Posted on by Dr. William Vlach · 1 Comment

Sometimes You Gotta Fold ‘Em

An increasing part of my clinical work has to do with loss:  loss of social connection, employment, retirement; personal mobility, plans for the future.  It can be as simple as loss of a hug.  Or as complex as loss of identity.   Or as painful as loss of a love one.  Or even the feared loss of one’s own life.

Like with the ideas around resilience, there are moments we can stop, breathe, and figure the next step.  Holding on tight or bounding on have never served me well.  A moment in traffic after being cut off turned into a mini stupido Grand Prix, until the guy in front slammed on his brakes.  I rear ended him.  My car was totaled and his fine.  And it’s my fault.  Clearly, I needed a to take a brake, both metaphorical and real.

Take a break or have a break, I figure. Easier said than done.  And what kind of break?  A breather?  Or perhaps retire from the field all together.

Two of my oldest and dearest therapist friends have given up their offices because of the pandemic issues.  Norita (spouse and co-therapist) and I are currently paying to hold onto an office we are not using.  Paying for a placeholder.  Retire?  Move to full time teletherapy?  Easy to forget to be grateful that I even have the choice.

So let’s say you have spent years helping and guarding the city, the county, the state, the nation.  Your identity is profoundly connected to being a protector, whether it is as police officer, the service, firefighter, medical worker, social worker, or therapist.  You are our guardians.  And in this long term pandemic, you’re getting tired.  Now what?  Hold ‘em?  Fold ‘em?

Written by a 23 year old Don Schlitz, it took two years of trying to sell the song “The Gambler” before it was picked up.  Kenny Rogers recorded it, sending the song to spectacular heights.  It has been selected by the Library of Congress for preservation in the National Recording Registry.  Clearly, for Don, it was a good decision not to fold ‘em.  

You’ve got to know when to hold ’em
Know when to fold ’em
Know when to walk away
And know when to run…

When to hold ‘em, when to fold ‘em

Kind of like Hamlet’s ‘To be or not to be.’  Perhaps a bit less intemperate.  What are the factors in deciding whether to hold ‘em or fold ‘em?  

Having been hit with severe economic issues after my father died, (ranch to a small single parent home), my own approach is inevitably economic first.  Is a different life style sustainable?  Would I have to cut back things that are meaningful to me and my family?  Will the kids be okay?  We have been blessed with a solid financial advisor to help with that one.  Still not easy.

The psychological aspects are even more complex.

 In an earlier blog I proposed a series of emergent roles in this pandemic: The Guardian, The Opponent, The Isolate.  These were complimented with subsidiary roles:  Placater, Egoist, and The Chaos Creator.  Let’s see how these roles play out in the face of “hold ‘em or fold ‘em.” 

The Guardian:  Here is the ‘First Responder’ whose work is to be protective, vigilant.  Our society cannot proceed safely without these folks.  And here, I would argue, you would find those who would have the worst time with “Fold ‘em.”  Yeah, I know, towards the final quarter of one’s career there is the constant watching the retirement clock, rumination about the pension, griping about management, and all that.  But, still, when push comes to shove, the Guardian will show up, take risks that most would avoid, and get the job done.  Lots of folks in this role have dedicated their lives to saving lives, protecting the innocent and helping survivors.  The question for the guardian becomes— if I ‘Fold ‘em,’ who am I?  What good am I?  What value do I have?  And even more painful — have I failed those that I was born to protect? The victim.  The city itself.  And the flip side of that is— If I ‘hold ‘em’- put off retirement, put off a lateral transfer, etc., won’t I just burn out?  Make an error that will get me fired… or even worse?  

The Opponent:  This one might be better named The Contrarian.  I’d guess every Department, company, cohort, family has its share.  Who knows why?  Maybe for the species to survive we need those who say— “This is BS.  I’m not going to try and capture that saber tooth tiger with a couple of sticks and a rock.”  In any case, ‘Fold ‘em’ for this role is equally difficult.  The Contrarian finds identity in opposition.  There’s energy and ego there.  ‘Fold ‘em’ means not going to battle anymore, arguing against.  Let it turn out however it may.  Give up.  

The Isolate: Of all these roles in the pandemic, I’d bet The Isolate would have the easiest time letting it all go and withdrawing from the field.  The Isolate never wanted to go out and play ball in the first place.  More interested in drawing on their own resources.  The Isolate will have a harder time re-emerging into society when this damn pandemic gets a vaccine.

Knowing when to ‘fold ‘em,’ (move, quit, retire, transfer) is a tough call at any time.  Now it is particularly rough.  More than any time in the last 100 years, the future social, cultural, economic course of this country is unclear. 

Hold ‘em is a gamble.  Fold ‘em is a gamble.

Some thoughts on steps:

  1. Start with ‘what do I need.’
  2. Check in with family, friends, therapist, 12 step sponsor, etc. 
  3. Be prepared to grieve (either way there will be losses).
  4. Take a look at, maybe make a list, of what is pushing you out, what’s pulling you.
  5. Look at both the positive and negatives of the next step.
  6. And remember, stay or leave, neither will be perfect.  Both might be ‘good enough.’
  7. And if figuring this out becomes obsessive, grab the remote and switch the internal channel to mute… for a bit.  
  8. A lot of times, a simple bit of action helps- a drive, a kind act.
  9. How does hold ‘em, fold ‘em match up with my innate values?
  10. And let’s not forget Mark Twain:  “Good decisions come from experience. Experience comes from making bad decisions.” 

Go easy, folks

Posted on by Dr. William Vlach

Relationships During Times of Stress- III

I’ve mixed feelings about the idea of ‘stages’ in psychology.  A whole world seemed to open up when Elisabeth Kübler-Ross presented her book- On Death and Dying.  At last a road map on the pain around death.  She postulated a five stages of grief model: Denial; Anger; Bargaining; Depression; Acceptance.  The thing became so popular it was a adopted as a framework in a movie about the choreographer, Bob Fosse (All That Jazz, 1979).  Even though I liked the guideposts, I had doubts.  They didn’t seem to match up with my experience around my father’s death when I was twelve.  All I remember was a long tunnel filled with a dark fog.  And from there, those five, in no particular order, and a few more…Then, of course, I felt some shame that my grief didn’t match up with the way I was supposed to feel things.

The argument about the power of cycles and stages is a big deal in Western philosophy, goes back to Classical Greece.*

In the first essay on the Pandemic I spoke of the stages of a community response to a natural disaster—Shock, Heroic, Honeymoon, Disillusionment. Right now, I’m trying to figure out where we are. And, figure where I am on the individual’s reaction to stress stages—Alarm, Resistance, Exhaustion.  There is also the stages of a First Responder’s career— Heroic, Cynical, Resilient.  These all seem pretty close to how it works, but they are not necessarily sequential.  They are not for everybody.  Gender, culture, class, and many other things play into this.  We are not locked into these sequential stages. 

In the discussion on roles, I ended up with— there are powerful pulls toward being a certain way (genetic, class, culture, history), they might even go from the possible to the probable, but they are not mandated.

Given the urgency of the pandemic and the social crisis, many families have had to re-form themselves without the outlet of schools, friends, couple date nights, etc.  First responders, work groups, and roommates the same.  This creates increased intensity. Pressure cooker city. There will be meltdowns.

So let’s take a look at Stages of Group Developement in this time of Covid and social crisis.  Again, these are ‘tendencies,’ not absolutes.

 The classic social psychology work on group development suggests several stages:  Forming, Storming, Norming, Performing, and Adjourning.  In each stage, various roles come into play such as Leader, Follower; Counter-dependent, Dependent, Independent, etc. 

Group Stages:

Forming:  Folks are unclear on what the goals are, what the roles are, who are the leaders, what the boundaries are.  There can be poor morale, poor listening, and low commitment.

Storming: Emotions that were disregarded at the beginning surface.  Arguments about boundaries, leadership, and power are abundant.    Cohesion and consistency are low while anger, resentments, and power struggles ascendant.

Norming: coming out of the conflict of the Storming Phase, members move toward ‘rules of the road.’  This is the way we do things.  Folks increasingly listen to and take each other into consideration.  Leadership issues, while not necessarily solved, are calmed.  Assertiveness is rewarded.

Performing:  After the earlier struggles, Folks relax into taking care of business.  Tasks tend to be less fraught with power issues.  There is increased creativity, openness, flexibility and pride in the group. 

Adjourning: The crisis looses its urgency and the intensity of the pandemic and social /cultural crisis decreases, folks return to the world.  Here there is a sense of loss, and hopefully, a sense of respect for their history together as well as respect for lessons learned.

There is a great hope in both role and group development models.  The roles we have become attached to are in fact flexible and can be dropped like a three day old halibut.   What seems like an intractable unproductive family, work group, is best seen as a thing in transition.  It is helpful to name the stage. This is especially true now in this time of monumental global change.

So today, I’d say I am in the Disillusioned, Exhausted, Group Storming stage, with a touch of Acceptance. Mañana? I’m planning on the Group Performing and Resilience Stages. We’ll see…

We are not stuck. This may be good time to take a look at the role you play, the stage your family, roommates, work group might be in.  Where do you want it to go?  What role do you want to play?  What do you need?

Step back and take a look.

Go easy, folks.

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* In Western philosophy, the argument about stages goes back to Plato.  He theorized there were several forms of societies that evolved from each other, tyranny, meritocracy, democracy, etc., ending in rule by the Philosopher King (presumably him and his buddies).  That stage idea went even further in the cycles of history theories of Giambatistta Vico (Theocratic->Aristocratic->Democratic, then Chaos leading back to the first). Karl Marx’s stages of society ends in a classless and free society.  Sure, right. Arguments against these political deterministic cycles of history were led by Karl Popper (The Open Society and Its Enemies).   Camus also weighed in for freedom from stages in his arguments with Sartre about Marxism. 

I guess I am with that great Marxist, Groucho, who proclaimed— “Be open minded, but not so open minded that your brains fall out.”

Posted on by Dr. William Vlach

Understanding Relationships During Times of Stress- II

“All the world’s a stage,
And all the men and women merely players.”

-William Shakespeare

There are masks and there are masks. We put on masks to slow the process of disease transmission— us to them, them to us. And, we put on an identity mask everyday.

In an earlier essay— Negotiating Relationships During Shelter in Place—I  explored the tension between a compliant response to the health care mandates, and the ‘lone wolf’ individualistic/rebellious response.  In the blog on children, the stress and strategies of the protective parent/guardian was explored.  Let’s take a deeper look at these masks, these roles.

As we grow up, for a lot of reasons, we assume certain roles.  Much of adolescence is devoted to trying out new ones, discarding one and trying on another, until it seems to fit.  Then we glide along in that role through adulthood.  Misfortune can hit (divorce, illness, trauma, midlife crisis, etc.)  which then can make us question— is this role Really right for me? Does it really fit?

Beginning in the 1970’s there was a lot of work in the family therapy field on how family roles play out in various contexts:  the alcoholic family (Rescuer, Persecutor, Victim), the dysfunctional family (Blamer, Distractor, Enabler, Computer), culture and ethnicity variables (Mexican, African-American, etc), gender (male/female, fluid), birth order (oldest sib vs youngest), adult children of alcoholics (The Responsible One, The Adjuster, The Placater,  The Acting Out).

I got a National Alcoholism and Alcohol Abuse (NIAAA) grant in graduate school.  We explored the roles around addictions.  I was struck with the flexibility of roles  The ‘rescuer’ can switch to ‘persecutor’ and back again.  The ‘victim’ can switch to ‘persecutor’.  It seemed to me then, and now, that there is a certain hope in that.  We are not absolutely stuck in a position.   Since then there has been an explosion in biomedical research.  We have powerful genetic and neurological pulls for certain behavior.  Got that, but still, there is an aspect of role theory that gives us great potential for change, for shifting roles.  For example, though the eternal struggle between Nature and Nurture is a delightful battle ground for social scientists, the research usually comes down to percentages:  there is a possibility/probability  given your genetic background, you will be a leader; and there is also the possibility/probability given your birth order, you will become a leader.  Kind of a crap shoot, I’d say.  One’s role is possible, perhaps probable, but not mandated. There is freedom in role choice.  Therein lies hope.  But that choice comes down to awareness of one’s role and whether we want to stay there.

Context:  after the Industrial Revolution, new roles developed.  Some were now paid, others not.  That added to the power issues between men and women: wage earner and housewife.  Throw in race.  Throw in class.  Throw in immigration status.  Throw in unemployment and the lack or benefit of ‘access.’  Some aspects of role are socially bound.  And this, of course, goes to what can we change, what we cannot, and what we have to fight for.  And against.

Some of the roles that seem to have surfaced in this pandemic and time of social crisis:

  1. The Guardian:  This is the one who is constantly checking the ‘north forty‘ to see if everything is safe.  Has the perimeter been breached?  In a covey of quail, there is one who sits on a fence post looking out for trouble, the vigilant one, the protector.  The strengths of this role include leadership, care for others, responsibility,  protectiveness. The weakness here can include a loss of empathy for other’s feelings, fear mongering, loss of self protection, and excessively controlling behavior. 
  2. The Opponent:  Here is the contrarian.  If you tell me what to do, even if it is in my interest, I’ll fight it.  Instead of- I think therefore I am, the rule is – I rebel therefore we are (thank you, Camus).  Here we may have the counter-dependent, and at worst, the oppositional personality.  If there is going to be a fight between the different people in the family, roommate, work group, it will be between The Guardian and The Opponent- ‘That’s not safe’ versus ‘You can’t tell me what to do.’  Not fun.  The strengths of this role include a critical thinking about the situation, a push toward returning to normalcy.  The weaknesses lie in knee jerk reactions, an undermining of the direction of the whole group, and inattention to potential dangers.
  3. The Isolate:  When there are so many dangerous winds blowing, some will simply retreat.  Back in the 50’s, school children were told if the school gets hit with an atom bomb, the best thing to do is to ‘duck and cover.’  Hide under your desk, or crouch down directly below the classroom window (the blast will blow the glass over you… yeah, right…). Here retreat is the solution.  Decrease in contact with friends and family as well as community connections.  The idea behind this is that one is safer out of contact with the ongoing pandemic threat and the societal crisis.  The strengths of this role include a certain self sufficiency, an effort to access one’s own resources.  The dangers are loss of support, loss of long term resilience, and depression.

There seems to be ancillary roles also:  The Placater (working to avoid conflict, people pleasing, ignoring one’s own needs); The Egoist (it’s all about me, what can I get out of this; the Chaos Creator (can’t stand calmness, stirs up anything that can be stirred up).  

The key issue here is that roles are not absolute.  They can change.  We are not stuck;  there is the opportunity for growth.  For example, families and groups (roommates, work partners)  are not static.  The group can form over years (family) or can be created spontaneously (police squad or a demonstrators’ cohort).  The point here is that as the group develops, various roles come and go as well as leadership styles. More on group development next….

If you can, stop for a bit.  Do an inventory:

  1. Does this role fit?  Is there something uncomfortable about what I’m doing…is there anxiety, guilt, shame?  A touch too much pride?
  2. Does this match up with what my dreams were when I was younger? What’s the difference?
  3. Am I drinking too much, other addictive behaviors, numbing something important?
  4. Are the conflicts I’m getting into seem ridiculous after I settle down?  (I’ve been there, done that!)

Go easy, folks.

Posted on by Dr. William Vlach

Resilience in the Pandemic

Earlier I wrote about the stages of the first responder’s career.  For the police it seems to be a journey from the heroic to the cynic to, hopefully, the resilient.  Fire fighters, doctors, nurses also follow a similar pattern.  This pattern tends to be parallel to the psychological stages of reaction to a disaster, such as this pandemic. So let’s take a look at resilience.

When I first heard the term I thought it was like a football player who takes an enormous hit, doesn’t even feel it and keeps going. Nope, that’s not resilience, that’s being a refrigerator.

The  word resilience came into use in the 17th century, came from the Latin resili, meaning to spring back, to rebound.  The Latin roots of the word offers a clue to a deeper meaning:  re and salire.  ‘Re’ in Latin means again; salire means jump.  Resilire: jump again, spring back.  From that word came the word resile, Now here is the crux of the matter.  Resile is defined as: to abandon a position or a course of action.  For example, ‘can he resile from the agreement? And from there, resilience.

So the way I see it, being resilient is— do, abandon that position and then jump back, rebound.  Stephan Curry shoots with the intent that the ball will go in.  He drops that plan when the ball bounces off the rim. Then he leaps, grabs the ball, and shoots again.  In it goes  (Yay, Steph).  He has abandoned the first plan, regained his composure about the loss, and shoots.  Here is resilience: do, fail, do again differently.

This pandemic is a long term crisis that will continue until there is a vaccine, prophylactic drugs, or, as in HIV- a cocktail of meds that will ameliorate disastrous results.  Epidemiologists say that ‘herd immunity’ is not a viable options because by the time that is reached  the mortality rate would be far too high (tens of thousands of deaths just in the Bay Area).  In other words, resilience in the pandemic is less 100 yard dash and more marathon.

In the flush of adrenaline, in fight/flight mode, the basketball player, the ER nurse, cop,  doesn’t have the mental space to consider our reactions of ‘well, that didn’t work, how do I feel about that?’  Far too busy dealing with death and destruction.  This has nothing to do with resilience.  This is athleticism.  This is warrior mode.  This is override for the greater good.  

The danger, of course, is that this is a potential set up for more problems down the road.  If the deep emotional reactions to the  ‘abandon the position‘ step is denied, there is the potential for long term consequences.  Running over the top of pain and grief by denial, numbing, re-entering the fray without acknowledgement can bring trouble.  I know how this works.  After my mom’s awful and sudden death, I quickly went back to work.  The irony, was of course, my work has to do with helping folks process the very emotions I was running from.  That glossed over grief turned into depression and ultimately got me back into therapy.  Thankfully.

This three part scheme of resilience (do, fail, do again differently) includes a very human reaction to the the fail-loss part. This can include anger, self blame, shame, and all kinds of other nasties. For some, there is a denial that can create psychological stress, and others a paralysis about the loss. And others: an acceptance and increased tolerance for that loss. A healthy resilience, I’d argue, in this pandemic, means to acknowledge the losses (a family member, patient; loss of social connection and touch; loss of economic stability, etc). Ideally, one grieves that loss, then takes the next shot. Doesn’t have to be in exact sequence. But, without that pause, this resilience may be short lived. That crucial ingredient has been glossed over. Burn out, irritability, depression may easily follow. And then attempts to fix that problem rather than the original one can lead to alcohol, drugs, sexual acting out, etc. Fall out from the not dealing with the grieving.

I’m not suggesting in the middle of the shift. Maybe not even when one gets home after shift. Or at the end of the week. But at some point— acknowledge the losses. Dealing with this damn pandemic takes a lot of control…letting go of that in a safe place helps. This sets in motion a healing process that will pay off as the crisis eases.

Building resilience is not rocket science… it’s mostly common sense.  Going back over almost a thousand years, Arabic medicine recommended a healthy diet, exercise and fresh air.  Sounds good to me.  These are basics to building resilience.

What to do/what not to do:

What doesn’t kill you, MAY make you stronger— if you do something about it.  If not, it will make you weaker.  For example here’s a recipe for doing damage to yourself:

  1. Get angry, resentful, ‘it’s their fault,’ I deserved so much better than this.
  2. It is my fault. I shoulda woulda coulda, etc. etc. etc.
  3. My life is turning into an ongoing streaming of “The Lord of the Flies.’ No one gets along. We’re an episode of Ozarks, without the pretty lake.
  4. Everybody is toxic: stay away. I am alone, and I want to stay alone.
  5. I’ll watch everything on Covid on the TV… that’ll help my nerves.
  6. Numbness to the fear is a good thing—bring on the booze and drugs.
  7. Do not laugh at anything. People are dying.

In fact, none of these are bad, simply in and of themselves.  For example, the first one, anger, if turned into positive political action can help recreate this damaged world.  Even the self blaming second one, with a little thought, can lead to alternative strategies going forward.

Remember the ancient Arabs’ recommendations : a healthy diet, exercise and fresh air.  Here are some more ways to build resiliency:

  1. The jangled body needs to slow down and rest. I don’t think I’ve ever seen so many people fishing the ocean here before. Maybe build something in the garage. Try a meditation app. Yoga if you like; go birding. Get yr partner to give you a bad ass massage.
  2. It would be sweet if building resilience could be done on our own. Not so much. In a safe place with safe friends, a partner, open up. The emotional build up from the fail-loss part of do, fail, try again, is toxic. This is the key moment of healing.
  3. Laugh. Yeah, it’s awful. And it may look, if you’re not in a safe environment, that you are cold and inhuman. In a safe place: Feel free. The grief, love, care, frustration, and pure pain can come out this way. Try not to get fired. (I’ll deny I ever met you…)
  4. I’ve a couple of friends who are on a mission through this. Their goal: Spot one kind thing a day. Probably not on TV which can be pretty cheesy and gamey. At work. In the neighborhood. Believe it or not, on the road. It’s there…. if you look for it.
  5. Meaning- see the earlier blog.

Go easy, folks

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check out these for more info:

http://www.apa.org/topics/resilience

https://www.mayoclinic.org/tests-procedures/resilience-training/in-depth/resilience/art-20046311

https://greatergood.berkeley.edu/article/item/five_science_backed_strategies_to_build_resilience

Posted on by Dr. William Vlach

Moral Injury and Morale in the Pandemic

We all have standards by which we live our lives.  Some say we blindly accept those passed down by our families and friends.  I’d argue most of us question the passed down standards as we grow up.  Starts at two years old or so.  The advent of that great word ‘No.’  Or even “Noooo…” coupled with a high pitched whine.  Drives parents nuts.  This is the first step towards the un-acceptance of received authority, the beginning of a separate individual, separate from parents.  Unpleasant process, but crucial.  ‘Me’ based on denial of your authority.

The Western tradition begins with with disobedience.  The first story in the Bible, Adam and Eve eat the forbidden apple.  From there on out they have to put clothes on and act civilized.  In the Greek origin myths, Prometheus disobeys Zeus to bring fire to humanity.  His punishment is to have his liver eaten out by an eagle.  Daily.  Forever.  Though there are plenty of stories of the acceptance of the prevailing rule, (Abraham prepares to sacrifice his son, Isaac; Agamemnon sacrifices his daughter, Iphigenia), the rebellion against received rule set up the origins of Western society.  

After the horrors of the Twentieth Century’s violence, psychology began to study how  blind acceptance of authoritarianism works:  ‘The Authoritarian Personality,’ the Milgrim Studies, the Zimabardo prison study.*  As an early college student, I first became fascinated by psychology when I read the Milgrim experiments.  Certainly fed my 60’s rebellious nature.

Later in life I was taken with the Greek Oxi Day.  Oxi, (οχι) pronounced ohi, means ‘no’ in Greek.  When Mussolini requested Greece to allow his troops to enter Greece, the prime minister denied him.  There were demonstrations in Athens where people shouted “oxi!” This is celebrated in Greece every October 28.  Oxi Day.  Greece paid the price for their ‘oxi’ by Fascist brutality.  Ultimately Churchill said about their defense:  “Hence we will not say that Greeks fight like heroes, but that heroes fight like Greeks.”

There is something compelling about a big fat oxi.  No!  I will not accept your authority over me.

But how do you say no to a pandemic?  I guess the moral choice here is— “No, I will not become one of the ill, hurt myself, my family, and overload the hospital beds.  I will stay home.”  Yet, in the wider world, there are those who have lost their jobs, health care coverage, have children to feed with no income.   What is the moral choice for them?  And the others, those who automatically say no to Public Health concerns because of their political viewpoint?

It would be nice if the moral issues in the pandemic were simple.  Virus evil, us good.  Yet, even with all the pain and suffering, now you can see blue skies above Beijing and Mumbai.  It’s complicated.

A morality based on ‘no’ is insufficient.  It does not build into a prevailing life code that includes care for others, building positivity, creating a caring community.  Plus, neurological research suggests we are hardwired for empathy. “The ventromedial prefrontal cortex processes feelings of empathy, shame, compassion and guilt. Damage to this part of the brain, which occupies a small region in the forehead, causes a diminished capacity for social emotions but leaves logical reasoning intact” according to an article on the research (LA Times, 3/22/2007).

Much of my clinical work has been working with those suffering from Post Traumatic Stress Disorder (PTSD).  In this pandemic, I’ve written on methods to prevent PTSD.  Though the concept of PTSD facilitated a clearer understanding of what psychologically injured folks are going through, it can miss a subtle, but crucial variable— the moral dimension.

Moral distress, moral injury, and moral repair.

Beginning in the 1990’s, writers and researchers have added the moral aspects to the understanding of trauma.  While the current treatment approaches to PTSD are mostly effective, they do not work with everybody. In fact, research now suggests that work with PTSD for some that does not include the moral dimension may be deleterious.  Further, in early neurobiological research, one can see the differences between PTSD and a moral injury in brain scans.

Moral Distress occurs when one knows the moral action to take, but feels powerless to take that action.   Taking that action may be limited by the internal (fear, doubt) or the external (no clear effective approach, failure of leadership).  Here is what one believe one should do, but can’t. Moral Injury is characterized as the result of being forced to engage in actions contrary to one’s moral values; a violation of what each of us considers right or wrong.  

These are wounds that are derived from damage to a person’s moral foundation.  These moral crises are not based on fear as is PTSD.  One of the tools psychotherapists use to treat PTSD is exposure therapy— easing one into remembering the traumatic event to decrease the emotional storm.  For the morally injured, this brings no relief, and can intensify the pain…and shame.

In this pandemic, we are all in a perpetual state of moral distress.  We see the mounting death toll among the elderly, the weak, the wounded, the poor. We may be at risk ourselves.  We may be on economic survival mode.  We may not be able to see a clear path to help.  So we are stuck.  

Hence, moral distress.  And moral distress over time can lead to moral injury. 

According to a VA report: “Guilt, shame, and betrayal are hallmark reactions of moral injury. Guilt involves feeling distress and remorse regarding the morally injurious event (e.g., “I did something bad.”). Shame is when the belief about the event generalizes to the whole self (e.g., “I am bad because of what I did.”). Betrayal can occur when someone observes trusted peers or leaders act against values and can lead to anger and a reduced sense of confidence and trust.“ https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp

The idea of stages of psychological reaction to this pandemic includes the cynical/disillusion stage.  Here is where folks may experience depression, burn out, exhaustion.  A part of this may include ongoing moral distress moving toward moral injury.  The cognitive dissonance between what we feel we should do and what we actually do eventually overwhelms.  Our morale drops.  

Let’s talk about moral repair and resilience in a later time.  But the initial steps to sort through the moral issues here are yet again the same as dealing with the power issues: Acknowledgement, resources, strategize.

 1. Acknowledgement:  look at what you are doing and feeling.  Over watching the news and feeling anxious; avoiding all the news and feeling empty; physical symptoms can include GI issues, insomnia, headaches, nightmares.  Is there guilt? Shame?

2. Resources: Imagine what you would like to be able to do and yet can’t, or won’t. Then think it out… talk to a friend, spiritual leader, 12 step sponsor, a therapist.

3. Strategize: Be clear on what you can do and cannot do.  Note what you have been able to do.  Then consider what may be possible: donations, checking on a neighbor, nodding to a passerby on the street.  And underlying all of this— be kind to yourself… and others.. if you can.

Go easy, folks.

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‘The Authoritarian Personality,’ the Milgrim Studies, the Zimabardo prison study:

Posted on by Dr. William Vlach

Power and Powerlessness in the Pandemic

A deadly pestilence is on our town, strikes us and spares not… – Sophocles, Oedipus Rex

#Covid19 #domesticviolence #childabuse #mentalhealth

Most of us are struggling right now, doing our best to sort through the stresses of the American mortality numbers, massive change in the economy, the loss of personal contact with family and friends, the inability to do the simple things one does that makes life enjoyable- dinner out, a movie, the gym.  Now we have isolation.  Our life styles have taken a huge turn.  And at the same time, the question of our own mortality has become present.  Bottom line— we question how much control we really have over our lives.  Depending on our fiscal and social arrangements, this may range from an uneasy time to a frightening loss of control.  

We are confined, for our own good.  If that place is mostly kind and caring, we can flourish.  If not…  Here is the one situation where I could agree with the infamous Sartre quote – ‘Hell is other people.’  His play, No Exit, is about three people trapped in a room together, with no escape.  Buñuel, in his 1962 film, went after the same notion in The Exterminating Angel.  His was a more satirical look—  Upper class diner party goers cannot escape their mansion and descend to their worst.

I’m not sure how much control we have anyway, but most of us had a sense that we had some control.  Much of that has been vanquished.  There are a lot of ways to react to this loss of power in our lives:  depression, anxiety, rage, insomnia, numbing by alcohol and drug use, trying to get control of others.  Some work for positive social change while others move toward spiritual, aesthetic, or intellectual pursuits.  Some garden, others build stuff.

Let’s take a look at the worst case reactions to this loss, and take a shot at possible remedies.

“We know lockdowns and quarantines are essential to suppressing COVID-19, but they can trap women with abusive partners. Over the past weeks, as the economic and social pressures and fear have grown, we have seen a horrifying surge in domestic violence.”

—United Nations Secretary-General António Guterres

The numbers of reported cases of domestic violence have risen.  I would argue this is a result of the loss of control, the loss of power.  Rape is about power, not sex.  Domestic violence is about control, not aggression.  Aggression is the means to that end.  Violence increases as one feels the loss of control.  I can’t control what is happening to me, but I can control her, which, I think, will make me feel better.  The mitigating factor in family violence is openness— other folks influence the family systems, help lower the level of tension, allow the potential ‘victim’ an out.  And now, in this time of shelter-in-place, there seems to be no escape. Hence, ‘Hell is other people.’

It comes down to how we deal with the loss of control over our lives.  One could make a case that we don’t have that much power anyway.  We just delude ourselves intro thinking we do.  Our brains make choices and we act, then think we made a conscious choice.  Or we believe we got where we did by our own hard work, forgetting parental bucks, government loans, etc.  

So on one hand we have the perception of loss of power and on the other we have the actual loss of power of economics, friendships, and sites to relieve stresses.  Add on the feeling of being trapped.  Add on the inability of the vulnerable to escape due to shelter-in-place, the concern that shelters may not be safe from the virus, and the looming loss of government revenue to support social services.   The one who has lost power has power reinforced by the limiting conditions of the vulnerable partner, child.  The children aren’t in school where a thoughtful teacher can notice and report to Child Protective Services.  

A perfect storm:

1. He feels the loss of power of having some semblance of control over his life.

2.  He believes his behavior will have no consequences.

3.  He asserts his will for control with psychological and/or violent means

4.  She and the children have no escape

5. Repeat

While, by far, most of this is gender-based, the male attacks the female, it can be the reverse and or male/male, or female/female.  We are also seeing a rise in elder abuse.  The trapped victim reactions can range from depression to suicidal ideas, from psychological numbness to physical symptoms.  No Exit.  The abuser’s psychology can range from a reasonably healthy but fragile personality to the personality disordered (narcissistic, borderline, or psychopathic).

What to do if you are under attack:

1.  Acknowledge that this is not going to change unless you take action.  

2. Find out what the resources are: a local battered women’s shelter or domestic violence hotline. 

3.  Strategize: talk with a trusted friend or family member, contact the local resources, plan an exit.

Then be prepared— if you or your children are in danger, call the police.  

The one who psychologically or physically strikes out has options, also.  In fact, they are basically the same as your partner’s: acknowledgement, find resources, strategize.  This disaster is avoidable.  There is an extremely interesting program in Mexico called ‘Gendes.’  They have had to shut done their in person services since the onset of the pandemic.  They’ve established a hot line.  Every day they get a call that begins:  “I’m calling because I don’t want to hit her.”  They are re-invisioning ‘machismo’ by supporting the positives of it (caring, protection) and inhibiting the negatives (possessiveness, controlling behavior).  You too can call a hot line.  You can read ”Why Does He Do That? Inside The Minds of Angry and Controlling Men.”  You can face your vulnerability.

Yes, there is a deadly pestilence in on our town.  Though mostly hidden, it is as awful as the pandemic.  It is violence against the trapped vulnerable.

Resources

National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224

Every county has a domestic violence, child abuse and elder abuse hot line.

All of us have lost much control over our lives.  How does one go forward?

1.     Take it one day at a time:  The situation is fluid.  We’ve got today.  

2.    Serenity prayer: 

God, grant me the serenity to accept the things I cannot change,

courage to change the things I can, 

and wisdom to know the difference.

3.    Micro change: when faced with a new client who is overwhelmed, therapists frequently suggest looking for the smallest step one can take. 

4.   Social action:  where can you put some time, energy, cash into something postive?

5.  Gratitude:    You are alive.  A great Roman playwright, born a slave, wrote: “Where’s there is life, there is hope.”

Go easy, folks

Posted on by Dr. William Vlach · 6 Comments

Searching for Meaning in the Pandemic

“He who has a why to live for can bear almost any how.”

– Friedrich Nietzsche

#mentalhealth #COVID19 #psychology #meaning

The current thinking in the psychology of disaster protocols is that the question of meaning should be delayed until things settle down.  Folks are on survival mode, and following the Maslow Hierarchies of Need model, this is not the time for ‘self actualization’ thinking.  This is the time for survival.  

The World War II aphorism, ‘There are no atheists in fox holes,’ suggests that under severe stress people do consider the larger questions.  The questions of faith, spirituality, morality, and the like are our ways to search for meaning in the face of terror.  Sure, we want to survive, and will do almost anything to survive.  But the underlying question is— Survive for what purpose?  

These are not questions we may ask, or should ask.  These are questions we do and will ask.  I’d argue that we are meaning making machines.  We are hard wired to find our place in the big picture.  Most of us begin this work in our adolescence and early adulthood.  The fruits of this labor are a sense of how the world is and how we fit into it (or would like to fit into it). There is no guarantee of success in this work.  A failed identity may lead to addictions, accepting negative roles, depression and anxiety.  Being lost in the universe.  Supporting young folks finding their way through this challenge has been a deeply rewarding part of my psychotherapy practice. 

This earned sense of the world can be re-questioned at different times in the life span:  midlife crisis, a loved one’s death, trauma, or what we now face, a global pandemic.  The meaning of one’s life that had been worked on and understood suddenly does not fit with how the world is.  In that discrepancy lies the fuel for a renewed search for meaning.  

We all search for meaning, whether we want to or not.  The best approach is to do this consciously, with critical thinking, in oneself and with others.  This hard work is crucial when one’s sense of control over one’s life and the assumption of the predictability of the world has crashed.  Without that work, the path easily descends into thoughtless knee jerk reactions that can further slide into undeveloped and crude conclusions. 

Easy outs, foolish conclusions: 

1. God’s Wrath:  God sent us this disease to punish us.  A recent American example is Jerry Falwell, Sr.- “AIDS is not just God’s punishment for homosexuals, it is God’s punishment for the society that tolerates homosexuals.”  There are cancer patients who believe their disease is God’s punishment.  Sadly, research shows this approach leads to poor subsequent psychological adjustment.  

2. Blame someone, anyone, for your lack of control:  In the United States, there has been a rise in aggression against Asians and Muslims, and an increase of domestic violence cases against women.  Some countries are showing an increased  attacks on gays and lesbians.  History reveals persecution against Jews during and after plagues.  In the early 20th century, when the cotton market would crash, there was an increase in lynchings of African-Americans. 

3.  Nihilism:  If one gets stuck at the cynical-disillusionment stage of disaster response, it is easy to give up working on finding meaning.  The meaning of it becomes meaninglessness.  Here depression, isolation, anxiety, and phobias prevail.  The depressed cynic can become antisocial or even suicidal.

4.  Hedonism:  After the last great American pandemic, we had the Roaring 20’s.  Then there is the biblical response (I Kings 4:20):  “Let us eat and drink; for tomorrow we shall die.”  Here meaning is found in sensuality.  

5. Authoritarian Acceptance:  After chaos of the pandemic and the slaughter of World War I, the people of several nations chose meaning by merging with a authoritarian state.  Here there is no need to work to understand your place in the universe. You have replaced that work with a blind acceptance of an ideology.  This is both a lazy failure and psychological suicide of sorts. 

Now I suppose it would be easy to list positive outcomes from a search for meaning in this pandemic.  I could say meaning is in the realization that all of us are in this together,  e.g., as C.S.Lewis said:  “Friendship is unnecessary, like philosophy, like art… It has no survival value; rather it is one of those things that give value to survival.”  Or I could say it all comes down to kindness, like the Mark Twain quote—“Kindness is the language which the deaf can hear and the blind can see.”   Or perhaps meaning is found in the spiritual as in the Rumi quote- “These pains you feel are messengers. Listen to them.”

These are answers, someone else’s conclusions. It is far easer to accept another’s answer than asking the hard questions, and finding one’s own answer.  And there are plenty of folks out there pitching their existential conclusions, both because they want to help as well as for a quick buck. But, ultimately, I think there can be no end to this search.  It’s a daily process of living one’s life, feeling and intuition, decision making, reflection, and starting over again.  

Yes, we do need the psychological space to reflect.  It is difficult in times where  physical, social, psychological survival is at stake.  But, I would argue, it is necessarily part of the process. Traditional paths of this search include— talking with a spiritual advisor, a Twelve Step sponsor, or a therapist. Some have used their ‘gap year’ to explore meaning. Others travel to see how other cultures deal with this. Some read. Others garden. A walk in the park. For those stuck in ‘Shelter in Place,’ this down time can be an odd gift.

  1. Pause.  Find a way in the midst of dealing with the chaos of getting food, teaching the children, finding work, to just simply stop.  For a second, for a minute.  For ten minutes.
  2. Silence.  Let all the worries, planning, strategizing go.  There is silence underneath.
  3. Reflect.  If you can, out of this silence, think and question yourself about the larger questions.  
  4. Communicate.  What you are asking is deeply valuable.  By sharing in this search we all flourish.

Go easy, folks

Posted on by Dr. William Vlach

Stages of Psychological Reaction to Covid-19

I’ve worked with cops in psychotherapy for about 40 years. I’ve observed, and they have told me, that they travel through a series of stages in their cop career. The first is The Heroic. They see themselves as the man or woman who can help the legitimate victim, right the wrong, protect the innocent. Further down the career, after seeing unnecessary slaughter, criminal-like victims, helpless criminals, and a broken justice system, The Cynic stage emerges. Here the cop suspects the motivations of everybody. There is no joy in Mudville. The goal shifts from righting wrongs to watching the clock as one waits for retirement. I’ve seen an additional stage: The Resilient. Here the cop shifts from savior, then disgruntled to the appreciation of one’s limits and acknowledgment of the tides of human behavior.

Given classic research on stress and productivity*, work from the Substance Abuse and Mental Health Administration (SAMHA), and my contemporary clinical findings, I would like to propose a similar model for the over time psychological reactions to the global Covid-19 crisis. In this incredibly stressful time, it can be helpful, perhaps even comforting, to recognize patterns in our reactions. It’s like riding a rollercoaster. Helps to stop and gaze at the contraption before you get on. Doesn’t mean the thing won’t break and you’ll fly off into space, but at least you can see where the damn thing is supposed to go. And brace yourself for that particularly hair raising turn.

[Note: Each stage should be seen as a continuum. Like the virus itself, one may barely feel the symptoms or one may succumb to them. And everything in between.]

Alarm Stage

This phase occurred when we heard that there was a new virus in Wutan, China. There were several reactions ranging from Alfred E. Newman’s What, me worry? through Not Our Problem to running out and buying rolls of toilet paper. Our stress response to the potential disaster ranges from denial, compartmentalization to anxiety and panic. Calm reactions included thoughtful preparation. (Wish that last one would’ve been me. Oh, well….).

The Heroic Stage

Here the fear of viral contamination is overwhelmed by the psychological strength of planning and altruism. The sense of control arises as one makes plans, imagines ways to not only cope, but prevail. Work out plans are made, economic contingencies are strategized, in-home school schedule is pinned to the front of the refrigerator door. The clearer the plan, the stronger one feels. How will we get groceries? How will we exercise? Questions are answered by plans. Check on the elders, make sure the young are educated. And if possible, send a donation to a food bank. These bring a sort of calm direction. Hope mixed with anxiety energizes. Grief and loss are felt, but the survival mode is paramount. The crisis is fresh. This is coupled with fantasies of the pandemic’s conclusion: the celebration and relief of freedom from worry.

The Cynical Stage

The disaster psychology literature calls this the Disillusionment Phase. Here one just gets tired. Burned out. The relentlessness of the pandemic wears down the feeling that these are unique challenges. They become a routine without relief. At one end of the continuum is despair and at the other feelings of loss of family and friends. Grief. Getting re-energizing by friends, sports, a date night, a movie, dinner out are lost. The novelty of masks, strategizing how to keep six feet away, remembering to wash your hands, goes from novelty, to hassle to a relentless burden. Negative emotions and pettiness arise that are difficult to mitigate by the usual diversions and socializing. One realizes that all the work one has done will not bring back one’s old life style.

How does one deal with the fact that this is a global disaster with massive disruptions, hunger, economic and political instability? The idea of one’s ability to effect the situation let alone survive it is down-shifted to psychological fatigue and exhaustion. While this stage is not inevitable, without ongoing preparation for it, the potential is great.

The Resilient Stage

This is the payoff stage. Like the squirrel who buries his supplies for winter, resilience is the result of earlier work. Daily attention to ones’ body, social life, inner self can lead here. The understanding that not fretting about things that one cannot change brings serenity. This pandemic has brought us loss, grief, loss of control, anxiety, helplessness, and a ton of other difficult, but authentic, emotions. Resiliency is the acknowledgment of, and the ability to tolerate these profoundly painful feelings. With this acceptance comes the potential for renewal. This may take the form of an identity shift, prosocial activities, increased creativity and spirituality, or other forms one did not expect. And therein would be the good news.

Go easy, folks…

————————————————————————————————

* The early research on patterns of reactions to stress produced the Yerkes-Dodson Law. The idea here is that performance increases with stress, until the stress becomes overwhelming. Mounting anxiety then decreases the performance. The pattern is in the shape of a curve.

(From Francesca Gino’s article in the Harvard Business Review, ‘Are you to stressed out to be productive? Or not stressed enough?’ April 14, 2016.)

Posted on by Dr. William Vlach

Prevention of Psychological Damage in Children in the Pandemic

While I waited as my daughter was going through a particularly difficult surgery, I walked over to the hospital library.  I knew I couldn’t do anything for her.  It was up to the doctors.  Over the years I’ve found libraries are a good place to calm down.  A research paper was posted on an announcement cork board.  The main thing I remember about the study was that the parent’s reaction to a child’s trauma determined the severity of trauma in the child.    As hard as that time was, this common sense research greatly encouraged me.  Gave me a direction.   Calming down gives the frightened child a chance to feel safe.  And in that safety, a chance to psychologically heal.  

This pandemic is not a typical disaster.  There’s not a sudden unexpected shock like 911 or an earthquake.  Or an intense few few days followed by an ongoing crisis like hurricanes bring.  The course on this one is, as Drake sang, “It’s a marathon, not a sprint, but I still gotta win the race, yeah…” 

The 2020 Pandemic began slow as a warning, bringing a sense of threat.  This increased to schools closing,  shelter-in-place, masks, and images of nightly deaths on TV.  As parents now are home-schooling their children, the question remains about how to facilitate the child’s emotional health through this unique disaster.  Along with all the economic academic social challenges, the adult care taker must ask— how can I prevent psychological scarring and facilitate emotional resilience through this pandemic?

First, let’s look at what we are likely to see in children who are now encountering this unique and confusing threat.  The sad, but usual response to disaster, across the age span of childhood is regression.  The little ones, toddlers to kindergarten, may increase their clinging, temper tantrums, forget recently learned skills, and/or demand more attention.   Elementary school children’s regression may show up in night fears, academic inattention, behavioral problems, and/or feeling self blame and guilt.  The middle and high school kids, reacting to the shock of losing their in-person social life, may show regression via isolation,  poor home schooling progress, and, again, self blame and/or angry outbursts.  

The child with learning, psychological and/or developmental challenges brings other questions to parenting and caretaking.  Boundaries can get murky in the confusion, and again, we are faced with cognitive and emotional regression.  

Though each child is wondrously unique, there are patterns in childhood.  Understanding these can help us and decrease the potential for psychological damage.  

Things we can expect:

  1. The child will watch you intently, especially your face, for clues as to what is going on.  
  2. If there is no conversation about the disastrous events, in this vacuum the child will become increasingly confused, and/or blame themselves or the adults in the room.
  3. If the expectations are too high, or too lax, the child will flounder in guilt, blame or self absorption.
  4. If the adult ignores their own need to heal, because this is a long term challenge, the risk of burn out and emotional exhaustion is high.  

The fundamental role of parent and guardian is to protect the child.  And the most basic of this protection is physical:  sustenance, shelter, safety from attack.  Following this is protection by the support of an environment where the child’s needs for social, intellectual, psychological, creative, moral, and spiritual development can be met.  In a predictable environment, the child can grow.  In a chaotic environment the child’s survival mechanisms overwhelm all other needs creating deficits.

This pandemic challenges both the most basic protections adults must provide as well as their, our, ability to provide counsel and guidance.  It’s hard to provide leadership in this unknowable environment. This question of the parent/guardian’s ability to protect can down shift to self shame.  The challenge then is both external and internal.  External in the sense that ‘business must be taken care of.’  Food must be on the table, time boundaries must be set, expectations must be provided, play must be allowed, personality growth must be encouraged.  But on an internal level, the parent/guardian must face their own powerlessness and vulnerabilities without falling into paralyzing self recrimination.

Ways to resilient parenting:

  1. Communication:  Open up a conversation.  First and foremost, listen.  What does the child think and believe about the pandemic.   What does the child feel?  Before you correct misunderstandings and false information, acknowledge what they think and feel.  Then give them age-appropriate information.  Add on the emotional support as you go.
  2. Schedules:  Both over scheduling and under scheduling can be problematic.  This is the moment where the child’s unique needs come into play.  One child may need strong clear routines while the sibling may need greater flexibility.  Neither Boot Camp nor Lord of the Flies.
  3. Limit the news:  This global crisis is overwhelming for us all, especially children.
  4. Build the adult team:  Strategize with other parents/guardians.  The medical and social situation is fluid,  frequent check ins with other concerned adults helps us see alternatives as well as the recognition that we are all in this together.
  5. Take care of yourself:  When they see a calm, relaxed adult, that emotional tone calms their fears and anxiety.  Many a child will challenge that tone to see if it is real.  
  6. If the child begins to experience intense anxiety, withdrawal, outbursts, crying, etc. check in with your pediatrician or a therapist.  Telehealth works for children, too.
  7. Know parenting is the hardest job in the world.  And the most important.  You don’t have to be a hero.  That goal can lead to burn out.  The challenge is not to do the perfect job, it is to show up everyday and do the best you can.  Then take a break.
  8. And, most importantly, enjoy this time with your children. It’s like God said to us all—Go to Your Room!  In there we can build resentments, overwork and make our ourselves miserable.. or.. we can grow with our children, learn from them, role model the joy of learning and living.
  9. Let them teach you how to play again.
  10. Humor helps:  As Dr. Seuss said: ‘Everything stinks till it’s finished.’ 

Go easy, folks.

Posted on by Dr. William Vlach

Prevention of Psychological Trauma in the Time of Covid 19

Before psychological trauma was recognized, debilitating reactions to horrible events was seen as shirking or malingering, a coward’s way of escape.  The war horrors of the Twentieth Century brought about a different understanding.  The symptoms of psychological trauma were labeled as ‘shell shock,’ ‘battle fatigue,’ and ‘war neurosis.’  Those early labels undermined the previous pejorative moral judgments.  It medicalized the experience, and allowed it to be treated.  The Vietnam War brought about increased attention to returning Vet’s painful reactions.  This scrutiny led to the current diagnosis of Post Traumatic Stress Disorder (PTSD).

Research on PTSD is extensive: the effects of 911, Afghanistan War Veterans, car accidents, cardiovascular issues, etc.  See https://www.research.va.gov/topics/ptsd.cfm . There has been extensive research on the physiological, psychological, and social aspects of PTSD.  Likewise, many treatments have been researched and are now offered ranging from Psychodynamic, Acceptance and Commitment Therapy (ACT) to Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy.  The research on the effectiveness of these shows mostly positive results.  Generally, I have found that if the practitioner shows care, consistency and respect, healing follows. 

It doesn’t take a crystal ball to predict that there will be traumatic reactions to this pandemic:  Invisible threat.  Death rates increasing.  Forced familiarity with family and/or roommates.   Physical distancing nationally enforced.  Inability to enjoy one’s usual pastimes.  The challenge of home schooling.  And all too frequently, the inability to make enough money to provide sufficient food for the family. 

Biologically, we are wired up to deal with stress.  One may go the route of Fight— The bully gets punched in the nose.  Or one may go the route of Flight— the gazelle flees the lion.  In recent years researchers have added Freeze as a response.  The predator appears and one freezes in the hope of not being seen.   In the short term, these responses are adaptive and can lead to survival.  The problems arise when the Fight/Flight/Freeze reactions continue on after the threat has passed.  The remote is stuck on one channel.  This pandemic is forcing us all into a Freeze response.

While we can’t know yet the psychological damage this pandemic may bring about, we can plot ways to avoid post pandemic trauma.  ‘Avoid’ may be too strong of a word here.  How about mitigate?  There are steps to lessen the psychological scars that will follow from this global crisis.  There are ways to build resilience.  First the bad news:

Ways to increase trauma potential

  1. Drinking in excess, while briefly numbing, will lock the trauma into place.  Same with drugs.
  2. 24/7 news watching may feel like staying on top of coping strategies.  In fact, it sends the neurological alert systems on overdrive.
  3. Isolate and withdraw: while it may seem safer to keep away from everybody, we need the interaction to heal.
  4. Argue/rage:  when a situation, like this one, brings about feelings of helplessness, we can feel more in control if we blame the ones closest to us.  Scapegoating never leads to healing.
  5. Self blame: likewise, scapegoating the self creates so much internal static that we can’t calmly face the future.
  6. Indifference as a way of dealing with this challenging and deadly pandemic leads to numbness.  And numbness is one of the hallmarks of PTSD.
  7. Vicarious traumatization can be the wound of the empathetic helper.  This is a major danger for First Responders and caring professionals.  Frequently leading to burn out, it can create psychological paralysis.
  8. To deny our emotional reactions in the midst of ongoing fear, vulnerability and grief may seem safer, but the lasting impact again can be numbness and PTSD.
  9. Acting out against our vulnerability by challenging the common sense public health requirements may being a brief sense of being in control, but it can also lead to both physiological and psychological damage.
  10. Worry, worry, worry-  Anxiety and rumination tends to reinforce itself creating more worry.

Ways to build resilience (daily practice):

  1. Social support:  If there’s one thing I’d recommend above all others, it’s having a trusted buddy.  He/she can share the pain, confusion, strategies, and hopes.  Usually it’s better to have a couple, or even several.  No one person, partner, spouse, friend can do it all.  
  2. Physical activity:  Getting stuck on the ‘Freeze Channel’ backs up the stress hormones which can lead to cardiovascular damage as well as an inability to psychologically heal.  Keep active.  Everyday!
  3. Mindfulness:  There has been a lot written about this practice recently.  There are plenty of apps.  See https://psych.ucsf.edu/coronavirus/apps
  4. Creativity:  Creativity by definition facilitates changing mindsets.  And this then adds to our ability to change from a pre PTSD approach to more of a resilient mind set.
  5. Self compassion: given the entire world is going through a bit of hell, this is a great time to cut yourself some slack.  You don’t have to be the perfect home teacher, the great wage earner.
  6. Spiritual approaches:  though we can’t attend our places of worship right now, we can pray, meditate, talk with our spiritual guides, our AA sponsors.
  7. Acknowledge hard emotions:  Both fear and shame are foundations of PTSD.  They are natural reactions to this global crisis.  By not denying these and the ability to build a tolerance for these unpleasant emotions now, we don’t have to get process them later.  
  8. Acknowledge our limitations: The Serenity Prayer sums it up:  God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.  This saying is common now in AA and other 12 step programs was written by Reinhold Niebuhr and has its roots in Classical Stoicism.  
  9. Help out:  Those who pitch in to help do better both in the short and long run. These contributions can range from an economic donation to helping making masks, to bringing food to the elderly.  Do it for others thereby you do it for yourself.
  10. Humor:  As W.C. Fields said, “There comes a time in the affairs of man when he must take the bull by the tail and face the situation.”

Go easy, folks