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Why Can’t I Sleep? Do I Have a Sleep Disorder?

Sleep Disorder

Most people, at one time or another, have experienced trouble falling asleep or staying asleep. Inability to sleep occasionally is normal and is often the result of some sort of stress in life. However, when sleep problems become a regular occurrence and begin to affect one’s ability to function in daily life, the person may have developed a sleep disorder.

Do I Have a Sleep Disorder?

A lack of adequate sleep may not seem like a big problem, but it can seriously affect one’s performance at school or work, ability to concentrate, ability to control emotions, and ability to handle stress. Lack of sleep is a challenge to one’s own general health and well-being.

Adequate sleep is a great buffer that helps to protect people from everyday stress. Sleep is a vital support for one’s ability to rejuvenate the mind and body.

Any type of sleep deficiency can seriously increase one’s vulnerability to a variety of physical disorders and to a host of negative feelings, emotions and behaviors:

  • Anger
  • Anxiety
  • Frustration
  • Irrational thinking
  • Irritability
  • Sadness

Inadequate sleep:

  • A reduction in the amount of sleep one experiences. This occurs when people find that they are not sleeping enough hours each night.
  • A reduction in the quality of sleep one is receiving. This occurs when people find that they are having a hard time falling asleep, often awaken, and then may have difficulty going back to sleep. This reduction causes a dramatic break in the sleep cycle.

What is the Sleep Cycle?

Sleep is an altered state of consciousness in which brain waves pass through distinct stages that keep cycling between REM (Rapid-Eye Movement) and Non-REM sleep. This is referring to the sleep cycle, and this is how the sleep cycle works:

There are four stages of sleep: Stage 1, Stage 2, Stage 3, and REM. These stages do not always occur in order. In fact, they rarely occur in order. The sleep cycle begins with three Non-REM phases that people typically go through before reaching REM sleep:

Stage 1 – TRANSITION

This stage between asleep and awake is almost always first. It may be just a minute or so long, but is usually less. It is just a transition from awake to Stage 2 where one spends about seventy-five percent of the night. Typically, a person will drift straight through Stage 1 for a minute or two, and be in Stage 2 for some time. One’s eyes are closed, but it’s easy to wake the person up.

Stage 2 – LIGHT SLEEP

This is a light sleep. One’s heart rate slows and one’s body temperature drops. The body is getting ready for deep sleep.

Stage 3 – DEEP SLEEP

This stage is tricky. Deep sleep is also called delta sleep. It is the restorative sleep for the body, when the brain secretes growth hormones, and when our breathing is most regulated. Children have a long period of delta sleep. As we age, the amount of delta sleep that we have decreases by a certain percent each year, so that by the time we reach ages 60 to 70 we have little to NO delta sleep. Men begin to bypass the delta sleep stage sooner than women. So, it is likely that in an adult population, a researcher will not see delta when studying a normal night of sleep. There will be a night here and there when an adult will have an instance of some delta activity, but it is not a stage that they go through on a nightly basis. It is harder to rouse one during this stage, and if someone wakes one up, one would feel disoriented for a few minutes. During the deep stages of Non-REM sleep, the body repairs and re-grows tissues, builds bone and muscle, and strengthens the immune system.

The Sleep Cycle now moves into deep REM sleep: Usually, REM sleep happens approximately 90 minutes after one falls asleep. The first period of REM typically lasts 10 minutes. Each of the later REM stages gets longer, and the final one may last up to an hour. One’s heart rate and breathing quicken. One tends to have dreams during REM sleep. The cycle then begins all over again. The last REM cycle is the longest and most restorative and awakening during this cycle can leave one feeling disoriented.

Common Types of Sleep Disorders

Many different types of sleep disorders are listed below. Check if you think any of them might apply to you.

Delayed Sleep Phase Disorder is a disorder in which a person’s sleep is delayed by two or more hours beyond the conventional bedtime. This delay in falling asleep causes difficulty in waking up at a desired time.

Insomnia is the most common type of sleep disorder. Some of the symptoms of insomnia include difficulty getting to sleep, waking many times during the night, and often waking before it is time to actually get up. Insomnia can affect normal daytime activities. Insomnia is most often caused by stress, anxiety, certain medications, depression and/or inadequate sleep habits.

Narcolepsy occurs when people feel excessively sleepy in the daytime. The sleepiness felt with narcolepsy is overwhelming. Some people with narcolepsy have uncontrolled sleepy periods that can occur regardless of what they are doing, while others have constant sleepiness throughout the day. The person has this feeling for a period of time longer than three months, and it is accompanied by a higher than usual percentage of REM sleep.

Nightmares are frightening dreams that occur during deep, REM sleep.

Periodic Limb Movement Disorder is the movement of hands, arms, feet, and legs during sleep that frequently causes arousals and disturbs the sleep cycles. Whether the person remembers waking or not, the brain often shifts from sleep to wake in a response to the jerking of the limbs causing the sleep cycle to be disrupted and worse excessive daytime sleepiness.

Restless Leg Syndrome occurs during wake hours and is often worse in the evening and before bedtime, which can lead to sleep onset insomnia. This discomfort can come in the form of an urge to move one’s legs and feet to get relief. People find themselves experiencing excessive and rhythmic movements while they are sleeping.

Sleep Apnea occurs when soft tissue covers the airway, either partially or completely, causing a cessation of breathing for ten seconds or longer repeatedly through the night. This can cause frequent arousals and disruption of the desired sleep cycle. These disruptions cause those suffering from sleep apnea to be very tired during the day.

Sleep Talking is a sleep disorder defined as talking during sleep without being aware of it. Sleep talking can involve complicated dialogues or monologues, complete gibberish, or mumbling. The good news is that for most people it is a rare and short-lived occurrence.

Sleep Terror Disorder occurs mostly in children but can be found in adults. Night terrors are frightful images that appear in a person’s dream but are often difficult to remember upon awakening.

Sleepwalking is a disorder that causes people to get out of bed and walk while they are sleeping. It usually happens when a person is going from the deep stage of sleep to a lighter stage, or into the wake state. The sleepwalker can’t respond during the event and usually does not remember it.

My Self-Care Sleep Habits

Sleep habits are often dependent on wellness habits that you display during the day. Think about some of your wellness habits and how they may be negatively affecting your ability to sleep at night. In the chart on the attached worksheet, write about how you can make positive change in your wellness habits.

Click here to download the My Self-Care Sleep Habits worksheet.

This material was excerpted from Coping with Sleep Issues by Ester R.A. Leutenberg and John J. Liptak, EdD.

World Mental Health Day

Saturday was World Mental Health Day. Whole Person Associates would like to present the following in response to the reminder that we all need to care for our mental health.

Some people are more optimistic than others and see the glass as half-full rather than half-empty. The half-full folks are optimists. Their ability to look at the world in an optimistic manner helps them maintain their mental health.  As an optimist, regardless of transitions, setbacks, or disappointments, the person looks at the bright side and sees the possibilities life has to offer. Optimists expect good things to happen, expect to be able to solve problems efficiently, and plan to accomplish their life and work goals. They go through life with positive outlooks and are content most of the time.

What is your outlook on life?   Answer these questions to find out.

  • Do you believe yourself to be an optimist or pessimist? Why do you believe this?
  • How long have you been an optimist or pessimist? What brought this worldview on?
  • How did your childhood affect the way you view the world?
  • How can you begin to view the world in an even more positive light?
  • Think of a time when you viewed a situation as negative, and yet, something positive came out of it?

Click here for a link to a printable version of this exercise, Life Outlook.

Can you change your attitude on life? Try these suggestions or click here for a printable copy of Reconstructing My Attitude.

When you find yourself getting stuck in a cycle of negative thinking, what is one method you can try to restructure your thinking from pessimistic to optimistic?

Consider the situation, as an example, of going back to school.

  • When you feel yourself becoming negative, identify your negative thoughts: “I’m not good enough,” “I’m not smart enough,” “Everyone will be much younger than me,” “I have not been to school in such a long time.”
  • Think about the accuracy of your statements. What is the proof they are accurate? When you look at them objectively, what do you learn?
  • Think of positive ways to restructure these thoughts. “If other people can go back to college so can I,” “I will be more experienced than many of the other students,” “It’s never too late to learn,” “I deserve the benefits of going back to school.”
  • Take action: “I will go to the school on Friday and pick up an application. I will complete it over the weekend and search online for information about financial aid.”

The article and exercises above were excerpted from The Building Resiliency Workbook by Ester Leutenberg and John Liptak, EdD.

There are signs to look for if you or someone around you is showing evidence of early signs of a mental health problem: 

  • Eating or sleeping too much or too little
  • Pulling away from people and usual activities
  • Having low or no energy
  • Feeling numb or like nothing matters
  • Having unexplained aches and pains
  • Feeling helpless or hopeless
  • Smoking, drinking, or using drugs more than usual
  • Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
  • Yelling or fighting with family and friends
  • Experiencing severe mood swings that cause problems in relationships
  • Having persistent thoughts and memories you can’t get out of your head
  • Hearing voices or believing things that are not true
  • Thinking of harming yourself or others
  • Inability to perform daily tasks like taking care of your kids or getting to work or school

Retrieved from: https://www.mentalhealth.gov/basics/what-is-mental-health on 10/10/20.

What should you do if you notice these signs in yourself or someone else? Click on the link above for some helpful information.

Romantic Intensity Versus Intimacy

Intensity Versus Intimacy in a Romantic Relationship

Goals:

  • Gaining clarification between deep connection and passing infatuation
  • Maximizing enjoyment and minimizing the downside of dating

The beginnings of an intense romantic relationship can be exciting and fun. Being clear about the difference between intensity and intimacy, and knowing what you want from a relationship can help you stay balanced and avoid disappointment.

Exercise:

Studies show that falling in love activates areas of the brain associated with gut feelings and euphoria. The frontal lobe area, associated with higher thought, is not especially active. So how do you keep your feet on the ground when you are attracted to someone?

Answer these questions to help boost your intimacy IQ. Intimacy involves closeness, comfort, familiarity, trust, and acceptance.

Mindfulness for Emerging Adults Book Release
  • Can I talk openly to my partner about my fears?
  • Can I talk openly to my partner about my hopes and dreams?
  • Can I talk openly to my partner about my past?
  • Can I accept my partner’s past?
  • Can I listen and support my partner in conversations about fears, hopes, and dreams
  • Do I feel safe with my partner?

If you answered yes to most of these questions, you are on your way to establishing intimacy.

Intensity usually involves feelings of euphoria and preoccupation.

  • We have been physically close, but I really don’t know much about my new partner.
  • My partner doesn’t really seem to be interested in things that are important to me.
  • There has been a lot of “love bombing” – Heavy doses of romantic gestures and flattery, but not a lot of authenticity.
  • Does my partner try to change me?
  • Do I try to change my partner?
  • Does my partner often disappoint me by changing plans or otherwise being inconsistent?

If you agree with or answer yes to most of the above statements, you may be in the throws of an intense romantic and physical relationship. There may be nothing wrong with this! Just make sure that you are on the same page about the direction of the relationship.

-This exercise is excerpted from Mindfulness for Emerging Adults

Relax Away Your Stress

Physical distancing and isolation measures, [and] the closure of schools and workplaces, are particularly [challenging for] us, as they affect what we love to do, where we want to be, and who we want to be with,” said Dr. Hans Kluge, the WHO’s (World Health Organization) regional director for Europe, in his opening remarks.

“It is absolutely natural for each of us to feel stress, anxiety, fear, and loneliness during this time. At [the] WHO, we consider [effects on] our mental health [and] psychological well-being as being very important consequences of COVID-19,” he added.

Everyone seems willing to acknowledge that the pandemic and its consequences are stressful. To make it even more difficult to endure, our usual contacts with health professionals of all kinds has changed dramatically. We now have virtual appointments which are helpful, but not the same as a face-to-face visit with someone we trust to help.

Recently, to add to the cares and worry of the pandemic, there is civil unrest in the United States and throughout the world as the issue of systemic racism again raises its ugly head.

What can we do, pretty much on our own, to combat these stressors? Is there a magic wand out there we can wave over our heads to allivate this sense of drowning in stress? Of course not. However, there are some steps each of us can take that will help.

Kat Hounsell is a leadership coach and mental health first aid instructor, and founder of everyday people, says, “Be kind and patient with yourself and those around you.” She also stressed the importance of maintaining other healthful habits — such as eating regularly and sticking to a healthful diet — because these are, in themselves, a cornerstone of mental health.

In the same article, business neurolinguistic programming practitioner and mental health trainer Tania Diggory, founder and director of Calmer, said, “[w]hen working from home, prioritizing your mindset and well-being at the start of the day is essential.”

Of course, sounds simple. Anyone can do that. We can, but do we do it daily…not always. Try this, it will help.

Before you sign off for the day make a list of tasks for your next session. Prioritize them and refer to it first thing. Break things up into manageable units. Just saying, “Get final budget proposal for the company” isn’t going to work. Break down the tasks needed to accomplish large goals. You will find crossing off small tasks almost as satisfying as deleting big ones, and, when you eventually can cross off that giant budget approval that seemed so difficult and far off, you will not have driven yourself into the ground with frustration because you can’t see progress being made.

When you take a break at work, go to lunch, on your commute, take along headphones and listen to a relaxation script. There are several types of relaxation…their formal names are not important. Below is a link to a free script from Natural Tranquilzers, an excellent compilation of different types of relaxation. Remember: being able to relax on command is a muscle skill. Wayne Gretsky, the best hockey player ever, had to learn how to handle the puck and shoot at the goal just like any other 5 year-old Ice Mite did. Van Cliburn, pianist extraordinaire, wouldn’t have learned to play with the beauty and artistry he exhibits if he hadn’t trained his muscles to know where the notes were on the keyboard, practicing scales. You, when you first try to relax using a time-honored relaxation technique, will need to train your muscles, too. Many people find that at around the seven to ten day mark their muscles begin to relax on command and they see the benefits begin to accrue.

Schedule time to wind yourself down. Even at work, you can take 5 or 10 minutes to listen to your favorite relaxation MP3 file. Click here for a link to download Calm Down, a free relaxation script track from Natural Tranquilizers, one of our relaxation audio products. Practice it for seven to ten days. The trick is teaching your muscles to respond to the music and words you are hearing without you having to consciously tell them to do so. It works!

Pandemic Anxiety: Mental Health Awareness Month

May is mental health awareness month. Many of us are experiencing more anxiety than usual with the pandemic and all of the uncertainties we are facing. Pandemic anxiety can feel overwhelming at times.

Stressed by Anger
Intense anxiety isn’t always obvious.

If you are suffering from depression, if you can’t keep up your usual activities, if you have been sad for weeks and can’t seem to recover as usual, please contact a mental health professional right away. If you are feeling anxious, unable to function in your usual ways call your local mental health clinic. Even insurance companies are recognizing virtual appointments during the pandemic, and, most of the time, covering the cost. Of course, check with your insurer, but don’t put off getting the help you need. 

The conversations that go on in our own heads during the pandemic can be a contributing factor to our levels of pandemic anxiety. Click here to download the Worry Self-Talk exercise from the Managing Intense Anxiety Workbook, by Ester Leutenberg and John Liptak, EdD.   

In an article published in the March, 16, 2020  Psychology TodayDr. Deborah Serani gave five suggestions for dealing with pandemic anxiety and panic.  

1. Ground yourself in science. Resist viewing or reading sensational news or social media, where facts are often blurred or exaggerated. Instead, reach out to your local health or state department of health for up-to-date information on COVID-19. Science-based facts will help ground you in a reality where truth, hope, and interventions exist.  

2. Isolate but stay connected to others. Protect yourself with social distance and homebound activities. But make sure to keep your attachments to friends, family, and loved ones by calling, texting, using FaceTime or Skype.  

3. Think locally, not globally. Focus on what is happening in your local community and what you can do to keep yourself and neighbors healthy and safe. A sense of community is vital for moving through traumatic situations and builds resilience in children and adults. 

4. Practice self-care and make sure others do too. Be mindful of eating well, keeping a healthy sleep cycle, exercising, and other soothing self-care behaviors. Make sure to avoid using alcohol or drugs to cope with stress. And limit caffeine, as it heightens anxiety and irritability. 

5. Fight helplessness by finding purpose. The uncertainty that COVID-19 brings can leave many of us feeling unspeakably helpless. Finding purpose can alleviate restlessness and anxiety. Choose things you can control, be it shifting negative thoughts into positive ones, deciding what to cook for lunch, reading a good book, picking what movie you and the kids will watch, or other activities you have power over.  

Moodiness and Depression

As the pandemic drags on and on, more of us are struggling with depression, moodiness, and other mental health issues. In a March 20, 2020 article in US News and World Report, it was reported that “Fear of the unknown and uncertainty over how long we’ll have to resort to limiting our daily lives, fear of contracting the coronavirus or even worry about how this will affect one’s financial situation are legitimate concerns.”

Often, we are afraid to bring these concerns up to our families. We struggle on alone, chiding ourselves…we have so much, how can we be so sad; we are still managing to get up in the morning and go to bed at night, things can’t be all that bad; we lost our job, but unemployment is there and so helpful; I really miss the interchange between me and my coworkers (even though I used to complain about them to my partner all the time.) I ran short of food, but the food-shelf was there to step into the breach. I even saw my supervisor standing in line. It isn’t like my family is going without, why should I be so sad. My granddaughter asked if I ever smile anymore. I could have told my daughter how depressed I’ve been, but I didn’t want to put down my “Grammy can handle anything” reputation. Besides, I didn’t want to burden her with something so “silly” as being depressed. So why do I still feel so sad, depressed, lost?

Our unwillingness to act on our feelings of depression and sadness might well be based in the stigma that still haunts mental health issues. The stigma of experiencing depression or moodiness is often more damaging than the experience itself. Although we have come a long way, the acceptance of mental health issues is still a long way off. Learning to cope with your moodiness and the stigma that surrounds it will be helpful. If you would like help dealing with the stigma of mental health issues click here for a worksheet that will help: Focus on Your Strengths Worksheet

If you are one of the people like those in the first paragraph who minimize your depression or moodiness you might find this helpful: Ways I Try to Minimize My Moodiness Worksheet

Managing Moods Workbook

People become sad for a variety of reasons including disappointment, grief, frustration of not being able to accomplish a project or not getting what’s desired, experiencing despair during the pandemic, etc. When these feelings of sadness last for hours or even a couple of days, they may not be a cause for concern. They may be part of the normal “ups” and “downs” of life. It is common for people to feel blue or down, become frustrated and/or experience a sense of emptiness from time to time.

However, a sad mood which won’t let up can change the way people think and feel and may be a sign of a more serious problem. When people find themselves for several weeks taking little joy in activities they have previously enjoyed, appear irritable a majority of the time, and feel fatigue and a general loss of energy, they may be experiencing the symptoms of more serious problems.

These more serious mood or depression problems stretch far beyond the usual limits of disappointment, loss, frustration, and joylessness. They can be accompanied by an inability to cope with everyday life issues and stressors. Rather than temporary feelings of down in the dumps, these extreme feelings tend to last for more than a few hours or days. They tend to affect all aspects of a person’s life and leave the person feeling empty, unable to move, and hopeless for weeks, months and even years.

People who experience problems in maintaining a balanced and healthy overall mood are often incapable of functioning well in daily life. They often experience extreme emotional states, negative feelings, and self-defeating moods that are inconsistent with what is happening in their environment. People struggling with these mental conditions find that they are unable to overcome their moodiness in the workplace, at home, with family and friends, at school, and in their community. People who experience depression and moodiness may have problems in interpersonal relationships, ability to work effectively, study and concentrate, and in the ways they eat, sleep, relax and live their daily lives.

Much of the material above is from Managing Moods by Ester R.A. Leutenberg and John J. Liptak, EdD.

Oh Happy Day! Optimism Is Good for Your Health

Optimism during crisis

Photograph by Deb Lutkevich

During this time of crisis, when normal seems long gone, will those who are optimistic fare better? Will they cope with the change brought on by the pandemic better than their pessimistic cohorts? Does a magic wand sprinkle fairy dust over those who believe, no matter what, that things will work out for the best? Even if that optimism is unfounded in reality? It turns out optimistic folks do better than those who are more pessimistic in their outlook.  

In an article in Psychology Today, July 2016, Utpal Dholakia Ph.D. said, discussing dispositional optimism, or how much folks believe that things will have positive outcomes for their family, support systems, even for the economy and the entire world. “More than five decades of research have found that optimism is a potent health tonic. Optimistic people remain healthier and live longer.” (Dholakia, 2016)  

Dr. Dholakia believes there are four reasons that dispositional optimism leads to healthier people.  

  • Dr. Dholakia says that optimistic people know more about their health conditions and how to improve them. If you know what to do to be healthy and overcome health challenges, you are ahead of the game. Optimistic people are willing to study their conditions and find ways to do what is best. Compliance is high. 
  • Optimistic folks behave in a healthier way than those who are not optimistic. These behaviors lead to feeling better, which then lead to the continued practice of healthy lifestyle choices. They live longer and better than those who aren’t so optimistic. Dr. Dholakia says, “Optimists’ healthier actions lead to more positive health outcomes.” These, in turn, promote healthy activities, producing a virtuous cycle for good health. 
  • Optimistic people have better coping skills. When faced with a setback, they know how to deal with it. They believe that if they follow their time-honored skills, all will be well. 
  • Optimists believe they have better support systems both in and outside their family circle. Because they are usually likable folks, they often do have a larger group of supporters to call upon in times of need. They also believe that their support system will enjoy helping them deal with whatever difficulty they are facing. 

“Choose to be optimistic, it feels better.” – the Dalai Lama 

Retrieved from https://www.psychologytoday.com/us/blog/the-science-behind-behavior/201607/4-reasons-why-optimistic-outlook-is-good-your-health on April 20, 2020.  

-Written by Peg Johnson

For resources that promote optimism and support uplift, see our Self-Help section and titles like:

The Grief Experience

One of the important aspects of grieving that has been largely overlooked is the relational aspect. Each person’s grief is unique because he or she: 

  • Had a unique relationship with the deceased (loving, ambivalent, challenging)
  • Brings a unique personality and coping mechanism to the situation
  • Has a particular world view which will impact how he or she enters the process
  • Has ongoing relationships which may or may not be helpful
  • Has a unique relationship with death
  • Came to this particular loss with a unique history of dealing with earlier losses
  • Has particular expectations about what dealing with the loss means and wonders how dealing with the loss “should” proceed
GriefWork Resources

The grieving process can occur in many types of losses; although we focus on loss by death, the concepts presented can be applied to other losses.

We view the grieving experience as a long, winding path that curves back on itself, traverses hills and valleys, and has many obstacles. It is a path that is challenging to negotiate, time-consuming to travel along and may provide opportunities for personal and spiritual growth. Grieving is a part of the human experience. A person attached to someone will mourn the loss of that relationship and miss that person’s physical presence. We understand this as a simple truth. Remembering this truth does help some people cope with the loss because they are able to be somewhat philosophical.

The process may be more complicated when the relationship with the deceased was either ambivalent or challenging. The reality, for most people, is that relationships are not easy to put into these categories. Most long-standing relationships are at times loving, at times ambivalent, and at times challenging. The degree of challenge will likely add to the complex feelings that the person who is grieving will experience. Along with the death of the person, the bereaved may also grieve the reality of unmet needs represented by the relational difficulties.The death of a loved one is a major life event. When assessing the progress of a grieving client, the facilitator must be aware of that person’s level of functioning in all domains prior to the loss.

Definitions

BEREAVEMENT refers to the experience of the loss of someone through death.
GRIEF is the reaction to bereavement. It is a universal response to any loss.
MOURNING refers to the expression of grief in culturally specific ways.
LOSS refers to no longer having somebody or something.

Kinds of Losses

Loss is a part of everyone’s life at some point. Each person reacts to a loss in a personal way. As well as the emotional response, loss also has physical, intellectual, behavioral, social and philosophical dimensions. Response to loss is varied and is influenced by beliefs and practices.

People’s losses, no matter what, are important and often devastating to them. They represent the disappearance of something or someone cherished.

Some examples of loss: 

  • Addiction
  • Death
  • Divorce
  • Failed business venture
  • Faith
  • Financial security
  • Home
  • Independence
  • Mental ability
  • Pet
  • Physical health
  • Plans, hopes and dreams
  • Relationships
  • Role in life
  • Sense of safety/security
  • Status
  • Treasured possessions

Many of the handouts in this book will apply to some of the losses and to most people. Carefully choose the handouts given to each person. If handouts are being distributed to everyone in a group, instruct participants to complete only the parts applicable to them.

-From the Introduction to GriefWork: Healing from Loss by Fran Zamore, LISW, IMFT and Ester R.A. Leutenberg

Use the Coupon Code GRIEF2020 at checkout prior to June 1st, 2020, and receive 30% off of the following workbooks (print and/or PDF eBooks) from our GriefWork Series:

About Caregivers

During the pandemic we are making our book, The Complete Caregiver Support Guide, available at a reduced price to help more therapists add this valuable resource to their library. Find the coupon code at the bottom of this blog post.

Former First Lady Rosalynn Carter stated,

“There are four kinds of people in this world: those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers.”

This includes virtually everyone!

A Brief History of Caregiving

In past generations, it was customary for people to have large families. Members of an extended family often lived within a few miles of each other. Few women had jobs outside the home, so the elderly and infirm were cared for within the family. Both the primary caregiver and care-receiver had the support of nearby relatives, friends and community.

Circumstances are different today. Families are typically smaller and are often scattered across the country and around the globe. A much larger percentage of women work outside the home. People live longer, often with chronic illnesses. These factors make caregiving much more complicated than it was in the past.
The early stage of caregiving is often handled by family members or by friends who live near the person needing help. They begin by simply doing what they can and often, as time passes, assume the caregiver role without realizing it – caregiving isn’t a job that many people choose to sign up for.

The tasks caregivers perform can vary widely, from transporting a child with disabilities to school each day, to doing someone else’s laundry, to helping with medications, to dealing with insurance companies. Caregiving can be temporary, as when someone is recovering from an accident, or long-term, as when caring for a person in need of significant ongoing support.

In an attempt to define family caregiving, the National Family Caregivers Association (NFCA) developed a list called “Caregiving Is.” The text below was inspired by that list.

Caregiving is as diverse as the individuals needing it. It can be 24-hour care for persons who cannot manage daily tasks of living or are suffering a significant level of cognitive loss. It can be preparing for an uncertain future because a spouse has a progressively disabling disease, even though that person is still able to function quite well. It can be temporary, last several years or last a lifetime.

Caregiving means being a person’s healthcare advocate. It requires learning to work with doctors and other health care professionals and to navigate government healthcare programs. It can also be learning what it means to die with dignity and making sure that the care-receiver’s wishes will be honored.

Caregiving is stressful work. Most people have had no training or education regarding the many aspects of caregiving when they begin helping their care-receiver. They discover that caregiving is assuming tasks they never dreamed of undertaking. It can be learning about medications, wheelchairs, lifts and gadgets that help struggling fingers button a shirt. It can involve doctor visits, calls to 911 and long days and nights in a hospital waiting or emergency room.

Caregiving challenges people to go beyond their comfort zone. It is having conversations on topics most people hope they will never need to address. It is grappling with questions that often have no easy answers. It is loving, giving and sharing. It is accepting, adapting and being willing to keep on going.

Caregiving forces individuals to deal with change. They are often required to re-evaluate finances, living conditions and/or their personal work situation. They will need to make compromises and readjust again and again as the circumstances change.

Caregiving is an endless search for balance. It is seeking the middle ground between doing too much for the care-receiver and doing too little. It is trying to find time for personal needs – and hopefully, even wants – while providing for another’s needs. It is recognizing that one cannot do it alone – one can and should ask for help, respite care and time off for a vacation to recharge through activities that help maintain a sense of self.

Caregiving is a strain on relationships. Even the best of relationships can be challenged by the stress of caregiving. The demands on one’s time and energy may leave family members or friends feeling neglected. Moving a parent into a family home – or moving into the parents’ home – can be a source of contention between couples, and between parents and their children. Finances and other emotionally charged issues can also cause tension between adult children of an ailing parent.

Caregiving can be a lonely world. While the tasks and experiences of caregiving may be similar in nature, surprisingly they are not what unites family caregivers. According to the National Family Caregivers Association, the common bond of caregiving is the emotional impact.

Those caring for others often feel lonely, isolated, and unacknowledged for all their work and sacrifice. They can experience anger and resentment toward family members and others who carry on as usual, while they of necessity give up much of their normal life. They grieve the losses in their own lives as well as and the loss of the person their care-receiver once was as they watch him or her decline. They often experience depression, sadness, pain, the need for normalcy and regret for what they might have done had circumstances been different. They also may feel guilty because they sometimes wish it were over.

Caregivers can find comfort in learning that such feelings are perfectly normal and in finding ways to cope with them in support groups and within these pages. They can also find hope in the possibility of connecting on a deep level with their care-receiver and creating closer bonds with family members. In fact, discovering positive meaning in the tasks of caregiving is crucial for the emotional health of everyone involved.

Caregiving can also be moments of joy and fulfillment.

  • Happiness when seeing one’s child with a developmental disability learn a new skill.
  • Joy when a spouse’s face lights up, expressing thanks for being his or her partner on a difficult path.
  • Closeness during nighttime conversations about love, life, death, and what’s most important.
  • Satisfaction in the knowledge that one has provided something for the care-receiver that has made life better.
  • New recognition of one’s inner strength and determination.
  • Gratitude for simple things, for each new day.

-From the Introduction to The Complete Caregiver Support Guide, by Ester R.A. Leutenberg and Carrol Morris, with Kathy Khalsa, OTR/L

Use the Coupon Code CARE2020 at checkout when you order The Complete Caregiver Support Guide before June 1st, 2020, and receive 30% off the workbook. This code can be applied to your purchase of the print workbook and/or the PDF eBook.

Resiliency: A Key to Winning the Battle

Resiliency has been defined as the ability to:

Building Resiliency Workbook
  • manage life’s challenges, stresses, changes, and pressures effectively.
  • cope and adapt successfully to adversity.
  • bounce back to a balanced state after facing a major disruption in life or career.

People have an innate ability to demonstrate resiliency when they have resiliency skills built into their lives. Resilient people are able to adapt successfully under adverse circumstances such as: poverty, mental illness, disasters, terrorism, physical or psychological trauma, divorce, job loss, prison, loss of a loved one, parent’s divorce, prolonged stress, physical or sexual abuse, or a lack of safety. Resiliency, or a positive behavioral adaptation, is critical when people encounter any type of trauma.

Right now, in this current Covid19 crisis, we all need resiliency. Look at the bullet list above. Managing the new challenges, etc. posed by the crisis is crucial to surviving it. Do we need coping skills that are healthy and effective? For certain. Do we need the ability to bounce back from the bizarre lives we are currently facing? Absolutely. It has been vital that people rise to the challenges the pandemic presents. For the most part we came up to the plate and hit a homer. We sorted out the mixed signals that bombarded us from our elected officials. Recovery as a nation will depend, to a great extent, on individuals, families, work groups, and total strangers. The ability to bounce back to our new reality and forge a new normal for our families is key.

Research shows that resiliency offers protection from distress and illness in the face of change or adversity. The presence of high levels of resiliency is associated with these factors:

  • high level of happiness,
  • high level of self-esteem,
  • high sense of energy and vitality,
  • high level of optimism,
  • high level of self-reported health,
  • high sense of meaning and direction,
  • low level of depression.

People who are resilient . . .

  • work because they enjoy it,
  • react in an optimistic way,
  • see problems as challenges,
  • take positive action,
  • think of change as natural and go with the flow,
  • thrive under challenging situations,
  • find it easy to be content in various situations,
  • believe that they can influence events and their reactions to events,
  • recognize that with stress comes growth.

That same research cited above tells us that resiliency can be built.

So, let’s first look at our ability to bounce back from adversity with the following resiliency scale: Ability to Bounce Back Scale.

Next, try this Invest in Yourself exercise.

Good luck to us all as we begin to see an end to this historic effort to save lives.

This material was excerpted from Building Resiliency by Ester Leutenberg and John Liptak, EdD.

Guided Meditation for Shelter-in-Place

With so many of us honoring a shelter-in-place mandate it is only to be expected that stressed out folks are going to feel overwhelmed every-once-in-a-while. Try a family guided meditation, guided imagery, or a simple breathing exercise to encourage calm. After describing the material you will be reading, suggest that the participants find a comfy place they can relax. Tell them if they would like to close their eyes, to do so. Once everyone is settled begin reading the script. Use your regular voice. Don’t over dramatize the content. Choose a slow and steady pace. You should practice reading the guided meditation script alone. Note: read the script yourself a couple of times so you can read it smoothly to others..

Things to remind your family or group:

  1. If the material makes you uncomfortable you do not have to participate. Instead, relax, be in the moment, clear your mind of everyday worries, and go on a self-led guided meditation tour by remembering a place that you love, people you love, and activities you love.  Let them fill your imagination.
  2. Relaxation techniques are like any other muscle memory response. They will improve with practice, so don’t be discouraged if it doesn’t work the first time out. Try different relaxation techniques such as guided imagery, progressive muscle relaxation, or being mindful.  Put yourself in the present moment where you are aware of all the things around you. Experience them, don’t push them away. Remember Coby Bryant didn’t become who he was without hours of practice nor does a concert pianist. Practice.
  3. If your mind wanders during the exercise, don’t be alarmed. Gently bring it back to join with the group.
  4. We are all individuals; our responses to the guided meditation reading will be different. Celebrate that individuality.

This first guided meditation is from 30 Scripts for Relaxation, 2nd Ed. Volume 1

The Sea – Guided Meditation

Don R. Powell

Time: 5 minutes

In this script, participants relax by taking an imaginary journey along a beach, listening to the birds and waves and watching a brilliant sunset.

Script

It’s time to make yourself as comfortable as possible. You’re invited to close your eyes, becoming more and more aware of which parts of your body are feeling tight or tense…and which parts are relaxed…noticing all the sensations…even where it may feel neutral or blank.

Now take a few deep breaths. Each time, take the air in through your nose, holding it momentarily … and then slowly exhaling through your nose … You’ll find yourself relaxing more and more deeply, more and more completely, with each exhalation.

Taking the air in … letting the air out … allowing yourself to relax, more and more.

In a few moments, I’m going to describe a very vivid scene in which you’ll imagine yourself walking along a beach. Allow yourself to imagine this scene as though you are there experiencing whatever sights, sounds, smells, tastes, textures, and touches you can by using whatever senses and concepts come naturally for you to bring the experience alive.

Using your imagination, bring to mind a bright summer day. It’s late in the day. And you decide to go for a walk along the beach. Notice the sun is radiating warmth and comfort as it shines boldly… The sky is crystal clear without a cloud in sight… The grains of sand at your feet reflect the sunlight, warming and comforting the soles of your feet…The sound of the waves are beating against the shore and echo in the air.

If you would, notice the warm, light breeze brushing against your face as you walk onward… Far off in the distance, you can hear the cries of sea gulls … and imagine them gliding through the sky, swooping down into the sea, and then flying off once again.

As you walk further along the shore, you decide to rest. Sense yourself sitting down on a mound of pure white sand and gaze out at the sea, staring intently at the rhythmic, mesmerizing motion of the waves rolling into shore.

Each wave breaks against the coast … rises slowly upward along the beach, leaving an aura of white foam, and then slowly retreats back out to sea, only to be replaced by another wave that crashes against the shore, works its way up the beach, then slowly retreats back out to the sea. Let yourself bring this alive … hearing the sounds … watching the movement … feeling the sensations.

With each motion of the wave, as it glides in and as it glides out, you find yourself feeling more and more relaxed, more and more calm, more and more serene.

The waves are gliding in and the waves are gliding out … You’re feeling more and more calm … Continue to experience the waves gliding in … and out.

Now, staring off into the distance, you notice that the sun is beginning to sink into the horizon. The sun is sinking down and you’re feeling more and more relaxed as you see its movement going down … down … and down.

The sky is turning brilliant colors of red … orange … and all manner of yellows … blues … and purples … As the sun sets, sinking down … down … down … into the horizon, you’re feeling very relaxed and soothed. And you watch the sun as it continues sinking down.

The beating of the waves, the smell and taste of the sea, the salt, the cries of the gulls, and the warmth against your body—all these sights, sounds, and smells leave you feeling very soothed, very calm, very peaceful.

Give yourself room to relax even more.

Pause

In a few moments, I’ll count from one to three. When I reach the count of three, allow your eyes to softly open. And you’ll feel completely refreshed and totally relaxed.
1 … 2 … 3.

It’s time to open your eyes. Stretch … and notice how you’re feeling.

Repeat the above instructions until everyone is alert.

Too grownup for your kids? Try this guided meditation, from
Stress Relief for Kids: Taming Your Dragons

Imagine You’re a Dragon – Playful Exercise

Purpose: stretch your body in seven different ways

Stand comfortably with your arms relaxed at your side.
Let go of the tightness in your knees.
Imagine you’re a dragon who lives up north.
You like cold weather and snowstorms.
Breathe in and lift your arms up over your head.
Move your arms like the cold winds of the north.
Let the snow fly during a big blizzard.
Lower your arms and relax.
Imagine you’re a dragon who lives along the East coast.
You like to play in the ocean.
Breathe in and lift your arms up to waist level.
Move your arms around your body like giant waves.
Let the waves roll in along the shore.
Lower your arms and relax.
Imagine you’re a dragon who lives in the South.
You like warm weather and sunshine.
Breathe in and lift your arms to the side with your palms facing up.
Feel the sun rise over your head.
Lower your hands down over your face and body.
Feel the sun showering you with its warm energy.
Imagine you’re a dragon who lives along the California coast or in Hawaii.
You like palm trees and tropical weather.
Breathe in and lift your arms up over your head.
Move like a palm tree swaying in the breeze.
Feel the stretch in your trunk and limbs.
Lower your branches and let go.
Imagine you’re a dragon who lives in the Midwest You like wide open fields of wheat and corn.
Breathe in and lift your arms up to shoulder level.
Stretch your fingers out as far as you can in every direction.
Reach out over acres and acres of farmland.
Lower your arms and relax.
Imagine you’re a dragon who lives in the Rocky Mountains You like snowy peaks and high elevations.
Breathe in and lift your arms up as high as you can.
Climb up to the Continental Divide.
Reach up to the top of the highest mountain and look out at the view!
Go down to the bottom of the mountain and relax.
Imagine you’re a dragon who lives in the Southwest desert.
You like open skies and beautiful sunsets.
Breathe in and lift your arms up all around you.
Feel the openness of the sky filled with giant clouds.
Stretch your whole body out into space.
Now let go and relax completely.

*Download a printable version of this exercise here.

The Healing Power of Nature

Elizabeth Roberts is a most extraordinary woman. A teacher, philosopher, humanitarian, and social activist, Elizabeth is no stranger to the vanguard of social change. In the early ’60s, she marched with Reverend Martin Luther King to promote civil rights. Years later she launched a crusade for television reform. Her resumé lists her as a former program director for National Public Radio, and it was she who coined the title for the now renowned afternoon news program, “All Things Considered.”

“Most likely that will be my epitaph,” Elizabeth says, jokingly. However, her most lasting legacy may be her awareness of the healing power of nature.

I had been given her book, Earth Prayers, in 1992 by a very dear friend of mine in Vermont. So moved was I by the prayers and poems that I began to use several of them in a relaxation slide show I produced titled, “Mother Gaia: The Healing Power of Nature.” Word circulated about the tremendous impact of the slide show and one day I received a phone call from a conference coordinator wishing to team Elizabeth and I up to do a joint presentation, with Elizabeth reciting the poems from her book. As it turned out, we both live in the same town, so we arranged to meet at her house one afternoon. Over a cup of tea, she shared this story:

“How did the book come about?” she said, repeating my inquiry. “Let me tell you. I had been sick for quite some time with Chronic Fatigue Syndrome. It got so bad that I was bedridden for about nine months. It was horrible. I was so exhausted I could barely lift my hand up to my face. About the only thing I could do was read, but I was too tired to hold a book. The most I could hold up was a piece of paper.

“While I was sick, I had many conversations with God, many times not believing in a God anymore. My theology became a cosmology as I turned to the earth for help. And I got it.

Under a large tree

“Elias, my husband, had sent the word out to my friends not to call because I couldn’t hold the phone to talk. Instead, he said to them, ‘Write letters.’ So they did. Knowing how much I loved poetry, and knowing my love of nature, several friends sent me poems to read. In nine months time, I had quite a collection.”

Elizabeth explained how her dark night of the soul became a womb of creation. She decided to edit the collection of poems into a book called Earth Prayers. The project became her raison d’être and the energy to edit this project became a healing energy itself. “Elias and I sent out invitations for our friends to contribute a poem as well. And oh, the permissions to use some of these poems, you should see the folders in my office,” she exclaimed.

Through her illness, Elizabeth came to see the powerful metaphor nature is. “Nature speaks to us in seasons. There is a time to produce and a time to lay fallow. In hindsight, I saw my down time as that which my body needed to heal. Although I knew of the concept of laying fallow, it took chronic fatigue to make me realize I was not honoring this aspect of life. Now I have learned my lesson.”

In 1990, Elizabeth and Elias formed The Boulder Institute for Nature and the Human Spirit, a social activist organization, which organizes grass root ecological projects as well as small group vision quests in the quiet surroundings of Colorado’s southwest corner. When Elizabeth speaks about the vision quests, her whole face lights up. “We have so much to learn from nature. Nature in all her infinite glory speaks to us, and we must listen.”

Elizabeth is one who walks her talk. It is not uncommon for her to be found in the calls of nature, partaking in a vision quest. There she listens to the wisdom of the rocks, the songs of the trees, the lullabies of the streams, and the energies of the earth. And if you were to hike the many trails in Boulder’s park system, you might see Elizabeth out there. She partakes regularly in the healing process of nature. Her example is one to follow, for in this high-tech age it is all too easy to distance ourselves from our primal environment and lose contact with the heartbeat and resonance of Mother Nature.

There is a right time for everything. A time to be quiet and a time to speak up, a time for keeping and a time for throwing away (Ecclesiastes: 3).
May we often reconnect with the rhythms and healing energies of nature

From STRESSED is DESSERTS Spelled Backward, by Brian Luke Seaward

Coping with Pandemic Fear and Stress

In light of the current COVID-19 pandemic, and the accompanying pandemic fear and stress, we thought a look at some stress and anxiety management basics was in order. In our frenetic society with demands being placed upon people in the workplace, school, community, and home, it is more important than ever for people to find creative ways to cope with and maybe even eliminate distress in their lives. Distress is different than eustress (a name for good stress), which is the helpful type of stress, one that is a burst of energy, telling one’s body what to do. It is the type of stress that can help one accomplish tasks, goals and projects, motivating one to move forward. Eustress becomes distress when it is overdone.

Dimensions

Emotional – Emotional wellness is a deep sense of happiness that comes from understanding personal own feelings and the feelings of other people, accepting personal strengths and weaknesses, and attaining a sense of emotional stability. It is also the ability to maintain effective personal and interpersonal relationships with others. Emotional wellness is the ability to express feelings in an appropriate manner, adjust well to change, and cope with life despite its frustrations and disappointments.

Cognitive – Cognitive wellness encompasses the ability to think clearly and creatively, willingness to continue learning throughout life, ability to apply the things learned in a variety of settings, and readiness to engage one’s mind in interactions with the world. People who are cognitively well are able to absorb new ideas and concepts, understand how thinking affects behavior and emotional reactions, and are to remain steadfast in the face of challenges.

Physical – Physical wellness is associated with living a healthy lifestyle and includes eating a well-balanced diet, sleeping enough, engaging in plenty of physical activity and exercise, maintaining proper weight, and restricting intake of harmful substances such as alcohol, tobacco, drugs, and caffeine. Physical wellness encompasses taking measures to protect one’s physical health, protect against illness and disease, and remain active throughout the lifespan.

Social – Social wellness is the ability to feel at ease and comfortable with oneself and with others. It is the ability to relate well to other people, be outgoing and friendly, and develop and maintain intimacy. Social wellness means one has the ability to handle conflicts while being true to one’s own ideals and beliefs. It is being tolerant of others, especially those who are different. Social wellness means loving oneself in order to be able to love others.

Sources

We live in a world fraught with stress. Stress has many sources and can be generated from within a person through self-imposed thoughts and feelings, while others stressors come from the environment:

Stress generated from within a person – Stress can be self-imposed through low self-esteem, anger, feelings of hopelessness, feelings of helplessness, anxiety, perfectionistic tendencies, jealousy and hostility. For example, people who are perfectionistic often bring stress upon themselves by being too careful and worrying about tasks being perfectly accomplished.

Stress generated from the environment – Stress can be felt from the results of environmental catastrophes such as severe storms, earthquakes, tornadoes, hurricanes, floods and acts of war. For example, people who are trying to rebuild their homes and lives after a hurricane find themselves struggling to meet their most basic needs.

Stress generated from conflicts – Stress can be the result of situations in which people are faced with an incompatibility with people, needs, demands, opportunities or goals. For example, a person who does not get along with a co-worker will experience stress on the job.

Stress generated from daily hassles – Stress can be the result of minor irritating annoyances that occur in daily life. Some of these daily hassles may be losing keys, car breaking down, waiting in long lines at a store, waiting for appointments, and getting stuck in traffic. For example, a person having to sit in traffic going to and coming home from work will experience stress.

Stress generated from economic factors – Stress can be the result of economic factors such as losing money in the stock market, not having enough money in retirement, growing inflation, and amassing too much debt. For example, many people have to work later in life because of a lack of enough money to live on in retirement. People may struggle with overcrowded housing, inadequate heating or air-conditioning, dangerous neighborhoods, etc.

Stress generated from changes in families – Stress can be the results of changes in the family such as parents’ separation, divorce, blended families, loss of loved ones, change in residence, birth of a child, adoption, changes in health of family members, and caring for aging parents. For example, people who are forced to care for aging parents often feel guilt, and are stressed because it takes time away from work and other family obligations.

Stress generated from changes at work – Stress can be the result of changes on a job, loss of work, changes in a role played at work, uncomfortable physical demands in the workplace, a lack of safety, interpersonal demands such as an abrasive supervisor or co-worker, and having too much work to complete. For example, a person who must work with an abrasive supervisor will feel uncomfortable most of the work day.

Developing good coping skills is an important component to living a wellness lifestyle. The following exercise fosters laughter, and excellent mood lifter.

Talk To Your Fear

Write a letter to one of your fears describing your feelings about this fear and how much time you devote to worrying about it. Describe how this fear affects your life and the lives of those around you. Describe what you will do to stop being afraid of this situation.

You, __________________________________________________________________________________________, are my fear.
My feelings about you are_______________________________________________________________________ ______________________________________________________________________________________________________________.
I spend ___________time worrying about you because _____________________________________________________________________________________________________________________________________________________________________________________________________________________________.
This affects my life _____________________________________________________________________________________________________________________________________________________________________________________________________________________________.
It also affects those around me by _______________________________________________________________________________________________________________________________________________________________________________________________________________________.
This is what I am going to do about my fear of you ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Excerpted from Coping with Anxiety by Ester Leutenberg and John Liptak, EdD.

Have a Good Laugh

Laughing and developing a good sense of humor can help you to effectively and creatively deal with the tension and stress in your life. There are several ways to bring laughter back into your life:

Wear a smile. Go ahead and try it right now. Put a big smile on your face. How do you feel?

What kind of reaction will you get from someone to whom you give that smile?

Read a humorous book. What is the funniest book you have ever read?

Watch a funny movie. What are your favorite funny movies?

Talk with a friend who gives you a good laugh. Which friends make you laugh?

Recognize that there are situations that can be frustrating and stressful at the time, but when you look back at them, they can actually be seen as humorous. Name one of those situations.

Excerpted from Coping with Everyday Stressors by Ester Leutenberg and John Liptak, EdD.

Compassion in Action

Compassion in action

At the first sign of stress, my sister Gail would not hesitate to light up. The cigarette dangling from her mouth started as an occasional social habit in college. With the advent of her first job as a graphic artist, however, it soon became an adult version of a baby’s pacifier. Like most people who smoke, Gail tried passionately to quit, but her efforts met with little success. More than once I would hear her quote Mark Twain, “Quitting smoking is easy, I’ve done it hundreds of times.” Eventually, social pressures at work forced her to take her adaptive coping technique outdoors, yet the habit continued.

As Gail explained to me, “Cigarette smoking is horribly addictive. The craving for a smoke, actually it’s the nicotine, is beyond approach. I have had other addictions, which we won’t go into, but this has got to be one of the hardest.”

When Gail was pregnant with her first child, Ashley, she kept the consumption of cigarettes to a strict minimum. “I would catch flack from some people—the non-smokers who haven’t a clue. My friends who smoke were more compassionate.” With the second pregnancy she did even better; yet old habits die hard. Within a month of delivery of her son Ian, Gail went back to a pack a day.“

I am very careful not to light up around my children. I know the dangers of second-hand smoke. I don’t smoke in the house or the car. And you wouldn’t believe the nagging I get from my kids.”

One day her four-year-old son, Ian, asked his mom if he could invite a friend to stay over night. As parents do, Gail called the mother of the child to make the arrangements. The answer was a polite but definitive No!

Gail hung up the phone and called Ian over.“

Listen honey,” she said. “Curtis can not come over to spend the night. In fact, he cannot come over at all. His mom explained to me that he has only one lung and she is very careful not to expose him to any chance of cigarette smoke or anything else that would pose a threat to his health.” At first Ian had a blank look on his face, till the message was fully understood. Then Niagara Falls started.“

The tears from Ian’s face continued for three days. He just couldn’t understand why I couldn’t quit. Looking back, I am sure I probably had a few tears too,” Gail explained. “It was one of those, Dammed if you do, dammed if you don’t, situations.”

“You know you can do a lot for your kids to show them you love them. Most of these require large blocks of time, and a lot of it seems to require money. There are sacrifices and compromises for sure. And to be honest, sometimes there’s resentment with these decisions. Any honest parent will tell you so. In this case, there was none of that. I had simply broken my son’s heart. Broken hearts are mended with love. I knew there was only one thing to do. I had to quit smoking.”

Smoking cessation for Gail was not an overnight sensation. It took several stressful weeks. As any of us can attest, to change habits just for ourselves is hard. Doing it for someone else doesn’t make it any easier. But when our actions are motivated by love—for those we love—then we gain footing to a new level. With a good month behind her of smoke-free lungs, Gail made another phone call to Curtis’ mom. This time she got the green light. Ian was beaming.

In simplest terms, compassion in action is an act of service. Until love is acted upon, it is merely a theory, a seed set upon inhospitable rocks. Fear is the motivating factor of stress. It undermines much of our behaviors. Compassion in action is a conscious act of love. We do acts of service not to make friends, to win brownie points or earn favors from God. When we engage in acts of service, everyone benefits.

Compassion in action is nothing less than an act of unconditional love. When we give in the name of service, we give to ourselves as well.

By Brian Luke Seward, from Stressed is Desserts Spelled Backward

Never Again!

ONE DAY, WHILE STANDING ALONG THE SIDE of the swimming pool to start my workout, a man twice my age walked up to me and, with an accent I couldn’t place, asked if he could share my lane. His smile was genuine and I could have sworn I saw one of those Hollywood twinkles in his eyes. Getting in the water is by far the worst part of swimming, so, in an effort to stall the chilling effects of immersion just a moment longer, I nodded my head and waved him in ahead of me. In he plunged, and for the next fifty minutes he never paused once to rest along the pool’s edge. I was intrigued by his good nature, not to mention his stamina, and hoped to strike up a conversation at the end of our workout. As I approached the wall to do a flip turn, he tapped me on the foot, waved good-bye, and jumped out of the water, heading for the locker room. By the time I finished my workout, he was gone.

Several days passed before I saw him again. Once more he approached me, motioned to my lane, and this time, without saying a word, dove in and started swimming. As he entered the water, I noticed a tattoo on his left forearm. Throughout my workout, I was puzzled by the engraved numbers, distantly familiar, yet beyond my immediate recognition. In fact, it bothered me all day long. Just as fast as he entered the water, he jumped out fifty minutes later, but not without tapping my foot, waving good-bye, and smiling.

My curiosity now heightened, I began an inquiry as to this man’s identity. I learned that, like me, he was a faculty member of the American University. His name was Arnost Lustig. But unlike me, he had a very different past.

Originally from Poland, Arnost was about seventeen when he and his family were rounded up by the German Nazis and sent off to the notorious concentration camp, Auschwitz. Like all prisoners who entered that camp, he was separated from his family, stripped of all his belongings, robbed of his essence, and denied his humanity. I was told by those who knew Arnost that the horrors of Auschwitz can never be put satisfactorily into words. The tattoo I observed on his forearm was his official identification number. About a year after he was interned there, the American Forces liberated the camp and hell came to a gradual end. Arnost was a free man in a world riddled in chaos and grieving lost innocence. Like many Holocaust survivors, he emigrated to the United States to start a new life.

The next time I saw Arnost it was in the pool locker room. He approached me and introduced himself to me. We exchanged names and then he gave me a big hug, kissed my forehead, and, with another big smile and twinkle in both eyes, said, “You are like a son to me!” On that day we started a budding friendship, enjoying several workouts and conversations. I later learned that his last name, Lustig, means humor or laughter in German, a name he wears well. Putting his hand to his mouth, he whispered, “It’s how I got through that horrible ordeal in Auschwitz.” Then he put his arm around me and proceeded to tell me a joke.

Until the day I met Arnost, the Jewish Holocaust was a distant event in history to me. From the film footage I saw in high school to the works of psychologist Victor Frankl to Steven Speilberg’s, Schindler’s List, the stories of the Holocaust were disturbingly moving. Yet on that day, Hitler’s “Final Solution” became a living memory. For those who survived, it is said that the atrocities of the Jewish concentration camps were the worst hell on earth.

The same semester I met Arnost, one of my undergraduate students shared with me this story during a classroom discussion about anger and forgiveness. Her grandmother, also a concentration camp survivor, had moved to New Jersey after the war. She returned to Europe two decades later with her daughter. Crossing a street in Poland, she saw the face of a man she could never forget, a Nazi concentration camp supervisor. Filled with emotion, the woman grabbed her daughter’s hand, and walked over to the man, with the intention of slugging him. As she got within a foot of the decrepit old man, she looked him straight in the eyes and quickly changed her mind. Instead she said “I forgive you,” then slowly turned and calmly walked away.

Recently my intrigue with Holocaust survivors led me to a book titled, The Triumphant Spirit, by Nick Del Calzo, a collection of portraits and stories of Holocaust survivors. Although the common theme of hope, the internal sense of a positive outcome is evident amongst all survivors, there emerges another theme as well—and that is the theme of forgiveness. From the thoughts of many survivors, it is explained this way—we had to learn to forgive and move on. To hold disdain and hatred toward a person or people for such horrible atrocities only perpetuates hatred. There are many lessons to be learned, forgiveness is one of them. In the words of Paula and Klauss Stern, Auschwitz concentration camp survivors, “We didn’t survive to hate—but to hope that the world learned something from the experience, so that atrocities like these will never happen again.”

Yom Kippur is a Jewish holiday, the Day of Atonement. It is a day to make peace with our mistakes, injustices, and wrongdoings. Although not a national holiday, many of my students excuse themselves from class to honor the day. I honor the day too. For me, it is a day of forgiveness, and a day to remember.

By Brian Luke Seward, from Stressed is Desserts Spelled Backward

Applied Improv: The “Type O” of Skillsets

Izzy Gesell

I call Applied Improv the “Type O” of skillsets because of its universal usefulness. Each day my Google Alert (set for Improv) brings new examples of the effectiveness of Applied Improv. One day, furloughed workers are taking Improv to cope during the shutdown. Another day, it’s Improv’s role in a business leadership class. I read how teens on the autism spectrum use it to learn communication skills and why caregivers are encouraged to use it with dementia patients.

It’s certainly eye-opening to see how a simple set of games has been rebranded as the Swiss Army Knife of life-skills curricula. (Yes, I’m hooked on metaphors). How can something so ephemeral be so functional in such disparate arenas? What’s the common denominator that makes Applied Improv relevant for everyone? Can something be a jack-of-all-trades AND master of them too? (Yes, I like mixed-metaphors).

Practicing Spontaneity

Improv groups meet regularly to rehearse. Not to collect the best endings to the games for future use, but to practice playing the games without ever needing to know the ending. By becoming comfortable with not knowing, the improviser changes the way they show up in the game. They learn how to act on things they can control and let go of things they can’t. This practice, carried out of the improv class or rehearsal, changes the way they show up in the world. In a very real way, improv practice trains us to treat life as if it were an improv rehearsal.

The PAT Equation ‒ Taking Improv Skills into the Real World.

Three transferable qualities improvisers develop are presence, acceptance, and trust (PAT). Success in Improv requires the ability to stay in the “now,” (P), deal with what you get rather than what you want (A), and rely on a process you don’t have control over (T). Substitute the word “life” for “Improv” in the previous sentence and you have the answer to “How can Applied Improv be useful for so many different purposes?”

Game to Play

This is NOT a…..(Spatula)

Objective: To develop flexible thinking by listing as many uses, real or imagined, as possible for an ordinary object.
Process: Pick an object at random and find possible uses for it other than its primary function.
Players: 1-5
Time Needed: 5 minutes or more depending on number of participants and their creativity.

Directions: After choosing an object, hold it and say, “This is not a (whatever it really is). This is a …..(give it a different function).” To practice, pretend that you have a spatula in your hand. “This is not a spatula, it’s a stake to hold up small plants in my garden.” Pass the item to the next player or add another yourself. “This is a cat-scarer to keep him off my couch.”

Focus Point: Notice, then let go of judgement, evaluation, or looking for best answer.

Hint: 1. Change your perspective on the item when stuck. Turn it around or get up and move away and look at it from afar. See it from the point of view of a child, space traveler, etc.

Hint 2. Use sensory prompts to see new possibilities. What does it look, sound, taste, smell, or feel like?

Variations: Add movement to your description. Make believe you are using it for the purpose you describe. Ex: If the spatula is now a microphone, hold it and sing into it when defining it.

By Izzy Gesel author of Playing Along

I’m Exhausted! How Did I Get Here?

A Brief History of Caregiving

Excerpted from The Complete Caregiver Support Guide, by Ester R.A. Leutenberg & Carroll Morris with Kathy Khalsa

In past generations, it was customary for people to have large families. Members of an extended family often lived within a few miles of each other. Few women had jobs outside the home, so the elderly and infirm were cared for within the family. Both the primary caregiver and care-receiver had the support of nearby relatives, friends, and community.

Circumstances are different today. Families are typically smaller and are often scattered across the country and around the globe. A much larger percentage of women work outside the home. People live longer, often with chronic illnesses. These factors make caregiving much more complicated than it was in the past. 

The early stage of caregiving is often handled by family members or by friends who live near the person needing help. They begin by doing what they can, and often, as time passes, assume the caregiver role without realizing it – caregiving isn’t a job that many people choose to sign up for.

The tasks caregivers perform can vary widely, from transporting a child with disabilities to school each day, to doing someone else’s laundry, to helping with medications, to dealing with insurance companies. Caregiving can be temporary, as when someone is recovering from an accident, or long-term, as when caring for a person in need of significant ongoing support.

In an attempt to define family caregiving, the National Family Caregivers Association (NFCA) developed a list called “Caregiving Is.”  The following is inspired by their list.

  • Caregiving is as diverse as the individuals needing it. 
  • Caregiving means being a person’s healthcare advocate.
  • Caregiving is stressful work. 
  • Caregiving challenges people to go beyond their comfort zone. 
  • Caregiving forces individuals to deal with change.
  • Caregiving is an endless search for balance. 
  • Caregiving is a strain on relationships. 
  • Caregiving can be a lonely world.

Caregiving requires a great deal of emotional, physical, mental and spiritual energy. Given all that it entails, it is not a surprise that caregivers suffer from stress. The cost of that stress – whether short-term or chronic – on the caregiver’s health can be considerable.

Stress (or the stress response) is what you feel when your body prepares to meet a challenge. It goes into a fight-or-flight mode, releasing a flood of adrenaline and cortisol. The breath quickens, the heart beats faster, and the senses sharpen. The body readies for action both when the danger is immediate and real and when it is a matter of perception. 

When short term, the stress response is beneficial. It helps us react quickly to avoid accidents. It keeps us sharp. It provides the endurance to keep going beyond our normal strength. When the threat – perceived or real – passes, the stress level lessens and the body returns to normal. Long-term stress is another story.

When a real or perceived threat to well-being or the need for action is ongoing, the stress response remains activated, releasing hormones over an extended period of time. The body acclimates to being in a defense mode. It turns on the stress response more quickly and leaves it on longer. 

Many people in today’s fast-paced, complicated world live with chronic stress. They may come to depend on the accompanying adrenalin lift and feel down in its absence. But chronic stress has health consequences. Studies indicate that the majority of doctor’s visits are for stress-related complaints.

The list is long. Stress exacerbates health conditions such as asthma and arthritis. It weakens the immune system, making us vulnerable to illness. It can cause headaches, high blood pressure, chronic fatigue, digestive tract problems, higher incidences of diabetes, and sleep disorders. It can negatively impact memory and judgment, cause depression and anxiety, and lead to substance abuse.

If you’re a caregiver, your situation can be a perfect storm of chronic stress.

Making Life Easier

Survival Strategies for the Stressed

It may sound simplistic, but it’s true: Taking time to plan your day and organize your environment can go a long way toward reducing stress and helping you feel you have some control over your situation. With your lists in hand, you will not have to wonder what it is that you need to do, whom you plan to call, where you want to go, or what you intend to buy.

If you do not accomplish everything you hoped to in a given day, move undone items to the next day, putting those of highest priority first. If you repeatedly move the same thing forward, ask yourself: Why do I resist doing it? Is it essential or necessary? Can someone else do it for me? 

Strategies for minimizing daily stress and irritations:

1. Organize your environment (cupboards, closets, a place for your keys, etc.) 

2. Go through mail daily (sort, toss or keep.) 

3. Make lists in a portable notebook/calendar you can keep with you (to do, phone calls, groceries.) 

4. Schedule a realistic day (important things first, doesn’t have to be perfect.) 

5. Create a “What If?” plan. (What if my care-receiver wanders off when we’re shopping?) 

6. Prepare the night before (prepare meds, set the table, review to-do lists.) 

7. Rise before your care-receiver wakes (read, shower, meditate, or enjoy a cup of tea or coffee.) 

8. Do one thing at a time (multi-tasking isn’t always effective when you’re stressed.) 

9. Know your limits and learn to say No! (Protect your time, energy, health.) 

10. Be prepared (food and postage in the house, full gas tank, extra house and car keys.)

11. Keep up with maintenance (fix, replace, maintain – yourself or ask someone.)

12. Take care of your health. (Have a physical exam, eat healthy, sleep well, exercise.)

13. Maintain good relationships (apologize if needed, forgive others, and yourself.)

What will I do to make life less stressful?

After reviewing the list above, write down the stress-relievers you think will work for you. Use the space below or your journal. If you can, chat with other caregivers to see what they are doing to cut down on their stress levels. It could be anything from yelling encouragement at your kid’s hockey game, to reading a good book, to meditating for an hour. Choose what will work for you. Then choose two to implement in the next month. Each month thereafter, add a couple of new stress-reducers to your repertoire.

Remember, it doesn’t have to work for anyone else, just for you. 

Is Your Stress Spoiling Your Holiday Experience?

Only 9 more days until December 25th and the stress level is rising. Cortisol is racing through your body, anger is way too likely to erupt into a scene, and burned cookies turn into a disaster equal to global warming. What can be done over the next few days so that the big day is one of joy and celebration and not one of apologizing to your loved ones because you lost your temper when the dog ate a roll of wrapping paper.

Here are some suggestions that may help.

In The Wellness Lifestyle Workbook by Ester Leutenberg and John Liptak PhD, they suggest the following tips for managing your stress.

1.         Seek to change the situation

How is that supposed to work, anyway? You can’t change the situation, the Holidays are coming in only nine days and you have to be ready. Try reframing the issue by saying, “The holidays will be here in nine days. I will complete the most important tasks before me and celebrate that I managed that. I will not fret about what cannot be accomplished.”

2.  Be more organized

Being more organized is a no-brainer. Make a prioritized list of what needs to be done. Put a couple of easy ones at the top so you get the satisfaction of crossing them off quickly. As you write it, remind yourself for example, that twenty different kinds of cookies are not necessary for a happy holiday.

3.  Ask someone to alter his or her behavior

Someone making you crazy? Constantly asking if you got this or that done and bemoaning the fact that you didn’t. Ask them to alter their behavior. Nicely. Don’t scream at them to back off right after they ask you the same question for the tenth time. When your temper is under control tell them that their constant questioning (read nagging) about what is and isn’t done only makes you crabby and slows you down.

4.  Exercise

Get out of the house for a run or go for a swim. If the weather is too bad go to the Y, the mall, or the gym and be in the moment while you are there. Think of how good it feels as the endorphins speed through your body. Notice how much better you feel when you get home after a few hours away.

5.  Engage in deep breathing, meditation, etc.

If you have tried meditation or guided imagery you already know how helpful it can be. If you are a newbie, find someone who will read you a relaxation script or purchase a relaxation CD. They are quite inexpensive and can be an amazing help. Remember, though, if you are trying this technique for the first time it might take a few attempts before it works easily. Here is a link to a good beginner’s relaxation script.

6.  Be assertive

How can being assertive help your stress levels? The thought of conflict makes many folks cringe. However, learning to say no is an important part of maintaining your mental health. Don’t say yes to something you don’t have time to do.

7.  Alter irrational beliefs

This is one of the best stress relievers. During the holidays many people try to replicate what they had as a child. Handmade gifts, tons of cookies and candies prepared to perfection, a huge dinner with all the relatives before the midnight service, a spotless house before the kids wake up in the morning, a gingerbread house that replicates the National Cathedral, or wrapping each stocking gift separately and writing a poem to go on each one. Most of us work full time.  Most of our mothers did not. It is irrational to expect to get the same amount of preparation done in the time we have. Rewrite your expectations of what the holidays should be keeping in mind your limited free time. Get rid of the traditions that are marginal to the enjoyment of your family and go with a plan that is actually possible.

8.  Withdraw from the situation

Withdrawing from the situation doesn’t have to be as drastic as it sounds. Perhaps you sing in your church choir. Maybe you always shovel the snow for your neighbor. It could be that you are the one who prepares the coffee and cookies for after the service. Someone else can do those things. Trust in the fact that as valuable as you are to the organizations you serve there are others who would relish the chance to try their expertise on what you do.

9.         Accept the stressor

You can, of course, simply accept the thing that is stressing you out. Saying to yourself I’m going to be a bit more stressed than usual because I have to finish 20 angel costumes by morning and then hitting the machine and doing it doesn’t really relieve the stress of the moment, but if you insist on doing the task you know is going to make you a bit crazy you can accept the stress that comes along with it. Understanding this will help you get through whatever it is with grace. Finishing the task will give you an immediate lift in spirits.

10.       Maintain good health by nurturing yourself

Don’t forget during this often frantic time of the year to take good care of yourself. You can’t avoid holiday stress if you are overtired, hungry, or have overindulged in your favorite treats. Don’t eat the whole fruitcake, don’t feel you have to finish that last Tom and Jerry,  remember to take your meds on time, and don’t cheat yourself of needed sleep. Limit your day and go to bed at least within an hour or so of the usual time. You will find that you get lots more done if you are fully awake and rested.

Leutenberg and Liptak suggest these coping strategies in The Wellness Life Style Workbook that will help manage your stress.

  • Changing old habits takes time. Do not attempt to change too much too soon or you might get frustrated.
  • Assess the types of support you will get from family and friends before choosing your coping strategies.
  • Remember that you cannot change or control everything. Focus on which you have control.
  • Do not expect a single coping strategy to “fix” the stressful situation.

Suicide and Self-Injury on the Rise

Whole Person Associates announces publication of two new resources: Suicide & Self-Injury Prevention: A Clinician’s Guide to Assist Adult Clients and the Teen Suicide and Self-Harm Prevention Workbook, two outstanding new offerings from Ester Leutenberg and John Liptak, EdD.

Suicide & Self-Injury Prevention Workbook

Suicide rates are on the increase in every state except Nevada. They are rising at an alarming rate: by more than 30% in half of the states and as much as 58% in some. Suicide is the 10th leading cause of death in the United States. Every 28 seconds someone attempts suicide. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db330.htm on 6/17/19.

What can a clinician or trusted mentor do to help end this epidemic? Where does one look to find the right avenues to follow? Will discussing suicide with someone we are concerned about simply place suicide ideation in their minds where it wasn’t before instead of diverting the person’s mind to a safer place?

Not so. In their two new books, Suicide and Self-Injury Prevention Workbook: A Clinician’s Guide to Assist Adult Clients and the Teen Suicide and Self-Harm Prevention Workbook authors Ester Leutenberg and John Liptak, EdD, collaborate to create a resource “…to help clients recognize that many other people have many of the same issues, to which no shame is connected, and that self-injury and/or suicide is definitely not the answer to their problems.” Trained clinicians are given a plethora of assessments to help discover what their clients are thinking and feeling. Worksheets and handouts then provide methodology to guide clients through a process to reevaluate their situation and find reasons to continue the battle and lead them to find their own safe place.

Teen Suicide & Self-Harm Prevention Workbook

Click here for a free worksheet titled Why You Can Be Hopeful.

While self-injury or self-harm are not the same as an attempt of suicide, many of those who self-harm eventually adopt suicidal ideation. A review of some of the myths about self-harm from the teen version of the workbook reminds us that it isn’t just kids who self-harm.

Myths about SELF-HARM
It is important to look at self-harm from an objective mindset. Below are some of the myths and misconceptions that surround the topic of self-harm.

MYTH: Only adults self-harm.
People of all ages self-harm. Self-harm is not particularly meant as a suicide attempt. It is an unhealthy attempt to cope with emotional pain such as anger, frustration, loss, sadness, etc., and physical pain.

MYTH: Teens who self-harm are usually open about self-harm behavior.
Self-harm in teens is usually kept private.

MYTH: Teens who self-harm do this as an occasional expression of behavior and only do it once or twice.
Some teens may self-harm once or twice and then stop. However, many teens do it frequently and it becomes a long-term, continual behavior, and possibly a habit.

MYTH: Teens who self-harm use only the cutting behavior.
Teens who self-harm cut or scratch with a sharp object, hit or punch themselves, carve on or pierce the skin, pull out hair, burn, pick at a wound, etc., or continually put themselves in harm’s way, i.e., engage in fights, drive recklessly, abuse substances, etc.

MYTH: Only teens with a mental illness consider self-harm.
Not all teens who self-harm have a mental illness, but they may have emotional, physical, and/or social issues that create unbearable emotions that lead to extreme physical responses.

MYTH: Teens who self-harm are willing to talk about it with others.
Usually, teens who self-harm do not share with other teens. It is vital for the person having self-harm thoughts or behaviors to talk with someone they trust: a therapist, friend, family member, spiritual or religious leader, etc.

MYTH: Self-harm calms the person for a long time.
In fact, the person usually feels guilt, shame, and other painful emotions afterwards.

MYTH: No real damage happens with self-harm.
There is a strong possibility that serious or life-threatening consequences can occur from self-injuring behaviors.

MYTH: Teens self-harm for attention.
Teens who self-harm should not be considered attention-seeking. Teens self-harm for many reasons: to help themselves feel something when they are emotionally numb; to distract themselves from their emotional pain; to punish themselves; or to disfigure themselves.

Although these are only a few of the myths and misconceptions about self-harm, they will provide you with some insight into the thinking that is prevalent about people who self-harm. Encourage individuals to call a trusted person, see a mental health facilitator or medical professional, find a positive support system, and use local or national resources and hotlines.

Click here for the Myths about SELF-HARM handout designed to help clients reframe bothersome incidents.

Erasing the Stigma of Mental Illness

By: Peg Johnson, MA

Erasing the stigma of mental illness. But what is stigma? A stigma is defined by Merriam Webster as “A mark of shame or discredit, a stain, such as she bore the stigma of cowardice.”  Defined like this it makes us cringe. Surely an educated person in the U.S. would not think this way. Not true. In a survey published in June 2009, Vol 40, No. 6,  Sadie F. Dingfelder  found that:

Despite decades of public information campaigns costing tens of millions of dollars, Americans may be as suspicious of people with mental illness as ever. New research by Bernice Pescosolido, PhD, published in the Journal of Health and Social Behavior (Vol. 41, No. 2), finds that 68 percent of Americans do not want someone with a mental illness marrying into their family and 58 percent do not want people with mental illness in their workplaces.


Sadie F. Dingfelder, Monitor Staff
Erasing the Stigma of Mental Illness

Imagine what it feels like to have that stigma applied to you when you are already struggling with mental illness. When the people surrounding you believe that you are socially unacceptable, when they see your illness as an unwanted attribute, it only deepens the sense of unworthiness you are already trying to overcome. 

People who stigmatize and /or stereotype others bring about unfair treatment rather than help. This unfair treatment can be very obvious. For example, people make negative comments or laugh. On the other hand, this unfair treatment can be very subtle. For example, people might assume that a moody person is dangerous or violent. Rather than improving, some attitudes have gotten worse over time: For instance, people are twice as likely today than they were in 1950 to believe that mentally ill people tend to be violent. Sadie Dingfelder reports:

Of course, the vast majority of people with mental illness are not violent—though they are 2.5 times more likely to be victims of violence than members of the general population, according to a study published in 2001 in the International Journal of Law and Psychiatry (Vol. 24, No. 6). And a new study, published in February in the Archives of General Psychiatry (Vol. 66, No. 2) finds that mental illness alone does not increase the chances that a person will become violent.


Sadie Dingfelder

How can we reduce or (better yet) succeed in erasing the stigma of mental illness? Why should we bother? Compassionate reasons aside, one in four Americans will be affected by a mental health disorder in any given year, and many more will have a family member affected. According to the National Alliance on Mental Illness (NAMI), serious mental illness costs the US $193 billion in lost earnings per year. There are ample statistics to underscore the need to remove this extra burden from those already struggling with a difficult diagnosis. Sixty percent of those with a mental illness fail to seek care, many because they fear the stigma.

Erasing the Stigma of Mental Illness Worldwide

The stigma of mental illness is a world-wide issue. What can be done? What has been tried? In Israel Ezer Mizion offers a variety of psychological support services and rehabilitative programs for people suffering from psychological disorders, emotional issues and mental illnesses. These services include:

  • A Big Brother/Sister Program that pairs individuals suffering from mental illnesses with trained mentors who provide companionship, offer assistance with basic daily function, and teach the skills necessary for independent living.
  • Rehabilitative employment centers that provide mentally handicapped people with basic vocational training and employment, and ease their integration into free market employment.
  • A psychological referral team that recommends appropriate psychologists, psychiatrists and counselors to people grappling with emotional disturbances, mental health issues or difficult relationships.
  • A network of psychiatrists and psychologists throughout Israel who provide their services at a discount to patients referred by Ezer Mizion.
  • A 24-hour crisis hotline for non-medical emergencies, including mental health crises such as suicide attempts or severe manic episodes.
  • Click here to go to their website: https://ezermizion.org/mental-health-services.html

In Canada the focus has been on the prevalence of mental illness, as well as the symptoms of the disease. JianLi Wang, Phd, found 75 percent of Canadians could diagnose a depressed person described in a story. A follow-up survey revealed the not-so-good other side of the issue. Forty-five percent of the folks surveyed said they were sure depressed people are unpredictable, and 20 percent believed the depressed folks were dangerous. Wang posited, “You can hold the belief that mental illness is a real disease and still be afraid of people with it.”

The message that mental illness is a disease like any other didn’t seem to work, either, according to Bernice Pescosolido, PhD, professor of Social Science at Indiana University. 

A recent campaign in Scotland called “See Me” tried a different strategy around erasing the stigma. It educated reporters and editors about the harmfulness and inaccuracy of the stereotype that people with schizophrenia are prone to violence. While it succeeded in reducing the number of stories linking violence and mental illness, other unexpected results occurred. Coverage of people with mental illness became more negative. They were often shown as being objects of pity (International Journal of Health Promotion (Vol. 10, No. 1). Neil Quinn, PhD, from Glasgow School of Social Work noted that journalists became afraid to report on mental illness.

A lesson of the Scotland campaign, says study co-author Lee Knifton, Head of Scotland, Assistant Director UK, is that anti-stigma campaigns can’t just focus on eradicating negative depictions of people with mental illness. They need to tell positive stories as well, he says. Read more about the Scottish Mental Health Arts and Film Festival at https://www.apa.org/monitor/2009/06/stigma.

The take-away: “If you focus on the competence of people with mental illness, that tends to lead to greater tolerance,” says Pescosolido.

Canada is now telling the stories of people with mental illness. Here in the U.S. more and more celebrities and people in the public eye are coming forward to discuss their mental illness and show how they have been able to succeed even though they had a mental illness. The National Alliance on Mental Health (NAMH) has issued the following:

Navigating life with a mental health condition can be tough, and the isolation, blame, and secrecy often encouraged by stigma can create huge challenges to reaching out, getting needed support, and living well. Learning how to avoid and address stigma are important for all of us, especially when you realize stigma’s effects:

  • People experiencing mental health conditions often face rejection, bullying and discrimination. This can make their journey to recovery longer and more difficult.
  • Mental health conditions are the leading cause of disability across the United States.
  • Even though most people can be successfully treated, less than half of the adults in the U.S. who need services and treatment get the help they need.
  • The average delay between the onset of symptoms and intervention is 8-10 years.
  • Suicide is the second leading cause of death of youth ages 15-24 and the tenth leading cause of death for all Americans.

Click here to go to the NAMI site and sign the pledge to fight mental illness stigma: https://www.nami.org/Get-Involved/Take-the-stigmafree-Pledge/StigmaFree-Me. Let’s work together on erasing the stigma, and unite to relieve those with mental illness from this additional burden.