worked up about. I think both of us have some valid points, so why don’t we just agree to disagree and work together?” In other words, take the high road, the honorable road, at least in your mind. Doing so should relax you and make it easier to put the episode behind you. And who knows, you may even find yourself making forgiving comments the next time you see the person. Even if you never make conciliatory face-to-face comments, however, or if the other person persists in being belligerent in the future, your symbolic forgiveness in your mind will help you shrug it off with a smile, knowing, “I tried! It’s their problem now.”

Did you know that, compared to non-churchgoers, people who regularly attend church services, pray, and read scripture are more likely to have low blood pressure and strong immune systems? That they less likely to suffer depression from stressful life events? That if they do get depressed, they are more likely to recover? That they have a lower incidence of cardiovascular disease and cancer?

Sounds like religion is a winner, doesn’t it? But, before you head to church and praise the lord, let’s dig into this information a bit. It would appear that religious faith provides health benefits for folks because their faith system, their spirituality if you will, is part of an overall approach to life they have developed. Sincerely and intrinsically spiritual people – we use “spiritual” to emphasize that we don’t mean those who follow a particular church or denomination – tend to have positive thinking styles about life. Events in their lives are not perceived as random and accidental, but as part of an overall pattern or plan. Furthermore, unpleasant circumstances are seen as challenges to be confronted, not as something beyond their control and potentially devastating.

Psychological studies show that spiritual people exhibit many of the traits we talk about in this blog: They tend to accept themselves and others as they are; they accept their responsibilities, and can enjoy themselves and live relatively free of guilt; they function in reality; they see the value of taking care of their bodies by following health-enhancing behaviors. In short, their sincere and intrinsic spirituality encourages them to appreciate and participate in life, following practices that we know assist in effective coping.

There’s no secret to maximizing the probability of being physically and emotionally healthy and feeling good. These states evolve and emerge from focusing on those parts of your life that are under your control: your actions, thoughts, and the perceptions and interpretations you make about events and people around you. A sense of coherence and purpose to life, and the confidence to meet the challenges of life, evolve from these lifestyles. We know of no anti-depressant or anti-anxiety drugs, or any other type of prescription or recreational substance, that has such positive, long-term psychological consequences.

Several times we have used the words “sincere” and “intrinsic” to clarify what we mean by faith and spirituality. Your internal compass, no matter where it comes from, must be genuine. Merely paying lip service to a Supreme Being just won’t cut it. You might go to church so someone will see you there and think more highly of you, but this use of religion to obtain non-spiritual goals will not translate into better physical and psychological health. For a personal faith system to be part of a healthy and productive lifestyle, that faith must be valued for itself, not for the material rewards, status, or power it may bring. Faith that brings good health and a feeling that you can exercise some control and direction in your life is a faith that is genuine and honest. Such faith can be a principal motivating force in your life, and something that influences your everyday behavior and decisions.

Spiritual people show many characteristics of being self-actualized: they have a sense of purpose, usually humanitarian in nature; they feel deeply connected to other people and have empathy for others; they can look at the world with an open mind, eager to find fresh ideas and perspectives; they do not rely on extreme points of view that stifle their flexibility to meet varying challenges; they have a strong sense of personal ethics and responsibility; they enjoy applying their problem-solving skills to real-world situations, avoiding emotion-based reactions when faced with stress.

Spirituality can help many learn to cope with stress, and there is even a form of counseling – pastoral counseling – that focuses on religious belief, but that doesn’t mean a belief in God is absolutely essential for the coping journey for all people. Discovering personal values, a sense of purpose, morality, ethics, civility, and developing a social conscience that focuses on the welfare of others can proceed independently of religious belief.

Greg entered therapy because he felt passive and dependent. “I always seem to be searching for someone to depend on because I have lousy self-esteem and no confidence in my own abilities. I have a good job, a loving family, but something’s missing. I go through the motions every day, but why do I bother? Is this all there is? What if I leave here today and step off the curb outside and get run over and killed by a car? Would it matter in the long run? Am I useful or needed? Sometimes I don’t think so.”

One day a co-worker, Ryan, came to Greg and asked him for help with a project he was working on. “I’m really having trouble with this, Greg, and I wish the boss hadn’t given it to me. I honestly don’t have much confidence in my ability to do it.” Greg was immediately interested because he felt a connection to Ryan. “When he said he didn’t have confidence in himself I related because that was me, too. Over the next couple of weeks, I helped him out and found myself working on his poor self-esteem. I found myself saying things my own counselor had been saying to me over the past three months in my sessions. It was amazing. One day I realized that I was being something of a counselor for Ryan, and at the same time, doing that was therapeutic for me. I began to understand what empathy really was, and how my empathy for Ryan was helping him and helping me! Like I said, it was amazing.”

Spirituality can help in the empathy process but it’s not essential to discovering the meaning of empathy. Empathy is not sympathy, but a level of understanding that benefits both giver and receiver. Empathetic service to others helps eliminate the need for a dominating figure to run your life; it eliminates the need to seek artificial chemical crutches to help you cope by giving you the beauty and grace of other people; it helps you enjoy self-fulfilling discoveries along a meaningful and enjoyable road of life as a part of humanity. If your spirituality helps you on that journey, that’s great. But if you don’t feel you’re a spiritual person, that’s OK; don’t give up. Greg was not a spiritual person, but circumstances helped him discover how service to others benefits both giver and receiver.

Billy is 15 and his father is in jail – again. He’s talking with one of his friends about it, who says, “It must be tough having a dad who’s in jail. Doesn’t it make you feel ashamed?” Billy answers, “My dad has had some tough breaks. But you don’t get it. He’s really a great dad. He’s always asking me about school and how I’m doing in baseball. He cares for me; he gives me advice; he watches out for me.”

Tom is showing a neighbor his new car. The neighbor comments, “I’m surprised you got that model, Tom. Didn’t you read that it gets lousy mileage?” Tom is momentarily stunned because he did not know about the mileage study. He says, “Ah, that study wasn’t a good one. Besides, I got this car because of the incredible braking system and other safety features. They’re the best on the market. Let me show you.”

It’s not a good day for Mabel. After years of appeal of his death sentence for killing 8 people in a mass shooting, Mabel’s son will be executed this day at 6pm. Mabel is being interviewed by the local news, and asked if she’s still hopeful her son will get a reprieve from the Governor or a judge. Mabel says, “He’s a good boy. Always took care of his family and his friends. He was so generous and kind. It’s just too bad he had to kill all those people.”

Jared’s wife asks him how he feels about the politician he voted for being indicted by a grand jury for misuse of campaign funds. “I told you he was a no-good crook,” she says, “but you didn’t believe me.” Jared replies, “Oh, come on, grand juries would indict a ham sandwich if the Attorney General asked them to. Besides, you can’t tell me that my guy has been a poor representative. He’s in town all the time holding town-hall meetings. He works with local charities; he got the legislature to approve money for that bridge project; he’s supported the cops with their crime prevention program. He’s done more for this area than I ever thought he would.”

            These are four examples of the power of the psychological process called cognitive dissonance. When a person holds an attitude or performs an action that is totally inconsistent with an event – the dad I love and respect goes to jail; the car I bought after thorough study is a klunker; my beautiful son is a murderer; the guy I voted for may be a crook – the result is dissonance, a very uncomfortable feeling that you may not be as smart as you think you are. The theory of cognitive dissonance predicts that you will be motivated to get rid of the dissonance.

            The simplest way to reduce dissonance is to change your attitude about your judgment: I was wrong about dad; I have poor judgment when buying a car; I raised a murderer; I let that politician fool me. Simplest? Yes. Most comfortable psychologically? No way! The last thing we frail humans want to do is change our positive attitude about ourselves to a more negative attitude. Oh, sure, when appropriate some folks have the personality strength and self-esteem to do the attitude change, but most people do not. So how do they reduce the dissonance?

            According to the theory of cognitive dissonance developed by Leon Festinger, if you hold an attitude that just isn’t consistent with how things turn out – “I raised my kid to be honest, but he got caught shoplifting” – you can change your attitude about your childrearing ability and admit you did a lousy job; or, you can blame your son for not listening to you; or, you can discount the seriousness of his action; or, you can identify additional positive traits in your son that outweigh his negative behavior. One thing for certain: People are least likely to choose the first alternative and change their attitude about themselves; most people divert blame away from themselves when dissonance occurs. In our original four examples, for instance, each case involves reducing dissonance by finding additional positive features in the person or object: Bill focuses on his jailed dad’s positive parenting traits; Tom diverts attention away from gas mileage to safety features; Mabel says her murdering son is a pillar of generosity and affection; and Jared notes a variety of positive actions shown by his indicted candidate.

            The power of dissonance in the coping process should not be underestimated. How many times have you heard someone say, “How can he continue to support that guy?” Or, “When is that family going to admit that they have a crook on their hands and they need to stop enabling her?” Maybe the answer is, “Because the support and enabling are in the service of dissonance to protect one’s fragile ego-strength.” In other words, the inappropriate actions serve to reduce dissonance and make the person feel good over the short run. The problem, however, is that over the long run, those inappropriate actions interfere with behavior flexibility, which is often what one needs to cope well with stress when attitude change about oneself is necessary. Thus, whenever you are confronted with a situation that poses a direct challenge to your self-esteem, once you decide on an action you need to evaluate if you are under the influence of cognitive dissonance.

            Mark got a call from his son who’s away at college. “Dad, they’re suspending me for a semester. They say I stole money from the cafeteria, but I didn’t.” Mark told his son to make an appointment with the Dean for the next day. “I can get there around 11. We’ll meet with the Dean and appeal the ruling.” They met with the Dean the next day. Mark’s son was on work study and he worked at a cash register in the cafeteria. Mark told the Dean, “I’m sure you’re mistaken. My boy would never steal, and he says he didn’t do it.” The Dean showed them a closed-circuit recording that left no doubt the son took a $20 bill out of the register and put it in his pocket. After about 10 seconds of silence Mark said, “I’m sure he intended to pay it back. He doesn’t deserve suspension.” Mark’s image of himself as a parent who raised a son to be honest, was totally at odds with his son’s dishonesty. Mark was under the influence of cognitive dissonance, and it motivated his inappropriate enabling defense of his son. Rightly so, that defense failed. The Dean upheld the suspension. The son transferred to another college, free to steal again. Mark, succumbing to dissonance, left angry at the Dean, but deep down, angrier – and ashamed – at himself.