Therapy is a common place to find people definitely situated between a rock and a hard place. There simply are those times when neither choice is great or all choices have so many unwanted consequences. Let’s look at some of the rock and hard place situations that cause you and most folks considerable angst.A rock and hard place dilemma is also known as Morton’s Fork where contradictory arguments lead to the same undesirable outcome or conclusion. The origin of this term is from the 15th century. There is a book by Aron Ralston, Between a Rock and a Hard Place. This autobiography was later made into the film, 127 Hours. As some of you may know, Aron was forced to amputate his own arm when he was trapped in a crevasse while hiking in the Canyon Lands of Utah.

A rock and hard place example I recently encountered was while counseling a mother. She has been divorced for many years and has a teenage daughter. The daughter hates mother, according to mother and daughter. The father is rather unstable, has few rules, and let’s the girl call her own shots. Mother and father have joint custody, another rock and hard place situation for many. Daughter wants to live with dad; mother wants to have her influence as mom. However, the girl makes visitation time a nightmare with physical assaults, threats of harm, destruction of property, and more profanity than one can talk about in a blog.

Mother would like her life back. She would like to walk away from the girl.

Mother doesn’t want to give up on her daughter.

Mother has found herself between a rock and a hard place or Morton’s Fork. There is no simple good outcome as both choices involve unwanted consequences. The loose variable is the daughter. If only we could effect what is going on with the girl and bring understanding to her anger, her acting out, her violence, and her crazed ways? It could be drugs, but dad vetoed drug testing. It could be mental illness, but that too was vetoed for the girl. Hmm.

Another example of a rock and hard place in everyday life is when you have a child on drugs. One young man I worked with was using alcohol and off and on every imaginable drug. He had settled with the comforts of heroin. Of course, heroin made it impossible for him to really do anything of substance and soon he become held hostage to the predators known as drug dealers. Drug dealers know a great deal about rocks and hard places. They exploit these queasy opportunities.

This young man’s mother went into debt, mortgaged her house three times, maxed out her credit cards, and put her son into treatment three times. He relapsed again. She didn’t give up on him, but she stopped paying his bills and his drug dealers. She offered him the opportunity to move home, get into a fitness and diet correction routine, and try alternative medicine for healing his now poisoned body. This was a rock and a hard place for years and then it changed.

Have you found yourself between a rock and a hard place with someone you love or with a situation at work or school? I would enjoy hearing about your examples.

Take care and be well,

Nanette Burton Mongelluzzo, PhD

People are prone to relationship upsets. Sometimes they find themselves in quite a fix and feel depressed, anxious, overwhelmed, and just plain unhappy. Clearly, there are legitimate times for concern, however, many times the problem is more related to state of mind, unfinished business from another time, or phase of life. Let’s look at what happens to love and how it loses its practicality.I love the practical side of love. Practical is the sharing of chores, resources, and dozens of feelings about a myriad of things. We share with our loved one about our day, the political debate, the state of the economy, and the news story about yet another school shooting. We listen to his day and he listens to the tales of ours. We both listen to the stories of aging bodies and changing physiology.

In the longer term committed relationship passion is bound to wane and people sometimes question the integrity of the relationship. Relationships take work and relationships are supposed to change over time. Core values and beliefs may remain over many years, but life events have a way of changing us and through this change we allow for new ways of being and new viewpoints.

In my clinical practice I see relationships that have become sad. The individuals who make up the couple unit want something more. They want more passion or more excitement. Sometimes they want more time with one another or one person wants more time and the other feels complete. Most long-term couples don’t want to rock the boat of marriage. I understand why.

Relationships are not about things always being OK or about our needs always being met. Relationships are about learning about the other and supporting them. It is also about learning about yourself in relation to this other person. Disappointments are bound to happen and missteps are common where judgment is concerned.

When people make a commitment to be together they are agreeing to ride through hard times as well as good times. Everyone has a line they draw in the sand. This is the place where things are no longer tolerated or no longer negotiable. Lines in the sand include things such as physical, sexual, or other forms of abuse. It also includes harm to others such as by way of abusing, murdering, or causing grave harm to someone else. There are lines in the sand that have to do with finances. To empty a bank account out and spend it recklessly without the others approval may be a line in the sand for many people. There are always reasons why things cannot be repaired and couples simply cannot move on.

There are many more situations where the reasons for despair or unhappiness are not so concrete as the examples I noted. Loss of that loving feeling, boredom, and relational sadness are all difficult situations, but are they reason enough to break a commitment or are they opportunities to learn just how much you can do for yourself, your partner, and the relationship? I encourage clients to not give up without a big fight.

When we push past our limit we come to understand ourselves better. We come to understand just how much we are made of. We see we are more than our limitations, our judgments, our fears, our disappointments, and most of all we see the vanity of pride. Pride gets in the way of most things. People in counseling often note their feelings were hurt by the other. I understand. Our feelings, however, are simply our feelings. Feelings don’t define reality; feelings inform about our position on a reality.

If you think about the practical aspects of your relationship, what do you see? Do you have a friend and companion? Do you have someone who helps you replace the screens or hold the board so the hammer and nail do their dance more easily? Does someone make you a snack or bring you a chilled iced tea when you are working in the garden? We do so many things for one another and nothing is wasted or unimportant.

Relationships have a solid practical side. This is the most beautiful part. Just having someone listen some of the time or giving a hug when sadness is around is worth gold. Being gentle with one another is a gift. Loving someone is easy. It begins with kindness. Life is not about some explosive fireworks display of romance and passion. Life is about the day-to-day sharing, helping, caring, and experiencing with another.

Some Reasons Love Loses Its Practical Value

• A significant loss of another loved one shifts focus from the practical.

• A major health scare or illness produces fear and the practical joys move into the background.
• A major mental health problem including drug and alcohol dependence and abuse.
• All losses that result from life events.
• Losses that turned to grief and the grief was not negotiated well.
• Complicated or traumatic grief.
• Betrayals and Comprised Lines in the Sand.

Pay attention to the beauty in the practical aspects of your relationship. Identify your losses and try to prevent the losses from blinding your practical joys in your relationship.

Be well and take care,

Nanette Burton Mongelluzzo, PhD

What do you do when the distance traveled between two points is not in a straight line?

Ah, life’s little detours, curves, steep grades, and uphill climbs. Life can be likened to a most interesting and varied road trip. Parents lament when their teen or young adult finds him or herself in trouble with the law or with the abundant variety of drugs to numb whatever feels as though it needs numbing. How do you avoid the panic?Panic is a form of anxiety. Anxiety is a fear of something that has not yet happened. Often, because things have historically happened people have some legitimate basis for their anxiety. Let’s look at the curves.

Curves are detours, diversions, and casual or calculated maneuvers around going from point A to point B in a straight line. If point A is childhood or adolescence and point B is a comfortable and happy adulthood, the distance between A and B can be a straight path or it may involve many perilous curves. But childhood and adolescence are not the only place where dangerous curves exist. They exist in adulthood as well.

Curves:

Potentially dangerous turns in a road. Things that happen to you. Things you do to yourself.

• Physical Illness

• Death

• Drug and Alcohol Abuse

• Mental Illness
• Victimization
• Accidents
• Economic Loss
• All Other Major Losses as a result of Life Events and Your Choices

Panic in the Curve:

The tendency to under correct, over correct, or otherwise not pay attention to the fact that you are traversing a curve.

Every curve requires a plan of action individually designed to understand the nature of the curve.

There are aspects common to all curves. These include:

Danger, the inability to see far ahead, uncertainty as to the correct speed, apprehension, adrenalin, loss of confidence, doubt, wavering trust, anxiety, potential panic, and plenty of fear.

Let’s look at a Panic in the Curve example:

Jason was twenty-six and a college graduate. He had his fair share of traumas along the way including some off and on serious bouts with alcohol abuse and dependence. He had a couple of failed relationships with young women. One relationship was with an ice princess who specialized in cocaine use and abuse. Another relationship was with a girl who had a childhood history of sexual abuse. Both girls left Jason dizzy and unsure of himself. The third girl had a history of abuse, a diagnosis of borderline personality disorder, and a history of many passive suicide attempts.

Jason decided on returning to school for a professional degree. He applied, was accepted, and his parents were pleased.

He was in professional school and finishing his fourth year. One night he was at a party. There was drinking going on and he had some to drink as well. Somewhere during the night a fight broke out and Jason was hit in the face several times by a fellow classmate who was out of control from drinking and drug use. Jason did not defend himself. The next day Jason spoke to some friends, family, and his new girlfriend. He decided to press charges, as the damage to his face was quite severe and he also had a few broken ribs. He was not entirely comfortable with the decision because the person who did this was also in a professional program.

Jason thought it through the best he could and then called the police. The assault was not denied by the accused.

Jason found himself living in fear. Due to the fear he began using alcohol again. From alcohol things escalated to bigger drugs and ways to simply not feel afraid anymore. There are only a couple of drugs known to erase fear. He found them.

Jason was now using drugs as a way to cope with life. He found himself being beat up by drug dealers, ripped off by drug dealers, and out of money. His parents were in a panic. Jason was in a panic. The girlfriend fled.

How do you not panic with curves  like this?

First of all you need to survey the situation: Jason was a good guy, always was and always would be. He chose negatively inspired ways to cope with fear.

Jason needed to get back on track. He had close relationships with his family and had been honest to a fault about any and all of his transgressions. These are strengths or what we call in psychology, protective factors. Protective factors are those things that protect people as they go through major losses, life-events, or curves.

Risk factors are those things that place a person at risk for more harm, death, and dangerous curves that may not be able to be negotiated without a fatal accident. Risk factors are also challenges the person owns as a part of who he is.

We look at the Protective Factors and Risk Factors in order to decide if we can do without panic on the curves.

Protective Factors for Jason:

Strong family connections

Basically good intentions and love of life and others

A conscience

Resiliency evidenced physically, emotionally, and inter-personally

Intelligence and ability to carry through with academic goals

Risk Factors for Jason:

History of drug and alcohol use and abuse as a form of self-medicating

Overall lack of assertiveness due to fear of offending others

Relationships are not well chosen. Too child-like regarding others and relationship

Risk taking behaviors

More on how to not panic on the curve in the next blog. Until then, remember, curves are simply turns in the road that can make the journey more memorable as long as the curves are well negotiated.

Be well and take care,

Nanette Burton Mongelluzzo, PhD

In my blog of the same title earlier this week we talked about compassion fatigue and the warning signs you might be at risk for this form of secondary traumatic stress (STS). Today we will look at how to intervene on your own behalf or on the behalf of a professional at risk.An intervention plan for the  the professional, and others who extend compassion toward others in ongoing ways as a part of their daily routine involves some amount of change. Change is good, even though change represents loss. We give up something even when we are doing the right thing.

Treatment for the caregiver is just as important as what you do for others. There are many ways to get help. First it is important to understand that it is easy to get swallowed up by other peoples problems and suffering. An intervention plan is in order and includes things such as the following:

• Find time alone for yourself

• Engage in a daily activity that recharges your battery

• Try to engage in a meaningful dialogue every day with at least one person

• Limit or temporarily cut back your work hours

• Find a way to engage in humor, preferably on a daily basis

• Engage in personal care every day. This includes what you wear and physically taking care of self
• Consider finding a counselor to help you organize the best possible intervention given your situation professionally
• Watch self-medicating
• Watch what you eat. Remember food is fuel
• Try to find time for exercise at least four days a week. It can be just walking the mall and this will help de-stress
• Stay away from television or the horror stories others want to tell about suffering. You already understand this!
• Keep a journal, write a memoir, or start a blog
• Be 100% present on the job and when you leave, leave as completely as possible
• Start a professional support group or find one in your area to attend
• There is little time, but there is always time to take care of yourself.
• Let your family or significant others know you need support. Perhaps your partner or children can make dinner for you two nights a week just because
• Sit on the ground, the earth, ground yourself
• Remember that things like massage therapy, acupuncture, and forms of physical therapy such as cranio-sacral therapy relieve stress and tension in the body. These are better choices than self medicating.
• Remain positive
• Thank yourself for the courage it takes to show up and do what you do for others every day.

Take care and Be well.

Nanette Burton Mongelluzzo, PhD

Photo Credit: Doctors Without Borders, Norway

Anyone who has ever cared for another during an illness, following a death, during a mental illness, drug addiction, or any of the many loss scenarios that exist understand that compassion will involve fatigue and stress.Caretaking involves energy of the physical, emotional, intellectual, and spiritual kind. It is hard to care for another. It is also rewarding and meaningful. But, it is difficult and the caregiver must take care as well.

Compassion fatigue is also known as secondary traumatic stress (STS). It used to be referred to as caregiver burnout. Caregiving is an individual activity when one cares for a child, spouse, loved one, or close friend. Caregiving extends into the ranks of professionals who show up every day to take care of you and those you care about.

Sometimes I hear caustic comments based largely on ignorance such as, “Well, doctors are trained to put up with that stress.” Or “Psychologists are trained to put up with client’s anger and rage.” Or “Nurses shouldn’t have become nurses if they can’t handle people yelling at them.”

My response is a silent, “Wow.” People haven’t a clue.

Professionals enter the caregiving professions because they care about people, human suffering, and because they wish to make a difference. We are trained to understand all manner of things related to suffering, but no one is “trained” to put up with rudeness, rage, excessive anger, and hostility. Professionals are people first and professionals second.

Physicians, first responders, police officers, fire fighters, paramedics, nurses, social workers, psychologists and counselors, nurse aids, attorneys, and all the long list of helpers out there do what they do because they have a heart.

For the amount of education required it would have been more lucrative to be a house painter, plumber, or electrician. Many do not realize what it takes to enter the helping professions in terms of education, money, student loans, student debt, and years of on the job training, not to mention licensing and license renewal costs.

Compassion fatigue can also apply to the general public who is bombarded nightly on television and anytime on the Internet with disturbing stories about tragedies and suffering throughout the world. Over exposure to suffering creates secondary traumatic stress. For those with preexisting mental health problems it makes problems worse. Anxiety sufferers will feel more anxious. Depression sufferers will feel more depressed. Feelings of powerlessness start to pervade our personal and geographic landscape. People begin taking “it out” on one another.

Here are the signs of secondary traumatic stress or compassion fatigue:

•  Feelings of hopelessness

• A decrease in pleasurable activities

• Anxiety and stress

• Insomnia

• Nightmares

• Negative or pessimistic attitude

• Being quick to anger

• Reduced productivity

• Difficulties with focus and concentration

• Self doubt

• Feelings of inadequacy and incompetence

• Taking on symptoms of those you are caring for

• Emotional detachment

• Self-Medication

• Isolation from Others

• Work demands encroach on personal life

• Somatic complaints

• Blaming others

• Depression

• Fatigue

Treatment for the caregiver is just as important as what you do for others. There are many ways to get help. First it is important to understand that it is easy to get swallowed up by other peoples problems and suffering. It is important to come up with an intervention plan for yourself.

We will look at how to intervene in the next blog.

Take care and be well.

Nanette Burton Mongelluzzo

Contents for this blog are from the upcoming book, Understanding Loss and Grief, to be published by Rowman & Littlefield in the fall 2013. By Nanette Burton Mongelluzzo

Teenagers are graduating in May and June from high school. This long anticipated date is mixed with emotion. It is both exciting and terrifying at the same time. It is a transition and transitions are dangerous, as well as profound opportunities. Transitions are also part of the path of a teen’s life journey.

By the time a teenager is ready to graduate from high school most are tired. It has been the same old thing for a long time. Most teens have been in school thirteen years by the time graduation takes place. This is a long time to become familiar with something. Although change is desired for something new and different it may be hard for the teen to see how that is going to take place.

I have worked with hundreds of teenagers over the years. Graduation and senior year are filled with emotion. Often the teen keeps secrets about their fears, their doubts, and they feel they may have missed some turn along the way. I remind them everything is going to be Okay. The shortest distance between two points may be a straight line, but it is seldom the way human beings arrive at their goals, dreams, and aspirations.

Now we have to talk a bit about parents.

Most parents love their children more than anyone or anything else. They also worry. Parents want their children to be healthy, happy, successful, and to live a respectable life. Parents often think that a well-designed path is the way to insure this. So, preschool is attended, music lessons are given, sports participation is encouraged, and studying is a part of life. A parent is a great director in the production known as their child’s life. Some parents take cues from their children, others don’t listen much at all, and still others decide the direction regardless of protest.

One of the things that causes great angst for teenagers is parents wishes and desires superimposed on their own wishes or on the space waiting for wishes to percolate. Teens tell me that they love their parents and know they are thinking about their best interests. However, teens start feeling directed and railroaded early on. By graduation they are a bundle of nerves, depression is rampant, and anxiety is electric throughout their emotional makeup.

Instead of feeling more confident and secure with all of the directing and experiences offered to them, they often feel more insecure. Children from families where there was little extra cash and even less involvement with extracurricular activities often emotionally mature earlier. They learn about life by way of their own successes and failures, rather than learning about life by way of parental direction. This does not mean children don’t have a parental compass inside if they come from a family of lesser means. All children and teens carry the good and not so good that they experienced from parents.

Whenever possible, and this is quite often, it is a good idea to listen, stand back, and ask more questions. Stephen Covey is known for his work with organizations and what makes for success. One of his observations is, Seek to Understand Before Seeking to Be Understood. This particularly applies to children and teens.

Teenagers are in transition between childhood and adulthood. They are capable and wise. Listen to what they need. Even if they do some things you don’t approve of, seek to understand the meaning of that behavior. It is easy as a parent to squash an unwanted behavior, habit, or emotion evident in your teen. By making it go away you may miss the opportunity to understand why the behavior, habit, or emotion is there. It will just re-surface somewhere else or in other time if it is not understood.

I can hear objection already. What about drug use and abuse? Well, your child will need treatment. Be sure your counselors or treatment center seeks to understand and not just disappear the unwanted behavior.

Be well and take care.

Nanette Burton Mongelluzzo, PhD

I have been thinking a lot about cancer these days. Almost half my caseload has cancer or I see children who have lost a parent to cancer or spouses with a partner with cancer. It seems like cancer is everywhere. Cancer does affect everyone.

Grief is an intimate process of a uniquely individual design initiated for the purpose of transitioning loss.Loss is everywhere. Just like cancer.

When I work with cancer and those who bravely traverse the terrain of what this means to them I am in wonder of the courage it takes to make this emotional journey. Words help the process, yet words are difficult for people even though this is our main platform of communication. I hear people stumble with words, hold words back, bite their tongues, and express fear of saying too much or too little. I have some suggestions.

Words help us bridge to another. We want honest words well-honed to identify the emotion that is uppermost in our heart. So for the child with a dying father or the wife with a dying husband it is important to say things and to work on any unresolved piece that may exist. It is not that the world will fall apart if one doesn’t step up with truth, but the survivors of a death have years ahead to mull over what was and wasn’t said.

Children need help from the healthy parent (the one who does not have cancer) and the healthy parent needs help from friends, siblings, and other family members. Help that comes in the form of encouragement to go to the truth is important.

I work with so many people who are left with unfinished business following a death. It is as though the cancer that took mother carries on into her children or spouse. It is not cancer, but an emotional cancer.

Cancer that is not treatable or one that is aggressive and terminal produces a state of helplessness. Helplessness is an alarming state for mind, body, and spirit. Studies show a connection between depression and cancer, between stressors and cancer, and between sustained powerlessness and disease or illness.

Words of love, words of connection, words of gratitude and words that evoke hope are all good. Everyone leaves a legacy and even death is filled with a gift. People leave their spirit, their contributions, their love, their strength, their bonds, and hundreds of things behind for the use of others with their passing. These things that are left often come in the form of words. We are all pebbles thrown into a large or small pond with ripples that extend endlessly.

There is power in words. Words have the ability to soothe and mend or to wound and destroy.

Take each word and mold it to fit your most compassionate truth. Find the word that rolls easily from your heart before it is projected outward. Practice how gently you can convey even the most difficult feelings. Words are our creation. Words help us grieve. Words are an intimate part of the grief process.

Take Care and Be Well

Nanette Burton Mongelluzzo, PhD

The suicide rates increase as we turn to the warmer months. They amp up in April and reach their peak in May and June. May is a peak month as schools ready to dismiss for the summer months and parents prepare for a different non-academic manner of relating. Warmer months encourage awareness of economic woes.The APA (American Psychological Association)  noted that the suicide rates (per the CDC 1928-2007) for the age group from 24-65 rose and fell due to economic conditions. On average the suicide and homicide rates increase with the advent of spring. This is contrary to a popular belief that suicide is higher during the dark and cold winter months. This has never been the case.

Just why does the seasonal change act to increase suicide?

This has plagued scientists for some time. In the winter months many people suffer from severe depression, seasonal affective disorder (SAD), and problems with maintaining balance due to severe weather, increase in costs of heating a home, and job lay-offs that often take place prior to the holiday season. People hang on with depression, anxiety, fear, and a host of other mental health concerns throughout the winter months.

When spring emerges and the weather warms there is an increase in energy. You have heard of how people who end their lives by suicide have an improvement in mood days or weeks before the actual attempt? Seasonal suicide rates are believed to operate on the same principle.

It takes energy to end a life. It takes momentum and a plan to decide on the how, when, where, and what of a suicide. People in the throes of depression do not have energy to plan and execute a suicide plan. Very often people mistake the mood improvement following a severe depression with the individual’s mental health improvement. Friends and family hope that their loved one is finally getting better. They notice more energy, smiles, follow through on projects, and an overall improvement in mood.

Sometimes a person is getting better, but many times the increase in mood is due to finally having the energy to plan and follow through with a suicide. This is why we want to watch our loved ones closely.

Some studies suggest that with spring comes an increase in serotonin levels. This is our built-in “feel good” chemical that provides for a sense of well-being and energy. Serotonin peaks can create energy and this energy might also be aggressive energy. Have you ever noticed in urban areas how the street gangs and hustlers start hanging out at the end of the block the soon as the weather begins to improve? They shout, they stay up late, they drink too much, and rowdy becomes an understated description for the fear they can instill in the neighbors on the block.

Still other studies ponder melatonin as a partial culprit. With an increase in sunlight melatonin levels in the body are decreased. We can stay up later and get up earlier in the warm months whereas in the dark winter months many people are prepared to go to bed much earlier. Melatonin does affect our behavior and mood.

Another explanation has been offered by physicians who have studied the effects of allergens on mood and on the chemical balance within the body. With spring comes flowers blooming, grasses pollinating, and trees emitting yellow dust (pollen) with each gust of wind. Life is reproducing itself. And these life producing chemicals from our plant friends cause many to have moderate to severe allergies. Allergies influence mood and behavior as well.

All together it is good to dismiss the myth that suicides are the highest with the holiday season. This has never been the case. We are entering the peak time for suicides.

Some facts to keep in mind:

Men are more likely to end their life by suicide. Women make more attempts, but men tend to succeed on their first attempt.

Risk Factors:

A prior suicide attempt

A completed suicide by a family member, close relative, or friend

Family history of child abuse

History of a mental illness, especially depression

History of a substance abuse or dependence problem

Impulsive or aggressive tendencies

Isolation

Loss and Grief Issues

Physical illness

Limited access to mental health or health resources

Protective Factors:

Access to medical and mental health services

Family and community support

Skills in conflict resolution, problem-solving, and working things out in non-violent ways

Remember that there are many things each of us can do to help one another. Apathy is the worst position to take. A life is not replaceable.

Susan Sontag said, “Compassion is an unstable emotion. It needs to be translated into action, or it withers. The question is what to do with the feelings that have been aroused, the knowledge that has been communicated. If one feels that there is nothing “we” can do–but who is that ‘we”?–and nothing “they” can do either–and who are “they”?–then one stars to get bored, cynical, apathetic.”

Abuse knows no rules, no boundaries, and does not take exception with the wealthy or the poor. Abuse doesn’t care if you are the clever one, the beauty, or the hunk down the street. Anyone can find themselves in a potentially abusive relationship. Once in one of these relationships it may place you in a trance and you may find yourself unable to extract yourself.

Domestic violence is also known as intimate partner violence. Violence is an interesting word. It can speak about physical harm, sexual harm, or an entire array of emotional repercussions. Often people think domestic violence has to do with marriage, hence the word domestic. If we use the description of  intimate partner violence we see it opens up how we think about abuse.

Can teenagers be involved in intimate partner violence? Absolutely. Teenagers date, they engage in sexual intimacy, and they spend lots of time together. Most of their time together is spent in isolation and away from the watchful eyes of others. This is clearly different than a married couple where parents, in-laws, and even neighbors or children have a viewing angle of the relationship. Teen relationships often exist in a very private setting.

The nature of the privacy lends itself well to abuse, violence, verbal tirades, brainwashing, confusion, distortions, and one partner feeling they must do what the other wants. Often teens are dealing privately with drug and alcohol issues, suicide threats, pregnancies, abortion, physical violence, sexual violence, or sexual acts that they don’t want to engage in.

Women, and this includes young women, are more vulnerable to developing posttraumatic stress disorder. There is some understanding of this in the research.

Women are twice as likely to develop PTSD. In a 2004 study of women veterans in military service it was concluded that women in military service were more likely to develop military PTSD if they had a history of military sexual assault, childhood sexual assault, or civilian sexual assault.

Many studies have shown the connection of prior traumatization to risk for developing PTSD as well as for revictimization. It is not that women or men who have been victimized and traumatized choose to have a repeat of these circumstances. We discussed in earlier blogs the way the brain and limbic structures are affected by trauma. If the limbic system structures are over sensitized it places individuals at greater risk due to the inability to correctly ascertain or discern safe from unsafe in the environment and in interpersonal relating.

Research has indicated childhood exposure to violence can result in negative mental health repercussions in childhood and later adulthood. A 2011 study attempted to determine if there was a difference between childhood exposure to violence and PTSD by looking at two different violence exposures. The study looked at children who witnessed violence (domestic violence) and those who experienced violence (child abuse). This study found a correlation between later development of PTSD or current PTSD as related to child abuse only or a combination of child abuse and witnessing but not to witnessing only.

Alina Suris, Lisa Lind, Michael Kashner, Patricia Borman, and Frederick Petty, “Sexual Assault in Women Veterans: An Examination of PTSD Risk, Health Care Utilization, and Cost of Care,” Psychosomatic Medicine: Journal of Biobehavioral Medicine 66 (2004):749-756.

Fossil records show that wild fires took place over 420 million years ago. Wild fires are a natural disaster. They are a phenomenon of nature and of man within nature. When our geography is wounded or destroyed a part of us is wounded as well. One plays off the other. Geography affects people and people affect the geography.Pat Conroy in The Prince of Tides wrote, “My wound is geography…it is also my anchorage, my port of call.” Fire is about destruction, loss, grief, dismantling, decomposing, fragmenting, things falling apart and then somehow putting things back together again, but not in an identical way, because that is not possible.

Fire is about losing your anchor. We feel passionate about our geography. Our sense of place in the world is tied to our geography. One of the most immediate losses for individuals who live in communities affect by fires is the loss of their geography. It changed; it is now charred, disfigured, and barely recognizable. It is no longer the place of solace, nurturance, and interdependence. It has been harmed and cannot now care for you. You have to care for it, while also attending to your other wounds.

There is a link between people and land. The people who live on the land are insiders; it is their land and they have an intimate relationship with the land. People who visit the land from elsewhere are outsiders. They do not have the same relationship with the land. This may, for some, complicate the grief process, as many of the helpers who come to assist are from elsewhere.

Natural disasters include wild fires, but also tornado’s, tsunami’s, earthquakes, flooding, lightening strikes, and just about anything else that originates at the hands of nature or combined with man and nature. Man made disasters are made by man and include things, like torture, rape, terrorism, assault, mass murder, school shootings, genocide, and any number of other human rights violations.

Wild fires, along with other natural and man-made disasters are life events. All disasters are life events. Life events include all of our combined experiences that lead us from birth through death. Life events carry a responsibility known as loss. Every event, every situation has a marker of either a significant or less significant loss attached to it.

Birth is a life event, attending kindergarten, graduation from elementary school, graduation from high school, the best friend who moved, the sibling who died, the grad mother who just had her 97th birthday, the dog who ran away, the cat who got sick, the time you had the flu for three weeks, and the terrorist attacks are all life events. All event are life events whether they are good events or extremely bad ones. All life events are characterized by loss, because unless we are suspended somehow in time, we must move from an event to the next event waiting our attention. Loss requires change. Loss involves grieving.

We are accustomed to loss and we know how to grieve the losses that move us through a lifetime. Judith Viorst talks about loss in her book, Necessary Losses. She says,

“For we lose not only through death, but also by leaving and being left, by changing and letting go and moving on. and our losses include not only our separations and departures from those we love, but our conscious and unconscious losses of romantic dreams, impossible expectations, illusion of freedom and power, illusions of safety—and the loss of our own younger self, the self that thought it always would be unwrinkled and invulnerable and immortal.”

Whether it be a wild fire, other natural disaster, or a disaster given you by another human being there are things we lose in all fires. Let’s look at what can be lost in a fire.

Physical Impact

You may have lost your health or physical well being.

Were you hurt, harmed, injured? Was someone close to you injured? There are many physical repercussions including blood pressure, heart rate, respiratory issues, and the release of adrenaline and norepinephrine. Adrenaline and norepinephrine allow us to cope with overwhelming stress. What was your physical health before the disaster, before the fires?

Psychological Impact

You may have lost your psychological balance

What pre-existing mental health issues existed before this event? Did you have depression, anxiety, posttraumatic stress disorder, obsessive-compulsive disorder, or another mental health concern?

Intellectual Impact

You may be challenged by what the fires have brought to bear in terms of decision-making.

Did you suffer from smoke inhalation(or its counterpart in other disasters)? Have your cognitive abilities been affected? Is decision-making more difficult? Are you having trouble remembering things? How is your short-term memory?

Emotional Impact

You may have lost your emotional equilibrium.

Are you more emotional or less emotional? Have your emotions fled? Are you feeling too much or not enough? Do you feel you could explode? Are you angry?

Social Support Issues

You may have lost your social safety net.

We all need a social net to catch us if we start to fall. Who is there for you? Family, friends, neighbors, co-workers, your pastor, priest, and rabbi, your therapist? There is community loss. With everyone struggling to pull their life together, the sense of community is loss, at least temporarily.

Occupational Impact

You may have lost your job or had to leave your job or your job was destroyed in the fire (or its counterpart in other disasters).

One of the dimensions of wellness addresses our occupational wellness. When we lose our connection to how we interface with the world through our employment there is unsteadiness.

Financial Impact

You may have lost your ability to produce income or your losses are more than your finances can handle. You may have repair bills, health bills, and additional things the fire (or other disaster) brought to you that require financial expenditure.

Spiritual Impact

You may have lost your spiritual or religious bearings. You may ask why me? You may feel forsaken by God.

When life is more or less predictable people take comfort in feeling they must be doing the right things, because all is well. When things don’t go well or when disaster strikes it is not unusual for people to question themselves and wonder if they are being punished. Everyone is impacted spiritually following a disaster.

Environmental Impact

You lost your land, your physical surrounding, and your geography.

We depend on our physical surroundings to reflect back something beautiful about who we are.  If the reflection we see is disfigured and blackened we are reminded about the loss, death, destruction, and we can do nothing but grieve. The environment gives to us and we are stewards of the land. Some people may feel they failed their land.

It is important to take an inventory where loss is concerned. It is important to allow for your personal narrative of the grief process. Fires engulf and take away everything known. Much can be lost in a fire. Rebuilding following a fire is possible. It takes time and it will not be the same as before. This is OK.

Be well and take care,

Nanette Burton Mongelluzzo, PhD

Photo Credit: David McNew, Getty Images