What is your Relationship Status?

In an effort to revitalize, I took a break from the most time consuming medium for me, my presence on social media. I felt that with my slow and begrudging return, I would have an honest look at the things I uncovered for myself in an effort for you, too, to explore your relationship with this newish phenomenon. My goal here, as I will try to do with all my goals moving forward, to be as clear and laser accurate as I can. I hope not to come off as self-centered (inasmuch as an article about my personal experience can devoid me that charge) and that you may find you are able to locate some lost island of understanding for yourself.

Or, maybe you are good where you’re at and want to follow along in a process of meditation and examination and can adapt it for your purposes. Whatever your flavor, here it goes:

So, I’ve been gone for longer than I said I would. I completely disengaged from Facebook, Twitter, and LinkedIn. It was a case of burn out. As a helper, as many of you readers are, you might relate to this – the idea that you are both doing 20 percent more than you are capable of while simultaneously believing it wasn’t enough.

This was an interesting exercise for me, though not my first foray into social media disappearances. But, given my education and experience, I felt better equipped to perform and introspective examination of what it means to be connected in the way I was.

First – the guilt. This sweet, little, nugget of emotion was the most persistent throughout this process. My sense of responsibility toward each and every reader that I had amassed over the few years, washed over my “helper” lobe in my brain. This, I knew, was a sign of the immense enmeshment that social media and I had. Like an out of balance relationship. I continuously felt the need to reach out – make sure everyone was good. In the therapy world, we would label this as “my shit” to deal with. I had become a rescuer – embodying the very traits I used for good in my fire career and, now, therapy one… except these were hell bent on ensuring that I put everything else as second. The impact was not unnoticed – each time I was distracted when those around me would try to talk, or grew irritable when trying desperately to write for multiple publications at once, or frustrated when some would reach out and I was unable to connect at the level and time commitment they wanted. The pile kept growing, and I was actively avoiding solving any of it.

Second – Exhaustion. This is an interesting experience, because most of the time I know when I am tired. A week into it, I realized (on top of how I would check my phone INCESSANTLY, despite knowing there would be no notification waiting for me) that I had grown exhausted of living a very narrow and often emotionally drying world. When I waded the waters of mental wellness in the cultures where open discussion often teeters only on the worst cases, it becomes hard to extricate oneself without a sense of the abovementioned guilt. I continuously had folks I felt connected to as they had reached out in moments of vulnerability, of loss, of confusion, of absolute frustration. And, I had severed that tie. The ego that becomes wrapped in a bow with my actual ability to effect change with the real world impact I may or may not have had, played a major role in this. I felt like I was constantly trying to keep up, to a race that only I knew I was in; as if, in some magical way, my sense of purpose would wash with the waves of 100 percent success within the field. Even in the wars waged within mental wellness on the civilian side, ones that continue to rage strong, haven’t winked at such a success rate. This idea was wholly fabricated by me, one that I played to my detriment.

Third – Reliance. Knowing that I signaled to myself that with each article, quip, shot at the status quo, like, rebuttal, straight forward challenge, I grew reliant on the vehicle itself. It’s a wonder how I never before saw that the shake of the phone was clearly the same anticipatory response with what used to happen with my Minitor. I, as we do, waited in excited anxiety for that random time when the pager would go off and something “big” would be on the other end. And, just as when I was in service, I always responded as if it was the real thing. I created a sense in which this was active service. Of course, in my cognitive distorted process ignored that there was always down time, or time the pager was off. But, not here. Not while people hurt. Not when I felt true to my message. As often as it was uncomfortable, I never shot an arrow I didn’t 100 percent believe in. But, this heavy reliance on needing that connection was a telling sign that for as much as I felt this need, there was an equal and opposing realism that what I really needed was to break this relationship.

Fourth – I forgot my own message. In almost every talk I give to departments, therapy for individuals or groups, etc. I explain the mechanism for which stress impacts on the individual. I frame this in a (very broad) explanation that seems to be on many folks minds – why do some develop struggles and others don’t? But, I was ignoring the tenant that I preach upon my small pulpit. Not checking in with self to recognize the emotional impact that involvement in this was having. Indeed, I often felt the clear signs, but I told myself a different tale. This tale was one of ignorance, of ego, of self-aggrandizing. And, I told this tale to myself at my own peril. It was an honest two or three weeks, before the initial impact of breaking free really hit. And, only then did I recognize that I had failed to check in with myself. To see where I had slipped into full rescuer mode and to recognize where such a process and outlook, is never sustainable.

Fifth – the fear. At coming back! Who would have thought? And, this isn’t some earthshattering keep you up at night fear. Nonetheless, I began to understand the true time commitment that I was unfairly giving to this online presence and not to those things that actually matter – namely, almost categorically, everything in my personal life. I found clarity and relaxation for god sakes. And, therefore I had a healthy, balanced and informed concern for where this slippery slope may lead if unchecked. So, my ascent back onto the horse has been a slower, calculated, and precise an exercise. In some cases, my leg lay lame behind me dragging, a sign that a large portion of my brain was accepting and inviting the downtime. But, and as I said on my way out, I believe that the messages that I send are wholly different and often in complete contrast to the messages en masse. And, there needs to be this challenge to the status. As I have said elsewhere our intentions are true, but our aim is not.

My new rules for engagement –

I think one of my biggest takeaways, and this is likely more aimed at those that are helpers for the services, is creating rules for engagement. Without these, without a clearly defined boundary, we can flounder into feelings of guilt for not doing enough, or exhaustion or resentment for constantly giving everything we have without rest. Create a list of rules that are reasonable within the cause you are putting forth and stick to it. Hell or high water. I tell people ad nauseam and yet forgot myself – boundaries are essential in the way that they are as equally difficult to stick to. Break them for no reason, or suffer the ailments that follow.  

Create a standard you can reasonably reach.
Get comfortable with “good enough”.
Distract, but don’t avoid (your situations or positions).
Engage what you love, let little take away from that.
Create office hours – outside of that, put that shit down.
Recharge, at all costs.
 Disengage.
Challenge yourself to move through the things that pain you.
Disconnect and meditate on your relationships.
Have fun – even when the thing in front of you is supposed to be serious.
Stretch yourself, but in short, measured ways.
Get a dog (ok, this may not be sound advice for everyone).

My philosophy remains the same. I’m happy to be back at it, pushing and proding (sometimes kicking and screaming).

Let’s put our boots on, we got work to do.

Challenging the Paradigm

We have spent so much time talking about mental wellness issues with First Responders. Politicians, activists, writers, therapists and anyone else with a stake in this conversation has leapt up and screamed that we need support for PTSD.  

And, we do.

But, there is a dilemma. We are focused on the wrong area to invoke real, long lasting change. With our unfortunate, myopic viewpoint, we are tackling a problem at its most difficult state. By the time ‘PTSD’ is on the table for discussion much of the damage to the person’s family, career, and personal life has already been done. We are effectively stating, “No. No. You don’t get any help until you have the worst case scenario for your mental wellbeing”.

It seems even in our mental wellness struggles we continue to demand to be treated from a macho heavy, hero state: as in, wait for the toughest folks to be in the toughest position. But, for all of our attempts, for all our training programs and awareness discussions, here we still sit, in continued despair.

The reason is because we continue to ignore all other aspects of mental wellness. It has done wonders for the First Responder field to have growing public awareness of the potential impact of viewing car accidents, the deceased and dismembered, and the destruction of people’s homes and lives. Make no mistake, a First Responder does work in a field of trauma. But, a little support can go a long way. Educating them effectively on how to take care of themselves will actually become the preventative interventions we dream of.  Hopefully, we can avoid making this career in trauma, a “traumatic career”.

Moreover, this raises an entire diagnosing issue. First Responders will soon recognize that in order to get any support from the government, their organizations, and recognition from their peers they will have to have a PTSD diagnosis. Nothing other than that will be accepted. First Responders, then, need to seek out those that might be able to offer them this diagnosis, so that they can receive support, and, may push back against those who offer a different diagnosis in the face of their symptoms. In essence, denying the support they have received because it isn’t the “right” support they need or assume they should have.

Languishing while still working - Waiting to get the "right" disorder to receive help.

The overwhelming irony is that by following the timeline necessary for a PTSD diagnosis, people need to remain unwell. A claim is difficult to make if, at the time of it being honoured, the person has been able to effectively manage through their own means. Unfortunately, many have been forced to manage through their own means, because wait times for mental health treatment remain an insult to those who reach out for help. When people finally do reach out, the response they hear is "Hurry up and wait."

Real conversations do need to happen. More importantly, however, there needs to be a commitment to real change within our organizations. In order to do this, we need to recognize that the rigid, one-size fits all mental health training we are currently proctoring as the savior to our mental anguish, is going to fail. It will help some, and the argument could be won there. But, “some” is not enough. We need to remove the veil of heroism to understand that First Responders are exercising an immense amount of mental currency to remain focused on the job. First Responders often wish to identify themselves as “burying” these emotions, however, for anyone who has experienced the unfortunate events of having their emotions explode out of them, you realize that emotions can't be buried. They are compressed, shelved and constrained, and compression only works for so long.

When we continue to deny our friends and family in the First Responder field the proactive approach of programs and support allowing for the decompression of those emotions, we encourage them to spiral into mental illness; not mental wellness. For some, this results in the development of PTSD.

In order to overcome this, there needs to be a change of approach. We need to challenge the paradigm that reactive services are going to best support First Responders. There has been a lot of talk and not a lot of change. We are feeding our First Responders bread and water; enough to sustain a few, and to ensure our budgetary requirements for other “operation based demands” remain intact. We continue to ignore the very fact that anxiety, depression, and other issues will quickly boil over and while an individual case is vastly complex, a more global viewpoint is quite linear. If organizations don’t provide the opportunity for support and proactive wellness, the costs will be greater with sick leave and long term disability. With folks engaged in extensive psychological interventions in order to garner some semblance of normality back in their lives.

We need to head in the "right direction" - a focus away from "diagnosis-only" to Mental Wellness approaches.

The loss of time, then, is placed on those still at work. But, overtime in this field can often mean overexposure of negative events. Therefore, the failure to provide effective mental wellness across the board doesn’t just affect one individual, it carries on to affect those still working.

If we wait until First Responders develop one of the most difficult and life changing disorders to get support, we are effectively leaving them to languish in utter mental hell and chaos. The most acutely problematic irony here is that they continue to work and suffer in the midst of this mental hell and chaos, and that we ask them to do so.

And, in their time of desperate need, we ask them to continue suffering until they meet the right “check box” for support.

Stress and Disease

Stress. Something we often think about, deal with, then move on. While there can be a lot said about "Eustress" aka. "good stress", when it comes to first responders we rarely mean "good" stress. The overwhelming amount of negative stress that First Responders experience has lead to the national recognition that Post Traumatic Stress Disorder as a "workplace hazard". We have heard about PTSD often in the media (and it has been spoken to on this site, and many others). What we hear about are the immediate impacts of this disorder; however, if those effects weren't horrific enough, there is some shocking research suggesting the impacts might be much further reaching!

As research progresses, we are growing to find that the mind and body are connected. This may seem intuitive, but this has been debated for years between psychologists and philosophers alike. It is a psychological paradigm shift to have therapists now paying attention to how the body is reacting to different issues from depression, to anxiety, to trauma. What is more, is that this is rarely something that First Responders are oriented to pay attention to, let alone spend any time considering.

In a discussion with Dr. Andy Brown, he asked me to reflect on a moderately stressful call. "Focus on an event, not one that was very traumatic, but one that was a little bit stressful". Once I had one in mind, Dr. Brown led me through a "Body-Scan", identifying areas that were strained, sore, or otherwise abnormal. While this experience was void of the typical clinical approach or atmosphere (you can only get so much of that via phone), I was still able to find areas in my body that seem to be triggered when I recalled the event. This is not to say that I, or you, have PTSD, but rather that the traumatic calls and stress from them can be "remembered" by our bodies. Dr. Brown hypothesized that trauma gets "stuck" in the body. If this is left long enough without intervention, the body may turn these experiences into pain.

This is the basis behind a lot of the newer research, especially that of psychiatrist Bessel van der Kolk. His book, "The Body Keeps Score" culminates his journey in psychiatry that had led him to uncover the importance of the body in understanding trauma. " Not the emotions such as anger, anxiety or fear", Bessel writes, "but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow and so on".

The research is becoming quite clear on the impact that this disconnection between mind and body can have. From the relatively basic and somewhat harmless concern or attempt to supress a thought, which ironically increases the desire and obsession of the very thoughts we want to avoid (Baird, Smallwood, Fishman, Mrazek, & Schooler, 2013), to the severe and significant impact of “Alcohol dependency… considered a dissociative reaction of individuals with difficulties in identifying, expressing, and regulating emotions” (Craparo, Ardino, Gori, & Caretti, 2014).

But, studies are beginning to link a connection between the effects of on-going stress and the development of dementia. Quershi and colleagues made this link when looking at Veterans with PTSD (2010). Alarming was the finding that those with a PTSD diagnosis were twice as likely to develop dementia. This was a similar conclusion of researchers Maziab and colleagues whom found comparable results with their work with Veterans and POWs (2014).

And, while all these studies are not specifically looking at First Responders, I assume it is only a matter of time before the link is made within the ranks. While the severity and frequency of those events experienced by our military friends is significant, the accumulated experiences by First Responders can add up as well. And, of course, in some extreme cases the experiences can be almost identical. This is made ever more true by the increase in terrorist attacks on civilian targets.

Unfortunately, there is also a growing body of research finding connections between stress and fibromyalgia (a chronic pain disorder).  In one study, for example, of the participants with PTSD, 45 percent had fibromaylgia and 65 percent had chronic pain (Hauser et al., 2013). Though it's too soon to make any solid conclusions, one could certainly argue the connection between stress and disease.

It is easy to see, therefore, why EMDR (Eye Movement Desensitization and Reprocessing) therapy found such great success so quickly. While the modality (type) of therapy matters little, a therapeutic focus on integrating the mind and the body is going to yield the best results.

Pixabay.com

Keeping in touch with how you are responding both psychologically as well as physiologically will go a long way in ensuring your flourishing mental health. There are many different ways to reconnect with your body. The body scan is one simple, but effective way. There are many sites that can outline these processes. Just choose the one that works for you.

In the meantime, a friendly challenge: Try to notice the first thing that happens when you grow upset. Where do you first feel frustration?