How Can I Trust Him Again?

From Canada: My husband lied to me years ago and I just found out I have been married for about 4 years but together for 14. As I was browsing on our desktop computer looking for some old photos over the weekend I discovered photos from a work trip my husband went on about 8 years ago. These photos contained him and another women (selfies, dinner together and shopping). I was and am completely furious. I recall right after that trip as I saw some other photos of him with the exotic car he had rented and asked who took the pictures. He told me at that time he got people off the street to take the photos and I naively believed him.

The photos I saw this weekend have completely devastated me. He swears it was just an acquaintance and nothing sexual happened. We have had a solid relationship for the past 14 years and I am at a lost. How can I ever trust him again?

Please slow down. You’ve had 14 years together. For you to be so devastated suggests to me that there may be other red flags you’ve been ignoring. Another possibility is that you are way over-reacting. Having some fun while on a work trip isn’t necessarily cheating. It may be that it’s just as he says. On the other hand, maybe he was having doubts about your relationship at the time and was trying out what it would be like with someone else. If so, he got his answer. He stayed with you and married you.

The question for you, then, is whether the last 8 years including 4 in a committed marriage outweighs a possibly dishonest weekend. A situation like this can deepen or break an otherwise good relationship.

It depends entirely on what the two of you do next. If you can talk about it openly, honestly and calmly, you may learn important things about each other and your relationship. If your discussion degenerates into accusations, defensiveness and counter accusations, it can result in a very deep wedge developing between you. I hope the two of you can take a big step back from the emotional first responses and instead talk seriously with each other about what your 14 years mean to you and what to do now.

He can’t undo the weekend. But he can apologize. And both of you can reaffirm the value of a shared life of 14 years. If there are problems in the relationship the two of you have been ignoring, this is the opportunity to work on them. If you find that you are unable to do that on your own, I hope you will make an appointment with a couples counselor for some guidance.

I wish you well.
Dr. Marie

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Is Masturbation Bad for You?

It’s funny how many people feel awkward talking about masturbation. Because of that awkwardness, there’s also a lot of false beliefs about the pros and cons of masturbation, and whether it’s bad for you.

Masturbation is simply the act of self-stimulation for sexual pleasure. There’s nothing mysterious or weird about it. And in fact, although virtually nobody talks about it, most people have masturbated.

Masturbation is a completely normal behavior associated with our own sexuality. Whether done with or without the aid of a vibrator or other sex toy, when done in moderation, masturbation is a common, healthy sexual behavior. How many people engage in this behavior depends upon their cultural and religious background.

How Common is Masturbation?

In the U.S., studies show that masturbation is common. In one study of 1,047 men, over 69 percent had reported masturbating in the past 4 weeks. Of those men, nearly 32 percent reported masturbating 1-3 times per week, 22 percent acknowledged doing so less than once per week, 10 percent said they did it most days of the week, and 5 percent acknowledged doing it daily (Reece et al., 2009).

In women, masturbation is less common, with only about 38 percent of women reporting they did so in the past month (ages 18-60), rising to about 63 percent when looking at the past year (ages 18-60; Herbenick et al., 2010). This same research found higher numbers in men ages 18-60 — just over 62 percent in the past month, rising to 79 percent when looking at the past year (Herbenick et al., 2010).

In teens ages 14-17 in the U.S., 74 percent of males and 48 percent of females reported ever having masturbated. When looking at just the past 3 months, that number drops to 58 percent for teen boys and 36 percent for teen girls (Kott, 2011).

In a British survey sample of 11,161 people from the early 2000s, just under 37 percent of women and 73 percent of men reported masturbating in the past 4 weeks (Gerressu et al., 2008).

Is it Bad to Masturbate?

There are virtually no negative consequences from masturbation, and in fact, many sexual health researchers and experts suggest it is a normal part of human sexuality that can have many benefits. The myths that surround masturbation (or masturbating too frequently) include: automatic addiction, it’ll make regular partnered sex uninteresting, numbing of your sexual organs, cause infertility, or shrink your genitals. None of these are true.

Masturbation, however, does have many health benefits.

Masturbation, however, does have many health benefits. First and foremost, it is an important stress reliever for individuals, helping to relax a person and take their mind off of other things. It also helps relieve sexual tension and can help strengthen your pelvic muscles. Some research has shown an improvement in a person’s self-image and self-esteem, as well as helping a person get a better night’s sleep.

Humans gain new skills through practice and knowledge. Masturbation helps a person gain positive sexual health skills by learning how your body responds and what you like sexually, without the complications of another person’s feelings or reactions complicating your own feelings and responses. Self-knowledge is important in every aspect of your life, and so naturally this includes your sexuality as well. If you know what works best for you sexually, there’ll be less confusion and misunderstandings in future sexual encounters with others.

Ultimately, though, people masturbate because it feels good. For those who masturbate to orgasm (not everyone does!), it also provides a release of endorphins, the brain’s “feel good” hormones. And while it’s not uncommon, especially at an earlier age, to feel guilty about masturbating, that’s a feeling that’s often tangled up in the cultural or religious dogma we’ve been taught. Such guilt can be unlearned through practice and a reminder that you’re engaging in a normal, health, human behavior.

Masturbation and Relationships

Masturbation is also both common and normal when a person is in a long- or short-term relationship — even marriage. There’s nothing wrong with masturbation in a relationship, unless one partner has a problem with this behavior. In that case, it may be helpful to learn why it’s okay and normal to masturbate in a relationship or marriage.

Most importantly, masturbating takes the pressure off of the relationship to meet all of the sexual needs of both partners, since partners — no matter how perfect they are for one another — rarely share the exact same sexual drives. Masturbation allows the more sexually active partner to release their own sexual tension without constantly requesting sex from their partner. This is empowering and can result in a more healthy overall relationship.

When is Masturbating Bad for You?

Masturbation, like any human behavior, becomes a drawback in a person’s life when it’s done too frequently, or in an inappropriate manner (such as in public, or in front of non-consenting others). In terms of frequency, there’s no number that’s too much (although some might argue that masturbating multiple times a day, every day, for months on end is “too much”).

Instead, what therapists counsel is that when the behavior starts interfering and negatively impacting other areas of your life — or feels like a compulsion — it’s become a problematic behavior that needs attention. For instance, if you’re missing school or work due to your need to masturbate, that’s likely a problem. If you’re staying home rather than hanging out with friends all the time in order to masturbate, that’s likely a problem.

* * *

Remember, masturbation is a normal, health human behavior. Psychological research has shown for decades that this behavior improves most people’s sexual health and self-knowledge. Masturbation is rarely bad for a person, unless they’re doing it to the point of negatively impacting other areas of their life. And remember — not everyone masturbates. That’s okay too, because we all have different sexual needs and drives. Just remember that if you do choose to masturbate, it’s okay to do so without any long-term negative psychological consequences.

 

References

Gerressu, Makeda; Mercer, Catherine H.; Graham, Cynthia A.; Wellings, Kaye; Johnson, Anne M. (2008). Prevalence of masturbation and associated factors in a British national probability survey. Archives of Sexual Behavior, 37(2), 266-278.

Herbenick, D., Reece, M., Schick, V., Sanders, SA,- Dodge, B., Fortenberry, JD. (2010). Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14-94. The Journal of Sexual Medicine, 7, 255-265.

Kott, A. (2011). Masturbation is associated with partnered sex among adolescent males and females. Perspectives on Sexual and Reproductive Health, 43(4), 264.

Reece M, Herbenick D, Sanders SA, Dodge B, Ghassemi A, and Fortenberry JD. (2009). Prevalence and characteristics of vibrator use by men in the United States. J Sex Med, 6, 1867–1874.

 

Thanks to Elsevier and ScienceDirect for access to their research database that helps make articles like this possible.

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Why Work-Life Balance is Futile—and What to Focus on Instead

Many of us feel guilty, anxious or uneasy when our work overrides family time and vice versa. Maybe lately you’ve been working long hours to meet a variety of deadlines. Maybe you’ve also been working most weekends. Or maybe you’ve been focusing more on family time, which has meant that you’re working fewer hours. You’ve been closing up shop early so you can drive the kids to sports practice, and eat dinner together — and you’re too tired to pull the split shift. Which means email keeps piling up and projects remain unfinished.

Many of us feel guilty, anxious or uneasy because we’re not achieving that so-called work-life balance. We feel like it’s regularly out of our reach.

This is understandable, because we are trying to achieve something impossible, something that doesn’t exist.

Work-life balance is a “placeholder term,” according to Jones Loflin, a speaker and trainer who helps individuals and organizations who struggle with too much to do. It was the best descriptor at the time—“and it stuck.”

But trying to live this way—to have a balance between work and life—is utter futility, he said.

“There will always be days, weeks, or even months where more of our physical, mental, and emotional energy will be required in one area of our life than another.”

Loflin uses the analogy of a high-wire act: The person uses a balancing bar to help them walk across the wire, and that bar is constantly shifting.

So if work-life balance is futile, what is actually useful and helpful?

A better term and concept is “work-life satisfaction.” Because, as Loflin said, it’s really about “making the right choice about where our time and energy is needed right now based on our purpose, goals, values, or whatever principles guide our lives…If we are living our lives in close alignment with our purpose, we are more satisfied with our outcomes. And satisfaction can be measured much more accurately than balance.”

Work-life satisfaction is specific to each person, said Loflin, author of several books, including his latest Always Growing: How To Be A Strong(er) Leader In Any Season. Again, it depends on your values, goals and priorities. For Loflin work-life satisfaction is: “having the desired impact on my world each day.” “It’s the feeling I get when I put my head on my pillow at night and have the satisfaction of knowing I did my best to live this day in alignment with my values.”

To start exploring your own satisfaction, Loflin suggested finishing this statement, and identifying what needs to be changed: “I would be more satisfied with my life if….”

Below, he shared other ways we can explore and boost our work-life satisfaction.

Consider the three key categories. Loflin breaks his life down into these areas: work, self and relationships. He regularly asks himself honest questions about each area to understand his satisfaction. He shared these examples:

• Work: “What did I do to move a project forward today? If I used my time like I did today for the next 30 days, would my business grow or shrink?”
• Self: “Did I start my day in such a way that it provided me with the physical, emotional, and mental energy I needed? Am I a better person because of the choices I made today?”
• Relationships: “Did I do my best to be an encouragement to everyone I interacted with today? Did I do my best to grow at least one relationship today?”

You might create your own questions for each area based on what’s most important and essential to you. You might even come up with your own areas.

Next consider if you’d like to change anything in any of the categories. For instance, if Loflin finds he’s not satisfied with his progress in writing his next book, he explores why he feels stuck and takes action to get moving.

Maybe you’re feeling disconnected from your spouse, so you talk to them about scheduling a date night every Friday. Maybe you feel disconnected from yourself, so you decide to carve out 20 minutes in the morning to journal about your thoughts and feelings and stretch your body.

Identify what’s important to you. Figure out “what you truly want to create and experience,” and “what brings you your greatest joy and makes you feel most alive,” said Loflin. Then figure out what that looks like day to day—and what concrete steps you can take to make that happen.

For instance, Loflin worked with a client whose core value was adventure. Loflin helped the client see that building relationships can be an adventure, too. So one step his client took was creating more engaging conversations.

Take the time to celebrate. Loflin has found that too many people fixate on bashing themselves for what they’re not doing, instead of savoring and celebrating what they are doing. “If you are always chasing work-life satisfaction, you miss the chance to harness the incredible energy that comes when you take a moment to reflect on all the positive things that you have done or experienced.” So what is making you smile right now? What are you enjoying about work? What are you enjoying about your family? What do you feel good about?

Of course, life is fluid. The demands and needs of your job and your family are constantly shifting. So are your own needs.

When we use work-life balance as a barometer, we often end up feeling bad about every area. And that stress, anxiety and overwhelm dampen everything.

The better question is: Are you satisfied in the different areas of your life? Which you can follow up with other questions like: How satisfied? Do I want to make any changes?

Or perhaps this is simply a season where work has a bigger role, or your family does or your wellness does. Either way, it’s up to you—and it’s totally OK that it’s completely out of balance.

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Obsessive People Have This Personality Trait

Obsessional people often have recurring thoughts or fears.

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How To Tell If Someone Is Lying

The words that liars use only seem to distract observers from the truth.

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Roots of Jealousy and Mistrust

I’m 63-year-old male. I was abused physically and emotionally from a very young age by my father. He often whipped me with a thin pigskin belt as hard as he could while he screamed at me. When I cried he would whip me until I stopped crying. I remember the feeling of imploding when I had to do this. My mother tried to make him stop but he would lock us in the bathroom while the beating took place. I can still hear my mother screaming from the other side of the door for him to stop. When he didn’t whip me he called me names and told me I would never amount to anything. If I cried when he taunted me he would say they were “crocodile tears and didn’t mean anything.” My father died when I was 11 and as much as anything I felt relief.

My father loved my mother very much but she married him to get out of war-torn Italy. She told me years later “ she respected” him but didn’t marry him out of love. I was the only son and my mother loved me very much.

I have always struggled with relationships with women because of jealousy. I am hypersensitive to cues I think I’m getting from a women. If she doesn’t smile at me at the right time I take it as a rejection. It’s the intensity of the feelings I continue to have today that has made me wonder if my early experiences of my attachment to my mother and my hatred for my father influence my jealousy and lack of trust for women and at the same time my need for intense attachment to women. If so, is there help?

Thank you for sending in your email. It takes courage to begin addressing such important and difficult issues. Although your mother wasn’t able to help when you were being abused she became an emotional lifeboat when your father died. Your insight about your “…early experiences of my attachment to my mother and my hatred for my father influence my jealousy and lack of trust for women and at the same time my need for intense attachment to women…” is right on target.

There is a whole field of attachment psychology that has researched such matters and good therapists will be proficient in helping you unravel these mysteries. Here is an article about attachment from Psych Central’s Sharon Martin — and the ‘find help’ tab at the top of the page will help you find therapists in your area who can help.

Learning about how to unlock the chains of the past so you can have a more fulfilling relationship now is something the therapist you work with can help you through.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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Atypical Presentation of OCD in Children

I’ve been an advocate for OCD awareness for over ten years and have not seen much progress in the understanding and diagnosis of obsessive-compulsive disorder.

Estimates vary but still hover around 14-17 years from onset of symptoms to receiving a proper diagnosis and treatment. That’s 14-17 years of untreated OCD which becomes more entrenched and difficult to treat as time goes by. To me, and I’m guessing to most people, this is not acceptable.

In a July 2018 article published in Comprehensive Psychiatry titled “Atypical symptom presentations in children and adolescents with obsessive compulsive disorder,” the authors detail some lesser-known symptoms of OCD that children and adolescents might exhibit. Typically, clinicians who want to rate the severity of obsessive and compulsive symptoms in children and adolescents use the Children’s Yale Brown Obsessive Scale (CY-BOCS) checklist. This checklist contains the most common symptoms presented in youth with OCD and includes obsessions related to contamination, aggression, and magical thinking, to name a few. Compulsions listed include but are not limited to, checking, counting, cleaning, repeating, and ordering. The CY-BOCS can be an extremely helpful tool for clinicians, especially in diagnosing a more “straightforward” case of OCD. Still, many cases of childhood OCD are either undiagnosed or misdiagnosed. Sure, OCD experts know their stuff, but there just aren’t enough of them to go around. Unfortunately, many mental health providers simply do not know a lot about obsessive-compulsive disorder.

Back to the study mentioned above which describes two distinct types of atypical OCD symptoms found in 24 children. Researchers showed how these symptoms are part of a larger clinical picture, not a feature of an alternate condition such as psychosis or autism spectrum disorder. As explained here:

Twelve of the children had obsessions rooted in a primary sensory experience (such as auditory, olfactory, or tactile) that they found intolerable and which was sometimes linked to specific people or objects. To soothe or avoid the associated sensory discomfort, patients were driven to engage in time-consuming repeated behaviors. Many of these patients struggled with ordinary activities such as eating or wearing clothing and can be at risk of seeming to exhibit symptoms of autism spectrum disorder, especially when the patient has a level of self-awareness that leads them to conceal the obsession behind the behaviors.

The other 12 children had obsessions rooted in people, times, or places they viewed as disgusting, abhorrent, or horrific, and which led to contamination fears connected to any actions or thoughts they saw as related to these obsessions. These kinds of contamination obsessions could result in concrete contamination concerns but more often resulted in abstract, magical-thinking fears of specific, highly ego-dystonic states of being. When the fear was a reaction to a particular individual or individuals, the obsession most often resulted in avoidance behaviors designed to placate a fear of acquiring a characteristic or trait of the individual by contagion. Patients exhibiting these symptom presentations are at risk of being diagnosed with psychosis.

Obsessive-compulsive disorder is complicated and I have connected with a number of people whose family members (or they themselves) have been misdiagnosed with autism spectrum disorder, schizophrenia, and even Bipolar Disorder. These misdiagnoses can have devastating effects on the person with OCD, not only because proper treatment is delayed, but because therapies used for other disorders can make OCD worse.

This case study is a good example:

Master A, 10-year-old male child, with uneventful birth and developmental history without past and family history of neurological and psychiatric illness presented with complaints of repetitive spitting, withdrawn to self, lack of interest in study, repeatedly closing his ears by hands from last 8 months and refusal to take food from last 7 days. He was hospitalized. On physical examination, all parameters were within normal limits except presence of mild dehydration. Intravenous (IV) fluids were started. On initial mental status examination, the patient was unable to express the reason behind this type of behaviour. On repeated evaluation, the patient expressed that he did not want to take food as he thinks that any word spoken by him or by nearby people or any word heard by him from any source were written on his own saliva and he cannot swallow the words with food or saliva. For this reason, he was spitting repetitively, avoiding interaction with people, avoiding food. To avoid any sound, he closes his ears by hands most of the times. He expressed that this type of thought was his own thought and absurd one. He tries to avoid this thought but he was unable to do so. After 6 months of onset of his illness, he was treated by a psychiatrist as a case of schizophrenia and was prescribed tablet aripiprazole 10 mg per day. After 2 months of treatment, instead of any improvement, his condition deteriorated and he visited our department. After evaluation, a diagnosis of OCD, mixed obsessional thought and acts was made… His CY-BOCS score dropped to 19 after 8 weeks of treatment and he was discharged from the hospital.

What I find particularly heartbreaking about cases such as this one is the fact that atypical antipsychotics (in this case aripiprazole) have been known to exacerbate the symptoms of OCD. How many people are misdiagnosed and never receive a correct diagnosis?

Health care professionals need to be better educated about OCD, so at the very least, it will be on their “radar screen” when evaluating patients. Obsessive-compulsive disorder has the potential to destroy lives, but it is also very treatable — once it is properly diagnosed.

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Emotional Blackmail: A Subtle Abuse

As the last of her children left for college, Janet realized she was done with her marriage. She had maintained the image of a “perfect family” for too long. It took her several years to get to this point – including many hours with a counselor – but after all that time she was finally here and ready to move forward into a new phase of life. The emotional, mental, verbal, and financial abuse she endured had taken its’ toll on her and while she was no longer impacted by it daily, she knew did not want to live with it any more.

She, of course, had asked her husband to get help, but he refused. Instead he only escalated his emotional abuse tactics to include emotional blackmail. The regular, more frequent abuses of name calling (verbal), gaslighting (mental), and interfering with her success at work (financial) were typical experiences and ones she already knew how to counter act. But the emotional blackmail she was now experiencing was intense and far more hurtful.

Gangster movies such as “The Godfather” love to portray the inner and outer conflict that arises from being blackmailed, especially when someone’s life hangs in the balance. There is the villain (the blackmailer), the victim (the target), a demand (what is being asked for), and a threat (what negative thing will happen if the victim refuses to comply). But blackmail does not have to be a life or death situation to be real or significant. Emotional blackmail is a subtle threat. Here is how it works:

What is Blackmail? For Janet to understand the impact of emotional blackmail, it was helpful for her to think of examples of blackmail in everyday life. Here are a couple of them. At school, one child says to another, “If you don’t say I’m the coolest, then I’ll beat you up.” In a neighborhood, it is a neighbor threatening to do property damage if turned into the homeowner’s board. At the office, a co-worker who knows some private personal information threatens to use it against another in exchange for a small fee. This type of blackmail has some sort of physical or tangible harm attached.

What is Emotional Blackmail? This is a bit different. The threat is not tangible, rather it is emotional. Susan Forward and Diane Frazier (Forward and Frazier, 1997), coined the acronym FOG (fear, obligation, and guilt) to describe the three main emotions a blackmailer uses against a victim. Because the threat is not tangible, the villain can easily claim no responsibility. Janet’s husband used Janet’s fears, her sense of obligation to the family, and feelings of guilt to make demands of her. Janet, unknowingly at first, gave into his demands of perfection because she didn’t want to experience the negative emotions. This is often cyclical and can build in intensity as the threats are incredibly effective.

Fear. After being married for so long, Janet’s husband knew which fears to target for Janet. Obvious fears are left alone such as a fear of spiders or heights. Rather, the fear targeted is deep rooted such as a fear of abandonment, loneliness, humiliation, or failure. These fears tend to be unique in intensity to individuals so one person may not perceive that a threat is being made while another one is mortified. This allows the villain to have some additional cover in their deception. Janet’s fear was of failure. Her husband threatened to tell Janet’s boss about how she got fired years ago if Janet didn’t stop hanging out with a friend her husband did not like. Other examples include, “If you don’t do this,” the blackmailer will leave the relationship, isolate the victim from friends, ridicule the victim in front of family, or expose other past failures.

Obligation. As a functioning alcoholic, Janet’s husband talked and acted like most addicts including using this blackmail tactic. Addicts need to justify their use of a substance, so they blame others for things they are responsible for doing. This refusal of accepting any responsibility translates into projecting responsibility unfairly onto others. Thus, emotional blackmail through obligation is born. Janet, who is the enabler to her husband, repeatedly fell into this trap hoping that by doing what is asked, her husband will stop. However, he didn’t, and matters just escalated. Here are a couple of examples. “If you kick me out of the house, I’ll drink more, and the kids will blame you.” “If you don’t take the fall for me (because he was late and missed an important work meeting), I’ll lose my job and then we will lose the house.” “I won’t drink if you give me sex.”

Guilt. This type of emotional blackmail is more commonly known as “guilt-tripping.” Unlike the other two categories, this one has a mutual negative threat attached to the villain. The threat is designed to make the Janet feel guilty for causing some negative outcome to her husband. Many times, the guilt is implied, and the demand is not overtly stated. For instance, “You make me feel so angry (rejected, abandoned, or unloved),” “Only a selfish person would do that,” or “If only my life was as easy (good) as yours.” These backhanded remarks left Janet feeling guilty for causing some pain to her husband. However, the pain does not have to be real to her for her husband to utilize it, rather it is a projection of the pain that he might be feeling.

Understanding emotional blackmail is a critical step in eliminating its effectiveness. The next part is harder; the target must stop being a victim. This can be done by ignoring the comments or refusing to cave into the demands. For Janet, she had enough and left. If you are unsure of how emotional blackmail may be playing a role in your life, get help – and be ready to maybe make some tough decisions.

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Can You Give Me Guidance about an OCD Relapse?

From the U.S.: I have been diagnosed with OCD years ago and it has recently resurfaced worse than ever due to stress. I can’t see a psychiatrist anytime soon so I’m reaching out for advice. I fear that I’m in the stages of prodromal psychosis. I’ve been on Celexa for the past 3 weeks and it isn’t reacting well with me so I’m tapering off now while getting on Anafranil because the medication saved me years ago.

My therapist that used to work in a mental hospital has told me I’m not showing signs of psychosis and she thinks my “symptoms” are the result of extreme stress and anxiety. I have told her I worry I’m hearing things and I do occasionally see movement in my peripheral vision but I’ve been told I’m just hyper aware of my surroundings right now and that I’m experiencing normal things but just worried about it all because of my OCD.

I’ve been dealing with this OCD relapse since May (after an extremel stressful month) and it’s only gotten worse and the reason I got on this obsession about psychosis was because I was experiencing Derealization and Depersonalization and wasn’t sure what it was so I began suspecting I was experiencing schizophrenia or psychosis and I began researching it only to make my OCD latch onto it.

I see a primary care doctor and specialized therapist as of now but I can’t see an actual psychiatrist anytime soon and I worry about my sanity in the meantime. I’m worried that starting this Anafranil will make any psychosis I might be experiencing worse but I have been told I don’t have psychosis so I will take it in hopes it will help me as much as it did 5 years ago which my doctor said is likely.

I’m not sure what else to do at this point and I’m hoping for guidance. I’ll also add in that I went to our local mental hospital where they said I wasn’t experiencing any signs of psychosis so I shouldn’t worry anymore but I can’t help but still half believe I’m experiencing the early stages.

Thank you for writing. I’m sure this is all very distressing. But I think you need to listen to the people who know you well and who are doing their best to help you. I can tell you that in my experience Anafranil has been very helpful to some of my patients who also are challenged with OCD.

I wish you well.
Dr. Marie

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Sexual Assault: What Is It? How to Empower Recovery for Survivors

Despite growing awareness, sexual assault is not going away. In fact, every 98 seconds, someone in America is sexually assaulted, reports RAINN, a leading support provider for sexual assault survivors.

Most incidents of rape or sexual assault — 69% — happen to people between ages 12 and 35.  Each of us can learn something and do something safely to make a huge difference to reduce risk, prevent trauma, and help more people heal.

Victims include men, women and children. Assaults are most often carried out by someone they know. Sexual assault is most prevalent among younger women:

• 9 in 10 victims of rape are female(1)
• Most sexual assaults — 69% — involve victims between ages 12 and 35(1)
• 82% of all juvenile victims of sexual violence are female(1)
• Nearly 2 in every 3 college students (male and female) experience sexual harassment (2)
• 7 in 10 of rapes are committed by a person known to the victim (3)

What Is Sexual Assault?

Sexual assault consists of any unwanted sexual touch. While it includes rape and groping, any “sexual contact or behavior that occurs without explicit consent” is sexual assault, says RAINN (The Rape, Abuse and Incest National Network).

The degree of violence does not matter. Rape and drug-facilitated sexual assault are two of the most recognizable forms. But assault can also happen when someone rubs up against your body without your consent. It can happen with the uninvited touching or holding that violates your personal space and boundaries.

Placing Responsibility for Sexual Assault Where It Belongs

We need to question and challenge attitudes that blame the victim: “Oh, well what was she wearing? Was she drinking? Or did she lead him on?” This view comes from ignorance or misinformation and needs to change.

Sexual assault is in no way the victim’s fault.  What a person is wearing, whether they are smiling, flirting, partying, or whether they are drunk or sober does not matter. Unless that person freely says ‘yes’ to sexual behavior, that behavior counts as assault.

Victims of assault need to know: You did nothing wrong in that moment. You just happened to be there. And then this person decided that your body was up for grabs.

The more attention and awareness we can bring to examine our biases, the more I hope we can reduce the incidents of assault and the suffering and shame of survivors.

Why Failure to Resist Does NOT Mean Consent

Without awareness and education, attitudes and misinformation can make it difficult to recognize sexual assault when it occurs. Some people mistakenly fault the victim who does not appear to say no to what is happening. We need to know that victims — especially those who have survived prior traumas — may freeze with terror, which is triggered when someone violates their sense of safety.

Most of us understand the “fight, flight, or freeze” response to fear. Once triggered, our neurobiology takes over, and it is very hard to shut off. When a sense of danger overwhelms the nervous system, it is not uncommon for sexual assault victims to freeze.

As a primal reflex, freezing can increase the odds of survival. After all, if your victim isn’t fighting, why not ease up the attack and save your energy?  Unfortunately, freezing rarely enables escape from a person who is intent on forcing sexual activity on someone else.

When a person feels violated — especially for a person with a trauma history, paralyzing fear is common. It’s a misunderstanding that victims do nothing to resist assault. What they do is freeze, to survive the trauma overwhelming them in that moment.

It is never right to blame the victim for what happened, no matter what they are wearing or where they happen to be, or whether they failed to stop it.

How to Reduce Your Risk

Basic personal safety is key to prevention.  

It is important to remember that the vast majority of sexual assaults happen in a setting with people you know.  Tips for staying safe include:

• Make sure you go to social events with people you know are safe.
• Plan ahead of time to look out for each other. Have plans to check in with each other and make sure each of you is okay.
• If you are going to be drinking, watch your drink and don’t accept open drinks from others.  
• Agree to go with a designated non-drinker who knowingly takes the role of watching that the situation stays safe.

Helping Others Reduce Their Risk

As one person, you may feel too insignificant to matter.  Please know that the difference you can make is huge. Because so many acts of assault begin in social settings, a bystander can interrupt in safe and helpful ways to help prevent an assault.

Follow your gut.  If a situation does not look right, and it feels safe to interrupt, say something:

• “Hey, I’ve been looking for you – let’s go someplace to talk…”
• “How’s it going? Is that okay with you?”
• “Sorry, but we have to leave.”

If a situation looks unsafe, you can get the attention of someone in charge, such as a security guard or someone working at the venue, to help intervene.

For bystanders, RAINN provides the helpful cue CARE: Create a distraction, Ask Directly, Refer to an authority, or Enlist others.  RAINN provides more resources for safety planning, campus safety, and how bystanders can help.

Recovering from Sexual Assault

If you have experienced sexual assault, it is not your fault — even though you may be feeling guilty, ashamed, even devastated and worthless after what happened.  Know that it is possible for you to better protect yourself and to heal, and it is not too late to begin.

The important thing to do is tell someone you can trust about what happened.  If you do not know someone you can trust, there are local and national resources you can call to talk to someone who is trained to listen, and guide you responsibly to the help you need.  See More Resources below.

Signs of Change in the Media, On Campus and in the Legal System

Fortunately, thanks to the hard work of victims, doctors, therapists and advocates, more people are starting to recognize sexual assault for what it is — a trauma and a crime that needs greater awareness and prevention.

More colleges are holding surveys of students to learn the extent of unwanted sexual behavior and put better safeguards in place. The tragic sexual assault and murder of Hannah Graham, a local Virginia student, gained national media coverage, including stories on CBS News (for example, these stories in 2015 and 2016) and in the Huffington Post. Celebrities including Lady Gaga and Mary J. Blige are using their music as a powerful way to reach survivors and challenge the bias of blame (See More Resources below).

Lawmakers are beginning to help better protect the rights of rape victims. State Department official and rape survivor Amanda Nguyen has been a forceful advocate for a bill now introduced to Congress: the Sexual Assault Survivors’ Rights Act, which aims to protect victims’ rights to their evidence, whether or not they decide to press charges.

Your Voice Matters

If you think your voice is too small to matter, please know it does matter. If you think you alone can’t make a difference, that is not true: you can make a huge difference.  Each of us can learn something to help prevent the next incident, and empower another victim to get help.

Sexual assault happens too often and devastates too many lives for us to accept without greater awareness. It is so important for all of us to educate ourselves about what we can do.  

Where Our Numbers Came From

(1) Victims of Sexual Violence: Statistics (RAINN)

(2) Get Statistics (NSVRC)

(3) Perpetrators of Sexual Violence: Statistics (RAINN)

More Resources:

Education and Support for Victims of Sexual Assault

RAINN (Rape, Abuse and Incest National Network) has excellent educational resources  support for victims, and a hotline:

About Sexual Assault

Hotline: 1-800-656-HOPE

Survivors of Incest Anonymous

Local Resources

Alexandria Sexual Assault and Awareness Program
Hotline: 703-683-7273

Advocacy

No More, a campaign for public awareness and to help engage bystanders in ending domestic violence and sexual assault

RISE (to support passage of the Sexual Assault Survivor’s Bill of Rights)

Songs

Caution: This content may be triggering for survivors of sexual assault

Lady Gaga – Til It Happens To You: https://www.youtube.com/watch?v=ZmWBrN7QV6Y 

Mary J. Blige Sheds Spotlight on Domestic Violence in ‘Whole Damn Year’ Video, by Bennan Carley, Spin magazine

Ten Inspiring Songs About Domestic Violence & Sexual Assault That Will Move You, by No More staff

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Rebel with a Cause? On Taking the Road Less Traveled

Rocking vintage tees throughout law school?

Sure thing.

Shunning a conventional legal job for a flexible writing gig?

You know it.

Turning down an all-expense paid family vacation to Cancun, Mexico for the Spring Break charms (I use that term very loosely) of frigid Duluth, Minnesota?

Of course.

Before reading Gretchen Rubin’s The Four Tendencies, I wondered if I was just different. Not in a creepy, peculiar way — more in a you zig, I zag type of way. My contrarian instincts have always been there, manifesting themself in an overwhelming (and overriding) desire to assert my own distinctive identity.

Call it Mattology.

In her informative book The Four Tendencies, Gretchen Rubin introduces and defines the concept of rebeldom. We rebels are proudly individualistic and iconoclastic — upending conventional wisdom with a knowing smirk on our faces. We revel in our own independence,  prizing autonomy over conformity — even when adhering to the status quo would be a wiser option.

As a self-professed rebel, I love my fiercely independent streak. It has provided an identity — and made my life that much more enriching and dynamic. From backpacking around the world to chronicling my mental health trials and tribulations in an all too public forum, my rebeldom has provided the impetus to flout, at times gleefully, expected social conventions. “Matt, you know, you are 37. You can’t keep crisscrossing the world on your budget flights. Isn’t it time to settle down — find a nice, little house and carve out your own slice of Americana?” my family gently urges.

And my smart aleck response: “Who says? But you know what — maybe you are right. I’ll settle down .. into my comfortable airline seat on my next far-flung adventure.” You can imagine how that response goes over (I will summarize: head-shaking disbelief).  

While I revel in my autonomy, rebeldom — as I imagine my fellow rebels know all too well–can cause tension — even strife. Chafing at constraints — either internal or external, we want the flexibility to do what we want to do when we want to do it. We will get the job done (relax, supervisor) but it needs to be on our schedule. Needless to say, this, ahem, scheduling flexibility can pose problems–particularly for more rigid, domineering types. Case in point: a former supervisor, who incidentally had a military background, wasn’t exactly enamored with my scheduling ideas. Shuffling into his office for his daily 8:30 AM (don’t be late!) monologue, I realized — perhaps all too well — that not everyone operates on my idiosyncratic timeline.

There is a solution to this — as Mrs. Rubin hints in her thoughtful exploration of the rebel prototype. We rebels need a cause — something worthy of devoting our creative energy. In my case, mental health awareness serves as my cause celebre. My mental health advocacy efforts have reinforced my identity–that of impassioned advocate committed to something bigger than myself. But before consummating my employment marriage with Psych Central (yes, I will be approaching year four of, I hope, thought-provoking contributions), it has taken years — even decades — of employment search and discover to pinpoint that true passion. And, at least in my case, that has meant a decade plus languishing in mind-numbing jobs — feigning interest over squabbling insurance companies as I counted down the nanoseconds to 5:00 PM. Happy Hour indeed.

You see, we rebels are part contrarians and part idealists. We scorn convention but crave something — a cause, an organizational mission — that stirs our soul. And while we may be contrarians — priding ourselves on rejecting society’s seemingly capricious rules, ultimately we want something — anything — that we just can’t say “No” to.

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Psychology Around the Net: September 29, 2018

Happy Saturday, sweet readers!

This week’s Psychology Around the Net gives tips on how to spot unnecessary opioid prescriptions, offers ideas for emotional self-care you might not have thought of, takes a look at legislation requiring mental health disclosures by students, and more.

Parents Are Leery of Schools Requiring ‘Mental Health’ Disclosures by Students: Legislation passed after the school shooting at Marjory Stoneman Douglas High School in Parkland, Florida requires Florida school districts to ask whether a new student has ever been referred for mental health services, and some parents are wondering: Will this actually help troubled students, or increase the stigma of mental illness?

How Netflix’s ‘Maniac’ Uses Mental Illness to Interrogate What It Means to Be Normal: Without giving anything away, Netflix’s new show Maniac “tackles the idea of achieving normalcy despite mental illness by thrusting its characters into bizarre, otherworldly landscapes.” [SPOILER ALERTS IN ARTICLE]

How to Spot an Unnecessary Opioid Prescription: Opioid addiction is devastating so much of our country; it’s no secret, and if you live in an area that’s suffering particularly hard, you don’t need any fancy studies to prove it. According to new research, one thing that could be contributing to opioid addiction is an inappropriate prescription. Here are a few ways you can talk with your doctor and determine whether an opioid prescription is necessary.

8 Ground Rules for Better Emotional Self-Care: These tips go way beyond just taking some time to yourself.

Octopuses On Mood Drug ‘Ecstasy’: By giving particularly unfriendly octopuses the mood-altering drug ecstasy, scientists say they’ve found preliminary evidence of an evolutionary link between the social behaviors of humans and the sea creature. Says lead investigator Gül Dölen, M.D., Ph.D., “The brains of octopuses are more similar to those of snails than humans, but our studies add to evidence that they can exhibit some of the same behaviors that we can […] What our studies suggest is that certain brain chemicals, or neurotransmitters, that send signals between neurons required for these social behaviors are evolutionarily conserved.”

Why Emotional Labor May Be Physically Hurting Women: Despite the strides we’ve made in equality, studies show the bulk of the “second shift” (all the family- and household-related work — everything from physical work like cooking and cleaning to mental tasks like planning vacations and coordinating schedules) falls on women. Not only does this affect women mentally by increasing stress and anxiety, but also it can hurt them physically.

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A Simple Sign That A Relationship Will Last

Only one partner in a couple needs to have this quality.

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How Victims are groomed by Abusive Predators

People who recover from abusive relationships of any type, including cult situations, domestic violence, sex trafficking, and even “run of the mill” types of abusive relationships often ask themselves the question, “How did I let this happen to me?”

There are a few common reasons people stay in abusive relationships, but the primary reason they get caught up in one in the first place is one reason:  Grooming.

What is grooming?

Grooming is a manipulative process used by a sexual (or other) predator for the purpose of creating a sense of trust with a targeted person prior to the act of actual victimization.

People of all ages can be groomed.  Here is a list of common grooming tactics used by predators prior to actually abusing their victims:

1. They pretend to be someone and something they’re not. They pretend to be someone you can trust, so you put your guard down. They do this in a variety of ways, as will be described next.
2. They are very charming and present themselves as people who are the answer to all your needs. They seem to be “better than life.” This is because they aren’t really who they are portraying. Their charm is merely a ploy and involves superficial connecting at best.
3. They appear to be very empathic – mirroring you and showing a great amount of “seeing’ you and validating your felt needs and experiences. If the groomer is a an adult and the victim is a child, the abuser will put himself at the child’s level and act as if he really “gets” the child and meets him where he’s at.
4. Groomers act very innocuous and light-hearted. They don’t seem heavy, dark, or full of some deep, hidden secret. Victims do not suspect that he/she is anything but easy to be with.
5. They pretend to be your protector, acting outraged if anything bad happens to you and promising to protect you from all evil (how ironic.)

Once you’ve been groomed, the perpetrator uses more overtly abusive tactics:

1. He/she starts using direct coercion. “Come in here.” “Take off your clothes.” “Do this; do that.”
2. He/she holds a psychological (metaphorical) knife to your throat. Examples, such as, “Have sex with me or I’ll find someone who will.” “You’re lucky to have me. No one else could possibly want you.” “If you tell anyone I’ll kill your parents.”

How victims think:

Victims of abuse, after being groomed, feel confused. They have been told to stand on a rug; stood on it; and then they had the rug pulled out from under them, “Psyche!”  Victims feel devastated and humiliated over how they are treated, confused because of mixed messages, and self-loathing. Victims always blame themselves.

Why do victims put up with the abusive behavior? 

For the following reasons:

• In the beginning stages of grooming, if the perpetrator is an adult, the target of the grooming has become completely smitten initially, wondering, “Why hasn’t he/she been taken by someone else yet?” “Why is this awesome guy/gal still available?”
• Victims start filling in the unknown blanks by explaining the crazy or abusive behaviors away.
• Victims start living in a state of shock. They are numb and don’t experience their emotions. This is protective because numbness protects people from pain; numbness is a psychological analgesic.
• Victims believe they’re the problem. The groomer is such a master-propagandist, he/she has groomed the victim to believe he/she (the victim) is the problem.
• Victims take responsibility for causing the abuse.
• Victims assume they are the only ones being victimized.
• Victims are ashamed that it is happening and just pretend that everything is fine.

The main thing to understand about perpetrators of abuse, is that they somehow have a sixth sense and seem to know how to exploit the weaknesses of their victims. They somehow tailor make their tactics to fit the vulnerabilities of their targets.

It is helpful to identify a perpetrator of abuse at the grooming stage of the relationship, in order to prevent further damage from occurring. Teach yourself and your loved ones to trust your own instincts and don’t ignore the small little voice in your head that tells you, “Something is not right here.”

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OCD Resurfaced, Worse than Ever Before

I have been diagnosed with OCD years ago and it has recently resurfaced worse than ever due to stress. I can’t see a psychiatrist anytime soon so I’m reaching out for advice.

Thanks for reaching out. The two most immediate things you can do are to check out our forums where people are struggling with issues related to OCD and educate yourself on the elements of it. Here is a good article by Psych Central’s very own Dr. John Grohol that should help.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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I May Have Been Traumatized as a Child; Should I Go Get Help?

From a teen in the U.S.: I will try my best to get all of this stuff out in a condensed manner. Contextually, I may have been traumatized during my 3rd grade school year. I remember the incident unusually well, and can recall definite features 8 years after the fact. I had gotten into an argument with this one kid. In the midst of this argument I had dragged another guy into it (so-to-speak). All-in-all I was harassing the guy, and I said some really awful things to him. That much, I feel guilty for.

However, the next morning the guy I (essentially) bullied rightly told on me, and this escalated into a conversation outside a computer lab (in the hall). My teacher asked the three of us what was going on, and it was basically laid out. Me and the argument guy laid out our points against each other, and about halfway through the conversation the third guy was excused to go into the lab. This is where things got bad.

The teacher was invariably making me nervous. This manifested itself into (possibly) a nudge into the other guy via the shakes (not to mention I move around quite a bit). The teacher accused me of pushing the other guy, to which I refused (I did not intentionally push him). The teacher then got in my face, and low-key threatened that if I did not stop this “behavior” I would go to the principal’s office. Her eyes were deadlocked with mine, and her tone (as I remember it) was venomous. I yielded, despite the fact that I being honest.

When I got into the car that day, I did not tell my dad about the incident. I wouldn’t tell anyone about this for the next eight years (in fact, you’re seconded only to my former employer in this knowledge). And yet, despite the passage of time, I have been afflicted.

I have had a string of panic attacks since the incident, and all of them have two common attributes; a woman getting in my face and speaking in a accusatory or annoyed tone. Each time I lose composure and cry. Each time it revises memories of what occurred, and those memories leave me in despair. It has happened at school and at work. I’m sick of it. I’m sick of being embarrassed. I ask you: does this sound like PTSD? Should I get help?

According to the DSM5, the first criteria for a diagnosis of PTSD is that “The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence”. It’s a stretch to consider a threat to be sent to the principal as meeting that criteria. That being said, some kids are so sensitive and/or anxious, that their reactions to stressful situations are unusually extreme. It seems that you are by temperament an anxious person. For that reason, it’s possible that the teacher’s behavior was traumatizing to you.

It sounds to me that you continue to be anxious. It could be that you latched onto the incident from so many years ago as a way to make sense of your anxiety. It could also be that you haven’t yet figured out a way to navigate conflict with women and that triggers memories from then.

In my opinion, you’ve suffered with anxiety and the fallout from that incident much too long. You are understandably sick of it. You said that you are often in despair. Regardless of whether an assessment would determine an official diagnosis of PTSD, you are in emotional pain. That is reason enough to get some help.

A mental health professional will be able to determine a diagnosis, of course. But far more important than a label is that counseling will help you learn new skills for managing your emotions and for dealing with stressful interactions with people. You are in your teens. Working these issues through now will help you now and in the future. You deserve to have a life without despair.

I wish you well.
Dr. Marie

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The Power of One: A Supportive Adult Has Huge Impact in the Life of an Abused Child

One person.

One act of kindness.

One changed perspective.

One acknowledgement of pain.

One offer of support and encouragement.

Both in my work as a child psychotherapist and personally as a survivor of childhood abuse, I’ve seen what a difference these “ones” can make to a child who is living with domestic violence. Children are resilient. They can survive and even thrive after unthinkable trauma. But that resilience generally comes from having a caring adult in their life who supports them and helps them make sense of the situation.

For me, that person was my paternal grandmother, a hearty, hardworking, no-nonsense New Englander who never complained despite the abuse she received from my grandfather. She sheltered me and gave me tools to avoid his and my father’s wrath. But more importantly, she was a kind, gentle woman who loved me unconditionally, encouraged me, and helped me feel safe.

Children’s responses to domestic abuse are varied and impacted by numerous factors. Age, birth order, temperament, innate coping strategies, the severity of the abuse and the relationship with the abuser can all impact a child’s reaction. Some children find ways to cope and may not show any outward signs of distress, others may exhibit extreme behavioral changes, and yet others may fall somewhere in between. Withdrawal, clinging, tantrums, sleep disturbances and increased fear and anger are some of the reactions that can emerge at home or at school. Depression, anxiety, difficulty concentrating and hypervigilance can impact academic and social functioning. Lifelong health or behavior problems often result.

As the oldest child, I shouldered the responsibility of protecting not only my mother but my younger siblings as well. I would take my younger sister into a closet to escape my father, something she experienced as a fun game, thankfully unaware of my more serious motivations. Taking on this caretaker role is a common coping strategy, especially of eldest children. It is fueled by the mistaken assumption that they are to blame and that by understanding triggers and changing their behavior they can predict and mitigate the abuse.

Another strategy that children adopt is to become “bad” to divert attention away from the abused parent in an effort to protect them. Still others identify with the abuser and become disrespectful and aggressive toward the non-violent parent. All children receive flawed messages about relationships that may be interpreted in a variety of ways. Many repeat the domestic abuse in their later relationships, either as the abuser or the abused, believing that problems are solved by either aggression or passivity.  It’s what they’ve learned and they don’t have a framework for anything different.

Others grow into their futures determined to do things differently. And that determination and resilience is often due to having had someone in their life — a parent, grandparent, teacher or coach — who acknowledged the reality of their situation, who showed them a different way, and who helped them feel safe and secure. My grandmother was the initial “one” who protected, guided and encouraged me. Others would follow, reflecting my strengths and reinforcing the seeds of resilience that my grandmother had sown.

Working with children and teens I’ve heard many stories, similar to mine, of people who made a difference to them when they were a child. Often it was a relationship with a teacher for a year or a family member or friend for many years. In other instances, it was as simple as a random kind word or gesture. There are many circumstances in our lives today in which we feel powerless, including trying to change the abusive behavior of some adults. Nevertheless, we all have the capability to protect, support and validate a child who needs that “Powerful One” in their lives.

*If you concerned that a friend, family member, coworker or someone else you know may be in an abusive relationship, contact the National Domestic Violence Hotline.

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What is Stockholm Syndrome?

When Bailey began therapy, she had already convinced herself that she was crazy. In her early 20’s, Bailey was still living at home with her brother and mother. She failed her first semester of college, had regular panic attacks, associated herself with unhealthy people, and was barely holding onto her waitress job. Her father also repeatedly told her that she was the cause of all the drama in the house with her irresponsible behavior and that there was a likelihood that she had a mental illness. She presented in therapy as insecure, scared, hesitant, and withdrawn.

After several sessions, a different side of Bailey emerged. The more she felt believed and accepted by her therapist, the better she communicated with them. She began to act confidently at work, opening the possibility for a promotion. She removed the unhealthy friendships and engaged with new people who inspired her to achieve more. Now instead of shutting down at home, she started speaking her mind and standing up for herself.

However, just as her home life seemed to be improving, that is when things escalated. Her dad picked a fight with her and verbally belittled her, threatened to throw her out of the house if she didn’t do exactly as he requested – he even cited her past suicide attempt from 3 years ago as evidence that she was the crazy person of the family. The old person from several sessions ago reappeared in therapy as if no progress had been made. His abusive treatment this time was insignificant compared to previous abuse.

That is when an evaluation on the types of abuse began. After reviewing an extensive list (posted here…), Bailey realized that she suffered from physical, verbal, mental, emotional, financial, and spiritual abuse from her father. Eager to confront him and desperately wanting a healthy relationship with her father, she agreed to do a family session with everyone. But instead of this session sparking healing, another issue emerged: Stockholm Syndrome.

What is Stockholm Syndrome? Normally the term is reserved for hostage situations referencing a bank robbery that occurred in 1973 in Stockholm Sweden. After spending 6 days in a bank vault, the four hostages refused to testify against their captors and instead raised money for their defense. The term refers to the trauma bond developed between the captor and the hostages in which the hostages feel positive feelings such as empathy for the person that is causing them harm. This allows the captor to not feel remorse for their actions as the hostages don’t hold them responsible.

What are some other examples? One of the most famous cases of Stockholm Syndrome is the kidnapping of Patty Hearst in 1974 who denounced her family name and sided with her kidnappers in assisting them to rob banks. She was given a prison sentence that was later pardoned by President Bill Clinton.  Another example is Jaycee Dugard who was kidnapped at age 11 in 1991 and held hostage for 18 years bearing 2 children by her abuser. In her book, she explains the syndrome and how she formed a bond with both of her captors over the years.

Are there fewer extreme examples? Absolutely. A person currently living in an abusive situation often has this condition. This is the reason why many people don’t leave their abuser but instead continue to hold onto the relationship. In the case of Bailey, she wanted to believe that her father was telling the truth so much that she accepted his assessment of her mental well-being as being crazy when she was not. Her desire to have a relationship with her father meant that she was ignorant of the different types abuse, justified his abuse in therapy as the result of his own childhood abuse, and minimized any impact. The result was she honestly believed that she was the problem and not him.

How do you recover? The recovery process requires identification and awareness. This is one of the few times when googling a disorder is helpful. Hearing and seeing examples of other victims brings awareness at another level. It is often easier to see the problem in someone else’s story before identifying it in yours. Once an understanding has been established, rewriting the abuse needs to occur. This is time consuming and should be done under the guidance of a therapist. A person with Stockholm Syndrome already has a hard time perceiving things correctly and needs professional assistance until a new, more accurate perception is developed.

How do you help someone with this? It is important to develop a bond of trust that is based on empathy and not judgement. Those looking at the scenario from the outside in are often highly judgmental and critical of the victim’s behavior. The victim is already overloaded with feelings of inadequacy, shame, and guilt that are disproportionately attributed to their actions and not the abusers. To overcome this, they need unconditional love and acceptance and a ton of patience.

After addressing the Stockholm syndrome, Bailey finally began to do better. She no longer allowed her father’s abuse to impact her. Moving out of the house helped and in a short period of time she was thriving. Without getting the proper help, she might have never been able to achieve this. Be sure that if you or anyone else is experiencing this syndrome or something like it they seek out professional assistance.

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Common Challenges for the Senior Client

The statistics concern me. Most of the adults now entering the mental health professions (who were born in the 80s and 90s) lived in two generation households while growing up. According to a Pew Research Center Social and Demographic Trends project, by 1980, only 12% of Americans lived in families of three generations or more.

That trend is slowly reversing because of  current economic pressures, up to 16% by 2008. But that is still only 16%. Many young clinicians only saw grandparents on holidays. Many have never known an elderly person up close and personal.

Those of us who work with seniors know that the last quarter of life has its own richness, delights and challenges. The “golden years” can indeed be golden. Those fortunate to have good health, to be surrounded by family and friends who are physically well and who have a good enough retirement income can enjoy an active social life, travel, and activities that may have been put off when time was limited by work and raising a family.

But those are not generally the people we see in treatment. For seniors who make it to a therapist’s door, the golden years aren’t all that golden. To serve them well, Millennials, Generation Y, and Gen Next (those who are now between ages 24 – 38) who haven’t had the opportunity to personally know elders, need to educate themselves and be specifically supervised to be effective with senior clients.

Challenges:

The following challenges are common for all seniors. But seniors in distress often don’t have the internal resiliency or the external supports they need to manage them well.

Physical limitations: My 90-year-old friend George told me that any gathering of his peers starts with an “organ concert.” “How’s your kidney?” “How’s your heart?” “My stomach is bothering me.” It’s not morbid. It’s usually not just a litany of complaints. It’s an attempt to manage health concerns with humor while at the same time updating each other on their vulnerabilities. Treating elders means supporting them while they deal with the normal and difficult physical limitations that come at some point to everyone.

Memory and cognitive decline: People with advancing dementia talk about the frustration and fear that accompanies a gradual loss of memory, common skills of everyday living, and ability to communicate. Some are very worried about what will happen if their families find out. Will they lose their license? Will they be infantilized?

(For an excellent overview of patient experience, see Suffering from dementia – the patient’s perspective: a review of the literature  by Marike E. de Boer,1 Cees M. P. M. Hertogh,1 Rose-Marie Droes, ¨ 2 Ingrid I. Riphagen,3 Cees Jonker2 and Jan A. Eefsting1: International Psychogeriatrics (2007), 19:6, 1021–1039) Clinicians need to educate themselves about the various forms of dementia and how best to support clients and their families as the disease progresses.

Change in identity: Those who retire from a career, even a career they didn’t like, often suffer from a loss of the identity that came with it. Those whose career was raising children and being active in the community sometimes don’t quite know who they are when those roles are dramatically reduced or over. Our clinical work includes redefining the source of self-esteem and supporting efforts to find new activities that are meaningful and pleasurable.

Loss of friends and family:  Sometimes our patient is the last of a friend and family circle. As one of my patients said, “I’m the last one standing.”  She was 95. As the youngest of eight siblings, she had attended funerals of all of her sibs, all of her sibs’ spouses, and most of her nieces and nephews.

All of her closest friends were already gone. The few who were left had dementia and were sick. She felt alone and lonely. Even those fortunate enough to still have peers who are alive and well know that the situation can change in a moment. Our job is to help our clients grieve those they have lost, find ways to be there for friends who are sick and dying, and find new social relationships.

Letting go of “stuff”: The kids have grown. The house gets too big. The stuff accumulated over 40 or so years begins to be overwhelming – and the kids make it clear they don’t want most of it. Sometimes, it’s liberating to start downsizing. Sometimes, it’s very difficult to realize that things they’ve treasured aren’t valued by others.

Senior clients may need help to sort out their feelings as they sort out their material possessions.

Family tensions: More than a few seniors have been brought to me by their adult children. “Maybe you can talk sense into him!” they say. Or: “She’s always been difficult. Make her change.” Changing a 80+ year old’s personality and behavior is unlikely. Changing the family dynamics isn’t.

Although I’m happy to have a session or two with the senior, ultimately I want the family to join us to try to make peace with each other. Often members in a conflicted family are willing to give it a try as they understand it’s a “last chance.”

Mortality: Seniors who come for therapy usually want to talk about end of life. No matter how physically and mentally fit they are, they know death is inevitable. Some respond with fear, some with depression, some with a basket of “should ofs-could ofs-would ofs”that only make them feel badly.

Some react with acceptance and even some relief. Their challenge – and ours – is to find ways to heal the things that can be healed and to make peace with those that can’t; to let go of old hurts and pain; and to embrace the parts of their history that have been well-lived.

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What Do I Do about Side Effects?

From the U.S.: Can dietary mineral supplements like potassium and/or magnesium (or anything else) reduce the solitary adverse reaction of muscle stiffness I’m having to my daily 20 mg of Latuda. It’s a terrific drug for doing what it’s supposed to do., but I have stiffness. At first stiffness caused me to stop going to the gym so I gained weight. But when I realized that the soreness was not getting worse, and I was getting fatter, I went back to the gym. I basically feel like I’ve been working out 24/7 even when I’m not. I’e taken ibuprofen occasionally for the pain, but not often. I’ve been on Latuda about 6 months; noticed soreness right away.

My psych said it was just a side effect; the drug manufacturer had no insight. So, has ANYONE found a natural remedy to offset this annoying side effect? It’s not enough to make me stop the med, but it would be nice if the soreness could be lessened. (FYI, I drink lots of water; ta ke levothyroxine 40mg daily).

Thank you for writing. You are asking important questions. But we are not medical doctors so are not in a position to answer. I can only suggest that if you aren’t satisfied with the answers your psychiatrist is giving you, you seek a second psychiatrist’s opinion. I also suggest that you talk to your medical doctor. It’s possible your symptoms are a side effect of the Latuda. It’s also possible that you have coincidentally developed a medical problem that has nothing to do with the medication.

Do pursue this further. If it is a side effect of the Latuda, you will need to evaluate whether the benefit you are getting from it is worth the discomfort. If there is a medical issue, you need to know — and learn what to do.

I wish you well.
Dr. Marie

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Book Review: Bringing Your Shadow Out of the Dark

There are many things in this world that are forbidden and many more that we forbid ourselves. We may not allow ourselves to feel or acknowledge our shame, anger, longing, or grief.

When we are not aware of the feelings we disallow, they act under the surface, driving behaviors we may not fully understand. In his new book, Bringing Your Shadow Out of the Dark: Breaking Free from the Hidden Forces That Drive You, Robert Augustus Masters takes us inside the world of the shadow self and shows us that in breaking free from our shadow self, we also break free from our ingrained conditioning so we can find a fuller, more grounded sense of self and an enhanced capacity for life and love.

“All of us have our own shadow, which is packed with our unique assembly of those aspects of ourselves we’ve learned to keep out of sight, a collection accumulated over the course of a lifetime. We learned, for reasons of survival, to deny or bury our deeper pain and core wounding,” writes Masters.

The fear of the shadow self is also universal as it is often only witnessed in dramatic and unforeseen outbursts that leave us painfully aware of the discord within ourselves.

Masters writes, “Our shadow is the place within each of us that contains what we don’t know, don’t like, or deny about ourselves.”

Yet the exploration of the shadow — although uncomfortable at times — moves us from an abstract experience of the self to a direct one. Masters describes the experience of his client Mark: “I saw his internal division: there was sincerity, hurt, and a subtle flatness in his left eye, but something darker and harder was emanating from his right eye. I had him face me and cover his left eye with his left hand, and then I guided him into expressing what he felt as he looked at me through his right eye: aggression and entitlement, tightly coiled but very much present.”

The shadow also houses all of our early conditioning, which can often feel like a sort of imprisonment that we interpret as normal. “Though we may intuit, at least to some degree, that we’re trapped, we still tend to invest a lot of energy in seeking effective distractions from this sense of imprisonment, perhaps visualizing freedom as a more comfortable place, without seeing that this apparent freedom actually may just be another kind of prison,” writes Masters.

Interrupting the reactivity that is fueled by the shadow self, Masters tells us, requires that we step back, slow down, and create space. He writes, “You start to realize that, while you were being reactive, your voice sounded much like it did when you were seven or eight years old. The same desperation, the same drivenness, the same cadence. You were hurting considerably then and trying to keep your hurt out of sight, because earlier times had been met with parental rejection and shaming.”

The shadow can also emerge in our sense of self, influencing how dependent or independent we feel, and how capable we are of recognizing and embracing our interdependence. One way to begin exploring our shadow, then, is to look to our fears. Masters writes, “When we are in the grip of fear, things often become more shadowy, more threatening and more edgy, keeping us excessively vigilant — and small.”

Through exploring our fears, and especially not shaming ourselves for them, we become open to compassion, empathy, and our inherent vulnerability.

We also come to see the underlying motivations of our actions — a kind of honesty that is committed to recognizing and no longer being controlled by the motivations we’ve kept in our shadow.

Reactivity, for example, can be a chance to explore our shadow more fully, and in doing so, open the space for increased transparency and vulnerability.

While working with our shadow is a major undertaking, Masters tells us, four practices are necessary: being present, having healthy empathy, the practice of not-knowing, and holding space for our shadow elements.

We may also find that in exploring our shadow, we find our inner critic. Masters writes, “There are painful, dark, embarrassing things in each of us — qualities we can easily disown, reject, or deny. But when we move toward these things, approaching them with both care and curiosity, there’s a sense of them leaving our shadow, shifting from being disowned or rejected its to reclaimed me.”

To emerge from our shadow, and the pain, grief, shame, anger, and self-sabotage it contains, we have to enter it. And when we do, we may find that not only are we no longer controlled or imprisoned by our shadow, but rather fueled by empathy, compassion, wholehearted love, openness, honesty, and a complete experience of who we are.

Bringing Your Shadow Out of the Dark: Breaking Free from the Hidden Forces That Drive You
Sounds True, October 2018
Paperback, 248 pages

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