Author: thecopingblog

            Coping with stress does not have to be that difficult. Unfortunately, many folks make it hard by violating some basic principles. Consider Maribeth. She had a tough childhood filled with emotional deprivation. Both mom and dad were alcoholics; dad also liked to beat-up mom when he got mad, which was often, and he generally terrorized Maribeth who learned to hide from him by retreating to a neighbor’s house by the time she was 3. An aunt eventually “rescued” Maribeth when she was 9, and took her to live in another town. By this time, Maribeth was full of hatred toward her parents, and distrustful of all adults – including her aunt even though she did her best to provide a stable, emotionally-supportive environment for Maribeth.

            By her late teens, Maribeth had learned to wear her poor upbringing as a badge of sympathy: “Treat me gently because I have been rejected and beaten by my parents, who never gave me the love I needed when growing up. I deserve better, and am now totally screwed up, filled with anxiety and out-of-control emotions. I want to have a good life, but I can’t; my rotten parents destroyed me and made it impossible for me to live a normal life.”

            Maribeth believed she was owed something, and she decided that she deserved to be indulged and enabled by everyone because of the way her parents raised her. Many young people  carry around this attitude, and say things like: “My parents were killed in a car accident when I was 12. No one understands my grief. Life stinks and people are mean. It’s not fair.” “I’ll admit I have a lot of issues, and I owe it all to my parents.” “How can I be expected to be normal when I was raised by the worst people on the planet?” “My so-called friends just don’t seem to understand how I’ve suffered. I don’t get it. I’ve already had more than I can take.”

            The problem with people who choose to use their torment to get sympathy from others is that the badge they wear makes it impossible to take three steps that are essential to successfully coping with a rough past, and with current psychological pain. The first coping step is Accountability. If you’re busy blaming others for your problems, you cannot take responsibility for your decisions. The second step is Humility. Here again, the reason you’re blaming others for your problems is because you have this sense of entitlement; it’s not fair that you’re suffering; you don’t deserve it because you’re special.

            Maribeth began to gain some insight into her problems in her early 20s when she ran into trouble with the law. She lived with a man and their relationship was very turbulent; there were numerous calls for domestic abuse and disturbing the peace. On one of those calls Maribeth pushed a cop aside and that move sent her to jail and court. After a night in jail, at her hearing the judge levied a hefty fine against her. He also ordered her to professional counseling with a psychologist. “I’ll give you six months to get your life in order, or you’re going to face some serious consequences,” the judge warned her.

            After about 10 productive counseling sessions, the psychologist invited Maribeth to join her group therapy sessions with abused women. Their issues concerned recovering from abusive relationships with a spouse or boyfriend, not so much childhood abuse from parents, but the therapist felt Maribeth could profit from seeing a few realities that went beyond her self-absorbed approach to her anger. The therapist was correct. Maribeth was amazed to hear women talk about their near-death experiences from beatings – and in one case, being shot – inflicted by sadistic men. She began to realize that her anger toward her parents focused her on feelings of entitlement and indulgence that she felt she deserved because life cheated her. After only a few group sessions, Maribeth took the first uncertain toward step three of the coping process. One day she said to a group member who had an emotional breakdown while describing one of her horrific experiences, “What can I do to help?” Maribeth had discovered Empathy. Hearing others’ horror stories made her realize that she had no right to expect the corners of the world to be padded for her. Others were worse off.

            Maribeth stayed in counseling and she continued to attend the group sessions with abused women. She discarded her Badge of Sympathy, and slowly became more and more involved in volunteering with social service agencies devoted to helping abused women. She still harbored anger toward her parents, but she no longer allowed that anger to be used to blame them for her travails; she used it instead to guide her to personal humility, and empathetic service to others. That’s what coping is all about; not avoiding or denying a troubled past, or the negative emotions that go with it, but using those memories and emotions to motivate you to choose not to make yourself the center, but to make others in need the focus of your road to self-understanding.

More than 30 years ago, researchers Berkowitz and LePage demonstrated that the sight of a weapon can increase aggressive thoughts and actions. The standard explanation of this weapons effect involves the gun as an activator of the brain; that is, seeing a gun can automatically increase aggression-related thoughts. Of course, in the past 30 years the increased prevalence of visible guns in American society has probably resulted in the habituation of brain activation in many observers. This possibility means that the sight of a gun today will probably have different effects on different observers. For instance, if you walked into a mall, a restaurant, or a retail store, and you saw another customer wearing a gun, how would you feel? Would seeing that gun make you feel safer? Would it make you angry and more likely to entertain aggressive thoughts? Would you feel some stress and anxiety? The answer would probably depend on the person and the particular present circumstances.

Is it not interesting that at a time when Americans are becoming more and more vocal about the need for gun safety laws, many states are loosening gun restrictions? About thirty states allow open carry of guns without a permit. Open carry, of course, makes the weapon visible to others. Many argue that such visibility will inhibit violence by others. Psychologists point out, however, that if the presence of a gun can increase aggressive tendencies in some people, its presence could increase the likelihood that conflicts will be resolved by deadly force. They point to recent instances: five family members shot by a man angry about being asked by a neighbor to stop target shooting in his own yard; a young man shot when he rang the doorbell at the wrong house; teen girls shot when they mistakenly got in the wrong car in a parking lot; a woman shot when her car turned into the wrong driveway.

There is no doubt that psychological dynamics play a role in gun violence. That’s why many people say, “Gun violence is a mental health problem.” Is it not troubling to realize that conditions we all might see in our families – anxiety and panic attacks; depression; narcissism; sociopathic tendencies; self-harm; drug and alcohol abuse – can qualify as disorders in the Diagnostic and Statistical Manual of Mental Disorders? Psychologists can only wonder, if we make it easier for everyone to obtain guns without any mental health evaluation, are we running the risk of putting guns in the hands of a disturbed individual?

But that question is only part of the mental health equation when it comes to guns. The emphasis on mental health disturbances as a cause of the misuse of guns overlooks the terrible effects gun violence has on victims. Not only can being injured by a gunshot cause a host of psychological problems – PTSD, anxiety/panic disorders¸ drug/alcohol abuse, depression – but those same problems can result indirectly in those who only witnessed an act of violence, even if it involves  a stranger. When someone is a direct victim of gun violence, the indirect collateral damage to family members, friends, and even unacquainted witnesses, is enormous.

Gun violence is a mental health problem? You bet it is, both as cause and effect. And it is compromising the psychological stability of American society.

Psychology has a lot to tell us about raising children. Consider Sandra Bem’s work in the ‘70s on teaching children to embrace a variety of emotions and characteristics. Bem said parents should certainly teach sons that they will find themselves in situations when they should be forceful, competitive, and dominant. But Bem also said parents must teach boys that sometimes sensitivity, emotionality, caring, and empathy are appropriate, and showing such traits does not destroy their masculinity. When a parent tells boys they must always show tough-guy masculinity, they will be unable to participate in a broad range of productive interactions with others. Bem also argued that parents should teach girls to be nurturant, supportive, sensitive, and understanding. But parents must also teach them that sometimes they need to be assertive, competitive, forceful, and decisive, or they will find themselves dominated by those around them. Plus, girls should be taught that firmly standing up for themselves in no way sacrifices their femininity.

Bem’s position boils down to the value of teaching kids two things: (1) your emotions are not an enemy to be feared; (2) flexibility is important in expressing emotions. When faced with challenges, if we want our kids to be effective in handling stress, they must be able to call on a variety of responses when conflict arises. Raising kids to show only one pattern of responses – my boy must always be firm, decisive, and tough no matter what the circumstance, and my girl must always be sensitive, caring, and submissive in all situations – is a form of indoctrination and personality grooming that is psychologically harmful to the child. If we teach our kids to be emotionally limited, they will cope poorly with stress.

Bem’s work deals with how we teach gender roles to kids, that is, what sorts of behavior are appropriate for males and females. I have heard politicians confuse this topic with “sexualization.” According to the American Psychological Association (APA), sexualization means regarding people as sex objects, and evaluating them in terms of their physical characteristics and sexiness. Women, for instance – and far more often than men – are frequently portrayed in the media in a sexual manner, such as wearing revealing clothing, and displaying suggestive poses. The APA maintains that this focus on physical attributes is not only psychologically damaging to young girls, but also contributes to sexist attitudes and sexual violence in society.

In 2006, the APA formed a task force to examine sexualization. The task force highlighted numerous studies that provide evidence of the sexualization of women and girls in the media, and found negative consequences of repeated attention to physical appearance: it interfered with other mental and physical activities; it led to increased feelings of shame and anxiety about one’s body; and, it increased the incidence of anorexia nervosa among 10-to 19-year-old girls. Boys were also affected. Their inability to attract girls who fit impossibly narrow ideals of female attractiveness lowered boys’ self-esteem and masculine identity. Healthy friendships and romantic interactions with girls were difficult for many boys who believed they had to find a girl who fit the media ideal.

Bem’s work on appropriate roles and personality traits described earlier has clear lessons for how to help young people be better prepared to cope with stressors in their lives. Sexualization provides an equally clear lesson on how young people, especially girls, become vulnerable to those stressors. Young girls see and read the false sexualization message from a variety of media platforms, and they suffer a host of negative emotional reactions like shame, anxiety, sadness, confusion, frustration, ambivalence, and fear. Then, they wrongly conclude that they are mentally ill – not normal. This belief can trigger deeper despair, depression, and thoughts of suicide, especially in those who already feel rejected, abandoned, confused, and alone. The irony is, the experience of those emotions is quite normal and a part of living. The key to coping with them is to acquire flexible actions that help to deal with them in rational and confident ways. When it comes to our adolescents and young adults, however, many have been indulged and overly protected from adversity by parents and other adults, with the unfortunate consequence that they never learn how to deal with negative and confusing experiences like sexualization, or with negative emotions like shame and anxiety. Too many parents today are more concerned with how to help their kids avoid sources of anxiety than with helping kids navigate their way through, and cope with, what is a complicated and frustrating path to adulthood. Next time you read about the increase in psychological problems in young people, ask yourself if we are doing enough to enhance parental guidance about Bem’s work, and enough to minimize the perverse role of stressors like sexualization.

I once met a gentleman at a social event who was President of a major corporation. We hadn’t been chatting long before it became clear to me that this was one impressive guy, and it was easy to understand how he ended up at the top of the “business ladder.” He wanted to talk about psychology, which was fine with me. At one point he volunteered that he had ADHD, and I asked him what sort of concessions he had to make to succeed in his world. In so many words, of course, I was asking him how he coped. To paraphrase his reply:

            “I really became aware of my condition when I was in college. Up to that time I had a lot of trouble focusing on things, carrying through with my plans, and keeping myself occupied with the task at hand. In high school I could coast along, but college was another matter. I took a basic psychology course in my freshman year and one day I made an appointment with the professor. I told him my symptoms and he suggested ADHD. That changed my whole life.” He went on to tell me how he learned all he could about his condition and what steps he could take to compensate for it and be a successful student. As we continued to chat, I began to see the specific characteristics that explained why I was impressed with him: His level of achievement motivation was off the charts at the high end; his work ethic was unmatched by anyone I had ever known; his energy level was unbounded; he was articulate and a clear thinker.

            He went on to tell me he continued the coping strategies he developed in college. He gets up an hour earlier than necessary to be at work at the time he wants to arrive. “During that hour I map out my day, writing down meetings I have, memos to write, tasks I need to assign to others, and so on. To do all that, of course, I refer to a complete list of what I had done the previous day and what was still on the list. I also refer to my appointment book for the upcoming day.”

            As soon as he gets to work (about an hour before anyone else on his office floor) he puts in a call to his Executive Associate. “She knows the daily routine and she knows the call is coming, so I’m not disrupting her own early morning schedule. We go over everything on the list I have prepared for the day. We spend about 15 minutes adding some things, deleting some things, and editing others. As soon as she gets to her office, which is next to mine, we go over things again, and I’m now ready to face the day.”

             Not surprisingly the assistant was present while we were talking, only a few feet away. During our brief conversation she intercepted others coming to chat with him, saying something like, “Give him a minute and he’ll be right with you. So, how have you been?” Had she not done so, she knew his attention would have been diverted to the newcomer and my conversation with him would have ended, hanging in the air. He told me his executive associate is indispensable as he goes through the day. “She keeps me on schedule, keeps me on track during meetings, and knows that when something unexpected comes up, she must keep it under wraps until we get together at the end of the office work-day. Then, together, we discuss where the matter belongs for my evening and the next day.”

            It is no exaggeration to say that by the time our conversation had reached this point I was literally exhausted. The energy level he expended telling me his story was fast-paced and intense, and required some mental effort just to follow him! Still, his words and fast presentation style showed considerable sophistication. I have had interactions with people who, in my estimation, would clearly be diagnosed with ADHD. Unlike this gentleman, however, many had little underlying structure or logical organization to their words, and trying to follow them was like trying to converse with a fly. Their deficit also dominated their actions, and they lived haphazard, nonproductive lives. On the other hand, our CEO’s approach to each day is a model of effective coping: He does not allow his ADHD to define who he is; he attacks the day as a challenge to be met within the realities of his condition, not something to be avoided because of his condition; he develops a strategic plan not only to take on the things he knows are ahead, but a plan that also allows him to deal with unexpected contingencies; he enlists the help of someone else in carrying out his plan, admitting that he can’t do it all alone, and that there is no shame in reaching out to another person.

            Kristin Woodling, owner of Pamper Your Mind, a private counseling practice, describes the characteristics of successful entrepreneurs, noting that their characteristics are typical of ADHD diagnoses: high energy, vision, creativity, insight, impulsiveness, and risk-taking. She says that the trick for them is to channel these traits so they can lead to productive results. My CEO friend used his executive associate to help him channel his traits that, unchecked, could produce haphazard decisions, projects hanging undone, and general disorganization that would frustrate all involved. These are lessons for all of us. Coping with everyday life often requires us to meet challenges by engaging in creative strategies to deal with problems; organizing our thinking and our efforts; maintaining our energy level to persevere with purpose; and, enlisting the assistance of someone trustworthy.  

Coping requires honest self-discovery and awareness of your strengths and weaknesses. Unfortunately, if you don’t work at translating your strengths and weaknesses into productive actions, you will have no anchor to reality; you will have nowhere to go, and begin on a road of self-criticism that leads to unhappiness. We talk about depression often in this blog because people feeling “down” can easily fall into the trap of believing that they’re severely depressed and need medical intervention. Sometimes that is the case, but it’s also true that unhappiness can occur simply from actions that allow you to avoid facing challenges. Over time, these actions become hard to change, rob you of energy, motivation, and positive attitudes, and are unlikely to be affected by anti-depressant medications.

You are human. Like anyone else you experience unhappiness, anxiety, anger, and other emotions brought about by current life circumstances. When that happens, instead of saying, “I’m depressed,” ask yourself some important questions: “Am I depressed or simply unhappy?” “Are my problems related to anger or anxiety that make me unhappy?” “Could there be underlying conflicts from a harsh past that I have never dealt with?”

If you decide to seek professional help, see both a psychologist and a psychiatrist. The former will recommend non-drug approaches to your problem; the latter will also likely write you a prescription. If you have periods of unhappiness because of current life circumstances, remember: psychiatric medications are generally no better than a placebo for low levels of depression; these drugs can take as long as 4 weeks to begin working; only about a third of clients prescribed a specific medication show improvement; treating depression with medication is largely trial and error, because some compounds may not work well with your particular biochemistry, but others might; and, there is no medication that will help you develop a plan to navigate the challenges of life through satisfying and productive actions. This is not to say that you should not consider medication as part of your treatment plan. We are simply saying to keep the use of medication in perspective, get multiple professional opinions, and do not rely on drugs to “cure” your emotional issues. Any good psychologist or psychiatrist can help you decide if medication is appropriate for your treatment plan.

Here is a brief sample of some non-prescription actions you can do to try and take some control of your life and walk through each day with more confidence, assertiveness, enjoyment, and satisfaction. When done regularly, such actions tend to inoculate you against feeling overwhelmed by current circumstances. (1) Be vigilant about your health, and take a positive and assertive attitude toward life in general.(2)If you are feeling “down” more often than usual, monitor your daily behavior to look for avoidance actions you may be taking to reduce stress in your life. (3) Maintain a regular exercise routine, follow a healthy diet, and get frequent medical check-ups. (4) Identify actions that bring you satisfaction and contentment, and the situations in which you can express those actions. (5) Volunteer and help those in need. (6) At the end of the day write down your activities and how they made you feel. Use that information to your advantage tomorrow. (7) Others can be a great source of help in maintaining these activities, so cultivate a reliable and trustworthy social network of friends and acquaintances.

The pandemic threw a lot of kids a curve ball. No prom, no graduation exercise. This sort of disappointment can cause unhappiness, and that is precisely when folks young and old can let avoidance responses kick in. They deny the disappointment; they commiserate with others in a similar situation so everyone can feed off each other’s unhappiness; they feel sorry for themselves and wear their “I’ve had it tough badge”; they cultivate a martyr’s entitlement, and seek out enablers.

One day I was taking a walk and saw four young people in the park, each wearing their graduation cap and gown. They were laughing and having a great time as they posed for pictures taken by each of them in turn. I wasn’t sure what high school they had attended, but it didn’t matter because every school in the area had canceled graduation exercises because of the coronavirus. But these four kids were doing a great job of coping with what had to be a disappointing time for them. They took action, and spit in the face of the adversity that threatened to make them feel unhappy. Good for them! Some might say that their future will be rough down the road because they were robbed of the happy time of a graduation ceremony. Nonsense! You know what I think? Years from now those kids will have kids of their own, and one day their kids will suffer a terrible disappointment, and the parent will take them aside and say, “You think you have it bad? Let me tell you what happened when I graduated from high school!” Kind of like when our grandparents tell us how they walked five miles to school each day, usually in a foot or two of snow, uphill both ways.

Your biggest coping enemy is trying to avoid failure and unhappiness, because then you will never learn to correct mistakes and improve. To cope well, you must accept challenges, face your failures, examine the information they provide, and take action to correct your mistakes to increase your chances of success.

Education can make you feel a bit uneasy. A good teacher can use that uneasiness to motivate you to learn what you don’t know. If we make education easy – that is, keep you in your comfort zone, and present things you already believe because someone told you that’s the way the world is – then you learn to engage in denial and avoidance of new information. Why? Because if you learn only things in your security zone, when education gives you new information contrary to your beliefs, you will be afraid. Denial and avoidance occur because you are frightened that this new information may be more correct than your own. So, you disbelieve and avoid the new information. Unfortunately, when fear motivates you to avoid what makes you uncomfortable, you will be ill-prepared to challenge the stressors in life; you will be unable to communicate effectively with others; you will refuse to be held accountable for harm to others; and you will be unable to differentiate between reality and fantasy. In short, you will be dominated and blinded by fear.

Education means embracing – not fearing – and analyzing contrary information. People who are psychologically sound, who have appropriate levels of self-esteem, confidence, independence, and who are able to accept their weaknesses and work to improve them – these are the ones who embrace education, the ones who meet the hurdles imposed by stressors, and who are not afraid of being offended by information that contradicts their beliefs. These are the educated people who are willing to learn how to think critically about such information.

When politicians structure the school curriculum to further political agendas, they inevitably expose students only to material inside their comfort zone. This process is not education; it is indoctrination. Education welcomes mental questions and arguments; indoctrination welcomes mental comfort and reassurance. Education leads to cooperation, discovery, innovation, and progress; indoctrination leads to ignorance, fear, violence, and self-destruction.

The teacher asked the class, “What would you have from me?”

The students replied:

            “How do we care for our bodies?”

            “How do we become who we are?”

            “How do we correct our faults?”

            “How do we write with passion?”

            “How do we think for ourselves?”

            “How do we respect others?”

            “How do we speak with caring and understanding?”

            “How do we love?”

            “How do we grieve?”

            “How do we settle our disagreements?”

            “How do we share?”

Upon hearing these words, the teacher was saddened, and lamented softly in reply: “Alas, the lesson plans given me touch not on these things.”

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.