It is paradoxical, but the Christmas season, a time that should be filled with compassion, empathy and joy, is a time when many people are sad and depressed. This phenomena is so widespread that it has been named the Christmas (holiday) blues.
Ask any practicing psychotherapist and they will tell you that they see a disproportionate number of emotionally disturbed and/or depressed clients during the Christmas holidays than at any other time of the year. Since drinking and holiday cheer are so acceptable, alcoholics and other drug or food addicts tend to act out extensively during this season. I'll return to this last point in a moment.
No one knows when Jesus Christ was actually born. Traditions point to December the twenty-fifth, a time which corresponds to the onset of winter. No one knows why the celebration of Jesus' birth was early on enmeshed with pagan festivals of light, dealing with the onset of winter.
Winter is the season when days grow shorter and there is less sunshine. Winter is the season when darkness has it's dominant rule.
Sunlight is essential for both our physical and emotional health. In winter cold, dark dreary days are commonplace. The pagan festivals of light were intended to confront the darkness. In Christianity this combat was taken over by decorated Christmas trees and landscaped lawns with lighted trees. The lights and festive brightness symbolizes that Christ the Savior is the light of the world and has triumphed over the darkness of sin. Why then the Christmas Blues and depression?
The darkness itself and loss of sunlight is one reason given to explain larger numbers of depressed people during the winter months.
Another reason for the blues comes from the loss of our "magical childhoods". We gradually have to give up the magical belief that a wonderful caring old man with a sled full of toys will fuel the energy of eight tiny reindeer to fly over rooftops, and bring us toys.
The loss of "magical beliefs" is sad and we will also have to deal with the loss of other magical beliefs (like the fact that we will die and go to a wonderful place called Heaven). No one really knows anything about death or dying. As the years go by we experience suffering and the loss of loved ones; grandparents, parents, siblings and dear friends. We especially remember lost loved ones because Christmas is a time of love and joy. As grown-ups we cannot explain why nature natures (why hurricanes, droughts, tornadoes, tsunamis, floods) happen. Being an adult means leaving the magic of childhood.
If you grew up in a family where your parents were emotionally immature and childish, they could act out their suppressed rage, resentments and other unresolved wounds on each other or on other members of your extended family. I counseled people who dreaded seeing their in-laws and relatives at Christmas.
I mentioned earlier that alcoholics and other types of drug addicts act out during the Christmas holidays more than at other times of the year. If you are a child of an alcoholic (like myself) your memories of Christmas can be very painful. I can only think of one really happy Christmas during my childhood. We were also very poor, but I would have traded my toys any day for family peace, love and the absence of anxiety, shame and tension.
Like many children of alcoholics, I became a drinking alcoholic myself. I began binge drinking and having alcoholic "black outs" (periods of anmesia) at age sixteen. I can remember being drunk a large part of every Christmas season til I reached my bottom on Dec. 11, 1965. I spent eight days in the locked ward of Austin State hospital. I got out a few days before Christmas and enjoyed the most intimate time I had ever had with my family.
Sobering up during the holidays was great for me and my family. Many people thing of the Christmas holidays as the worst time to reach out for help; to do an intervention; or to go into treatment. In fact it is one of the best times. We can give our loved ones no greater Christmas gift than a sober recovering self. And for treatment centers that have family week, nothing can replace a family connecting (often) for the first time in an intimate embrace of support and love. Some of my most powerful memories are the "family week" at my former hospital in Ingleside California or at The Meadows where I am now. I encourage those of you who are using and/or depressed during the Christmas holidays to focus on the major source of your blues. The poet says "if winter comes, can spring be far behind?" You can recapture some of your magical childhood by letting your inner childlike self create new traditions and new family rituals. It's certainly okay to grieve for your deceased family members, just put some boundaries on your grieving. Life is so fragile and subject to fate and unexpected tragedy, don't let this time for celebration and love pass you by!
How many significant figures of history actually suffered with PTSD? We may never know. The diagnosis, now part of our collective 21st century lexicon, did not exist before 1980. Many historians point to the Civil War with the description of Soldier's Heart as the earliest attempt to describe emotional consequences of war. Jonathan Shay wrote about warriors from Greece who incurred the invisible injuries we now diagnose as PTSD. The earliest medical descriptions of PTSD started in the 1830s during the early era of railroads. Numerous collisions and explosions resulted in a condition called "Railway Spine", something akin to mild traumatic brain injury at first, but later described as a psychiatric condition consistent with PTSD.
Did Clara Barton suffer with PTSD? On the basis of Melinda Henninberg's article, (http://www.washingtonpost.com/lifestyle/magazine/clara-bartons-enemy-depression/2012/04/04/gIQAdryXzS_story.html), I would say it was quite likely. More importantly, what can we learn from Clara Barton's rather extraordinary life? I think there are many lessons applicable to modern observers:
Does growing up in a dysfunctional family better prepare you to survive during war, chaos and/or insanity? There is no absolute answer to this question, but a dysfunctional family may actually help you endure the unmanageable. No exotic constructs needed here; if you grew up having to dissociate to survive, you may simply have "more practice"- the equivalent of early military training. Conversely, some individuals are less prepared for chaos if they grew up in a "crazy" family. A lot depends upon context, types of stressors, etc.
My personal observation is that a dysfunctional family background may make you stronger during a crisis, but in the long term it might make recovery, or at least a balanced recovery, much more difficult. Early studies conducted at the University of Minnesota described a population of "invulnerable children". These were kids who grew up with schizophrenic and alcoholic parents but did not have overt problems as adults. In fact, many were highly adaptive and showed no signs of outward difficulty. When this population was studied more closely, researchers learned that outward coping masked many harsh consequences. They later gave up their quest and decided "invulnerable" was a flawed concept. On the flip side, growing up in a safe and nurturing family is no guarantee you will not develop harsh symptoms. We need to consider multiple variables- including frequency of exposure to trauma, intensity of the trauma, duration of the trauma and age of exposure. Invulnerability is a seductive illusion, but even those who look intact may endure severe suffering.
Clara Barton, the founder of the Red Cross, and her struggle with the "black snakes" of depression, illustrates the complex consequences of exposure to and immersion in trauma. While she lacked comprehension to describe the extent of her suffering, her self-described "depression" was insufficient in capturing the multiple and complex symptoms of what we would now call PTSD and co-occurring disorders. Ironically, Clara Barton"s symptoms propelled her into an excessive, perhaps addictive attraction to violence and war, providing her partial relief and affording comfort and relief to millions as well.
Jerry Boriskin, Ph.D, a Senior Fellow at The Meadows, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at http://www.jerryboriskin.com/.
For more about The Meadows'; innovative treatment program for PTSD and other disorders, see http://www.themeadows.com or call The Meadows at 800-244-4949.
The political and emotional complexities of PTSD (post-traumatic stress disorder) and TBI (traumatic brain injury) can lead to stigmatization and inaccurate attributions. It has long been assumed that soldiers, especially those who have served in combat, are at higher risk for violence. Following WW II several congressmen introduced proposals to send returning combat troops to islands for "retraining" before returning to civilian life. Following Vietnam we had Rambo movies and veterans "going postal". The facts are both simple and confusing: sudden outbursts of violence are rare and very hard to predict.
The article referenced above summarizes some of what is clear: PTSD and TBI can produce shifts in emotional management and changes in "executive brain function" resulting in possible impulsiveness. Complex phenomena like PTSD and TBI are difficult to study and data is scattered, sometimes inconsistent or contaminated by selective sampling or agency agendas. What is clear is that spectacular episodes of sudden violence are extremely rare, despite media attention. There are often multiple factors involved and these include co-occurring disorders, use of drugs or alcohol, lack of sleep, number of tours, severity of symptom or injury, just to name a few. We would love to have instruments that predict these rare outbursts, but they do not exist. We are reduced to the old maxim I learned decades ago: "the best predictor of future behavior is past behavior".
I do not wish to oversimplify; however, I want to reassure readers, especially military readers, that they are not likely to explode in some horrific headline-grabbing fashion. The title of the Washington Post article is generally accurate. Put aside the complexities of multiple tours, diminished capacity, head injury, partial recall, fugue episodes, sleep deprivation, isolation, and alcohol, and let's focus on the reassuring take-away message. There is no data supporting the worst fear carried by many. Most veterans are well trained, restrained, disciplined, highly ethical, and filled with a sense of justice, loyalty and honor. Most veterans I have treated live with the dread that they could lose control of their impulses and inadvertently hurt someone. Newspaper headlines about sudden violence and suicide add to their burden of fear. As a 66 year old combat Marine with severe health and mobility problems recently stated, "I am still afraid of what I could do to others.- That's why I need to stay away from others." The fear of losing control results in isolation, self-medication, avoidance, and a whole host of symptoms we see with PTSD.
I would argue that the most common symptom is not violence but extreme dedication to work or mission. I do not have the statistics, but from my years of experience I see pro-social zealousness- not antisocial outbursts- as the most common coping mechanism. Over dedication to work/mission becomes almost addictive. It is easy to get lost in working excessive hours, and it is rewarded by recognition and increased revenue. Channeling one's anger is difficult, but workaholism is an extreme response rewarded in our culture. However, family members can be angry and confused, and the internal burden remains hidden. Sleepless nights, avoidance, occasional road rage and other symptoms flourish, often visible only to a few. Spectacular outbursts are rare. PTSD tends to be a condition that most often fits the following: "Great souls suffer in silence." (Friedrich Schiller). The articulation of suffering is often the first step toward recovery.
Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at www.jerryboriskin.com.
For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.
A group I facilitate for Vietnam Veterans struggled with this question even before the name of the accused sergeant was released. Violence, injury, death and war stir intense emotions in all, particularly among veterans who have been up close and personal. The issue of atrocity and slaughter of civilians is, naturally, an incredibly intense and sensitive subject.
My group members wrestled with this for 90 minutes; most had extreme empathy for the cumulative damage war has upon warriors. They could not even begin to grasp the immense pressure put upon younger soldiers, some of whom serve three, four, and up to nine tours. They/we are humbled by shocking reports of soldiers committing sudden violence, some of which is toward family, but more often towards self. They embraced the contributing factors that need be considered: alcoholism, traumatic brain injury, post traumatic stress disorder (PTSD), financial problems, issues of unemployment, possible relationship problems, a passed over promotion, an unwanted next tour, recent injury, and experiencing the wounding or killing of fellow warriors.
Reports indicated that Sgt. Bales was suffering from many of these factors; he was also reported to be highly decorated, a model soldier, and has saved lives of civilians and Americans in some of the hottest conflicts in Iraq. How could a highly trained soldier, a member of an elite unit, trained sniper and leader of men possibly commit such an atrocity? Our group struggled with this question and did not come to a clear explanation. They had empathy and contempt; some launched into politics of the current wars, some blamed the military for too many rotations, some defended the military, others discussed the role of combat, loss of recent friends, PTSD, alcohol, and tbi (traumatic brain injury). The discussions were intense and a few favored certain factors, but no consensus or full explanation was derived.
One thing we did derive: in certain situations our usual narratives fall apart. If the conditions are right, we are all capable of sudden violence or extreme behavior. The media will no doubt speculate on which factor(s) were critical in this current horror. Forensic experts will attempt to definitively opine, but we may never fully know why this particular soldier "snapped" in such a dramatic and horrific fashion. Thousands of soldiers carry the burdens of war. Most struggle in silence and harm no one, and if they do injure anyone, they hurt or punish themselves.
We may never know the full explanation of what went wrong. My personal speculation is that alcohol played a large factor. It is the most common variable in violence: domestic, self or toward others. It also works in tandem with PTSD and traumatic brain injury. What will probably emerge is a complex picture of a determined and accomplished soldier worn down by many variables, military and domestic. Early reports suggest Sgt. Bales and others were drinking heavily that evening, against military rules. Those early reports also suggested drinking to levels of blackout. Sgt. Bales allegedly had a drunk driving hit and run episode while stateside. Whereas not the sole factor, alcohol might have been the "tipping point". Alcohol is a common way of "self-medicating" or "de-stressing", but it can have an almost "evil" impact in unleashing primitive emotions. In fact, it is a common but often understated factor in the surging suicide numbers in young soldiers. Alcohol has a long history of violence in so many settings, especially the home. Unfortunately, we continue to deny alcohol's power or even its presence. Mr. Bale's attorney alleged his client had not been drinking.
We will know more as facts emerge, but we may never fully grasp what went wrong or why. We do know that war is ugly; it changes people and distorts mind, body and soul. The results of war can make you feel "untouchable" and unique. My hope is that veterans or military personnel reading this blog will recognize that their worst fears are not reflected in the rare disasters. Most people, even civilians, have a fear of "snapping". Exposure to the horrors of war intensify that fear beyond that which most observers can express or comprehend. The vast majority of those who develop PTSD do not snap. Instead, they suffer quietly and deconstruct their lives. PTSD, especially with co-occurring addiction, is complicated and destructive, but highly treatable. Recovery requires Sleep, Safety and Sobriety, the three "S's" that are the first steps in separating you from the demons of war.
Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness.
For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.
Attachment Theory in Action: Feeling Attachment Security in the Body
Several months ago, as I sat waiting to board a flight, my attention was captivated by an active toddler sitting (for the most part) on her mother's lap. Beneath naturally curly locks of hair, her eyes, bright and curious, darted about the busy terminal, feasting on the smorgasbord of novel stimuli. When a scruffy-looking man passed by in a wheelchair and offered a gnarled hand to the young child, she fearfully buried her face in her mother's loose-fitting sweater. The girl's mother instinctively pulled her close and whispered softly in her ear while giving the grizzled man an apologetic smile. As the man pushed on, his course laugh still lingering in the air, the girl gingerly emerged from her safe, sweater-cocoon to survey the scene. Still within her mother's secure embrace, the girl stood-up and ventured an inquisitive glance in the direction of the retreating man. Her fear had been down-regulated and she was able to explore the environment once again.
Interactions like this between a parent and child are repeated on a regular basis throughout early development. From the perspective of attachment theory, these dyadic experiences are the foundation for all social-emotional development. It is noteworthy that, from the earliest moments of life, attachment experiences are interactions between two minds and two bodies. As illustrated by the example above, the mother sensitively responded to the nonverbal intentions and emotions of the child by communicating safety and security through an embodied interaction with her child. In this way, attachment experiences, whether secure or insecure (as in the case of relational trauma and abuse), are incorporated into the body's self-regulatory systems, and as a result, can play an important role in how the body reacts and responds in close relationships later in life.
This article is part of a series on attachment theory and relational trauma (see the first article for an overview) and is meant to illustrate how attachment theory can guide a therapeutic approach that incorporates working with emotions and the body. To ensure patient confidentiality and anonymity, the clinical example in this article is a fictional account based on many different patient histories and various treatment experiences. Although the following clinical information isn't associated with one particular person, it is representative of many people who have experienced relational trauma.
Karen, as I will call her, was a 37 year-old divorced female who entered treatment after becoming depressed and suicidal following a breakup with a boyfriend. She reported that symptoms of depression and anxiety had been a problem for most of her life, but they always got much worse during periods of relationship turmoil. Similar to previous episodes, when the most recent relationship ended, she turned to alcohol and binge eating to numb the pain.
Karen reported that whenever a romantic relationship ended, she felt a profound sense of emptiness and loss. After her partner left, she couldn't stop thinking about what she might have done wrong and she feared that she would never have a healthy relationship. She fantasized incessantly about getting back together and about how she would "fix" herself to make the relationship work. These kinds of thoughts plagued her day and night until the helplessness and despair were overwhelming.
As a child, Karen's mother struggled with alcoholism and her father with workaholism; she remembered feeling like she was constantly hungry for their attention and love. In fact, as a young girl she was certain that her father had a trap-door in his office where he would disappear and carry out his "secret life". Even when her parents were available, she often worried that she was "annoying" and she feared that her desire for attention actually drove them away.
Karen's parents divorced when she was nine-years-old and their separation only intensified her father's distance and her mother's alcoholism. The pain and loneliness associated with her parents" divorce was partially ameliorated by a warm and loving relationship with her maternal aunt, who had been a stable figure throughout her life. However, at thirteen-years-old, her aunt died, and not long after that, Karen began using food and alcohol in excess to alter her mood.
Karen's childhood history indicated that she likely had insecure attachment relationships with both parents that could be categorized as ambivalent/preoccupied. In other words, her early development was marked by implicit feelings of insecurity because she was unsure whether or not her parents could consistently provide a safe and secure presence in her times of need. Additionally, she believed that this lack of security was her own fault, which led to a pervasive fear of abandonment and a preoccupation with maintaining closeness. These patterns of thinking and feeling seemed to carry-over into adulthood where her romantic relationships were characterized by an anxious attachment style and showed clear signs of love addiction (as described in Pia Mellody's work).
This kind of assessment of Karen's attachment relationships was very helpful in formulating her treatment plan at The Meadows. Recognizing that she would likely harbor tremendous fear and anxiety about rejection and abandonment, treatment providers were careful to establish a secure therapeutic environment with clear limits/boundaries and a consistent, warm, and responsive presence (elements that were missing from her early attachment relationships). Through various forms of treatment (including highly experiential inner-child work), she was able to acknowledge and process long-held feelings of pain, fear, anger, and shame regarding her early attachment relationships.
Although Karen strongly identified with the concept of love addiction, halfway through her treatment she was still struggling with intense thoughts and emotions regarding the unhealthy relationship that preceded treatment. During a session when she was particularly emotional about this subject, the therapist asked Karen to close her eyes and imagine what it would feel like to finally end the relationship and say goodbye to the relationship partner. Karen said, "It would feel like saying goodbye to a part of me... there would be a hole in there." She pointed to her chest. The therapist asked, "As you imagine that hole in your chest, what does it feel like in your body?" Karen's face winced and her eyes shut tight as she responded, "It's like a sharp, stabbing sensation."
The therapist inquired further, "As you are feeling the stabbing sensation in your chest, do you notice any other thoughts or emotions?" Karen paused, her hand over her chest now, "I worry that the hole will never be filled - that I will never find anyone else." The therapist tenderly implored, "How does it feel in your body as you say that?" Her breathing increased and her shoulders tensed upwards, "Now I feel tightness in my chest and throat." Knowing that the tightness was likely defending against something even more vulnerable, the therapist deepened the approach, "What would happen if you never found anyone else? What would that say about you?" Karen's shoulders released, she bent over slightly and began to cry, "Maybe it's me... maybe I'm just unlovable." The therapist gently asked, "How does that feel in your body?" Through streaming tears, Karen replied, "There's a deep ache in the pit of my stomach - that's where the hole leads - that's where it ends. It really hurts."
Karen was invited to stay in-touch with the deep ache in her stomach while the therapist guided her in some breathing exercises. Once Karen's emotions were more regulated, the therapist asked her to think about a relationship in childhood where she felt unconditional acceptance and love. Karen immediately identified her deceased aunt and tears welled-up in her eyes once again. The therapist queried, "If your aunt were here right now, how would she respond to the deep ache you are feeling?" Karen was still crying, but a faint smile came across her face, "She would give me a big hug and then she would just stay here with me." The therapist asked, "When you think about your aunt's response, how does that feel in your body?" Her frame straightened and her smile broadened, "It feels warm all over... more open and free inside my body." After a few moments of quiet introspection, she spontaneously added, "The ache is gone."
Relying on the wisdom of her body (and with help from the therapist), Karen was able to drop below the habitual thoughts and feelings associated with love addiction and actually experience the pain associated with early attachment insecurity (i.e., "I'm unlovable"). More importantly, she was able to contrast, and even dissolve, this deep pain through an embodied experience of secure attachment (i.e., "unconditional acceptance and love"). Later she had great difficulty describing this therapeutic process in words, but it proved to be an "emotionally corrective experience" that she carried with her throughout her treatment. Gradually, by bringing awareness to feelings in her body, and the associated thought processes, Karen learned more about her love addiction patterns and she developed tools to tap into a hidden wellspring of compassion and positive regard for herself.
Like most people, Karen's childhood experiences with attachment figures profoundly influenced how she felt about herself and her relationship partners. Indeed, the mental and emotional scripts associated with early attachment relationships are written into the neurobiology of the developing child and, often without conscious awareness, are acted out on the stage of romantic relationships. Fortunately, meaningful and lasting alterations to these scripts can be facilitated by a variety of therapeutic techniques, particularly those that are experiential in nature and involve working with emotions and the body.