February 12, 2017

What You Can Do When Trauma Reminders Intrude

Victims are easy to identify — or so we think. We see them on TV each day. We are inundated with injury. Too many terrified people, mistreated people, and survivors of war zones and privation carrying their children and belongings. The images arrive from displaced persons camps, airports, and highways.

Look in the shadows, however, and you will find even more. Those are the second-hand souls, the past sufferers, the ones reinjured at a distance.

The men and women to whom I refer are recovering from Post Traumatic Stress Disorder. Some of them are rebroken by watching or reading about the latest victims and the menacing public statements of elected officials. They shudder at the unpredictability in the air. According to the conservative columnist David Brooks, we are witnessing “a rising tide of enmity” in the USA. Indeed, swastikas have appeared in the public library men’s room of my own suburban Chicago community.

Yesterday’s unfortunates are reminded of their imperfect healing by the incivility and xenophobia around them. Their bodies respond by saying “fight or flee.” A sense of being flooded, overwhelmed — even to the point of collapse — sometimes is not escaped for minutes or days.

Retraumatization of this kind can leave the individual disoriented and dissociated. He may undergo flashbacks of his past: a psychic reexperiencing of the event. At the extreme, there is the loss of awareness of where you are, in what circumstances you are, what age you are. You time-travel to a place you escaped, reinstalled into a mental chamber of prior misfortune. Perspiration, nausea, tearfulness, and intense fear are only a few of the possible sensations and emotions.

You are alone, even if others are nearby. The triggered individual is often unable to describe his internal world. He is awash in a fetid river of word-preventing feelings. The proper vocalizations do not come.

What is one to do?

Here is an example of a young man who dealt with a mild version of the problem, but still enough to put him in treatment. He was in his early teens. A bike accident — he was struck by a car — left him with a painful recovery. Even after the physical injuries healed, the newspaper account of the collision — one which blamed him — still felt like an attack. Moreover, the intersection where he had been hurt remained dangerous. He felt both unfairly targeted and helpless to do anything either to vindicate himself or prevent harm to others. He continued to avoid the location, but traffic reports of pedestrian injuries (regardless of where they occurred) darkened his mood and made for painful and repeated revisiting of his experience.

One aspect of his treatment was a turning point. We talked about what he might do to get a sense of control and counter the wrong and wronging newspaper account. This thoughtful adolescent wrote a letter to the reporter who covered the event. Two things followed: 1. His comments were published in the newspaper. 2. The reporter researched the statistics pertaining to accidents at the place of injury and wrote another article detailing the danger. The city council then investigated the matter and made the intersection safer.

Where does that leave you?

You can, of course, hold your hands over your eyes and plug your ears. The avoidance of TV and radio is a close equivalent, as is holding to an agoraphobia-like self-protective self-confinement. Though understandable, these strategies must eventually be set aside lest you continue to remain terror-prone.

Another patient of mine, long after her father died and mother denied (in my presence) that any sexual abuse happened, chose to return to her childhood home. This was the site where years of sexual abuse by dad occurred with mom’s knowledge. She traveled 500 miles to get there. As it happened, the house was being redecorated and the new owner permitted her to look around. My client left the spot with a sense of palpable triumph. She had faced-down the ghost of her demon in the place of his iniquity.

If you are pained by news accounts in the aftermath of the President’s Executive Order of January 27, other actions commend themselves to your attention. The American Psychological Association offered a concerned Response to this Directive on February 1, 2017. It reads, in part:

‘Refugees, particularly those displaced from war zones, experience stress, trauma and other serious mental health problems,’ said APA President Antonio E. Puente, PhD. ‘Denying them entry to the United States, particularly those who have already been vetted, is inhumane and likely to worsen their suffering. This conclusion is based on extensive research and clinical experience … .’

Such policies can lead to a perception of reduced freedom, safety and social connection for those directly affected, as well as for society at large (my italics) … .

Research has documented serious mental health consequences for immigrant children and/or their parents who have been forced to leave the United States, which may magnify earlier trauma experienced in or upon fleeing their country of origin. Sudden and unexpected family separation is associated with negative outcomes on child well-being that can last well into adulthood.

If you have been retraumatized by the human consequences of your country’s immigration policy, your decision concerning any response may be more personal than most. Others, perhaps less impacted in this way, have marched, attended town hall meetings, written public letters to news organizations; and visited, called, or emailed their elected representatives.

In the end, those without trauma histories would be wise to refrain from judging whatever action you choose or do not choose. The world presents many chances to reinvent ourselves and repair the injuries it inflicted.

Remember, however, that you and your therapist aim to help you distinguish the present from the past, both intellectually and emotionally: to realize you can act today in an effective way not possible before. And to keep the past from recurring in any form by your self-affirming assertive actions.

—

The top photo is a Syrian Refugee and Her Newborn in Ramtha, Jordan taken by Russell Watkins for the UK Department of International Development. The second image is a World War I propaganda poster called Every Girl Pulling for Victory by Edward Penfield, created in 1917. Both are sourced from Wikimedia Commons.

April 1, 2011

Have You Had Your Daily Dose of Anger?

There is a test built into this essay, but not the kind you think.

There will be questions at the end, but they will make sense only if you read everything.

And even then, the questions are not the kind that allow for right or wrong answers.

Intrigued?

Read on.

—

In today’s bull’s-eye are teachers, unions, government workers, National Public Radio, and Washington politicians.

Yesterday it was bankers, stock brokers, deal-makers, hedge fund managers, and Wall Streeters in general.

It’s also been Obama for a while.

Anger doesn’t seem to be in short supply. And all these folks recently have been or continue to be convenient targets.

The argument pretty much goes like this: if only so-and-so (referring to an individual or group) were different, better, dead, living in another country, out of power, punished, making less money, or otherwise emasculated, then all the rest of us would be much better off.

They, the same so-and-sos, are the ones who are dragging us down, making the country worse, and so forth.

Of course, sometimes it’s true. But isn’t it interesting that even when the so-and-sos are disempowered, there are still just as many angry people around, looking for and finding another target?

Have you heard very many people deride BP (British Petroleum) lately? You know, the authors of that big Gulf of Mexico oil spill? No, the angry voices have moved on to other resentments.

Life is full of frustrations, a lack of control, and lots of unfairness. The highways are too full, the money we are paid too little, the bosses too demanding, the work too hard, the hours too long, the spouse uncooperative, and the kids are out of control.

Change alone can be frightening — enough to make a person angry — and, gosh knows, the country is certainly changing in ethnic and racial make-up, while the distance between rich and poor increases.

It did seem that people were quieter about their discontents a while back; certainly in the ’50s, not so much in the 1960s when the civil rights movement met the Vietnam War, and protests were all around.

I’m told the ’30s were pretty tame in the USA, despite the fact that people were out of work in large numbers (25% unemployed), many more than today. An equivalent level of hardship in 2011 might well generate a revolution.

What accounts for the change from mid-twentieth century America to today? Perhaps the after-glow of a shared national effort (World War II) and the prosperity that followed it made for less sense of grievance. But that wouldn’t explain the modest level of ear-splitting rancor of the Great Depression years.

Others would point to a subsequent loss of faith in government due to corruption or incompetence that made it an easier target, going back as far as the Johnson administration’s escalation of US involvement in the Vietnam War, the Watergate scandal of the Nixon administration, or the nonexistent WMDs (weapons of mass destruction) we were told with certainty required the hurried invasion of Iraq.

Social critics would identify permissive child rearing which allowed children not only to be seen, but also heard and listened to, instead of “seen and not heard;” or the Freudian penchant for finding the roots of adult problems in one’s parents’ child-rearing practices (thus, shifting the blame from oneself to others who become the target of resentment).

Or perhaps it was the creation of a social safety-net that led people to believe that they were “entitled” to things they had not earned and encouraged them to “demand” more dollars out of other people’s pockets — which found those people not taking kindly to the idea and in some cases quite opposed to safety-nets in general; nor should we forget a legal profession ready to exact payment for real and perceived wrongs.

And some might point to public anger as the last vestige of the “Don’t Tread on Me” motto found on the Gadsden flag of Revolutionary War days, the thing that helped enable the colonists to fight the British. Surely, it was then a more than necessary evil.

But for whatever reason, among us are angry people who find lots of fault with others, less often than with themselves.

Few of the those most insistent that things be done their way seem to have read their history books; nor have they thought through the consequences of their actions down the road.

The notion that “IF IT FEELS RIGHT, IT IS RIGHT,” seems persuasive, until you realize that just the opposite position might feel just as right to someone else. And every self-righteous person always thinks as the WWII Germans did: “Gott mit uns” (God is with us).

The red-faced, clench-fisted, self-appointed defenders of all that is good and proper (as they see it) refuse to compromise on anything. Blustering assertion has replaced reasoned and well-researched argument.

Little time is taken to locate and read — yes read, not watch or listen to — a reliable and thorough daily news source. Instead, many of us hear and watch the “info-tainment” of the 10 O’Clock news, or partisan “news” reports and sound bites presenting arguments that are one-sided and sometimes factually inaccurate, becoming the pawns of someone else’s vision of the way the world should be.

If the fountain that you drink at makes your blood boil, should you come back for more?

Rallying cries to “preserve the constitution,” poor analogies to the Holocaust or the Soviet Union, and threats of imminent “dictatorship” or “tyranny” have all been used to justify steaming outrage and urgent action. The word “government” is treated as if it were spelled with four letters, just as word actually made of four letters, “B-u-s-h,” was used in a similar derisive, “dirty word” way before his page was turned by a new election.

“Liberal” policy threatens encroaching socialism to certain groups on the right, while the “conservative” agenda augers the creation of a permanent “underclass” and the domination of business interests over the little guy on the left.

We make improper use of the names we call the objects of our anger. For example, but for a few extremists, there is no “far left” or “far right” in this country. “Far left” is communism, “far right” is fascism. Maybe I’m missing something, but I don’t see any major politician who resembles Lenin or Hitler, or who is advocating their policies.

Instead of thoughtfulness, there is a lot of venting. Anger, of course, is self-justifying, and fairness is in the eye of the beholder. Which is why the angry zealots do not usually seek psychotherapy voluntarily. Those few who wish to are advised to take a look at Ronald Potter-Efron’s Stop the Anger Now as a starting place.

Meanwhile, internal inconsistencies in one’s world view are ignored by those who are most incensed. Social conservatives who wish to legislatively forbid Gay marriage or abortion are attempting to regulate some very private events, but generally wish less government control over health care and fewer national rules for business and finance. Meanwhile, those who are socially liberal want their private lives kept private, but look to more constraint and control over health care and business practices.

In effect, the social conservatives want the government into the bedroom and out of your wallet, while the liberals want it out of the bedroom, but into your wallet.

Since 1940, significant groups within the good old USA have voiced strenuously opposition to:

Japanese Americans (who were interned in concentration camps if they lived on the west coast during World War II, even though most were US citizens), people who might have dabbled with Communism during the Great Depression (many intellectuals did), and “pre-mature antifascists” (who were suspected of being Communists after World War II, despite their prescience and courage in taking action against the Spanish and German fascists during the Spanish Civil War).

Others with a bull’s eye on their backs have included Blacks, civil rights activists, hippies, the “military-industrial complex” during the Vietnam War, anti-war protesters in the same period, doctors who perform abortions, Mexicans, Muslims, illegal immigrants, Gays (especially after the Iron Curtain fell and a new object of enmity was required to replace the USSR); and, of course, Presidents Roosevelt, Truman, Nixon, Clinton, George W. Bush, and Obama.

Not to mention Donald Rumsfeld and Dick Chaney.

I’m sure I’m leaving some important people out.

Clearly, some folks earn our intense dislike.

But many of those listed above simply seemed to be easy targets or had ideas or origins that were “different.”

My point is that there is a lot of misplaced anger out there — a bit like kicking the dog when you walk in the door because your boss gave you a hard-time at work.

Even where anger is justified, it can go off the rails. As John Dower notes in his brilliant book War Without Mercy, the Pacific portion of World War II was a race war. Both sides dehumanized and demonized the enemy in caricatures and words. One can only imagine what U.S. citizens of Japanese ancestry felt when they looked at posters such as this, a buck toothed, saber toothed, drooling, myopic, dog-eared, satanic travesty of their image:

Even in less fraught times, in-groups commonly defend against out-groups, while out-groups are trying to get in. The pie that represents the “American Dream” seems to be getting smaller, and everyone wants a pretty big piece. I suspect that some of the rage we see today is in response to the precarious, dangerous, and competitive nature of life itself: the daily indignities, the feelings of helpless, and the sheer dazzling and frightening speed with which things change faster than we can keep up.

And perhaps some other part is just our biological and genetic inheritance — the “fight or flight” capacity for anger that our ancestors had to have in order to take on the real threats to their existence and protect those they loved.

As an old 1960 Twilight Zone episode illustrated brilliantly, we are prone to believing that The Monsters are Due on Maple Street even if there are no monsters. If you haven’t ever seen it or haven’t watched it in a while, it shows how chaos and unpredictable change added together can trigger the search for scapegoats, even among the innocent in an average suburban community.

If instead you consult Brigitte Gabriel, author of They Must Be Stopped, you will be told that “America has been infiltrated on all levels by radicals who wish to harm America. They have infiltrated us at the C.I.A, at the F.B.I., at the Pentagon, at the State Department.”

And who are “they?” Muslims living in the U.S.A.

Really? Or is Ms. Gabriel simply Wisconsin Senator Joseph McCarthy in a dress? McCarthy was the man (eventually censured by the Senate) who told us of the non-existent infiltration of the government by Communists back in 1950:

The State Department is infested with communists. I have here in my hand a list of 205—a list of names that were made known to the Secretary of State as being members of the Communist Party and who nevertheless are still working and shaping policy in the State Department.

McCarthy never came up with hard evidence for his claim and sometimes changed the number of alleged traitors in government. Nor has Gabriel offered such evidence for her accusations.

When will Ms. Gabriel mention that the independent research group Triangle Center on Terrorism and Homeland Security, affiliated with the University of North Carolina, Duke University, and RTI International reports something rather different? It indicates that Muslims provided tips that helped thwart 48 of the 120 U.S. terror attacks planned by their co-religionists since 9/11/2001 .

Long story short: beware of angry people. Their anger just might be turned in your direction. Today, perhaps, they are your friend. But tomorrow?

Beware of those rabble-rousers who stir up the discontented. Enough of them can be found on cable TV, talk radio, and on the Internet. They aren’t your friends either.

Be careful of those who only occasionally see more than one side to any story; and the only side they tend to see is their own.

Be on guard against the people for whom angry expression and impulsive action are the solutions and not the problems.

If you are attracted to someone who appears to be your big, strong, and powerful protector, remember that your only real protection is in yourself and the rule of law; and that one day you may find that the fearsomeness of your companion has become a threat to you.

Beware, too, of angry people with a drink in their hands (McCarthy was one such), unmindful of the disinhibiting potential of alcohol to set their rage loose.

In 1919, just after World War I, William Butler Yeats wrote in The Second Coming:

Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity…

Are we are in one of those moments again?

I guess that depends on how the quieter voices respond.

The future is up to every one of us.

Make the future.

End of today’s sermon.

—

Now for the test questions.

Have you found yourself muttering under your breath as you read the above?

Have you cursed to yourself about the opinions I’ve expressed?

While I don’t claim impartiality, in more than one case I have pointed at difficulties on both sides of American politics. Have you been able to see the other side’s point of view even a little?

Do you believe that anyone who leans in a different political direction is unworthy of your respect or your ear?

Do you have good friends who look at politics from other than your perspective?

Can you have a well-reasoned, honest, and civil conversation with someone who does not hold your position about any of the issues described above? And, if you do, do you permit the possibility of altering your stance a bit?

Do you search for the facts that are available from non-partisan news sources and do they ever persuade you to change your mind about something?

Is there anyone on the other side of the aisle who you admire? Even a small amount? Is there a single writer from the opposition party who’s regular column you read?

Have your past judgments about others, as well as your personal and business decision making, been so good that you are utterly certain of the validity of all of your political opinions today? Put differently, has your life been such a shining example of wisdom and inerrant behavior that it is impossible that you are wrong?

No one on earth has ever been all-knowing in the arena of world affairs and even those solutions that work tend to have a short shelf-life. Angry self-righteousness, however, can last rather longer.

If you are unwilling to change course (in politics or anything else), consider new information, or compromise in a rapidly transforming world, you will have taken the fixed position of a stopped-clock — right only twice a day.

But, no matter your political persuasion, you will be angry all day.

—

The top image is A (gentle)man giving the middle finger angrily by Mgregoro. The second image is that of a Vietnam War Protest in Washington D.C. by Frank Wolfe, October 21, 1967, followed by the Gadsden Flag by Lexicon, Vikrum. The next photo pictures Protesters at the Taxpayer March on Washington by dbking, which occurred on September 12, 2009, after which is a U.S.A. propaganda poster from World War II: Tokio_Kid_Say.png. The final image is a 1954 photo of Senator Joseph McCarthy taken by United Press. All are sourced from Wikimedia Commons.

June 25, 2009

Anger Anyone?

Some of the very logical or morally upright folks out there believe that you should never get angry. Never ever.

I’m not one of those folks. First of all, we are all human, and to be human means to have emotions. Second, it is hard to imagine a humanity capable of defending itself, the spouse, and the kids, who can’t get in touch with some needed anger when we or our loved one’s are imperiled.

When danger appears, we are built to fight or flee. The sympathetic nervous system readies you for action. Adrenaline starts to pump, the big muscles of our body receive more blood as the heart rate increases, breathing becomes more rapid, the pupils widen (the better to see danger, my dear!), and sweat gland activity heightens to keep you cool in the event of a major exertion of energy (as well as to make you slippery, so that an aggressor can’t get a firm grip on you).

All of this has been “selected for” in the Darwinian sense: if our ancestors hadn’t successfully fled the tiger or defeated the enemy with the help of these physiological changes, we’d not be here and their genetic line would have stopped.

The same logic suggests that the female of the species historically tended to choose males who were capable of defending her and the kiddies, especially when pregnancy and child-rearing made them particularly vulnerable. But, since the female couldn’t always depend upon the male when he was out hunting and gathering, she needed some anger too.

So, if you get angry, as you almost certainly do, you have come by at least some of it honestly and through no particular effort of your own.

That said, how do you know when your anger goes over the top? Some people will tell you when that happens, of course, and sometimes the authorities will in the form of police. If you are no longer a child and get into fist fights or find yourself yelling a lot, you’ve almost certainly got a problem, either as an aggressor or as a victim. Alcohol might add to your combustibility since it tends to disinhibit people, making big emotions more likely. For some otherwise mild mannered men and women, drinking turns them to the dark side. As the old Chinese saying goes, “first the man takes the drink, then the drink takes the man.” Substitute the word “anger” for the word “drink” and you have an equally valid way of looking at anger. Do you have the anger, or does the anger have you?

On the subject of old sayings, there is an Italian saying that also applies to this issue: “If you want revenge, you should dig two graves.” This means, of course, that revenge is likely to consume you (and perhaps even lead to your demise) just as much as it is likely to succeed in hurting the other party. Lives have been eaten-up and made perpetually miserable by the preoccupation with righting wrongs. Think of the centuries long enmity that exists in the Balkans or the long standing animosity between the Greeks and the Turks. Numerous other examples could be cited. One act of revenge causes the victim to look for his own revenge and back again in a circle without end.

Anger is often the result of a real injury, but the danger is in becoming the thing that you learn to hate because of that injury. The data on the likelihood of child abuse being perpetrated by parents who were themselves abused is fairly well known. Such a parent is much more likely to abuse his children than a parent who was not himself abused as a child. When I tell people this they often find it puzzling. Surely, they say, the abused child would learn what not to do from the parent’s bad example. But think of cigarette smoking or drug/alcohol abuse. Again, the child raised by an addicted mom or dad is at greater risk of duplicating the parent’s behavior than one raised by parents who are abstinent. Not only does the child have the model of the parent as a bad example in these homes, but, in the case of abuse, the youngster has to deal with the anger and hurt inside of him, which comes from being targeted. As children these kids can rarely succeed in retaliating against their parents, but they can take their feelings out against other smaller children (including their siblings) or against their own helpless children when they have become adults. Indeed, unless the abused child is able to obtain relief from the feelings of anger and sadness that come with abuse (and this usually takes therapeutic intervention), he is likely to carry some of these emotions and their behavioral consequences into adulthood. A good book on the subject is For Your Own Good by Alice Miller. A first class movie that depicts exactly what I’ve described is Good Will Hunting.

Back to the question of how you might know whether you have an anger problem, there are a few additional indicators. Do you (or do people tell you) that you react out of proportion to events that are not seen by others as being that big? Do you find yourself feeling angry or irritable much of the time, or awakened by resentments in the middle of the night? Do you have road rage? Have you every punched a wall or thrown an object due to this sort of upset? If you are an athlete in a contact sport, do you enjoy inflicting pain on the opposition?

Even if none of the above apply, there might be other ways that you express your resentment. Do you intentionally delay or put off tasks that others (a spouse or a boss) want you to do, but you don’t believe are that important? Are you sarcastic to others, rather than direct? Do you grumble in discontent or talk behind the back of others at what they’ve done (or not done) or complain about their personal qualities, but put a friendly face on in front of them? If you’ve answered “yes” to some of these questions, you might just be “passive aggressive,” expressing your ire indirectly.

Again, I’m not saying that all anger is inappropriate. And, certainly, one shouldn’t always turn the other cheek, lest one regularly get taken advantage of. But anger can be a problem for you and for those around you. Like a big dog, it should be kept on a short leash. If you can’t manage that, think about counseling.

A recent review article in The Behavior Therapist by Kulesza and Copeland concludes that cognitive behavior therapy is the current treatment of choice for anger problems. The authors emphasize the need for both training in behavioral skills and the use of cognitive restructuring to insure the best results. Therapy for anger issues is therefore likely to include direct instruction about antagonism and its management; self-monitoring of angry feelings, thoughts, and behaviors; relaxation training; assistance in new ways of thinking about the events that trigger rage episodes; social skills/assertiveness training; direction as to how to think about and undercut anger when it does occur; and practice in being exposed to triggering events so that new skills can be employed and the patient can learn to tolerate or diffuse the emotional intensity and stop short of vehement outbursts.

Among self-help books, one of the best is Stop the Anger Now: A Workbook for the Prevention, Containment, and Resolution of Anger by Ronald Potter-Efron.

Dr. Gerald Stein

Blogging About Psychotherapy from Chicago

fight or flight

What You Can Do When Trauma Reminders Intrude

Have You Had Your Daily Dose of Anger?

Anger Anyone?

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