When Your Partner Can’t Cope


Considerations when one member of a couple fairs better psychologically than the other does.


When I work with couples, there is sometimes a difference in the level of functioning between the partners. Sometimes, people who like to take care of other people wind up with partners who are very damaged psychologically. This can be challenging, because the partner who isn’t as damaged expects more out of their partners them what they can deliver. It is a fine line between accepting abusive behavior and understanding that the person has had a difficult childhood or difficult past experiences in general. I do think that compassion is always a good idea, but sometimes compassion can turn into enabling behavior. We can be supportive and understanding of each other’s painful past, and accommodate it to a degree, but when it starts becoming a one-way relationship wherein one party is always favored or given his or her way, it stops being healthy for both partners.

This difference in functioning is not necessarily restricted to heterosexual couples. It can also happen in gay, lesbian, or polyamorous couples as well. I use a heterosexual couple as an example here but it could be any two people whose psychological function differs significantly, enough to cause relationship problems.

Meet Mary and Mac

Let me give you an example. Mary and Mac have been together for six years. Mary has been through a lot of trauma and often has angry outbursts where she cannot be talk to in a reasonable way and she cannot control her anger enough to have a productive conversation. Mac, wanting to be understanding, allows himself to be talk to in a demeaning, hurtful way that makes him feel insecure and depressed. This is been going on for at least two years, and Mary expects back to tolerate this without question or objection. Mac has asked Mary on repeated occasions to get help, but Mary says that she’s not ready yet. The truth is that Mary is frightened of the idea of facing all the horrible things that happened to her, and would rather skip processing that and just go on with life as if nothing happened. I can understand why this would be more tempting, but when she drinks or is just stressed, the anger and frustration that she was never able to express to her perpetrators come out. What should Mary do, and what should Mac do?

Often by the time they reach couples therapy, a lot of damage has been done because they say things to each other during fights that cannot be undone. Max starts to shut down more and more, or stonewall his partner. As Mary senses Mac pulling away, she becomes more desperate and her emotions more out of control. Usually these situations don’t work until individual therapy for the person who is in the most distress, has taken place. This is especially true if there is domestic violence going on. Couples therapy can bring up a lot of painful issues, and it’s important that both partners have a safe, responsible way to cope with their feelings. Sometimes therapists mistakenly think that they can see a couple where battery is going on, but it is best to refer them to anger management and other resources before attempting couples therapy.

 

Recommendations

It’s also important for the person who is coping better to get some help. Work on boundaries and self esteem is crucial when you have a partner who is emotionally needy or abusive. If you feel as though you’re always giving in the relationship and never getting very much back, it’s important to look at that and ask yourself why. A few books that can be helpful are Stop Walking on Eggshells, by Paul Mason and Randy Kreger, and¶ Coming Home to Passion, by Ruth Cohn. I also find a lot of couples like Seven Principles of Making Marriage Work by John Gottman and Nan Silver, although that book is more general in its audience.

The hope is that both of you can cope with stress and an effective, healthy way and thus truly enjoy your relationship. A relationship should be mutually beneficial, warm, and loving. If yours is not, consider getting some help.

Room for All of Us


Since this is LGBTQQIA Awareness Month, I thought I might share some thoughts about diversity and how we as a country have yet to fully embrace it. Diversity benefits us as a community, a nation, and a planet. Sameness may make us feel safer psychologically, but ultimately leads to creative stagnation if we allow fear to keep us from experiencing and exposing ourselves to the differences that make up the human race.

I see many people who are gay, lesbian, bisexual, transgendered, and I love it. I strive to make my practice open and inviting to everyone, regardless of gender identification or sexual preference. I learn so much from everyone I see who is different from me. I try to make myself as educated as I can, but there are times that I am not fully aware of my bias, and I strive to correct that. My graduate school, John F. Kennedy University, emphasized multicultural awareness and for that I am extremely grateful. This has been an interesting experience for me because I grew up in a very liberal area (the SF Bay Area) and went to school in equally liberal Santa Cruz (go Banana Slugs!). In that bubble of acceptance and outright pride in diversity, it was less common to see people disenfranchised for being queer-gendered or gay, lesbian or bisexual. However, when I moved to the Antelope Valley, I started seeing people having to hide their sexuality or gender differences from their families, as well as hearing strikingly sad tales of adolescents being kicked out of their family homes for being LBGT.

I see homophobia and transphobia hurt people, not only those who identify as LGBTQQIA but also cis-gendered and heterosexual people. I sometimes see self-mutilation, low self-esteem, substance abuse, depression, anxiety, and a sense of hopelessness in the people who have been ostracized. And in heterosexual people who are involved with gay, lesbian, bi and trans people, I also encounter hatred and disgust, rigidity, fear, anger, and unnecessary restriction of association. Relationships are ruptured and strained because of fear and bigotry. One family prevented their child from being best friends with a girl who identified as bisexual. Another person rejected her son because he was gay. These stories are all too common and horrible to hear. When we shun people who are different from us, we miss out on a different perspective, and our intolerance and ignorance makes us enemies where we could be allies. If you think about it, we all do best when we feel loved, accepted and respected by one another; why should that be different for someone who is different from you?

Where did we go wrong, I wonder. How did we become so intolerant of what we don’t know, or understand? How can we repair the ruptured bonds that hold us together as humans? And what can we do to educate people, including ourselves, about what it means to be LGBTQQIA? When can we let go of viewing diversity as a threatening force, and instead see it as stimulating, refreshing, exciting, interesting, an opportunity to hone our own self-understanding as well as grasping what it means to be one little person in a big wide world?

I think education is part of what we can do; but there are frankly those who choose not to educate themselves or embrace acceptance of difference. Can we effectively stand up for diversity, by not allowing bigoted comments like “that’s so gay” to go without confronting it? Can we intercede when we see bullying against an LGBTQQIA child or adult? Sometimes change has to happen at a political level, with policies that end bigotry. Such these battles are not easily won, for any group deemed non-dominant. Maybe we need to address bigotry against anyone on many different levels, both within ourselves, between people, and at the national and international level. I encourage you to be aware not only this month but all year round, of the lack of acceptance of people who are different from you. Hopefully it will be something you want to change, enough to change it. It’s a small planet in some ways, but I still maintain that there’s room for all of us.

Is my grief normal?


People often wonder if the way they respond to grief is “normal” and expected in relation to what other people do and say when they lose someone to death. Unfortunately, the answer is not always so simple. Some factors include the culture of the person, how they were doing psychologically before the loss, what they expect of themselves post-loss, and how they view the loss. For some folks, if their deceased love one was suffering greatly before they died so death may provide some relief, whereas someone who lost their loved one suddenly and unexpectedly may feel a sense of anxiety and bewilderment.

As mentioned in previous posts, there is a difference between what is psychiatrically considered normal, uncomplicated mourning and complex grief. A sense of bewilderment, some brain fog, sad feelings interspersed with other transient emotions, loss of appetite, and temporary anhedonia (not feeling pleasure in activities and things that used to bring enjoyment) are all symptoms of normal grief. Interestingly, other cultures seem to give people longer to grief before they consider a person’s grief pathological or problematic (e.g., Egypt). Our culture seems to think that most of the symptoms of grief should be over after about a year, which depending on the nature of the bond between the survivor and the deceased, could be an awfully short amount of time to sort out one’s feelings about the loss. To give you a sense of what is considered “complicated”, I refer to Pomeroy and Garcia’s book The Grief Assessment and Intervention Workbook for ease:

  1. Are you especially sensitive to other loss and separation experiences?
  2. Do you try especially hard to suppress anxiety with relation to loss and separation?
  3. Are you anxious about death and loss of other loved ones, or yourself?
  4. Do you have an especially strong, unrealistic idealization about the lost loved one or your relationship with them?
  5. Do you have rigid obsessions and compulsions about the dead person and the loss thereof?
  6. Do you avoid socializing with others because you’re afraid of losing new people too?
  7. Do you have a hard time expressing emotions about the loss, and does that difficulty last a long time?
  8. Do you self-sabotage other relationships after the loss?
  9. Do you abuse substances (drugs and alcohol) after the loss?
  10. Do you have PTSD-like symptoms like numbness, alienation, depersonalization, and emotional overwhelm?
  11. Do you have depressive symptoms like anger, irritability and hopelessness that last a while?

If these symptoms are present, you might want to get some help to cope with the loss with professional support. I would be happy to help you, can be reached at 661-233-6771. You can also look for a bereavement support group in your community. Many hospices have them and they are low or no-cost. Whatever you do, try not to judge yourself for what you’re experiencing. You are doing your best in a very hard situation.

 

Psychiatrists Versus Psychologists


There’s a lot of confusion about what psychiatrists and what psychologists do. In the beginning of our profession, there was no distinction, really, because psychiatry was invented by a medical doctor, Sigmund Freud. As the years have worn on, however, the functions and duties have become separate. I would like to help clarify some of the differences.

Psychiatrists

Psychiatrists are medical doctors who have specialized training in psychiatry, namely treatment of diseases of the mind. Some psychiatrists still spend time talking to their patients at length about life’s problems and how to cope with them better. However, for whatever reason, they have a lot less time now, especially since managed care has become such a prevalent force in the mental health field. Unfortunately, their time has become more and more valuable and a lot of times they are in a hurry to treat as many people as possible. At is not their fault; it’s just how it is and a lot of communities. As a result, people sometimes go to psychiatrists and feel offended and hurt that the psychiatrist can’t spend a lot of time listening to their problems. This is unfortunate, because sometimes people didn’t want medication in the first place and were hoping to be heard and understood. This doesn’t mean that psychiatrists can hear and understand people, just that there focuses mostly on how the person is doing physically with their mental health condition. Psychiatrists spend most of the time evaluating the symptoms presented to them and how medication can address so symptoms. They can be true lifesavers if a person has a mental health condition that lends itself to medication. For instance, severe depression and bipolar disorder often require medication in order for the person to fully heal. Similarly, psychotic disorders like Schizophrenia require medication in order to have a productive, happy life.

Psychologists

Psychologists are experts in psychology. There are many different types. For instance, forensic psychologists work in the law and criminal justice capacities. They do evaluations, psychological testing, and write reports about their findings, as well as testify in court cases. Health psychologists specialize in helping people with medical conditions and do research on different topics, such as the role of stress and different diseases on mental processes. Clinical psychologists treat emotional and psychological illness by using psychotherapy and often work in conjunction with psychiatrists. This is what I do mostly, and I am very grateful to have the ability to collaborate with medical professionals when there are complex cases of mental disturbance. Not everyone who sees a psychologist needs medication or wants medication; some want to try psychotherapy before resorting to medication, and women who are breast-feeding often want to wait until they are no longer breast-feeding to try medication. I respect the desires and needs of the patient, that in cases where severe mental illness is present, I strongly recommend that people at least be evaluated by a psychiatrist. There are also things that people can do to help themselves feel better that don’t involve medication or talk therapy, and I encourage people to take care themselves as much is possible in order to be empowered and have a full, healthy life. For example, exercise can be and honestly helpful for depression and anxiety. Taking medication is not incompatible with exercise, meditation, yoga, good nutrition, or any other non-pharmacological interventions. If you choose to take the herbs or supplements, however you should check to make sure they don’t interfere with whatever medication you’re taking, whether it be psychiatric meds or medications for physical illness.

I hope this clears up some of the common misconceptions about what I do versus what a psychiatrist does. We still have a long way to educate the general public about how each can help people with emotional and psychiatric illness. However, hopefully this is a step in the right direction.

Healing in The Now


Whether we’re suffering emotionally or physically, no one really likes to suffer for very long. This is natural and normal, and I never would blame anyone for wanting to get better quickly. However, sometimes the desire to get better becomes a permanent stance of impatience that can actually thwart our efforts to get better. If he comes a cool paradox in which we strive so hard to not feel the way were feeling, that we make ourselves more miserable. Living in the future too much distracts us from what we can do in the moment to make ourselves feel better.

I know a lot of people who have emotional or physical problems, both professionally and personally. I have been in that boat, and struggling with a chronic illness is never A fun thing. I have also noticed that the people who live well and feel better quicker, do not get caught up in how fast their healing. They’re not competing against other people who also suffer to see who gets better fastest and in the best way. We have what is called bio individuality, which means that each have a unique body chemistry that interacts with our emotional and spiritual selves, as well as the outside world. What works for one person may not work for another.

There are some things, like alcohol and cigarettes, that probably don’t work for most people to create optimal wellness. However, some people might do very well on them diet with a lot of meat and rich foods, while someone else might feel better if he mostly vegetables and fruit. The point of this is that if we find something that works for us, it doesn’t necessarily work for everyone else who has health problems or mental health issues. We need to be careful about how we talk about our health, not just for others’ sake but also for our own sake.

What do I mean by this, when we think of ourselves as inadequate because we have a mental or physical condition, and we get angry at ourselves for not progressing further, it rarely serves us. If it motivates us to action, such as exercising more, eating better, applying ourselves rigorously to what our doctors recommend, then it can be helpful. However, what I usually see is that people’s impatience and anger at themselves turns into a self-destructive pattern of self- rebuke and low self-esteem, sometimes even depression. It’s natural and as I said before to want to get better. When it turns unhealthy is when we get so bogged down in impatience and anger, that we ignore what we can do in the present moment to improve our well being.

Sometimes there isn’t a lot we can do in the moment, at least from a medical standpoint. They may be taking our medications as prescribed, going to therapy your physical therapy, eating the way we’re supposed to, but the internal work that needs to be done falls by the wayside.

What is this internal work? It’s noticing what’s going on now in our body, mind and spirit. If that sounds to ethereal an abstract, what I mean is that we can observe how were moving, how were thinking, and how we’re feeling emotionally. We can use that data to make decisions about how we care for ourselves. That is a better use of our time and energy than getting angry at ourselves for not being healthier. Anger at ourselves is only useful if it motivates us to protect ourselves order energizes us toward effective solutions. Please keep this in mind next time you find yourself getting frustrated with yourself for not being healthier, happier, more productive, etc.

Loss of innocence


Childhood sexual abuse is hard to cope with, but it’s better dealt with while the child is young than when the experience has a chance to infiltrate the personality.


Sexual abuse, especially in childhood, is one of the hardest experiences I have helped people resolve. It is not always as brutal and acute as physical abuse or an isolated rape incident; in some cases people can be led to believe that what’s happening to them is normal and fine. I’ve heard a lot of people say that what bothers them most is not the sex act itself, although that is often disturbing (especially if it happened to them as children). It is the inappropriateness of the touch or sexual attention that bothers them, haunts them to the core.

I have seen mothers who have been sexually abused themselves as children become hypersensitive to any adult touching their children, even if it is not with sexual intent and is objectively appropriate. I have also seen the opposite extreme. Some parents thing that because what happened seemed “normal” to them, they disbelieve their children when the children tell them about being abused. Or they think the child is doing it to seek attention. I’m sure there are some children who do lie about such a serious matter, but I think that far more often, the child is telling the truth and the abuse goes unreported because they are afraid of getting the perpetrator in trouble. It is especially difficult for some parents to believe when the perpetrator is their own husband, wife, or romantic partner. There are also people who distrust the governmental agencies to whom they would report such incidents. I can understand that, and I don’t pretend that child protective agencies or the police always handle these matters well. However, they are still there to protect children from abuse and neglect, and if the abuse continues unabated it can have lifelong, damaging consequences.

Children need to be able to trust their environments and their caretakers to take appropriate action when they tell their parents they’ve been touched inappropriately. It wouldn’t kill us as a society to take them seriously until the facts have proven that they are not telling the truth. By their very nature, children don’t have the resources and awareness to protect themselves. We need to be in tune with our children to know when something is off with their behavior. We don’t need to necessarily jump to the conclusion that they’ve been sexually assaulted, but we do need to protect their innocence for as long as we can. If you think your child has been touched inappropriately, you can get them help: proper medical attention; psychotherapy; and legal and physical protection against the perpetrators. Don’t let it become their problem later on in the forms of depression; anxiety; PTSD; dissociation; and other psychological and behavioral problems.

Responsibility for Symptom Management


We need to have compassion for our loved ones with mental health and behavioral issues. We (and they) also need to minimize the damage that can come with mental illness symptoms. Taking responsibility includes getting consistent help and observing and managing our own behavior.


Much as some of us struggle to get well from mental illnesses like depression, Bipolar illness, and PTSD, sometimes we have a hard time keeping those troublesome symptoms to ourselves. This can make our lives miserable, and also be difficult for those whom we love. It can be hard for partners of mentally ill people to balance compassion with self-preservation, especially if the symptoms hurt or frighten the loved one.

I often see couples where one person has been traumatized by something that has happened in the past, whether it was done by the partner (as in infidelity or domestic violence), or by someone else in the person’s past. This increases the reactivity of the trauma victim. The trauma survivor can become very sensitive to noise, sound, tones of voice, or cues that remind him or her of the prior trauma. When the person gets triggered, they might yell, become angry, get scared, or act in ways that are hard for the other person to understand.

Often the person who acts differently feels bad about it afterward, once their brain has restored balance and they are no longer in the grips of overwhelming emotion. However, many times their loved one feels hurt and reluctant to trust them again, for fear of recurrence of the emotional instability and erratic behavior.

There is some grace that we allow each other in relationships, whether they are friendships, intimate/romantic relationships, or family ties. On the whole, if we know our loved one has a good heart and kind intentions, we can forgive some of the erratic or hurtful behavior. But the person with the mental issues also has a responsibility to take care of themselves as much as they can so that they can prevent hurting those they love. If a person keeps yelling at someone or treating them poorly, and says, “it’s because I’m triggered by you”, then they are not fully taking responsibility for their part in the interaction. It can be hard to forgive this kind of assertion. Yes, loved ones should educate themselves about their loved one’s mental illness and try to put the strange behavior in context. At the same time, however, the mental illness diagnosis doesn’t give a person carte blanche to act as they wish at that time.

There is nothing wrong with seeking help in coping with mental issues, and in going to groups like National Alliance for the Mentally Ill (NAMI) to get education and support. Both the person with the illness and the partner/friend/family member need to care for themselves and take needed medication, therapy, or whatever will help them cope better, as well as learn to act in a way conducive to healthier relationships.

Courage in the Face of Despair


I recently saw an article about a young man from San Francisco who survived a suicide attempt off a local bridge. For the story, click here:
http://www.inforum.com/news/3828523-after-surviving-jump-golden-gate-bridge-man-brings-mental-health-message-fargo

One of the things that struck me about this story was how much courage he had to speak out about his mental illness, his attempt, and his despair. I wonder if I could have been so brave as to risk the stigma that attaches itself to speaking out about mental illness, to this day. But in another sense, that is how stigma is worn down and eventually broken — by speaking out, and having the self-possession and courage to say: “This is how I felt, and this is how I dealt with it.” I hope that more people speak out and help others, as it not only helps potential suicidal people but also the general public to understand that anyone can be affected by mental illness and substance abuse.

I have also spoken to some people who have recovered from mental illness and/or substance abuse, and who share their stories with others. What they often say is that it helps them get better because it reminds them of where they were, and how they have coped effectively with their affliction. It also reminds them that they are not their disease or condition; there is more to them than just a label.

This is important to remember when they’re struggling with a mental illness or substance abuse because there is an enduring person with likes, dislikes, talents, gifts, and resources that are uniquely theirs; this goes above and beyond any label like “Bipolar”, “depressed”, or “alcoholic.” As author Paul Williams once wrote, “Remember your Essence” — remember that there is more to you than what other people say or think about you. Also, whatever horrible feeling you are having right now, it does not define you either, nor is it how you will always feel. I encourage you to remember that if you suffer from mental illness, and to seek help. You don’t have to give up or live your entire life in misery. Please, have the courage to make a life worth living and to define yourself according to what you know to be true, not according to a temporary feeling or a label someone else has given you.

Murder-Suicides — How do we make sense of these tragedies?


As you all know, recently a young pilot committed a murder-suicide in a plane in Switzerland, leaving many to wonder why someone would do such a thing. To say that he was depressed doesn’t do justice to what he might have been experiencing. There appears to be personality abnormalities in those who commit such tragic acts, including a desire for infamy and a sense of undoing some injustice that the person perceives was perpetrated on him or her.

Many times when I see clients, they want to know why people do the hurtful and painful things they do — abusive parents, spouses, bosses, lovers, leaders, religious figures, etc. Unfortunately, while there is research on psychopathic, narcissistic and otherwise mentally ill offenders, the why of their misdeeds fails to soothe or ease the person’s pain. What’s more empowering, I think, is to contemplate how to recognize “red flags” or danger signals in relating to people who don’t have our best interest at heart and avoiding falling into deeper involvement (like marrying or having children with such people).

Nonetheless, for an interesting look at the research of why a very small portion of humans do such things, here is a link to a fascinating article:

Everyday heroes


Lately I have been watching documentaries about luminary, courageous, amazing people like Nelson Mandela, Miriam Makeba, and Mahatma Gandhi. They all possessed strength and amazing grit to stand in the face of injustice and fight on anyway. Equally amazing is that they didn’t let their hardships well, harden them. They were still loving, forgiving people even when they had a chance for vengeance and retaliation. On a smaller scale, I think many people display courage and grit, as well as love and forgiveness, in their challenges. Many are unsung in their valiant efforts to deal with oppression, poverty, and many other social ills. They are heroic nonetheless.

Similarly, I think we can all agree that the people who have served our country and given their lives, limbs, and health for our country are brave and praiseworthy. As we approach Veteran’s Day, I want to give thanks and praise to not only the people who serve our country in the military, but also the people who have courage and strength in the face of everyday challenges that might feel like a battle to them.

For some people with depression, just to get out of bed in the morning is an act of defiance against the disease that insidiously aims to claim their wellness. For people with PTSD and Panic Disorder, leaving the house can take tremendous courage to face the jarring, threatening stimuli outside their cozy sanctuaries. Folks with chronic illnesses like rheumatoid arthritis and fibromyalgia can also have difficulty even moving their bodies, and yet they persist in getting up, doing what needs to be done, and marching on through the pain and fatigue. Even to reveal one’s true self to a loved one and face possible rejection, which might seem small to many, can be terrifying and mystifying to couples in an embattled relationship, or families with a history of dysfunction. All these acts of valor go unsung, and yet we do them because something inside us says, “I must go on. I cannot let this problem conquer me; I deserve a better life and so do my children and their children, etc.” So for all those unsung heroes, please know that someone appreciates the struggles you face, and how brave you are to persist in the face of opposition.