The History of Psychological Trauma

Trauma, danger, crisis, and fear appear to be prevalent in today’s unsettled environment. An individual does not have to go further than the television in the living room to see images of death, destruction, and mayhem. The media has presented trauma as the “top story” and “headline news” to the point where they must vie for the most shocking story for the higher ratings. In the 1990’s, the public had been witness to numerous occurrences of psychological trauma and people in crisis. Events included, but were not limited to, the advent of road rage, school violence and mass execution of students, corporate violence, airline tragedies, government unrest, and the impeachment of a president. These images take not only a toll on an individual’s view of society; they take a toll on the individual’s sense of well-being. Prolonged exposure to violence and trauma has severe effects on an individual’s psychological state. The need for a model of intervention is paramount to help the individual cope with life’s tragedies. We must first define the nature of trauma and crisis, and then view the current models of treatment.

Crisis, according to Gilliland and James (1993), refers to a perception of an event or situation as an intolerable difficulty that exceeds the resources and coping skills of a person. The event or situation can manifest itself in many forms, but it is the emotional reaction to the event or situation that causes the state of crisis. This crisis can be too overwhelming for the individual and may cause the individual to respond in a pathological manner. The state of crisis may cause a person to respond with ideations of suicide and homicide. The crisis itself has the potential to cause serious damage to an individual’s cognitive, affective, and behavioral states.

Individuals in crisis have suffered from a psychological trauma. Psychological trauma is an affliction of the powerless (Herman, 1992, p.33). Trauma renders a person helpless and powerless due to the overwhelming force of the event. The traumatic event causing the crisis alters the individual’s belief of a just and fair world. The event or situation destroys the individual’s sense of control, connection, and meaning (Herman, 1992, p.33). The individual’s mind responds to this trauma similar to the body responding to distress. The mind will attempt to reach a state of homeostasis. The psychological trauma represents a condition of acute distress causing a disturbance in the balanced state, thus creating psychological disequilibrium (Everly & Mitchell, 1999, p.2). This psychological disequilibrium is a result of the individual’s usual coping skills failing to respond to the psychological trauma. As a result of this response, the individual will suffer from acute distress paired with functional impairment.

The degree of distress and functional impairment can fluctuate from mild to severe. Without some form of relief from the crisis, the individual may become increasingly more disturbed and their behavior may become more disruptive to normal functioning. Acute intervention is then needed to help the individual achieve adaptive functioning to the trauma and crisis. The goals of this crisis intervention, according to Everly and Mitchell (1997), should include: 1) stabilization of the symptoms of acute distress, 2) restoration of a “steady state” of psychological functioning, and 3) assist in the return to an adaptive level of functioning. The intervention should only deal with the current incident of trauma causing crisis and not past maladaptive functioning.

It is clear psychological trauma will alter an individual’s mental status. Crisis intervention is used to provide “first aid” for this altered mental status that will help reduce the individual’s distress and promote adaptive behavior. There are many theories surrounding psychological trauma that attempt to provide the much-needed “first aid” for the individual in crisis.

The study of psychological trauma has its roots in the later part of the nineteenth century with the work of the French neurologist Jean Martin-Charcot. Charcot was the first person to attempt to study and define a disease known as “hysteria”. Before Charcot’s research, hysteria had been considered a disease with incoherent and incomprehensible symptoms (Herman, 1992, p. 10). Charcot was able to document, in great detail, the development and characteristics of the disease. Charcot was able to demonstrate the disease was psychological in nature. He demonstrated his theory by artificially producing the disease’s symptoms in patients by using hypnosis. Charcot was unable to produce the nature of the disease and did not offer a reasonable intervention for treatment. It was the goal of his students, including Sigmund Freud, William James, and Pierre Janet, to research the nature and possible cure for hysteria.

Both Janet and Freud deduced the symptoms of hysteria were the result of psychological trauma. They believed the symptoms were the result of an altered state of consciousness produced by the unbearable emotional reactions to the traumatic events. Janet called the reaction “dissociation: and Freud called it “double consciousness” (Herman, 1992, p. 12). Janet and Freud discovered symptoms could be alleviated if the patient was able to verbalize the traumatic event stored in unconscious memory. Janet would call this treatment “psychological analysis” and Freud would eventually call it “psychoanalysis”. The work by Janet, Freud and, Freud’s counterpart Joseph Brueur gave birth to modern psychotherapy. This method of treatment would allow a person to discuss the hysteria in a manner that would be conducive to the alleviation of the symptoms.

Psychoanalytic theory dominated the research into trauma for the later part of the nineteenth century and the early twentieth century. Psychoanalysis became “a study of the internal vicissitudes of fantasy and desire, dissociated from the realty of experience” (Herman, 1992, p 14.). Freud based most of his research on the exploration of women’s sexual lives. Freud found a correlation between sexually abuse women and hysterical behavior. Freud later recanted his study of hysterics in women reporting the women were not sexually abused. He reported the patients “made up” the fantasies of sexual abuse. This recantation was the turning point away from the study of hysteria and trauma as associated with the unconscious.

After the death of Charcot and the recantation of Freud’s work, the study of psychological trauma resurfaced during World War I. Charles Myers, a British psychologist, was one of the first to examine soldiers who suffered from what he termed “shell shock” (Herman, 1992, p. 20). This nervous disorder was thought to be the result of the concussive effects of exploding shells. It was later discovered that soldiers, who did not see combat, would suffer the same nervous condition, as did the soldiers in combat. The prolonged exposure to war and the aftermath produced hysterical symptoms in men similar to the symptoms reported in women by Charcot and Freud. The diagnosis of combat neurosis was not viewed as being “honorable”. Traditionalists questioned the moral integrity of the soldier and questioned whether to treat a soldier with this disorder. Traditionalists viewed the soldier afflicted with combat neurosis as a coward and an inferior human being (Herman, 1992, p. 22). Lewis Yealland, a British Psychiatrist, held on to the beliefs of the Traditionalists. Yealland used a method, which included threats, punishment, and shame. If a soldier presented with mutism due to the effects of the psychological trauma, Yealland would apply electric shocks to the soldier’s throat until the soldier spoke. Yealland would apply the shocks after tying the soldier to a chair while yelling patriotic jargon for hours.

The Traditionalist view continued its form of treatment until W.H.R Rivers, a physician, offered a more humane treatment based on psychoanalytic principles. His work with a young officer, Siegfried Sassoon, demonstrated the humane approach to treatment could help the soldier return combat without the hysterical symptoms. Rivers’ approach proved to be a success, but a few years after World War I, the interest in combat neurosis faded.

Abram Kardiner, an American psychiatrist schooled in Vienna, began his research of combat neurosis in the 1920’s. Kardiner first attempted to develop a theory from the Psychoanalytic point of view on combat neurosis. He eventually abandoned the theory and replaced it with a framework based on the research of Janet. In 1941, Kardiner published his second book, The Traumatic Neuroses of War, which eventually gave way to his development of the modern framework of traumatic syndromes.

During World War II, Kardiner joined another American Psychiatrist, Herbert Spiegel, to revise his text and begin treatment based on the wok of Rivers. Kardiner and Spiegel found soldiers to be suffering from the loss of attachment to their fighting unit. The treatment would then have to be relatively close to the battlefront and include recreation of the traumatic event through hypnosis. This formed of treatment proved effective, but Kardiner and Spiegel warned military psychiatrist the effects of treatment would not be permanent due to the lasting effects of trauma on the mind. This treatment style stayed in practice until the end of World War I when, once again, the study of trauma would fade.

The Vietnam War would be the next reappearance in the interest of combat neurosis by two American psychiatrists, Robert Lifton and Chaim Shatan. Lifton and Shatan developed “rap groups” for combat veterans suffering from the psychological trauma of war and antiwar sentiment. These “rap groups” offered the soldier a place to discuss their experiences and raise awareness about the effects of war (Herman, 1992, p. 27). By the 1970’s, the “rap groups” spread across the nation forcing the Veterans Administration to begin research into the effects of combat exposure to soldiers. It was also during this time, the feminist movement began to raise awareness about the everyday violence in the sexual and domestic lives of women. Woman suffered the same effects of combat neurosis in their civilian lives. The effects of rape, sexual abuse, and sexual violence were more prevalent in women than the trauma of war on men. Freud touched on this sexual issue before his recantation several decades prior to the feminist movement.

In 1980, the American Psychiatric Association developed the category of posttraumatic stress disorders. This category was based on the work of Kardiner. It included the traumatic symptoms suffered by all effected by trauma. This category of disorders gave rise to the challenge of treating such disorders. The theories of crisis and crisis intervention began to take form amidst the newly found appreciation for traumatic stress.

There is no single theory or school of thought that encompasses every model on crisis or crisis intervention (Gilliand & James, 1993, p. 16). During the early 1980’s, three crisis theories emerged: 1) basic crisis theory, 2) expanded crisis theory, and 3) applied crisis theory. The basic theory focuses on helping people in crisis to recognize and change cognitive, behavioral, and emotional distortions that are brought on temporarily by the traumatic event. The resolution of these temporary maladaptive states may lead to positive self-growth and diminished negative feelings. The expanded theory draws on the psychoanalytic, systems, adaptational, and interpersonal theories. This theory holds that anyone can fall victim to transient psychological symptoms if the right combination of developmental, psychological, sociological, environmental, and situational determinants exist. The applied theory is a more flexible approach which views each individual reacts differently in any given crisis. This theory supports three types of crisis: 1) normal developmental crisis, 2) situational crisis, and existential crisis.

The three crisis theories opened the door for crisis intervention. All crisis intervention models are based on theory (Gilliand & James, 1997, p. 21). Three basic crisis intervention models were developed. The models are the equilibrium model, the cognitive model, and the psychosocial transition model. The equilibrium model helps an individual achieve a state of precrisis equilibrium. The equilibrium is used as a result of a person falling into a state of disequilibrium following a crisis. The model would help the individual regain a sense of control over the malfunctioning coping skills. The cognitive model’s basic premise is that people can gain control of the crisis by changing their thinking (Gilliand & James, 1997, p. 22). This premise is best described by viewing the state of crisis as faulty thinking about the events unfolding around the crisis. The psychosocial transition model is similar to the cognitive model. This model holds that the individual must gain control of their internal and external difficulties surrounding the crisis. The individual would need to incorporate coping skills and social supports with adequate resources to find a non crisis state.

The aforementioned theories and models were the product of the research done in the late 1970’s and throughout the 1980’s. After nearly 100 years of research, the value of crisis intervention after a psychological trauma appeared to be on the rise. This new research began to uncover many other facets of psychological trauma. Child sexual abuse was now viewed in the same category as posttraumatic stress disorder. In 1998, Christine Courtuois, a clinical psychologist, authored Healing the Incest Wound, which was one of the first texts to describe treatment for adult survivors of sexual abuse (Chu, 1998, p. 11). Sexually abused children and adult survivors displayed the same maladaptive functioning as female rape survivors and male combat veterans.

The trend continued by research being done on the effects of trauma with civilian paraprofessionals such as police officers, emergency medical technicians, paramedics, and firefighters. A new model of crisis intervention began to take shape with the research of a former paramedic and a clinical psychologist. Jeffery Mitchell and George Everly developed a model of crisis intervention designed specifically to aid in “the prevention of acute, disabling psychological discord and the rapid restoration of adaptive functioning in the wake of a critical (crisis) incident” (Everly & Mitchell, 1999, p. 12). This model, first used with the paraprofessionals, helped the individual cope with the crisis and allowed the individual to return to normal duty. This is the same premise of treatment used by Kardiner and Spiegel during World War II. Everly and Mitchell (1999) defined Critical Incident Stress Management as an integrated and comprehensive multicomponent programmatic approach to the prevention and mitigation of crisis states and subsequent critical incident stress. Mitchell later developed a technique called Critical Incident Stress Debriefing (CISD). CISD is a direct, action oriented crisis intervention technique designed to prevent traumatic stress following a traumatic event (Everly & Mitchell, 1988, p. 8).

As Critical Incident Stress Management (CISM) was defined and refined, the International Critical Incident Stress Foundation (ICISF) was formed in 1989. This was the first and largest standardized crisis response organization in the world. The ICISF was devoted to preventative mental health care for people in crisis. In 1992, The American Red Cross became the first agency to formalize training for disaster relief using a multicomponent mental health network. The American Red Cross was designated as the first response team in lieu of an airline disaster. The ICISF’s primary focus was on the reaction to psychological trauma by the paraprofessional whereas the American Red Cross’ focus was on civilians.

During major disasters in the 1990’s, the services of the American Red Cross and the ICISF were used extensively. The two organizations were vital in the healing process after the bombing of the federal building on Oklahoma City in 1995 and the TWA 800 mass air disaster in 1996. In 1994, The American Psychiatric Association published the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This edition now recognized Acute Stress Disorder that emphasized the impairments found in Post Traumatic Stress Disorder. By 1995, research into Acute Stress Disorder and Post Traumatic Stress Disorder was at an all time high. OSHA, the Gore Commission, the US Air Force, and the US Coast Guard began to implement crisis intervention models and techniques nationwide. The need for appropriate models of crisis intervention for trauma survivors appeared to be at its peek.

In 1997, Francine Shapiro, a clinical psychologist, developed a form of therapy for overcoming anxiety, stress and trauma. This therapy departed from the current models and trends as it was billed as a “cure for trauma”. Shapiro’s therapy was called Eye Movement Desensitization and Reprocessing (EMDR). This form of therapy worked with rapid eye movements to diminish anxiety consistently over time (Shapiro, 1997, p. 10). Shapiro incorporated techniques from many schools of psychotherapy including psychodynamic, cognitive, systems, and body oriented. Shapiro would move her finger in front of a traumatized individual encouraging the individual to follow the finger with the eyes-only. During this process, Shapiro would have the individual recount the traumatic event and would begin to process the nature, emotions, and behavior around the traumatic event. Shapiro reported tremendous success with this technique, but was unable to offer any clinical data supporting her findings. Clinicians trained by Shapiro and her staff only sanctions Shapiro’s technique.

Currently, many other forms of trauma therapy, such as Thought Field Therapy, are being developed and used throughout the country. Research into psychological trauma and the effects of the trauma have increased steadily. The tremendous advancements in crisis intervention have only surfaced in the past three decades, but is that only due to the amount of trauma found in the world. Initially, trauma was only researched because of war and tragedy. If there is not a push for steady research or the amount of violence in our society decreases to an acceptable level by the government, will trauma research fade away as it did in the past? The simple truth is trauma, in all forms, is a part to the human experience. All humans will suffer through some form of trauma in their lives. Crisis intervention techniques offer hope for victims for a solid and mentally healthy future.

REFERENCES 

American Psychiatric Association. (1994) Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: Author.

Blanchard, E. B. & Hinkling, E. J. (1997) After the crash: Assessment and treatment of motor vehicle accident survivors. Washington, D.C: American Psychological Association.

Briere, J. (1997) Psychological assessment of adult posttraumatic stress. Washington, D.C: American Psychological Association.

Callahan, R. J. (1995) The anxiety-addiction connection: Eliminate your addictive urges with Thought Field Therapy. Indian Wells, California: The Callahan Techniques.

Chu, J. (1998) Rebuilding shattered lives: The responsible treatment of complex post traumatic and dissociative disorders. Canada: John Wiley & Sons, Inc.

Everly, G. S. & Mitchell, J. T. (1999) Critical incident stress management: A new era and standard of care in crisis intervention (2nd ed.). Ellicott City, Maryland: Chevron Publishing Corporation.

Everly, G. S. & Mitchell, J. T. (1993) Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster workers. Ellicott City, Maryland: Chevron Publishing Corporation.

Everstine, D. S. & Everstine, L. (1993) The trauma response: Treatment for emotional injury. New York: W. W. Norton & Company.

Flannery, R. B., Jr. (1992) Post-traumatic stress disorder: The victim’s guide to healing and recovery. New York: The Crossroad Publishing Company.

Fullerton, C. S. & Ursano, R. I. (Eds.). (1997) Posttraumatic stress disorder: Acute and long-term responses to trauma and disaster Washington, DC: American Psychiatric Press, Inc.

Gilliland, B. F. & James, R. K. (1988) Crisis intervention strategies (2nd ed.). Pacific Grove, California: Brooks/Cole Publishing Company.

Gilliland, B. F. & James, R. K. (1997) Crisis intervention strategies (3rd ed.). Pacific Grove, California: Brooks/Cole Publishing Company.

Herman, J. L. (1992) Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York, New York: Basic Books.

Horowitz, M. J. (1997) Stress response syndromes: PTSD, grief and adjustment disorders (3rd ed.). Northvale, New Jersey: Jason Aronson, Inc.

Johnson, K. (1998) Trauma in the lives of children: Crisis and stress management techniques of counselors, teachers, and other professionals (2nd ed). Alameda, California:
Hunter House, Inc.

Shapiro, F. & Forrest, M.S. (1997) EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. New York, New York: Basic Books.

What is Trauma and Grief Counseling?

Grief counseling is a form of psychotherapy that aims to help people cope with grief and mourning following the death of loved ones, or with major life changes that trigger feelings of grief (e.g., divorce).
Everyone experiences and expresses grief in their own way, often shaped by how their culture honors the process or not. It is not uncommon for a person to withdraw from their friends and family and feel helpless; some might be angry and want to take action.

One can expect a wide range of emotion and behavior associated with grief.  In all places and cultures, the grieving person benefits from the support of others.   Where such support is lacking, counseling may provide an avenue for healthy resolution. Similarly, where the process of grieving is interrupted for example, by simultaneously having to deal with practical issues of survival or by being the strong one and holding a family together, it can remain unresolved and later resurface as an issue for counseling.

Grief counseling becomes necessary when a person is so disabled by their grief, overwhelmed by loss to the extent that their normal coping processes are disabled or shut down.   Grief counseling facilitates expression of emotion and thought about the loss, including sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness.

It includes thinking creatively about the challenges that follow loss and coping with concurrent changes in their lives. Often people feel disorganized, tired, have trouble concentrating, sleep poorly and have vivid dreams, and experience change in appetite. These too are addressed in counseling.
Grief counseling facilitates the process of resolution in the natural reactions to loss. It is appropriate for reaction to losses that have overwhelmed a person’s coping ability.

Grief counseling may be called upon when a person suffers anticipatory grief, for example an intrusive and frequent worry about a loved one whose death is neither imminent nor likely. Anticipatory mourning also occurs when a loved one has a terminal illness. This can handicap that person’s ability to stay present whilst simultaneously holding onto, letting go of, and drawing closer to the dying relative.

There is a distinction between grief counseling and grief therapy. Counseling involves helping people move through uncomplicated, or normal, grief to health and resolution. Grief therapy involves the use of clinical tools for traumatic or complicated grief reactions.   This could occur where the grief reaction is prolonged or manifests itself through some bodily or behavioral symptom, or by a grief response outside the range of cultural or psychiatrically defined normality.

Grief therapy is a kind of psychotherapy used to treat severe or complicated traumatic grief reactions, which are usually brought on by the loss of a close person (by separation or death) or by community disaster. The goal of grief therapy is to identify and solve the psychological and emotional problems which appeared as a consequence.
They may appear as behavioral or physical changes, psychosomatic disturbances, delayed or extreme mourning, conflictual problems or sudden and unexpected mourning). Grief therapy may be available as individual or group therapy. A common area where grief therapy has been extensively applied is with the parents of cancer patients.
Anticipating the impact of loss or trauma (to the extent than any one can), and during and after the events of loss or trauma, each person has unique emotional experiences and ways of coping, of grieving and of reacting or not. Sudden, violent or unexpected loss or trauma imposes additional strains on coping. When a community is affected such as by disaster both the cost and sometimes the supports are greater.

Weeping, painful feelings of sadness, anger, shock, guilt, helplessness and outrage are not uncommon. These are particularly challenging times for children who may have had little experience managing strong affects within themselves or in their family. These feelings are all part of a natural healing process that draws on the resilience of the person, family and community.

Time and the comfort and support of understanding loved ones and once strangers who come to their aid, supports people healing in their own time and their own way. Research shows that resilience is ordinary rather than extraordinary.  The majority of people who survive loss and trauma do not go on to develop PTSD. Some remain overwhelmed.

This article addresses counseling with complex grief and trauma, not only complex post-traumatic stress disorder but those conditions of traumatic loss and psychological trauma that for a number of reasons are enduring or disabling. For example, where an adult is periodically immobilized by unwelcome and intrusive recall of the sudden and violent death of a parent in their childhood.

One that they were unable to grieve because they were the strong one who held the family together, or whose feelings of outrage and anger were unacceptable or unmanageable at the time or because the loss of the breadwinner catapulted the family into a precipitous fall losing home, community and means of support.

Because of the interconnectedness of trauma, PTSD, human development, resiliency and the integration of the self, counseling of the complex traumatic aftermath of a violent death in the family, for example, require an integrative approach, using a variety of skills and techniques to best fit the presentation of the problem.
Disruption in the previously supportive bonds of attachment and of the person’s ability to manage their own affects challenges traditional, so called ‘non-directive’ client centered counseling approaches.

The post-traumatic self may not be the same person as before.  This can be the source of shame, secondary shocks after the event and of grief for the lost unaltered self, which impacts on family and work. Counseling in these circumstances is designed to maximize safety, trauma processing, and reintegration regardless of the specific treatment approach.

Recovering from Disappointment

Life surely has its ups and downs. Whether you lose a friend, a promotion, a significant other, or you just fail at achieving a goal, the anguish of disappointment can be devastating. Whether the disappointment is in us or in someone else, the overall feelings of disappointment are akin to the grieving process. Personally, I believe we can work better at grieving the disappointment with others versus the disappointment with ourselves. For me, being disappointed in myself leaves me feeling out of sorts, lost, and, dare I say, vulnerable. It’s often a reminder of how fragile life and the human experience is as it pertains to the loss of confidence. Disappointment can kick you squarely in the teeth leaving you dazed and confused. It is never a good feeling, but, with the right direction, you can recover from the feeling. The feeling of disappointed is also a part of life. Do we need disappointment? Well, maybe. I think we all need a modest level of disappointment to achieve a greater sense of self discovery. I believe a feeling of disappointment in ourselves can lead us eventually to a path of greatness. Paulo Coehlo once wrote, “When you find your path, you must not be afraid. You need to have sufficient courage to make mistakes. Disappointment, defeat, and despair are the tools God uses to show us the way.” We all make decisions in our lives which may turn out exactly the way we planned or go up in flames. Those decisions often lead to feelings of success or feelings of disappointment. As Coehlo suggests, the ability to recover from a mistake may turn out, in the end, to be exactly what we need. Have you ever been presented with a challenge knowing all the results would not be desirable? Have you ever had to make a decision which you knew had the potential to create disappointment in others and in yourself? Sure you have. We all have had those moments. We have all had those moments of shear dread of making an impactful decision which could lead to disastrous results or tremendous disappointment. But, as Joel Olsteen said, “You must make a decision that you are going to move on. It won’t happen automatically. You will have to rise up and say, ‘I don’t care how hard this is, I don’t care how disappointed I am, I’m not going to let this get the best of me. I’m moving on with my life.” Recovering from disappointment is not an easy or desired task. It takes internal power to rise up and move ahead. The power has to come from deep inside. Deep inside the place you reserve for the most daunting of tasks. It is within that place you live and thrive. You must face the truth of being embarrassed and ashamed of yourself and know these feelings will hopefully pass. Develop a sense of humility and be honest with yourself and others. Even if the ultimate honesty is painful, put it out there and be exposed. Be vulnerable. Be human. The worst thing that happens is you make the wrong decision and you lose what you had. The best thing that happens is you make the right decision and gain something valuable. Either way, it is much better to face the possible disappointment head on. Once the decision is made and everything has been exposed, the results of the decision will happen and you deal with the consequences whether they are good or bad. Life is measured by both the disappointments and the successes. Take the risk of losing something to gain something. Take the risk of disappointment to feel joy, happiness, and freedom. Being burdened by disappointment only allows you to wallow within sorrow. Be free to express yourself and move on. If a person is disappointed in you, apologize and move on. You will make mistakes in life. Sometimes huge mistakes, but acknowledge the mistake. Apologize for the disappointment and move on. We are not perfect beings. We can’t be perfect. Remember, life is a journey. During this journey, we will stumble and fall at times. We will not only make mistakes, but we will create disappointment. Take a moment and acknowledge the journey. It may be helpful to listen to the words of Thomas Jefferson, “If I am to meet with a disappointment, the sooner I know it, the more of life I shall have to wear it off.”

The Heart was made to be Broken

“The heart was made to be broken.” ~ Oscar Wilde Do you remember your first true love? That person who made your heart and mind flutter for a moment when they looked at or touched you? The feelings of love rush in like the tide and we get swept away with feelings of excitement, joy, and passion. Your thoughts turn to the person every waking moment. You dream about that person. You live to hear the sound of their voice. At times, you resist these feelings in the hopes to gain some control over yourself almost wanting those feelings to just go away even for just a minute. You can’t help but falling in love and wanting those feelings to last. You tell everyone your feelings because you are not afraid of these feelings. You expose your inner dialogue because you need to proclaim to the world this feeling of bliss. Do you remember the moment when this feeling ended? Do you remember when those feelings were changed into something you did not recognize? That moment when the person stopped loving or caring for you in the way which you grew accustomed. You feel as if the world is collapsing around you. It is like being stuck in a box and the walls are caving in. Sleepless nights, anxious moments, low feelings all become a reality. You tell yourself you will be ok, but you really do not believe it. You smile politely when your friends say you will find someone new. It hurts. It really hurts. The feelings may linger for days, weeks, months, or years. Time stands still when your heart is broken. Time has no meaning. Songs, places, people are painful remindersof the love you once had. Louise Eldrich once said, “Life will break you. Nobody can protect you from that, and living alone won’t either, for solitude will also break you with its yearning. You have to love. You have to feel. It is the reason you are here on earth. You are here to risk your heart. You are here to be swallowed up. And when it happens that you are broken, or betrayed, or left, or hurt, or death brushes near, let yourself sit by an apple tree and listen to the apples falling all around you in heaps, wasting their sweetness. Tell yourself you tasted as many as you could.” Heartbreak is a part of our human condition. If we have never experienced a heartbreak, dare I say, we have not truly lived and put ourselves out there in the world. Love, at best, is a risky proposition. We run the risk of not having our love reciprocated leaving us vulnerable and emotionally naked. If our love is reciprocated, our risk pays off 1000 fold. Recently, I spoke with a couple who have been married for 70 years. They both are 90 years old and were high school sweethearts who married shortly after graduation. I asked them if they ever experienced heartbreak prior to them meeting. He looked at me with a smile, “I never had to have my heart broken because it didn’t beat until I met my bride.” For them, the risk was investing in each other’s love and rolling the dice of life. Although a wonderful couple, I firmly believe they are not the norm in society. I believe the majority of us have gone or are going through heartbreak at some point of our lives. How do we mend a broken heart? Mending a broken heart is going to be different for everyone. It is not an easy process especially as an adult. There are no quick fixes and clearly no magic solutions. Do not fool yourself into believing you will stop loving the other person. However the relationship ended, there was love there at some point. Those feelings just do not go away. They are stored in the lovely computer known as the brain. Those feelings are activated any time you hear “our song”, eat at “our restaurant”, or hear from “our friends”. Do yourself a huge favor and never tell yourself you will stop loving the person. Just acknowledge it and begin the healing process. Trust me, it is much easier. So how do we get through this pain of a broken heart? The healing process is just that, a process. Similar to the physical death of a person,we grieve the emotional death of a relationship. The grieving process does not have time limits. I wish I could give you exact times when the hurt will dissipate, but I would be lying if I did. The following stages are a mere outline of how the grieving process works. Stage One: Shockand Denial – You are devastated and life is turned upside down. You may say, “This is not happening to me”, “Why me?”, or “This is all a dream”. It is the mind’s way of buffering you from the pain of the loss. Stage Two: Bargaining – As you emerge from the initial shock, you begin to think of ways to correct the loss. “If only” statements are used. “If only had I called more often” “If only I had said I love you more”. You question yourself in the attempt to make sense of the loss. Stage Three: Anger – Anger is a necessary stage of the healing process. Be willing to feel your anger,even though it may seem endless. The more you truly feel it, the more it will begin to dissipate and the more you will heal. There are many other emotions under the anger and you will get to them in time, but anger is the emotion we are most used to managing. The truth is that anger has no limits. Underneath anger is pain, your pain. It is natural to feel deserted and abandoned, but we live in a society that fears anger. Anger is strength and it can be an anchor, giving temporary structure tothe nothingness of loss. At first grief feels like being lost at sea: no connection to anything. Then you get angry at someone, maybe a friend who says the wrong thing, a commercial about relationships or even a family member. Suddenly you have a structure – your anger toward them. The anger becomes a bridge over the open sea, a connection from you to them. It is something to hold onto; and a connection made from the strength of anger feels better than nothing. We usually know more about suppressing anger than feeling it. The anger is just another indication of the intensity of your love. Stage Four: Depression – After Anger,our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever. It is important to understand that this depression is not a sign of mental illness. It is the appropriate response to a loss of love. We withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on alone? Why go on at all? Depression after a loss is too often seen as unnatural: a state to be fixed, something to snap out of. The first question to ask yourself is whether or not the situation you are in is actually depressing. Heartbreak is a very depressing situation, and depression is a normal and appropriate response. To not experience depression after a heartbreak would be unusual. When a loss fully settles in your soul, the realization that your heart has been broken is understandably depressing. If grief is a process of healing,then depression is one of the many necessary steps along the way. Stage Five: Acceptance – Acceptance is often confused with the notion of being “allright” or “OK” with what has happened. This is not the case. Most people don’tever feel OK or all right about a broken heart. This stage is about accepting the reality the relationship has ended and recognizing that this new reality is the permanent reality. We will never like this reality or make it OK, but eventually we accept it. We learn to live with it. It is the new norm with which we must learn to live. We must try to live now in a world where our love relationship has ended. In resisting this new norm, at first many people want to maintain life as it was before the broken heart. In time, through bits and pieces of acceptance, however, we see that we cannot maintain the past intact. It has been forever changed and we must readjust. We must learn to reorganize roles,re-assign them to others or take them on ourselves. Finding acceptance may be just having more good days than bad ones. As we begin to live again and enjoy our life, we often feel that in doing so, we are betraying our lost love. We can never replace what has been lost, but we can make new connections, new meaningful loverelationships, new inter-dependencies. Instead of denying our feelings, we listen to our needs; we move, we change, we grow, we evolve. We may start to reach out to others and become involved in their lives. We invest in our friendships and in our relationship with ourselves. We begin to live again, but we cannot do so until we have given grief its time. Ok, I have accepted the heart break, now what? The practically of moving on from the ending of a relationship varies from person to person. Friends will tell you to get out there and date. Co-workers may try to fix you up with someone. You may dive head first into work and isolate for awhile. You may start dating right away. The re-entry phase is different for everyone. I can offer a few things to try to help with there-entry: 1. Stop the insanity – Put away the pictures, stop going on the other person’s Facebook or Twitter, stop listening to the songs you listened to together. Constant reminders impede the re-entry phase. 2. Get in rhythm – Experiencing new or inspirational music may change mood. Listen to songs that get the blood flowing. 3. Hit the gym -Try some physical activity to sweat out your troubles. Physical exercise may allow some frustrationto be released. 4. Smiling is my favorite – As it has been said, “Laughter is the best medicine”. Watch a funny movie, go see a comedy show, laugh with friends, or read a funny novel. Put yourself in a position to laugh. 5. Surround yourself with positives – Try to reconnect with positive friends and people. Put yourself in a position where the people around you are a positive influence and have your best interests at heart. 6. A whole new world – Try something new or different. Involve yourself in new activities or experiences. Now is the time to reinvent and re-enter. Heartbreak is never easy. It is a difficult process to go through, but with persistence and patience, you will get through it. Do not be afraid to risk loving someone again. Do not be afraid to be vulnerable again.

“

End of Watch – The Final Inspection

End Of Watch Lt. Joseph Szczerba New Castle County Police, New Castle, DE 09-23-11. Lt Szczerba fatally stabbed while trying to subdue a suspect that was high after huffing bath salts and was out breaking into cars. Lt Szczerba is the 1st officer on the department to be killed in the line of duty since 1972.

God Speed Lt. Joseph Szczerba.

“The Final Inspection”

The policeman stood and faced his God,
Which must always come to pass.
He hoped his shoes were shining.
Just as brightly as his brass.
“Step forward now, policeman.
How shall I deal with you?
Have you always turned the other cheek?
To My church have you been true?”
The policeman squared his shoulders and said,
“No, Lord, I guess I ain’t,
Because those of us who carry badges
can’t always be a saint.
I’ve had to work most Sundays,
and at times my talk was rough,
and sometimes I’ve been violent,
Because the streets are awfully tough.
But I never took a penny,
That wasn’t mine to keep….
Though I worked a lot of overtime
When the bills got just too steep.
And I never passed a cry for help,
Though at times I shook with fear.
And sometimes, God forgive me,
I’ve wept unmanly tears.
I know I don’t deserve a place
Among the people here.
They never wanted me around
Except to calm their fear.
If you’ve a place for me here,
Lord, It needn’t be so grand.
I never expected or had too much,
But if you don’t…..I’ll understand.
There was silence all around the throne
Where the saints had often trod.
As the policeman waited quietly,
For the judgment of his God.
“Step forward now, policeman,
You’ve borne your burdens well.
Come walk a beat on Heaven’s streets,
You’ve done your time in hell.

Remembering September 11, 2001

Writing this blog was not an easy task. I have started and stopped several times trying to organize my thoughts and collect my emotions. As one of the numerous professionals who responded to the tragic events of September 11th, I did not want to sound too preachy nor did I want to come across as pretentious. My hope for the blog was to give personal accounts, recollections, and thoughts about the day and the ten years that followed. I realized, as I jotted ideas down, every first responder who went to New York has a story and my story is not unlike anyone else. There are some memories I will keep private and others I discuss. September 11th, 2001 was a day I will never forget, but, at times, wish I never remember. It was a day the world, as most of us knew it, changed. We can all recall where we were, who we were with, and what we were doing as the attacks began. My time spent in New York City helping people to recover from the tragedy opened my eyes wider than they were ever opened before. From the moment the attacks occurred to the last day of my several months helping in New York, I saw, experienced, and felt things I would never forget. As I think about that day and the ten years after, five very distinct words come to mind: anger, sadness, love, hope, and admiration.

Anger, for me, came a long time after the initial attack. I held back feeling angry because of all the work that needed to be done. I had to keep my game face on and help those affected by the tragedy. I do not recall feeling anything other than compassion my first month in New York City. I almost felt ashamed to be angry because of the loss and devastation. I remember talking with a Port Authority Officer and he told me he had no time to be angry because of the job he has to do. I’m not saying people were not angry. Trust me, there were a lot of angry people. I just placed my anger on hold for awhile. Anger is a normal and essential human emotion. It is easy for all us to be angry at the group of people responsible for the tragedies of 9/11, but I think the anger felt is more of a constant reminder of how the world changed. Shortly after 9/11, I had to take a business trip requiring me to fly. If you can remember, air travel was, at best, a surreal experience during the first few years post 9/11. Security was intense and lines were very long. I booked my flight and was notified to give at least three hours to go through security and check my bags. I will be the first to admit, time has always been a problem for me, but I knew it would be beneficial to adhere to the new security standards. As I arrived at my gate, the line was already a mile long. Soldiers with weapons were standing at the gate and mostly everyone was silent in line. I took my place and waited for my turn to pass through the security. As I stood there, an older couple hurried into line obviously in a rush not to miss their flight. I tried to keep to myself, but they were making their displeasure about the wait known to everyone. Twenty minutes in line felt like two hours. The more we waited, the more the older couple complained. I gathered from their loud conversation, they had only given themselves forty-five minutes to check in. I was wearing a fire house job shirt which is a very distinctive shirt with the fire company’s insignia and logo. A soldier walked down the line and nodded to me. Recognition, maybe. Being friendly, more likely. His simple act of acknowledgement was all the couple needed to launch into their tirade of ridicule and disdain for the military. And then it happened, the older man turned to me and said, “I bet you will get special privileges because of what you are wearing.” An explosion went off in my brain. The pain, the anger, the sadness from the recent tragic events came to me in one single blow. I have no idea what made me so angry at this little old man, but the anger was intense. I turned to him and said, “I’m sorry sir that the deaths of 343 fire fighters created an inconvenience for you today.” I did not know what else to say or do. I said what I said and turned around. Defiant, angry, appropriate, I’m not sure but it quieted them down. The gentleman in front of me turned and thanked me. I went through security and life went on. I think back to that moment and realized that little old man gave me my personal definition of anger for 9/11. The senseless deaths of over 3000 people created an inconvenience for others. It still gets me angry to think about it ten years later.

We all experience sadness in our own unique ways. Some are sad because of the loss of loved ones. Some are sad because of how the world changed. Some are sad because of the horrible memories of the attacks. Some are sad because they had to watch loved ones go off to war. My sadness stems from the overall sense of loss. The national pride and unity was incredible following 9/11. People seemed more kind and caring. For a moment in time, we all acknowledged our American pride. We flew our flags proudly. We had our flags on our houses and our vehicles. Flag makers could not produce them fast enough. But, our myopic view as a society reared its ugly head. After a short period of time, flags came down. I remember seeing a few tattered flags on the roadside and thinking how sad of a thing that was. A few flags turned into many forgotten worn flags on the roadside and, eventually, seeing a flag displayed with pride became a rarity. The sadness I feel is not because people do not fly flags, but it is because we, as a society, went back, for the most part, to what we were before. It is sad we only come together in times of tragedy. I remember a trip to New York City as a kid. I was only about 8 years old at the time. My first thoughts of the Twin Towers were ones of amazement and curiosity. The shear enormity of the Towers, for an 8 year old, was staggering. I am sad my children did not get to see them and experience what I experienced. I am sad all the children born after that day will not get to see the Twin Towers and marvel at their size. I am sad at the senseless loss of life and the pain the families of the deceased feel. This sadness started when I encountered the empty helmets worn by firefighters who rushed into the Twin Towers never to come back. 343 firefighters, 37 Port Authority Police officers, 23 police officers, 3000 civilians died and an additional 6000 people injured for no good reason. Not a single person killed that day imagined that would be their last day on earth. The world changed for everyone that day. This is where my sadness lies.

About nine days after the attacks, I emerged from an area where I had been talking to several firefighters. I was covered in ash and dirt feeling exhausted. I sat down on a bench and held my head in my hands. I was looking for a moment of peace, comfort, maybe even some absolution. A young girl walked up to me without saying a word and hugged me. I had no idea who she was nor did I ever see her again, but in that moment of exhaustion and inner pain, she gave me a glimpse of peace. Her simple act of a hug, whether she meant it or not, helped me to understand the sadness of the situation would eventually dissipate. When I think of the past ten years, the feeling of love comes from a deep place which was forged by those random acts of kindness. Compassion and caring about others seemed to take shape. I remember the Campbell’s soup trucks lining up near Ground Zero to offer a hot meal to the workers. Restaurants would open their doors for you and people would shake your hand just to say they appreciated you. I do not think that feeling was ever lost. To me, that is a feeling of love. The mere fact people appreciated what you have done for others helped me grow as a person. I have tried not to take people in my life for granted, but after 9/11, I tried even harder to show my love for the people in my life. There have been times where I was left flat with those feelings but, for the most part, I have remained true to those feelings. I have been accused of giving people too many chances or holding on to things too tightly, but I firmly believe you get what you give. If I give a second chance, maybe I will get one in return.

Moments after watching the Twin Towers fall, I was given the task of assessing and speaking to a group of children who had just lost one or both parents in the attacks. These were the children in the day care centers in the towers on the lower floors. I gathered them around and found some paper, pencils, and crayons. I asked the kids to draw whatever came to mind. Most of the kids created pictures of the planes going into the towers or the towers on fire, but one little girl’s picture was a rabbit in a grassy field. I leaned down, a bit befuddled by the picture, and asked the little girl, “Who’s that?” The little girl looked up at me and said, “That’s Max. He’s my bunny. I hope someone will feed him tonight because he is home all alone and I don’t want him to be scared.” Needless to say, I was touched and a bit choked up. Hope is the emotional state which promotes the belief in a positive outcome related to events and circumstances in one’s life. It is the “feeling that what is wanted can be had or that events will turn out for the best” or the act of “looking forward to with desire and reasonable confidence” or “feeling that something desired may happen”. Even in the midst of the tragedy of that day, this little girl retained a sense of hope. My hope stems from similar feelings. Not that her bunny Max was fed, even though that would have been a nice thing, but, rather, there is something beyond this event. Hope we continue to grow as a nation. Hope all the troops come home safe and alive. Hope the tragedies of 9/11 never occur again. Hope for the families of the deceased to find some sort of peace some day. Hope for the members of the emergency services to continue doing their jobs while staying and keeping us safe. I have tremendous hope I can continue to do my job helping people during disasters.

If you served or are serving in the armed forces, the quote, “All gave some, some gave all” has a very distinct and special meaning. With the utmost respect for our military personnel, I believe this phrase can also be used for the first responders of 9/11. There were thousands of men and women who responded to New York City, Washington DC, and Pennsylvania with the sole purpose of helping those in need. These people did not know if there would be injured or dead or even other perils waiting for them. They wanted to help. They wanted to help the victims and they wanted to help their nation. I remember meeting other disaster workers, firefighters, and emergency medical technicians from as far as California and even Hawaii who offered to help during the months after the attacks. As the work progressed, there were new faces to relieve the exhausted and weary. I admire the businessmen and women who continue to work day after day following the attacks. I admire the construction workers who are now rebuilding WTC1, the Freedom Tower. I admire the resolve of the citizens of the United States. Most of all, I admire my rough and ready crew who joined me during the relief efforts a few minutes after the attacks until the very last one of us went home months later and who join me every year in New York for the memorial services.

We cannot change what happened on September 11th, 2001. We can only learn from it. My thoughts and prayers are and will always be with the friends and families of all the victims of 9/11.

Kids reactions to the 10th Anniversary of 9/11

The tragedies of September 11, 2001 unfolded before the world through the media coverage of the event including the days that followed. In this area, a television station played the image of the planes crashing into the World Trade Center 1856 times during the first week following the attacks. This type of television coverage meant that many children were exposed to distressing images that may have been hard for them to comprehend.

The television coverage of the 10th anniversary of these attacks may prove to be the single most extensive media coverage of any memorial service. Teens and young adults who were children at the time of the attacks may be re-exposed to those same distressing images during the memorial coverage. Children who were not born yet or too young to comprehend the gravity of the situation may be exposed to those images as parents relive the events of that September morning. In situations like this, it is important for parents to monitor what their children are watching and, at the same time, help them understand and cope with the situation.

Children who have been exposed to a traumatic event are afraid of many of the same things adults are afraid of: that the event will happen again; that they or their family will be hurt; or that they will be separated from family members. They may also have fears based on misconceptions of what has happened. Witnessing the images of September 11th may leave children especially frightened, insecure, or upset about what happened. They may display a variety of emotional responses after watching the memorial services and replay of the attacks. It is important to recognize that these responses are normal.

How a parent reacts will make a great difference in the child’s understanding and recovery after witnessing or reliving the distressing images. Parents should make every effort to keep the children informed about what is happening and to explain it in terms that they can understand. Remember, the attacks happened 10 years ago, but for the child witnessing the images for the first time, that child may feel as if the attacks are currently happening.

Usually a child’s emotional response to this type of situation does not last long. Be aware that some problems may not appear immediately. The memorial service images may bring back memories the child had dealt with ten years ago. Nightmares, tears, sadness and anger are all normal reactions to the re-exposure of emotional pain. Talking openly with your children will help them to recover more quickly from witnessing the images and re-opening old wounds. Reassure your child that you are there to protect him, and that your family is safe and together. Provide extra physical reassurance. Hugging, sitting close to read a book, and back rubs can help restore a child’s sense of safety. Give your child a comforting toy or something of yours to keep. Your child may be afraid of separating from you, and keeping a reminder of you close by can help. Be available as much as you can for talking with and comforting your child.

Hurricane Survival Kit

During a hurricane, and possibly for days or even weeks afterward, electricity and other utilities might not be available. Debris and/or water might block the roads, preventing vehicles from getting in our out of your neighborhood. Help might not reach you for days after the hurricane, so you’ll need to be completely self-sufficient during that period.

Here are some of the most critical supplies to have on hand, well before a hurricane threatens:

• At least a 3-day and preferably a 7-day supply of water (one gallon per person per day)
• Non-perishable food
• Formula, diapers, and other baby supplies
• Manual can opener
• First aid kit
• Prescription and non-prescription medicines
• Toiletries
• Cell phones and battery-powered cell phone chargers
• Battery-powered radios and flashlights
• Plenty of batteries
• Extra cash
• Blankets, sleeping bags, books, and games (especially if evacuating)

Traumatic Reactions

Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to posttraumatic stress disorder, damage may involve physical changes inside the brain and to brain chemistry, which changes the person’s response to future stress.

A traumatic event involves a single experience, or an enduring or repeating event or events, that completely overwhelm the individual’s ability to cope or integrate the ideas and emotions involved with that experience. The sense of being overwhelmed can be delayed by weeks, years or even decades, as the person struggles to cope with the immediate circumstances.

Psychological trauma can lead to serious long-term negative consequences that are often overlooked even by mental health professionals: If clinicians fail to look through a trauma lens and to conceptualize client problems as related possibly to current or past trauma, they may fail to see that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects.

Trauma can be caused by a wide variety of events, but there are a few common aspects. There is frequently a violation of the person’s familiar ideas about the world and of their human rights, putting the person in a state of extreme confusion and insecurity. This is also seen when people or institutions, depended on for survival, violate or betray or disillusion the person in some unforeseen way.

Psychological trauma may accompany physical trauma or exist independently of it. Typical causes and dangers of psychological trauma are sexual abuse, bullying, domestic violence, indoctrination, the victim of alcoholism, the threat of either, or the witnessing of either, particularly in childhood. Catastrophic events such as earthquakes and volcanic eruptions, war or other mass violence can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic (though verbal abuse can also potentially be traumatic as a single event).

However, different people will react differently to similar events. One person may experience an event as traumatic while another person would not suffer trauma as a result of the same event. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumatized.

Some theories suggest childhood trauma can lead to violent behavior. Some ideas believe such violent behavior can be as extreme as serial murder. For example, Hickey’s Trauma-Control Model which suggests childhood trauma for serial murderers may serve as a triggering mechanism resulting in an individual’s inability to cope with the stress of certain events.

People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterward. How severe these symptoms are depends on the person, the type of trauma involved, and the emotional support they receive from others. Reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them.

After a traumatic experience, a person may re-experience the trauma mentally and physically, hence avoiding trauma reminders, also called triggers, as this can be uncomfortable and even painful. They may turn to psychoactive substances including alcohol to try to escape the feelings. Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience.

Triggers and cues act as reminders of the trauma, and can cause anxiety and other associated emotions. Often the person can be completely unaware of what these triggers are. In many cases this may lead a person suffering from traumatic disorders to engage in disruptive or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Panic attacks are an example of a psychosomatic response to such emotional triggers.

Consequently, intense feelings of anger may surface frequently, sometimes in very inappropriate or unexpected situations, as danger may always seem to be present. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night.

The person may not remember what actually happened while emotions experienced during the trauma may be reexperienced without the person understanding why (see Repressed memory). This can lead to the traumatic events being constantly experienced as if they were happening in the present, preventing the subject from gaining perspective on the experience. This can produce a pattern of prolonged periods of acute arousal punctuated by periods of physical and mental exhaustion.

In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. Emotional detachment, as well as dissociation or “numbing out”, can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied, distant, or cold. The person can become confused in ordinary situations and have memory problems.

Some traumatized people may feel permanently damaged when trauma symptoms do not go away and they do not believe their situation will improve. This can lead to feelings of despair, loss of self-esteem, and frequently depression. If important aspects of the person’s self and world understanding have been violated, the person may call their own identity into question.

Often despite their best efforts, traumatized parents may have difficulty assisting their child with emotion regulation, attribution of meaning, and containment of post-traumatic fear in the wake of the child’s traumatization, leading to adverse consequences for the child. In such instances, it is in the interest of the parent(s) and child for the parent(s) to seek consultation as well as to have their child receive appropriate mental health services.

Trauma can be caused by man-made and natural disasters, including war, abuse, violence, earthquakes, mechanized accidents (car, train, or plane crashes, etc.) or medical emergencies.

Responses to psychological trauma There are several behavioral responses common towards stressors including the proactive, reactive, and passive responses. Proactive responses include attempts to address and correct a stressor before it has a noticeable effect on lifestyle. Reactive responses occur after the stress and possible trauma has occurred, and are aimed more at correcting or minimizing the damage of a stressful event. A passive response is often characterized by an emotional numbness or ignorance of a stressor.

Those who are able to be proactive can often overcome stressors and are more likely to be able to cope well with unexpected situations. On the other hand, those who are more reactive will often experience more noticeable effects from an unexpected stressor. In the case of those who are passive, victims of a stressful event are more likely to suffer from long term traumatic effects and often enact no intentional coping actions. These observations may suggest that the level of trauma associated with a victim is related to such independent coping abilities.

Betrayal trauma theory suggests that psychogenic amnesia is an adaptive response to childhood abuse. When a parent or other powerful figure violates a fundamental ethic of human relationships, victims may need to remain unaware of the trauma not to reduce suffering but rather to promote survival. Amnesia enables the child to maintain an attachment with a figure vital to survival, development, and thriving. Analysis of evolutionary pressures, mental modules, social cognitions, and developmental needs suggests that the degree to which the most fundamental human ethics are violated can influence the nature, form, and processes of trauma and responses to trauma.

There is also a distinction between trauma induced by recent situations and long-term trauma which may have been buried in the unconscious from past situations such as childhood abuse. Trauma is often overcome through healing; in some cases this can be achieved by recreating or revisiting the origin of the trauma under more psychologically safe circumstances, such as with a therapist.

In times of war, psychological trauma has been known as shell shock or combat stress reaction. Psychological trauma may cause an acute stress reaction which may lead on to posttraumatic stress disorder (PTSD). PTSD emerged as the label for this condition after the Vietnam War in which many veterans returned to their respective countries demoralized, and sometimes, addicted to psychoactive substances. Psychological trauma is treated with therapy and, if indicated, psychotropic medications.

Following traumatic events, persons involved are often asked to talk about the events soon after, sometimes even immediately after the event occurred in order to start a healing process. This practice may not garner the positive results needed to recover psychologically from a traumatic event.

Victims of traumatic occurrences who were debriefed immediately after the event in general do far better than others who received therapy at a later time, though there is also evidence to suggest forcing immediate debriefing may distort the natural psychological healing process.

Politics and Mental Health

Before you go any further, this blog is not going to give any insight into health care reform nor will it attempt to sway your interests in any party affiliations. This is a blog about two subjects that have seemingly intertwined in our daily thought process.

At last count, I have watched 2 billion political hate commercials over the past two months. Keep in mind; I only watch about an hour of television a day. The ads run morning, noon and night. They are constantly on and constantly spewing hatred of the other party. The messages are loud and strong: This candidate didn’t pay their taxes, this candidate will ruin the government, this candidate cheated on their SATs, this candidate cheated on their spouse, this candidate is…..BLAH BLAH BLAH! I am waiting for the ad that simply states, “Don’t vote for this candidate because they are a no good rotten SOB who has bad breath, cooties, and will be personally responsible for the downfall of society!” Really?!? Why have we allowed this to go this far in advertising? As I said, this will not turn into a political debate; rather, I want this to be an awareness of what these ads do to society in general. I did not fully comprehend the impact of these commercials until some of my younger patients started to discuss them with me.

Patient X (no relation to Racer X) is a six year old first grade patient of mine. He is coming to see me for some depression and anxiety based around a divorce. He looked troubled last night when he arrived for his appointment, so as a good therapist, I asked him if something was wrong. Patient X answered my question with “Is Christine O’Donnell really a witch? Does she have powers to hurt people? Will Chris Coons come and take my house away because he is the taxman?” Out of the mouths of babes! Wow! Patient X looked noticeably troubled and very sad. I asked where he heard such things and he said he was watching Spongebob Squarepants (one of my personal favorite shows) and the commercials were on seven times. Seven times in a half hour children’s show spot. This seems very bizarre to me. What is the point to all this? Some officials argue children will grow to be a more educated consumer in our society by watching the commercials and debates. Other officials argue children will influence the parents to vote because of schools encouraging students’ active learning about politics. Personally, I think Patient X just wanted to watch a cartoon and be a kid.

On average, I have at least ten to fifteen younger patients ask political questions per week. Before you even think it, there is not one thing wrong with them wanting to discuss politics. Children need to learn about voting and democracy. I fully support educating children at a young age about our system of government. The questions they ask are not the questions about our system of government. They ask questions pertaining to the mudslinging of politicians. They discuss thoughts and feelings surrounding how angry or upset their parents are about “our government” and “why there are no good politicians any more”. They discuss their feelings surrounding an uncertain future because of what is being presented in the commercials. They discuss, dare I say it, the fear of our government and the politicians who are in it.

I cannot offer any quick solutions if your children are feeling generally anxious about our government. In all truth, I am feeling generally anxious about our government, but I can offer some advice for parents:

1. Minimize television time. If kids are exposed to hours of television, they will be exposed to hours of political commercials. Try to get the kids active and go outside.

2. If a child witnesses a rather angry commercial, discuss the content with them and try to process their thoughts and feelings about it.
3. Have family discussion about our system of government rather than political party affiliations and candidates. Our system of government is pretty fascinating.

4. Let kids be kids. Kids need to play and feel safe. Kids should not be encumbered by the rhetoric of politics.

5. Discuss the issues versus the mudslinging.

For the politicians, discuss the issues and stop the mudslinging. Voter apathy occurs because of the constant barrage of garbage spewed out from these ads.

Overcoming Regret

“Regrets. I had a few, but too few to mention”.

Those simple words so eloquently sang by Frank Sinatra in his classic hit “My Way” have, for some unknown reason, echoed in my brain for as long as I can remember. I often speak to patients about regret as the “shoulda, coulda, wouldas” or the “I wish” followed by the “I will” phrases. Call it what you will, regret plays a very integral part in how we perceive ourselves as people. Have you ever thought to yourself, “I should have bought that suit”, “I wish I was 17 again because I wouldn’t make those stupid mistakes”, “I I only invested my money wisely instead of buying stock in Enron”? Of course you have. We all do. It’s as natural as thinking about what you would like for dinner. What regret does to us emotionally is a whole different state of affairs and the reason for this blog.

A very good friend of mine once brought up the subject of guilt during a luncheon discussion. During the conversation, he stated, “Guilt and regret are two entirely different beasts”. I was intrigued as to where the conversation may go and to what point he may be trying to make. My friend originally hails from Manhattan and still has a very slight, but pronounced accent. He is also Jewish where I am Italian Catholic. Our conversations typically cover the “Do Not Discuss” topics, but we tend to always have the absolute best conversations. “Denny, my friend”. Before I continue I have to add a little something about this name he calls me. My father was always called Denny and I was always called Dennis. Don’t know why, but it had evolved that way. When my son was born, family and friends started calling him Little Denny and my Father Big Denny. I remained Dennis. There have only been two people in the world who have steadily and without fail called me Denny. One is my favorite great uncle and the other is my friend. I always know my friend is ready to say something profound when he starts his sentence with “Denny, my friend”. I apologize for the slight digression from the point of the conversation. “Denny, my friend” he says with a slight twinkle in his eye and smirk on his face, “Us Jewish people have the corner on guilt”. “How so?” I immediately shot back with a raised eyebrow. “We are born into guilt!” He leaned back into his chair at lunch almost taunting me for a speedy retort. “Come on now” I started. “Us Italian Catholics have the corner on guilt!” “How so?” he replied. Please allow me to digress one more time. Apparently, I get a devilish grin when I am about to win a conversation. Friends and family have both stated I get this look of victory. I don’t see it but apparently it’s there. “Us Italian Catholics are conceived in guilt”. His jaw dropped and then we both let out a loud belly laugh. After a good ten minutes of laughter he stopped and said, “Yes, but neither of our people have the corner on regret. No people do!”

The very definition of regret is to feel sorry and sad about something previously done or said that now appears wrong, mistaken, or hurtful to others. So regret had to be a matter of perception before it makes its way in to the dark recesses of our brains and hearts? Wouldn’t that stand to reason? I don’t know about all of that just quite yet. If something is never pointed out to us as being wrong, we never perceive it as wrong. Let me explain by saying a little something about my daughter. My daughter is a beautiful red head who lives up to the fiery personality traits of all red heads. She tries to win debates and arguments by merely rolling her baby blues at you and stealing your heart. With this said, she is also a free spirit to the core. As a good father, I almost never say no to this child. So, when it came time to the question of, “Daddy, may I have a hamster?” I couldn’t say no to her. Besides, I set up an aquarium for her and she has kept the fish alive so I figured why not. A hamster would make a great starter pet for my baby girl. Well, Hammy, yes the hamster was named Hammy, didn’t have a good run of things. He, I’m only assuming he was a he, was on a mission of self destruction. He would eat his way out the cage, jump out of the daughter’s hand, bite into electrical cords, if there was crack for hamsters, Hammy probably would have smoked it. So, Hammy died. The daughter left the cage open one night and the crack addict hamster got out and bit into an electrical cord. I was heat broken for her. This was her first hamster and it died. I also realized she was partially to blame for Hammy’s demise because she left the cage open. I sat my daughter down to tell her the news. I mustered all the strength I could and said, “Baby, I have some very bad news. It seems as if the cage was left open last night and Hammy got out. I found him this morning and he was not breathing. It looked as if he died from biting into an electrical cord. I wish there was something I could have done to help him, but it was just too late. I’m so very sorry. I know this must hurt something terrible, I’m hoping some big Daddy hugs might help you to feel better.” I thought I did well. I think I even teared up a tad. The daughter looked at my with those big blue eyes and said, “It’s ok, Hammy was a brat. Can we get a new one? I want to name it Nibbles.” She showed not one once of regret for leaving the cage open. To her, she had nothing to feel sorry about. To her, Hammy was a brat and good riddance to him. Obviously, I do not intend for her to grow up with no sense of humility and compassion, but regret is very personal and individualistic.

I am certain we can make people feel bad for the things they have done, but regret does not apply to everyone. For example, before he was put to death, a Psychiatrist asked Ted Bundy if he regretted killing any of the women he brutally murdered. Bundy said the only thing I regret is getting caught. The only thing he regretted was getting caught?!? Wow! We all know murdering someone is wrong, correct? We all know murdering hundreds of people is wrong, correct? Well, for Mr. Bundy, those laws of morality just don’t apply. This is where our regret becomes our regret. We have to respect each other when it comes to what another person regrets in their life. If they don’t view something as regret, I would presume we can’t make them regret it. If they do regret something, I think it is our responsibility to help them through it.

A Tribute to the Fallen Bravest

wanted to share with you a poem whose author is unknown. I have used this poem in lectures as it pertains to Fire Fighters and Critical Incident Stress Management. Please keep them all in your prayers.

“I Wish You Could Know”

I wish you could know what it is like to search a burning bedroom for
trapped children at 3AM, flames rolling above your head, your palms and
knees burning as you crawl, the floor sagging under your weight as the
kitchen below you burns.

I wish you could comprehend a wife’s horror at 6 in the morning as I check
her husband of 40 years for a pulse and find none. I start CPR anyway,
hoping to bring him back, knowing intuitively it is too late. But wanting
his wife and family to know everything possible was done to try to save his life.

I wish you knew the unique smell of burning insulation, the taste of
soot-filled mucus, the feeling of intense heat through your turnout gear,
the sound of flames crackling, the eeriness of being able to see absolutely
nothing in dense smoke-sensations that I’ve become too familiar with.

I wish you could read my mind as I respond to a building fire “Is this A
false alarm or a working fire? How is the building constructed? What hazards
await me? Is anyone trapped?” Or to call, “What is wrong with the patient?
Is it minor or life-threatening? Is the caller really in distress or is he waiting for us with a 2×4 or a gun?”

I wish you could be in the emergency room as a doctor pronounces dead the
beautiful five-year old girl that I have been trying to save during the past
25 minutes. Who will never go on her first date or say the words, “I love you Mommy” again.

I wish you could know the frustration I feel in the cab of the engine, squad,
or my personal vehicle, the driver with his foot pressing down hard on the
pedal, my arm tugging again and again at the air horn chain, as you fail to
yield the right-of-way at an intersection or in traffic. When you need us
however, your first comment upon our arrival will be, “It took you forever to get here!”

I wish you could know my thoughts as I help extricate a girl of teenage years
from the remains of her automobile. “What if this was my daughter, sister, my
girlfriend or a friend? What were her parents reaction going to be when they
opened the door to find a police officer with hat in hand?”

I wish you could know how it feels to walk in the back door and greet my
parents and family, not having the heart to tell them that I nearly did not
come back from the last call.

I wish you could know how it feels dispatching officers, firefighters and
EMT’s out and when we call for them and our heart drops because no one answers
back or to here a bone chilling 911 call of a child or wife needing assistance.

I wish you could feel the hurt as people verbally, and sometimes physically,
abuse us or belittle what I do, or as they express their attitudes of, “It will never happen to me.

I wish you could realize the physical, emotional and mental drain or missed
meals, lost sleep and forgone social activities, in addition to all the
tragedy my eyes have seen.

I wish you could know the brotherhood and self-satisfaction of helping save
a life or preserving someone’s property, or being able to be there in time
of crisis, or creating order from total chaos.

I wish you could understand what it feels like to have a little boy tugging
at your arm and asking, “Is Mommy okay?” Not even being able to look in his
eyes without tears from your own and not knowing what to say. Or to have to
hold back a long time friend who watches his buddy having CPR done on him as
they take him away in the Medic Unit. You know all along he did not have his
seat belt on. A sensation that I have become too familiar with.

Unless you have lived with this kind of life, you will never truly understand
or appreciate who I am, we are, or what our job really means to us……

I wish you could though.

New Years Eve: Amateur Night!

Three….Two….One….Happy New Year!!!!

The joys of celebrating the New Year echo in eternity. I can remember as a kid going outside and banging on pots and pans to celebrate the passing of a year. It’s a wonderful time filled with laughter and fun. Sadly, this joyous occasion often gets marred by the news of injured or even dead revelers who decided to drink and drive.

Although Thanksgiving is the deadliest night for alcohol related driving fatalities, New Years Eve comes in at a close second. In 2008, nearly 16,000 US citizens were killed in Drunk Driving accidents with almost 500,000 injuries. A person is killed every one half hour due to drunk driving and every other minute a person is injured due to an alcohol related accident. Over 40% of fatal automobile accidents are alcohol related and nearly 30% of all Americans will be in an accident involving alcohol in some way.

I do not want to preach to everyone, nor do I want to destroy any plans for you for your New Year’s celebration. Rather, I want to caution you and try to keep you safe. As a firefighter and NREMT-B, seeing the devastation of an alcohol involved motor vehicle accident is, to say the very least, an eye opening event. As a mental health therapist, to counsel the families of the deceased is a painful and heart wrenching experience. As I view the accidents on both sides, it gives me the ability to counsel realistically, but it also makes me the advocate for the designated driver or safer alternatives to the nights of heavy drinking.

Why do we drink and feel the need to drive? Quite simply, it is a matter of impaired judgment and reasoning. People will often think they can drive safely because they “only had a few” when in fact they are beyond the legal limit for alcohol consumption. In almost every state, the legal BAC (Blood Alcohol Content) is under a .08% and the legal drinking age is 21. This translates to approximately 4 drinks in one hour for a 175 pound man and 3 drinks in one hour for a 138 pound woman. During the holiday seasons, people are often caught up in the celebration versus counting their alcohol consumption rates. One drink leads to another leads to another which leads to another and so on. More alcohol related deaths occur during holidays because of the accepted stance on drinking during the events. Do yourself a favor and designate a driver or call a cab. And, at no point during these celebrations, should minors be allowed to drink. I have seen an increase in teen and early twenty something awareness to drinking and driving, but the devastating effects of the death of teen to a family and a community are not worth the risk.

What to do if you suspect a person is drinking and driving? First of all, be practical and be nice! Alcohol lowers inhibitions and the typically nice easy going person can become belligerent quickly. Ask for their keys, offer a place to stay, drive them home, and call a cab. Do whatever it takes to keep them from being a danger to themselves or others. Don’t just offer them a cup of coffee because the caffeine in the coffee will not help their impairments, it just speeds up their system. If you are on the roadways and you notice a driver whom you suspect may be under the influence, dial 911. When calling, make certain you have the make, model, and color of the vehicle along with the license plate number and a point of reference such as the road and cross street.

Please have a wonderful New Year’s Eve, but play it safe for 2010!

Winter SAD

Feeling blue, sad, or even depressed even though the holidays are upon us? You may be suffering from Seasonal Affective Disorder (aka SAD). According to the National Alliance on Mental Illness, “Symptoms of winter SAD usually begin in October or November and subside in March or April. Some patients begin to slump as early as August, while others remain well until January. Regardless of the time of onset, most patients don’t feel fully back to normal until early May. Depressions are usually mild to moderate, but they can be severe.” SAD is often found in women in their twenties and thirties, but statistics report children, men, and teens may suffer from the symptoms as well.

At first, symptoms are mild, but gradually increase in intensity. The symptoms of SAD include, but are not limited to, depression include oversleeping, daytime fatigue, carbohydrate craving and weight gain, features of depression, especially decreased sexual interest, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities, and social withdrawal. In a previous blog (Ain’t No Cure for Summertime Blues or is There?), I discussed the signs and symptoms of reverse SAD which are very similar to winter version of the disorder, but occurs primarily in the Sumer months.

I have had several patients over the years report increasing episodes of SAD and SAD like symptoms. Most studies report the disorder stems primarily from the shortening of days and daylight during the winter months causing a lowered production of serotonin in the brain. Other studies report the symptoms stem from the colder temperatures and lack of color of vegetation in the Northern hemispheres. In either event, SAD is a very real and often painful disorder. SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.

There are many different treatments Seasonal Affective Disorder, including bright light therapy, medication, ionized-air administration, cognitive-behavioral therapy and carefully timed supplementation of the hormone melatonin. Also, a minor dose of an SSRI (Selective Serotonin Reuptake Inhibitor) such as Lexapro, Paxil, or Zoloft may prove to be beneficial.

If you are feeling the signs and symptoms of Seasonal Affective Disorder, do not hesitate to contact your primary care physician for viable treatment options.

Dennis J. Carradin, Jr., LPCMH, NCC, BCETS

A return to blogging…The Joys of Procrastination

When I first set up this blog for the New Perspectives, Inc. web site, I had high hopes for myself. I was ready to sit down nightly and type out information which could be useful to any reader. But……I looked back to my last entry and saw that I had typed about summertime and here it is December 2009. What happened to my plan? What happened to all my hopes and goals? Did life just get in the way?

NFL hall of fame coach of the Dallas Cowboys Tom Landry once said, “Setting a goal is not the main thing. It is deciding how you will go about achieving it and staying with that plan.” Obviously, Coach Landry speaks to the idea of procrastination. Procrastination refers to the deferment of actions or tasks to a later time. Psychologists often cite such behavior as a mechanism for coping with the anxiety associated with starting and/or completing any task or decision. There are three criteria: for a behavior to be classified as procrastination, it must be counterproductive, needless, and delaying.

Procrastination may result in stress, a sense of guilt and crisis, severe loss of personal productivity, as well as disapproval by others for not meeting responsibilities or commitments. These feelings combined may promote further procrastination. While it is regarded as normal for people to procrastinate to some degree, it becomes a problem when it impedes normal functioning. Chronic procrastination may be a sign of underlying psychological disorder.

This would simply beg the question, “Do I have a disorder because I procrastinate?” Not necessarily. A psychological disorder is often associated with the dysfunctional behavioral actions creating severe distress in the person or people around that person. Procrastination, as previously mentioned, must be counterproductive, needless, and delaying. Often procrastination is not harmful, but it may be hurtful. For example, if I was to promise to copy a report for someone by 4 pm and I knew it would take an hour to copy the report, waiting until 3:30 pm to copy it would be counterproductive. It would be hurtful to the person I promised, but it probably would not be harmful. Basically, the person would not die because I did not copy the report. I say this, but there are situations where procrastination may be harmful. For example, if someone is having a heart attack and I take my good old time to administer CPR, I am very certain this will cause harm.

Procrastinators often have great difficulty in seeking help, or finding an understanding source of support, due to the stigma and profound misunderstanding surrounding extreme forms of procrastination. One of the symptoms, known to psychologists as task-aversiveness, is often mischaracterized simply as laziness, a lack of willpower or loss of ambition.

Procrastination can be a persistent and debilitating disorder in some people, causing significant psychological disability and dysfunction. These individuals may actually be suffering from an underlying mental health problem such as depression or ADHD. While procrastination is a behavioral condition, these underlying mental health disorders can be treated with medication and/or therapy. Therapy can be a useful tool in helping an individual learn new behaviors, overcome fears and anxieties, and achieve an improved quality of life. Thus it is important for people who chronically struggle with debilitating procrastination to see a trained therapist or psychiatrist to see if an underlying mental health issue may be present.

While academic procrastination is not a special type of procrastination, procrastination is thought to be particularly prevalent in the academic setting, where students are required to meet deadlines for assignments and tests in an environment full of events and activities which compete for the students’ time and attention. More specifically, a 1992 study showed that “52% of surveyed students indicated having a moderate to high need for help concerning procrastination”. It is estimated that 80%-95% of college students engage in procrastination, approximately 75% consider themselves procrastinators. One source of procrastination is underestimating the time required to analyze research. Many students devote weeks to gathering research for a term paper, but are unable to finish writing it because they have to review many contradictory opinions before they can offer their own perspective on the subject. Despite knowing how to consult resources, they struggle to perform their own analysis. Student syndrome refers to the phenomenon that many students will begin to fully apply themselves to a task only just before a deadline. This leads to wasting any buffers built into individual task duration estimates. Students have also difficulties to self-impose deadlines.

With all this said, I have a few simple ways to end procrastination and achieve goals:

1. Set daily, weekly, monthly, and yearly goals. Remember to make each goal moderately difficult. If a goal is too difficult or too easy, procrastination will set in.

2. Get yourself hooked or wired in. We all have cell phones, PDAs, planners and so on. Use technology to your advantage. Programs such as Microsoft Outlook can be utilized along with your blackberry or PDA to keep you informed of appointments and tasks necessary to complete the goals.

3. Give yourself time to complete the goals but don’t give yourself too much time because that will breed procrastination.

4. Always build in rest and stress management techniques. The more anxious and tense you become, the less productive you are.

5. Recruit some help. Family, friends, and loved ones may be willing to help you achieve your goals with friendly reminders and simple encouragement.

6. When you hit a stumbling block, pick yourself up and dust yourself off. We are all human and sometimes we will fail. Just realize you will be able to get passed that failure and learn from it.

7. Relax and remember you can only do one thing at a time. If you plan ahead, you will be surprised at all the things you can accomplish.

Ain’t No Cure for Summertime Blues or is there?

Well i’m a-gonna raise a fuss, i’m gonna raise a holler
About workin’ all summer just to try an’ earn a dollar
Everytime i call my baby, to try to get a date
My boss says, “no dice, son, you gotta work late”
Sometimes i wonder what i’m gonna do
’cause there ain’t no cure for the summertime blues’ (Eddie Cochran)

In a previous posting, I discussed the joys of having a stress free summer vacation, but I have noticed a significant trend among patients this summer. A trend, which at best, seems to be growing in a very rapid pace over the past few summers. This trend is the emergence of what the National Institute of Mental Mental (NIMH) has termed “reverse SAD” or reverse Seasonal Affective Disorder. SAD is most commonly asociated with the dark and gloomy days of winter where afflicted people suffer symptoms of depression including, but not limited to, fatigue, lethargy, excessive sleep, hopelessness, social withdrawal, decreased interest in activities, weight gain, irritability, and general feelings of apathy. “Reverse SAD” presents itself in the sunny summer months and will often include the symptoms of anxiety, restlessness, insomnia, feeling uncomfortably warm during the night, episodic anger, weight loss, irritabilty and decreased appetite.

Please humor me because I have to take a moment and again reflect back to my youth. Recently, I ran into a friend from the old neighborhood. It was great seeing him and catching up with all the happenings in our lives. Inevitably, we went back in time and talked about some of the fun things we did “back in the day”. During our summer vacations from school, we would gather other kids from the neighborhood and play baseball, capture the flag, football, head up to the community pool, ride bikes, tell jokes, and plan adventures. Growing up in a city community, there were always kids around to do all the aforementioned activities. I still get a minor thrill when I hear the bells from the ice cream truck or the sounds of the midway at a school festival. The very thought of a summer job or summer reading did send me in a bad mood, but I would quickly bounce back when a fun activity presented itself.

It was perplexing to me, at first, when patients came in suffering from reverse SAD. I thought, “How can you feel bad during the summer?” The signs and symptoms are very tangible and can be debilitating at times. Reverse SAD can be linked to the brain’s hypothalamus and temperature control issues in the body. As the temperature rises and the sun beats down on the patient afflicted with reverse SAD, the body’s natural ability to find a balance appears to be thrown off. The production of Serotonin (a brain chemical that is involved with the regulation of mood) and the hormone Melatonin appear to play a major role in the symptoms of SAD. There is also some evidence suggesting a low thyroid funtion could be the culprit in reverse SAD.

I can’t help to think environmental factors may play another large role in reverse SAD. We, as a nation, are going through some seriously stressful times. Last summer’s gas prices alone could send anyone into a depression. The unstable job market and economy has made people reduce spending in luxury areas. Families who have previously taken extended summer vacations may find themselves staying closer to home or not taking a vacation trip at all.

How can we treat reverse SAD and cope with the summertime blues? Unlike winter time SAD, light therapy is contraindicated. Minimizing light sources is the first part of the treatment. Patients may want to consider wearing polarized sunglasses, using room darkening shades in the house, and reducing activities during the daylight hours. Exercise and a healthy diet are always a good combination when it comes to combating depression. Drinking cool water along with regular cool showers may help reduce symptoms. An exam of the thyroid’s functioning from your primary care doctor is suggested. If symptoms persist, you may want to consider a prescription of an anti-depressant. Finally, as a good rule of thumb, try to surround yourself with friends and family who love and care for you. Human contact can often have healing powers.

Stress and Worry Free Summer Vacations

Can you feel it? Do you notice anything different? I think Country singer Kenny Chesney sums it up best…..

“Summertime is finally here
That old ball park man is back in gear
Out on 49, man I can see the lights
School’s out the nights roll in
Man, just like a long lost friend
You ain’t seen in a while
You can’t help but smile.”

Ah yes, Summertime. I can remember (vaguely because it has been awhile) being in grade school during this time of the year and listening to friends as we discussed our plans for summer vacations. Some friends would go to the beach (yes, in Delaware we went to the beach and not the shore in New Jersey), some would go to camp, some would visit relatives, and some of the lucky few would fly to Disney or other really cool vacation spots. I could remember how we all made plans to play baseball and go to the swimming pool everyday, but it was that word vacation that gave us the biggest smile. It seemed like a magical time of youth. Summertime!!!

Oh, I’m sorry. I was just thinking about my youth and forgetting what it was really like. Who forgot what, who had to pull over fifty times to go to the bathroom, who was stuck in the endless traffic, who was hungry, who was thirsty, who didn’t want to go because all of their friends weren’t going, who had better things to do, who was bored, who was homesick……Sound familiar? The problem, as I see it, seems to be in our inability to remember what it felt like to be a kid during summertime. Vacations are meant to be fun, relaxing and stress free, but I hear, more often than not, tales of vacation woes and unbelievable amounts of stress created by the simple task of getting away for awhile.

Stress will be right around the corner if you don’t keep a mindful eye out for it during vacation. I personally believe the number one reason for the stress during vacation is the lack of time given to prepare and go away. People think and dream of vacation for 50 weeks of the year, but it seems during the 2 weeks they are actually away, they have forgotten everything including simple strategies for traveling. Case in point, a few months back, I was called to an emergency and needed to fly. It wasn’t a great distance, but it required some planning on my part. My flight was scheduled for 10:30 departing from Philadelphia. As a somewhat savvy traveler, I took in consideration the lines at security, traffic, and even parking. I decided I needed to be at the airport around 8:30, giving me plenty of time to park, go through security, and possibly sit and relax for a bit before the flight. I knew I had to leave home a little earlier because of morning rush hour traffic, so I decided to leave at 7:00 just in case I ran in to any major delays. Ok. Ok. Ok. I know it seems a little obsessive compulsive so far, but trust me, after being burnt by missing a flight, you will take homage to my advice. The commute wasn’t horrible but I did run into traffic and I arrived at the airport around 8:15. I found my parking spot, gathered my bags, and headed to the ticketing area. I checked my bag and headed towards security.

Time out! I want to go off on a tangent for a second. People, people, people! When will you ever learn? The restrictions for carry on luggage is fairly strict following September 11, 2001. The guidelines are posted on the websites where you buy tickets. They are actually posted on the tickets themselves. The guidelines are posted on the walls in the parking garage of the airport, in the shuttle buses, on the front doors, at the ticketing counter, and right there at security. Why in the name of all the things good in the world, is there always that one person who wants to bring a Ginsu knife collection on the plane with them? Why? I think people believe they won’t get caught. Prior to the trip I was explaining, I had to go on another trip where a woman decided to bring her knitting needles in her carry on – all 87 of the 13 inch throwing dagger looking objects. The odd part about that one was she became belligerent when they said she couldn’t bring them on the plane with her. There was another time when I watched a woman attempt to bring 5 gallons of hair gel on board because she was going to some hair fashion expo. Please follow the guidelines and things will go smoothly.

Back to the story, I arrived at security around 9:00, had my ticket in one hand and ID in the other. The line was long, but moving. I was calm and ready for my strip search.

Time out! Please keep in mind as you travel on a plane, you will be asked to remove any objects including your shoes, watches, belts, necklaces, throwing stars, machine guns, or whatever else you may have on you that makes the little machine go ding ding. Don’t be offended. Don’t get angry. Please don’t yell at security. And, please don’t apologize to everyone behind you because you thought you could wear a full suit of armor on the plane.

Time in. As I moved along with the line, a young couple with their two adorable children come barreling down the ramp of the gate heading for security. You could feel the stress and tension. The little girl was crying. The little boy looked scared. The mom was frantic and dad looked pissed. It was roughly 9:15 now and I overheard the mom tell the woman at security, “We have a 9:30 flight to Disney. We need to get through security. Please let us in!” The woman at security simply, calmly stated, “Ma’am, you missed your flight. I suggest you head back to the ticketing counter and get a new flight.” The mom burst into tears, the dad yelled, the daughter cried, the son stomped his feet, and I went through security looking for a place to sit, relax, and drink a cappuccino before my flight. The moral to this story is: Take your time! Plan ahead for delays, traffic, security, or whatever else may create stress if you do not allow for enough time.

The other reasons for vacation stress seem to be derivations of the time problem. Over scheduling, over booking, unrealistic expectations of time limits, and the lack of compromise can all lead to extreme issues with stress. Please remember the main purpose of the trip is to have time to relax, have fun, get away from work, and spend time with your family or loved ones. It is very realistic to believe you won’t see or do everything on your vacation. It is very realistic to believe you may have a change of plans because something fun presents itself that may go against the schedule. It is very realistic to believe things will happen and life, including the vacation, will go on. Drop the resentment. Get rid of the attitude. Leave your anger at the door and just communicate with everyone involved. The stress will magically disappear when you compromise and just have a good time.

Well, my friends, please have a wonderful stress free summer vacation and remember to relax! Summertime only comes around once a year, so make the most of it.

I will leave you with the rest of the lyrics of Summertime by Kenny Chesney:

“And it’s two bare feet on the dashboard
Young love in an old Ford
Cheap sherris, and a tattoo, and Yoohoo bottle on the floorboard
Perfect song on the radio
Sing along because it’s one we know
It’s a smile
It’s a kiss
It’s a simple wine
It’s summertime
Sweet summertime.

Temperature says ’93
Down at the deposit can gurantee
But that swimming hole
It’s nice and cold
Bikin bottoms underneath
But the boys heart still skip a beat
When them girls shimmy off
Those old cut-offs.
[ Kenny Chesney Lyrics are found on www.songlyrics.com ]

And it’s two bare feet on the dashboard
Young love in an old Ford
Cheap sherris, and a tattoo, and Yoohoo bottle on the floorboard
Perfect song on the radio
Sing along because it’s one we know
It’s a smile
It’s a kiss
It’s a simple wine
It’s summertime
Sweet summertime.

The more things change
The more they stay the same
Don’t matter how old you are
When you know what I’m talking ’bout
Yeah baby, when you got.

Two bare feet on the dashboard
Young love in an old Ford
Cheap sherris, and a tattoo, and Yoohoo bottle rolling on the floorboard
Perfect song on the radio
Sing along because it’s one we know
It’s a smile
It’s a kiss
It’s a simple wine
It’s summertime
Sweet summertime…”

10 Years after Columbine: What have we learned?

April 20, 1999, for educators, students, parents, and most of the nation, will always be known for what became this nation’s fourth deadliest school massacre. On this day, 10 years ago, Eric Harris and Dylan Klebold, both Columbine High School students in Jefferson County, Colorado, embarked on a massacre, killing 12 students and 1 teacher, wounding 23 others, committing suicide, and forever changing the way this country views high school security and violence. This single action by the two gunmen provoked political and social debate regarding gun violence in teens, gun control laws, the availability of guns in the US, violence in music, film, and video games aimed towards teens, and the ideas of bullying.

The memories etched in American history from that day echo 10 years later. The students of Columbine High school, at the time 14-18 years old, are now in their mid to late twenties with families, careers, hopes and dreams. The memories of that horrific day burned in their psyche for eternity just as the images from Columbine are burned into the psyche of American Culture.

Sadly, those images of the Columbine Massacre were not the last images of school or world tragedy. In the past 10 years, the world has seen the horrors of September 11th, the War in Iraq, the Amish School Shootings, and the Virginia Tech Massacre to name only a few. Have we learned anything from these tragedies and have we learned anything from Columbine?

We have learned the true definition behind a traumatic event. The events compromise the individual’s sense of safety and leave people feeling insecure and vulnerable. These events are uncontrollable and unexpected. With that, we have learned the definition of traumatic stress. Traumatic Stress refers to the emotional, cognitive, behavioral, and physiological experiences of individuals who are exposed to, or who witness, events that overwhelm their coping and problem-solving abilities.

We have learned violence is progressive and gives off many warning signs. These warning signs are often displayed well in advance of an attack. Most attackers are often bullied, ridiculed or shamed. As a result, the attackers become dehumanized and often justify their killings by acts of vengeance against their bullies. Most attempted or had feelings of suicide. Students often notice something is wrong with the attackers before the events. Most of the attackers had access to weapons prior to the events. Most are male and most are socially isolated. We have also learned that this sort of event can happen anywhere, at anytime, to any one.

The one thing we have not learned is how to prevent this from ever happening again. We have learned so much, but there is so much more we need to know.

A Little Forgiveness

Martin Luther King, Jr. once said, “We must develop and maintain the capacity to forgive. He who is devoid of the power to forgive is devoid of the power to love. There is some good in the worst of us and some evil in the best of us. When we discover this, we are less prone to hate our enemies.”

In my practice, I have seen the hurt, pain and sorrow of many people. I have watched, sometimes in shear horror, man’s inhumanities to man, but I have been intrigued, and somewhat mystified, about the power of forgiveness. Humanistic Psychologists contend forgiveness is achieved when compassion replaces the desire for revenge. Compassion replaces the desire for revenge? Really? What does that mean? On the face value of it, something must happen inside of us to change, but what makes the change? People who have a higher sense of self esteem and self value seem to fair well with forgiveness. Religious or spiritual people seem to forgive more readily than nonreligious people. People who have higher emotional stability forgive quite quickly, but Dr. King speaks of something deeper, something a little more profound than just having a self esteem. He speaks of the power of love. The power to develop and maintain the capacity to forgive someone based on our knowledge of ourselves and the power to love.

So, what is forgiveness? To the best of my ability, I have not found one truly universal definition. Christians, Buddhists, Islamic, Muslims, Catholics, And Hindus all have different definitions of the concept of forgiveness. It wasn’t until the 1980’s did the Psychology community embrace the concept of forgiveness, but even us theory driven mental health practitioners cannot decide on one true definition.

So what? Who cares? Well, we have all been hurt by someone. We have all been made to feel small by another person. We have all had feelings of being unloved, mistreated, disrespected, embarrassed, admonished, or just “unused” as if we are put on a shelf by people and not had any type of attention. So, does this desire of revenge breed from these times of being hurt and in pain? Sure they do. We think, “I will get them back” or “I will hurt them as much as they hurt me”. I have a hard time with those thoughts. For me, those thoughts just don’t stick. Those thoughts just don’t stay long at all. I’m not really sure why, it just happens that way. If we look at the benefits of forgiveness, we can just say that it is healthier to forgive quickly rather than hold a grudge. By being able to forgive, we can lower blood pressure; we can lower heart rate; we can lessen depression and anxiety. On a spiritual side, we can become closer to our higher power; we can find peace. On the humanity side, we can develop stronger bonds with people; we can develop intact, healthy relationships; we can feel good about being around and with others.

Let’s get real for a minute here. Freud believed in a process known as “murderous impulses”- Our repressed desires to cause harm to others – A reaction which is purely from the Id and is fairly animalistic. When I was a kid, I loved to watch the nature shows. Still do. I would watch The Great White Sharks, The Lions, and all of the animals in their natural glory. Not once, not one single time, do I remember an antelope turning to the lion and saying, “Oh Mr. Lion I completely forgive you for eating my family and friends. I have now found inner peace for forgiving you.” Yup, never happened that way. Basically, that rage, the revenge, the absolute evil energy we have at times has to be driven by some unconscious, internal process, right? Well, my friends, so is forgiveness.

Forgiveness is a truly human act and feeling defined within the human context. For example, I was driving one day on the 95 through the Chester corridor in Pennsylvania. I will admit to having a bit of a heavy foot. Ok, I like to speed – a lot! Typically, I follow the blue signs instead of the white signs. I95 is a comfortable speed. 476 nearly destroyed the vehicle. Anyway, as I was driving, a gentleman in a rather small vehicle decided to cross three lanes of traffic (mind you, no one else was on the road besides our two vehicles at that particular time of the day) and get in front of me and my suburban. No worries, you say. Well, I was travelling at about 85 MPH and he was doing 2 MPH. I had to slam on my brakes to avoid plowing into him. Before I had a chance to react, he decided he wanted to get my attention, and I guess my approval of his IQ point status, by raising one finger in defiance to my evasive maneuvering. Basically, the man gave me the bird because I didn’t understand his internal thoughts of wanting to die that day. My reaction was fairly simple and straight forward. I blew him kisses and smiled. I almost immediately forgave his stupidity and dangerous way of driving. I started to laugh and continued to drive to my meeting in Philadelphia. Unbeknownst to me, the gentleman took grant offense to my well wishing kisses and smile. He followed me to the parking lot of my meeting and jumped out of his vehicle in an attempt to justify his lousy driving habits. As he emerged from his vehicle, I took a good look at him. He was about 5 feet 6 inches tall and approximately 165 pounds. He had a slight build and was around 40 to 45 years of age. At the time of the occurrence, yours truly weighed in at 6 feet 2 inches and 240 pounds. I had an athletic build and 33 years of age and, if things weren’t complicated enough, a very proud Italian to boot. LET’S GET READY TO RUMBLE!!!!!!!! The gentleman, bounding from his vehicle, came as close to me as he needed to and questioned, “What the hell is your problem?” The phrase that starts every bar fights in the world. “Not a thing” I replied. “You blew a kiss at me after you almost ran me over! What the hell was that?!?!?” he queried. “I love you!” was my reply. The shear look of panic, horror and wonder was priceless. “What did you say?” “I love you and I forgive you. May I have a hug?” The little man jumped in his vehicle and sped away. I thought the parking attendant was going to pass out because of his uncontrolled laughter. Only humans have the capacity to forgive that quickly. Only humans have the willingness to let the hurt and the pain go. Only humans have the absolute choice to either stay angry or understand we can make the situation different through forgiveness.

What is the definition of forgiveness? I don’t have the foggiest clue, but I clearly have an understanding of the concept. Forgiveness is an empathetic approach in allowing humans to be human. People will hurt us. People will treat us horribly. People will not care. Trust will be broken. We will be rejected, betrayed, embarrassed, and insulted at times throughout our lives. It’s not a great way to look at life, but these things are truly human. Because of these things, we, as humans, become resentful, hate driven, angry, vengeful, and develop grudges for the sake of having them. The energy we expend on those emotions alone could power all of California for years. Those feelings give us the negative energy which we hold on to until we can act on them. Typically, these feelings are displaced and projected onto non offenders. Basically, we take this stuff out on the ones we love the most because we believe they will always be with us not matter what we do or say. To forgive these humans acts takes an enormous amount of energy from us. We have to stop the anger and hate and replace it with empathy, and dare I say it, love. You do not need to excuse the action; rather, you excuse the person. You make the conscious effort to view them as human. You protect yourself by letting go of the pain and the hurt. You protect yourself by being weary of the actions, but you forgive the person and move on.

Holding those negative feelings in will only cause further pain for however long you want to have them after the event. It is your choice and your choice alone to forgive someone. It is your choice to be consumed with hate, anger, and resentment or replace it with empathy, strength, and understanding. It is your choice to love, respect, and forgive yourself along with forgiving the other person. Do we have the rite to hold onto these feelings of anger, hate, and resentment? Of course we do! But, it is also our rite to allow ourselves to live and enjoy life.

True forgiveness starts with taking responsibility for our own thoughts and actions. We can only truly forgive others by first understanding we are human as much as they are human. I guess this is what Dr. King is saying. Love yourself, so you can love others. Forgive yourself for being imperfect, so we can forgive other’s imperfections. If we replace hate with compassion, we will ultimately be better people in this lifetime and for many lifetimes to come. Peace!

The Belief in Believing in Someone

I was involved in a conservation regarding religion. Religion is, at best, a taboo subject which should only be discussed with the knowledge no one is right and no one is wrong. Anyway, the conversation dealt primarily with the idea that religious affiliation is the conduit for spirituality. Spirituality, in my terms, is the belief in a higher power or the belief in someone or some thing is out there controlling all that is going on. Well, I got a little lost in thought last night and my thoughts were confirmed this morning. The question, “to what extent will I believe in someone?” burned in my brain all last night. I departed from the idea of religion and started looking at humanity; more specifically, the people in my life who I should believe in.

I try to be a true person whether it is to friends, family, or loved ones. I try to be a person who people can trust, count on, and respect. Lately, I have questioned myself, but I am coming to an understanding that I should question others. I am someone who champions the underdog, who tries to help people who do not want to help themselves. I find these people riddled in my life and in every aspect of my life. I find these people in work, in friends, in family, and in loved ones.

Let me depart from my thought for a second and explain something. I know I am not the brightest crayola in the box, but I am very good at what I do and what I have become. By shear numbers of people I have seen over the years, I am able to realistically look at situations and determine the path with true accuracy. I am able to diagnose situations before they come full circle. I see trends and patterns before others do. Now, my approach to people (non-family, non-friends, non-loved ones) is to allow them to experience the path they need to take while understanding they are human and need to be aware of consequences. With the friends, family, and loved ones, I tend to be more critical and judgmental because I do not want to see them hurt or fall from grace. My tact is often terse because it frustrates me when people are blind to the realties of their situations. I know I should treat them like anyone else, but these are people are in my life more than a brief moment.

Back to my thoughts. Lately, I have become disgusted with my self for allowing me to fall victim to the nonsense presented to me by the people I champion. I constantly tell myself to stay distant and detached, but I go back to my old pattern of believing in people. I get engrossed in their basic BS approach to life in general and I am the one who cares more about them than they do about themselves. I know I am not the authority over people and they can choose their own life’s destiny, but, for the love of all that is holy, I would wish they would listen to truisms. It is the basic rule in a scary movie; if the guy says he will be right back, he is not coming back. If a scary voice in the house tells you to get out, then get the hell out of the house. Do not stay in a haunted house until someone dies.

I am writing this blog and I have to take breaks from time to time because I am getting frustrated with this whole thing. Maybe I should not care, maybe I should stop giving two thoughts about people, maybe I should pack my bags and go fishing in Alaska for a living because fish do not have the capacity to communicate with humans. It frustrates the hell out of me at times because I just do not get it. I do not think I am jaded about life, but damnit how can people be so blind.

Alright, let us talk about the lesson of the day, boys and girls. This is not their fault. This is my fault. My flaw in life is caring about humanity. At times, I wish I could be so blind and ignorant to realities by just moving through life without regard to anyone around me.

I was in Colorado a few years ago and I went on a Vision Quest with a group of Native Americans. One of the elders likened me to a person who carries the souls of the people in my life around with me where ever I go. A part of this Vision Quest solidified my belief in religion and humanity. I believe in positive and negative energies that surround us. For example, all the good I do for people builds up into positive energy that is released back into the consciousness of the planet. I know it sounds far fetched, but there is a lot more to it to be explained.
Basically, I am done! I am sick and tired of loving people who do not love me. I am disgusted with people who I care about and could care less about my feelings. I am sick of false friends. I am tired about being there for people who are never there for me. I am done with giving, done with loving, done with caring, done with giving a thought for people who do not deserve me in their life, done with people who do not take my advice, done with people who promise me the world and give me nothing, done with people who are too stupid to see their own issues, done with people who toy with my emotions, done with people who brush me aside, done with people who draw me in and kick me to the curve, done with people who complain and moan over every little thing, done with people who do not respect themselves, done with people who cannot help themselves, done with being an advisor, done with being a cheering section, done with being a person who listens, done with being the side of me that I just cannot stand anymore.

This is not directed to one person. This is not because of one incident. This is an accumulation of incidents and situations in my life that I am just so sick of at this moment. I have giving my very best to people. I have been to hell and back with people, but I just can’t do it anymore. I am tired and I want some peace. You cannot suck the life out of me anymore. You have to figure it out on your own.

Now, I say this, but tomorrow is a new day. I get angry, but I go back to my trends and my beliefs that people are inherently good. I believe people will change and will understand. I believe people will love and care for me. I believe people will respect my thoughts and my advice. I believe people will put me first and try to appreciate me. Like religion, you have to have faith in people and in humanity. I try to keep that faith alive in everything I do and everything I am about, but it has become so difficult lately. So many things have happened that I guess I am just tired and it is easier to be more cynical about people and about life. I am tired, but I know I have to continue and move on. I have to set the bar for myself and reach it everyday of my life.

Moral of the story is: if you are in my life, be in my life. If you are just in my life for the gains of having me in it, than leave me alone. Please spare me the anguish of living another day knowing that I really do not matter to you. Please spare me the hurt, the pain, and the sorrow in order for me to experience the true joy and satisfaction for caring about people who care about me. Allow me to live each day as I truly want to live each day. I want to be happy and content. I want to mutually share love, caring, and affection. I want to be free to give advice and receive it. I want to be understood and respected. I want to live and be happy.

Traumatic Reactions to War, Exposure to Trauma, and Terrorism

In the past few and the past few weeks, many traumatic events including, but not limited to the September 11, 2001 attacks on New York, Washington, D.C. and Pennsylvania, the threat of terrorism, and the war in Afghanistan have created or amplified a sense of fear, helplessness, and anxiety in the nation. These situations have weighed heavily on the world climate. Currently, with the war in Iraq, and the continuing threat of terrorism in the United States, those of you who have had previous traumatic experiences may find yourselves experiencing thoughts, emotions, symptoms, and fears associated with previous traumatic events. You may have feelings of being uncertain about the future while telling yourself, “All will be fine in the world”. These feelings can be overwhelming and often times distressing. It is important to remember that the reactions you are experiencing are normal reactions to normal thoughts and emotions surrounding an abnormal situation. Remember, these reactions are not a sense of weakness or frailty. These are normal reactions all people will face. The reactions you may experience include: 

• Shock and a feeling of numbness may occur because of the current world events. You may look at the war in disbelief wondering if it is a dream or if it is real.
• Feelings of loss and sadness may occur after the shock and numbness leave. You may grieve over the soldiers who have died or the loved ones who were left behind. You may have intense feelings of loss if you have a family member in the armed service that is fighting in the war.
• Intense anger is often associated with feelings of fear, uncertainties, and the loss of control. The intense anger may produce conflict in your family, at your job, or with friends and loved ones.
• Anxiety may cause feelings of anger which are associated with the fear of the unknown and the uncertainty of a post war future. 
• Anxiety and nervousness are the result of feelings of fear and hopelessness. These reactions may emerge in the form of the fear to fly, the fear to go to work, the fear of crowded public places, the fear of nationalities, and the fear of the unknown.
• As with the aforementioned reactions, sadness and depressive feelings are normal. Often the sadness may take the form of spontaneous crying or an overall “blah” feeling.
• Feeling alone, disconnected from others, self-separated, isolative, withdrawn, not wanting to talk.
• Feelings of guilt for being happy and safe while others are suffering may occur. You must remember that it is normal to have good feelings and to live life to its fullest even during times of distress.
• Physical symptoms such as headaches, stomachaches, breathing difficulties, nightmares, insomnia, hypersomnia, high blood pressure, nausea, changes in appetite, bowel distress, mental confusion, bizarre/racing thoughts, irritability, sweating, chills, and panic.
• Flashbacks, recurring thoughts, and intrusive images may emerge. These images and thoughts are often intensified by watching the on-going media coverage of the war and the threats of terrorism. 

What can you do to help with these reactions?

• Diet, rest, exercise, and keeping to your normal daily routine are often helpful in keeping positive attitudes alive during this stress time.
• Being close with family and friends while engaging in relaxing activities may help ease tension.
• Seeking out professional help or advice may help relieve these overwhelming feelings.
• Journaling your thoughts and feelings will often help get the racing thoughts out of your mind.
• Turn off the television and reduce your need to watch the war coverage.

If you or a loved one has experienced any of these feelings for more than a few weeks, you may want to consult a professional for help. A professional may include your primary care physician, a therapist/psychologist, a psychiatrist, or even a member of the clergy. 

Some helpful resources include:

• Employee Assistance Programs
• New Perspectives, Inc. Trauma and Wellness Center
• The American Red Cross
• The National Institute of Mental Health
• The American Psychological Association
• The Center for Victims of Torture
• The Delaware Psychological Association
• The Rockford Center
• The Delaware Mobile Crisis Unit