grief

I am amazed how frequently people talk about various mental health diagnoses. It is common to hear people talking about their “anxiety,” “panic disorder,” “ADHD” or other things, so much so that I hear such conversations while waiting in a cashier’s line. Of course, it is even more common in my business. I regularly do “ADHD neuropsychological evaluations” for people, both children and adults, who come to my office seeking some kind of answer to what ails them. Often, adults want to be “tested for ADHD” because they have some kind of trouble with memory or focus in their daily lives. I met with the parents of a teenager recently who has been diagnosed and treated with medication for his alleged ADHD condition for nearly 10 years. I found it interesting that the father noted that he most certainly suffered from ADHD as a child and adolescent but somehow got through childhood without medication. I told them that I was the same as a kid as I remember my maternal grandmother telling my mother that “you’re never going to raise that kid” because I was so active and unpredictable, like running down the block stark naked when I was three with my aunt chasing me all the way.

ADHD is certainly one of the more common “diagnoses” that people like to have. I use the phraseology “like to have” because it is my belief that ADHD and other diagnoses give people a sense of what is going on with their lives when things aren’t working out well for them. A diagnosis, namely a mental health diagnosis, helps people make sense of what is wrong in their lives. It is as if a person can have some kind of diagnosis, then they have some hope of recovery from the mental health “disorder” or “disease” that they have. Rarely, is that the case. Rather, people get this diagnosis and are not really better for it. Importantly, it is not only the mental health diagnoses that keep people busy figuring out what is wrong in their lives. There is even a larger number of physical anomalies that people suffer that lead to a similarly large number of physical/medical diagnoses. I see a couple whom I have seen off and on for 20 years as they have struggled with a variety of challenges in their marriage, interestingly, not the typical arguments and dissention that usually brings couples to see me. In this case, the original “presenting problem” (which I prefer to call the “presenting situation”) was the man’s impotence, but over the years we have dealt with a number of other (seemingly) external matters including finances and vocational adjustment. It is interesting to me that when I see this couple, the first thing the woman talks about is the great variety of physical/medical problems that she has, talk that could last for 30 minutes of our 2-hour time together if I allowed her to tell me all that ails her. This occurs while her husband sits patiently by until he can then tell me of his physical ailments. True, these people are in their 70’s where such things do occur more frequently, but it is continually interesting to me that they can talk about what ails them physically more fluently then they can talk about how they feel or what they think, this despite the fact that they are both well educated. When we finally get around to talking about how they feel or what they think, they then talk about the various mental health diagnoses that they both have.

The dependency on physical and mental health diagnoses has increased so much over the recent years that it is not uncommon for people to allege to have several diagnoses. I recall a woman I saw for an evaluation who initially said that she suffered from “bipolar disorder, ADHD, PTSD, anxiety, panic disorder, borderline personality disorder, and depression in addition to a similarly long list of physical disorders. I was amazed at her willingness to have all this wrong with her.

The popular mental health diagnoses

Consider how often you have heard about someone’s “bipolar disorder” over the recent years. Note that you never heard the term 10 years ago, much less 20 or 30 years ago. As you probably know, bipolar disorder was previously manic-depressive disorder. Despite the fact that you probably hear about someone having bipolar disorder, this is a very rare disorder that, like so many other diagnoses, is way over diagnosed. In fact, true bipolar disorder is a psychotic disorder where someone has a kind of delusion, often “manicky,” like s/he is going to be the next benign dictator of the world, or will most certainly suicide tomorrow. Bipolar disorder is not the ups and downs that all people have. It is not the grandiosity that we sometimes see with people or the hopelessness that we see with others, much less the changing of mood from one day to another.

The other “popular” diagnoses are as follows along with the symptoms of these disorders:

• ADHD: impulsivity, distractibility, hyperactivity
• Panic disorder: accelerated heart rate, feeling of dread, fear of a heart attack
• Depression: disturbances of three elements in life: low, high, or inconsistent:
  • Appetite (too much, not enough, not hungry)
  • Sleep (too much, not enough, erratic)
  • Energy (too much, not enough, erratic)
• Anxiety: fear of the unknown future; usually together with increased heart rate
• PTSD: symptoms of depression and anxiety related to past traumatic events
• Borderline personality disorder: feeling of a “deep hole” in oneself
• Addictive disorders (chemical or behavioral): compensations for traumata

There are many other mental health diagnoses that are less frequently self-diagnosed, like schizophrenia and personality disorders, but the foregoing are the most commonly rendered, often by the individual and frequently by a therapist or physician. It is notable that one of my psychology journals reported that fully 40% of Americans were on some kind of psychotropic medication; possibly more now. Medications are antidepressants, anxiolytics (sedatives; anti-anxiety agents), stimulants (usually for ADHD), and anticonvulsives (given to treat bipolar disorder). So, does have the country suffer from one or more mental health disorders? I don’t think so.

What do people suffer from, and what can be done about it?

• First, there is only one real mental health diagnosis.
• Secondly, there is only one cause.
• Thirdly, there is only one effective treatment.
• Fourthly, there is only one real “cure” because there is nothing “wrong.”

The one real mental health diagnoses: PTSD

PTSD stands for post-traumatic stress disorder. This is the correct diagnosis for 95% of mental distress, as I call them rather than “mental health issues” or “mental disorders.” In fact, I think it would be better “diagnose” this condition as PTD: post-traumatic distress, which would be more accurate. Better yet, when I deal with people who are really seeking psychotherapy for improving their self-understanding and their lives, I simply call it “distress” rather than PTSD, much less depression, anxiety, and the like. It is the distress that people find so disruptive in their lives, and it is the distress that I work diligently to help them to end.

I should make a comment about the so-called biological or inherited tendency people have towards various mental health disorders. There is no clear science in this matter but there is a good deal of theorizing in the matter. We do find that certain families have proclivities towards something, perhaps anxiety or depression. But the science is not yet clear as to whether this finding has to do with the environment (usually the biological family) or the heritability factor. We do know that if identical twins are separated at birth, and then they have some sort of mental illness, there is a 50% chance that they will have the same illness. Interesting. But what about the other 50% that don’t share the diagnosis? We come to the mixture of nature and nurture in this situation, with the suggestion that we may, indeed, have an inclination towards some kind of mental distress that surfaces because of the family environment. In my own family there is a plethora of people who have suffered from some kind of anxiety. I have found it necessary to attend to the phenomenon in my own life as well. But was I “taught” anxiety or is there a propensity in my genes towards anxiety? The answer is probably both are true. The larger question, however, is what shall a person do when s/he has some kind of mental distress, a question we shall tackle shortly. Certainly, in my own life, I suffered traumata in childhood, which may have caused or quickened anxiety in me. Read on.

The one real cause of mental distress: trauma

What is “trauma”? Trauma is an unexpected event that causes some kind of damage, be it physical, mental, or relational. We might even suggest that are other kinds of traumata (I use the German plural of the word, but “traumas” is just as good), like financial trauma, property trauma (some kind of loss), or even vicarious trauma. I think I was vicariously traumatized by watching a war-based movie last night that adversely affected my sleep. But PTSD is not just trauma. It is the emotional element in the trauma that causes the distress.

PTSD (or my “PTD”) is a condition in which an individual has not resolved the emotion attached to the trauma. The most obvious kinds of PTSD are sexual trauma and war trauma. I was thinking about the poor soldiers facing a myriad of traumata in the movie from which they might later suffer PTSD. A veteran of war or a victim of sexual abuse suffers PTSD because at the time of the trauma the individual is not able to feel the emotions associated with the trauma. The emotions associated with war are anger, fear, and sadness, but if you’re in a foxhole and need to shoot the bad guy, you don’t have time to feel these emotions. Likewise, if you’re being molested, you aren’t in the position to feel the emotions of fear, which is predominant, much less anger at your perpetrator, much less the pleasure that might actually be associated with the abuse. So, such people suffer from not having felt the feelings that naturally occur in these circumstances. But traumata are not just related to sexual abuse and war trauma.

Developmental traumata are situations where a child fails to receive one or more of the basic ingredients of childhood, which can be summarized as the following:

• Security and safety
• Sustenance (food)
• Physical affection
• Emotional affection
• Freedom
• Limitation
• Encouragement
• Challenge

In all of these circumstances, there are three possibilities for traumata:

• Too much
• Too little
• Inconsistent

Allow me to explain. Many children live in circumstances that are, indeed, dangerous, hence lacking in security and safety. But there are children who have too much security. Ideally, a child needs 100% security through much of her first year of life, but if she receives infantile security after that year, she will then feel unduly afraid of the world, perhaps for the rest of her life. Or, she might receive inconsistent security, which means safe and unsafe, which is actually even worse than no safety at all. Research psychologists call this “intermittent reward” (or punishment). Likewise, all the other aforementioned causes of possible trauma could be the “not enough, too much, or inconsistent” categories. Some children have too much limitation and are not allowed to explore the world with trials and errors, while other children have so much freedom that they fail to understand the value of laws and natural limitations. All of these circumstances contribute to PTSD to some degree or other.

Some children suffer from more than one of the lack of one of ingredients of an ideal childhood. For instance, some children are not loved right (lack physical affection), so they put up a real fuss in life. Then, to quiet them down, they are indulged with something. Then, they become even more demanding, and are then shamed. This combination of neglect, indulgence, and shame causes the condition known as borderline personality disorder. The other so-called mental disorders might be seen as having been caused by various traumata:

• Anxiety: almost certainly caused by some kind of neglect during early life
• Depression: most likely caused by losses in early life
• Bipolar disorder: both neglect and losses
• Schizophrenia: inconsistent love and limitation and some kind of chaos in general
• Personality disorders (narcissism): lack of encouragement, challenge, and limitation
• ADHD: too much limitation or too much freedom
• Additions: a coping mechanism that replaces what was lost in childhood

So what can be done to successfully treat these conditions?

The one real treatment for mental distress: grief

As you may know, Deb and I wrote a book on sadness entitled The Positive Power of Sadness, subtitled How Good Grief Prevents and Cures Anger, Sadness, and Depression. In this book we discuss how the mental disorders of anxiety and depression are prevented by honest sadness in addition to the phenomenon of undue anger. Let me summarize:

• You love something
• You are assaulted
• You lose this something
• You feel hurt
• You feel afraid of losing more
• You get angry to protect yourself from future loss
• You compensate with some kind of addiction (chemical or behavioral)
• You then develop “symptoms” like anxiety or depression

Our suggestion in the Good Grief book (as we all it) is to stop the process at the hurt level and then back up from there. If I feel hurt, I will simply and profoundly feel sad. Just sad. Not angry, not afraid. Not compensating. Just sad. The beauty of sadness is that it ends. It really ends. There is nothing that we cannot finish feeling sad about if I allow myself the privilege of feeling sad. Way too much so-called therapy focuses on fixing sadness or making up for it instead of just feeling sad and allowing sadness to run its course.

This having been said, it is important to note that feeling sad is painful. Hence we avoid sadness by feeling fear or anger or having some kind of compensation. But the problem is that people are generally not good at simply feeling sad. They would much rather feel angry at what happened to them, which always leads to depression, or feel afraid of what they might lose in the future. Both are delusional: we can’t change the past and we can’t change the future. We can reflect on the past and finish the feelings of sadness, or we can consider possible losses in the future and feel anticipatory sadness. But we can’t change the past or future. So, the “treatment” for all trauma is to feel the sadness that comes with all loss, e.g.:

• Loss of freedom as a child
• Loss of limitation as a child
• Inconsistent freedom and limitation
• Loss of security
• Loss of physical or emotional love

All of these losses can be felt and finished, but this is no easy task. Simple, but not easy.

The one real “cure” for PTSD

We have already suggested that the treatment for PTSD, or for any other mental distress is grief. Honest grief. But how is this done? Grief is simple, but it is hard, as I just said. It is simple because it is natural. It is natural to cry when I lose something, and it is just as natural to feel the sadness associated with crying. But it is not easy. It is not easy because of several matters, not the least of which is the cultural resistance to sadness and crying, particularly in America. Yet, there are ways to deal with the resistance we all have to grief:

• Find a competent therapist. There aren’t many, sad to say.
• Find a true friend…one who does not try to fix you and says very little but stays with you
• Find a time when you can be alone…and grieve the loss(es) you have suffered in life
• Write these losses down. You will see some “large” losses are no longer grievous, while smaller ones are still unfinished.
• When you are angry or afraid “back up” your feelings until you find the hurt that always precedes anger and fear. Then back it up further, and you will find the love that you have for something

If you do this process of finding the core “problem” in PTSD, or any of its derivatives, you see that they are all about love, principally the love of yourself, which has been lost along the way. Love of self is natural, and it is not the same as liking oneself, liking what you said or did. But this is another subject.