MY FAMILY IS CRAZIER THAN YOURS.

 

cartoon t;givingIn the month between November 26 and December 25 something odd happens:  Crazy families get crazier.

Giving Thanks, Spreading Light, Celebrating Culture, and Wishing for Peace on Earth are often replaced by the dread and fear of family fireworks.

Few families really are incident-free, although we figure it’s just ours that’s as dysfunctional as it is. While it might seem more comfortable to exclude certain family members to avoid celebratory disruption, what actually happens may be disrupting as well.

The classic struggle between expectations of “the way it should be” vs. “the way it really is” sets us up to have unhealthy negative emotions like sadness, guilt, anger, dread, and avoidance.

Shake the sugar plums out of your head and re-think your guilt:

The Throwback Effect:  Traditions, celebrated the same every year may be a reminder of past hurts, inviting behaviors that go way back.  Fight the impulse to side with your family against your partner; keeping  communication open is crucial.  Not everyone is happy at the holidays; no one has to be.

The Hallmark Effect:  U.S. companies will spend billions and billions of dollars on advertising this season, primarily on social media and television, to sell consumers on the notion that a perfect holiday can be purchased.  Movies — another holiday “tradition” — portray traumatizing family events as either funny or touching.  The constant stream of warm and fuzzy can lead to a very real mental health plague called holiday depression.

3 Monkeys Effect:  Pretending that crazy behavior isn’t crazy only makes you look crazy.  Minimizing reality for the sake of others’ comfort makes everyone uncomfortable.  Being honest is appropriate, even though ’tis the season for pretending everything is as it should be.

Forewarned, Forearmed:    Chat with the potential offender beforehand. Say why you’d like them to join everyone else even as you set boundaries for acceptable behavior.  Here’s the important part:  Quietly stick to the boundaries you set.  If you won’t, the offensive behavior is bound to be repeated and you and your guests are bound to be disrespected — again.

Cut the Drama:  It’s not like you’re surprised so don’t act like it.  Being dramatic about something you expect perpetuates bad feelings between people, who are likely to take sides.  This is one way that horrible holidays have become part of your family’s tradition.

Handing out explosives:  Alcohol and stress are a bad combination.  Bad stress makes everything worse; alcohol makes crazy worse.  If you fuel trouble, it will come.  Monitor the flow of booze if you want to avoid a bad scene.

Change It Up:  Change the usual setting or location, menu, focus of the day or even the day itself.   Get away from a personal, claustrophobic focus in order to re-focus outward to community — friends, neighbors, even strangers.  Take turns hosting; share the day’s responsibilities (being sure to include children); organize a neighborhood carol-sing, skating party or sleigh ride; volunteer; stay home and forge your nuclear family’s traditions; go on a Christmas tree hunt; or choose an activity that centers on the holiday’s meaning, are all examples of refocusing.

Come Down Easy:   The time and money spent preparing for, and celebrating, Thanksgiving, Hanukkah, Kwanzaa, and Christmas is disproportional to the let-down felt when all that’s left is the mess. Remembering how that feels might be incentive to celebrate in other, less costly but more rewarding, ways.

Take a Nap.  The day will wear you out so come rested to it, especially if you have a disability or chronic illness.  Add a few minutes to steal away, catch your breath and renew your smile.

No other time of year is as fraught with “shoulds”.  As with much of what’s difficult in life — leaving certain people out in the cold at holiday time — is a hard choice to make.  It’s reasonable to feel guilt and sadness and to feel guilty and sad because you feel guilt and sadness.

What’s important is that you acknowledge the situation and your struggle with it.  You don’t have to do anything.  There’s always next year and the crazies are likely to happen again.

Kathe Skinner is a Marriage & Family therapist in Colorado Springs where she lives with her husband David and their two hooligan cats.

Cartoon © Donna Barstow, 2015 Used with Permission

© 2015 Being Head LLC

A SAD AND SOGGY SPRING

rain woman

Rain rain go away

come back again another day in another month

Too much of a good thing is too much.

A nursery rhyme sung over and over comes to mind.  Too much gray becomes black.  And too much rain dampens the most cheerful spirit among us.

Scientific studies about the impact of weather on mood are inconclusive because there are so many factors.  Results of a study using Dutch teens, for example, may not translate to American adults: so is one study right and the other wrong?  Not necessarily.  When apples and oranges are compared, in this case Dutch teens vs. American adults, broad assumptions can’t be made.

Such is the problem with making sweeping statements with little data.

Take the question of weather affecting mood.  The short answer is “not always and not for all people”.  Nevertheless, enough studies assert that the weather does indeed affect some peoples’ moods. It’s called Seasonal Affective Disorder — SAD for short — which is an apt name, considering.

What seems true for more people is that when weather is persistently unusual mood is affected.

Here in Eastern Colorado the wettest spring ever is making people already sensitive to depression, well, depressed.  It’s not just flowers who miss 8 hours of sunlight; people who weren’t SAD before rain, gloom, and chill were on the daily weather menu are sure as heck sad now.  And cranky, too.

This is Camp Watchogue weather; I didn’t like it when I was 8 and I don’t like it now.  But this is Colorado; give it another couple of weeks and we’ll all be complaining about how darned hot and dry it is.

I can’t wait.

Kathe Skinner is a Marriage & Family Therapist in private practice on Front Range of Colorado.  She specializes working with couples, especially those impacted by invisible or visible disability.  She and her husband David will soon be in Arizona in hopes that Colorado dries out in the meantime.  Their kitties Petey and Lucy have been unaffected: it’s just another good reason to find a cozy spot and go to sleep.  She and David teach Couples Communication Workshops throughout the year.  You can find them at http://www.beingheardnow.com or at www.coupleswhotalk.com.

copyright, 2015 Being Heard, LLC

SUICIDE ISN’T JUST ABOUT DEPRESSION

suicide wordly

(This blog was first published by Disability.gov.)

 In the mega-wattage aimed at Robin Williams’ suicide everyone had something to say.  But when all was said, everything went back to the way it’s always been when mental health’s the issue.

The disabled or chronically ill population often inhabits a landscape where mental health is a place of shifting sands; they know that psychological symptoms are only part of the territory.  And though they might not know it, anyone else who’s ever seriously considered, or attempted, suicide has been there, too.

Reason 1:  Suicide is a perfect storm. A confluence of factors accounts for an attempted or successful suicide.  The biopsychosocial effect describes three separate but linked factors that make for the perfect behavioral storm.

The first, biology, talks about the genetically present markers that provide the tinder that can predict a life-ending event.  Certain mental health disorders result from biological events and can’t be caused by events in our lives, schizophrenia for example.  In fact, most of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), are a result of nature, not nurture.  (That doesn’t mean that nurture or experience can’t affect nature.  For example, brain structure can actually be changed by the cumulative effects of stress).

A solid neural whack is enough to upset the brain’s apple cart and to actually affect the apple cart itself (i.e., traumatic brain injury, chemotherapy).

The psychological factors refer to how thoughts and feelings are processed into behaviors.  How we think and what we think about ourselves and our world are significantly influenced by nurture and experience.  Amazingly, significant amounts of emotional stress will actually change the structure of the brain – the hard wiring.

The good news is that when brain structure has been determined this way it can also be reversed.  Buddha had it right when he said that we make the world with our thoughts.

Adult caregivers, or older children in our own families, are the early source of how we position ourselves psychologically.  Peer groups, even one person within that group, are also influential: bullying comes to mind.

Social factors refer to what’s happening around and to us.  For example, when terrorists blew up the World Trade Centers people around the world experienced significant psychological reactions that were clinically diagnosable.  These are the situational diagnoses without a biological cause, although an existing mental health problem may be triggered by events.

For instance, a major depressive disorder can be brought on by grief, whether or not a history of depression exists.   Trauma can be brought on by exposure, or over-exposure, to a horrifying event.  That’s what happens when people are flooded with 24/7 video of disaster images, or a job involves continual exposure to disaster or tragedy.

Reason 2:  Suicide is a game of dominoes.  A precipitant can be found in any third of the biopsychosocial formulation, igniting reactions in the other two spheres.  Reactions are ramped up as one sphere feeds the others in endless loops.  Without intervention in at least one area, a body’s systems can break down.

For example, I’ve worked with diabetic clients who pay poor attention to insulin levels, diet, and exercise.  This is especially true of teens.  Reasons might include not wanting to be different, interference with having fun, being marked as “not normal”, or that testing is an interference.  So while anxiety is part of diabetes’ medical description, that emotion may be worsened by psychological factors like negative thinking, and social factors like being shunned at school.

Reason 3:  Suicide is personal.  Duh.  Suicide is the ultimate personal decision and action.  Even if you think you’ve made up your mind about whether it’s ever right for a person to take such action, there’s always a “but what about this?” scenario.   The rule that works is stated “It Depends”.

Consider these factors:

· Quality of life

· Loneliness

· Unrelenting physical pain

· Chronic emotional pain

· Persistent emotional and/or mental pain despite treatment

· Terminal illness

· Loss of dignity in living

· Fearfulness about the future

Which of these situations justify taking your own life?   Do you think that one area of the biopsychosocial model predominates in a decision to commit suicide?  Does seeking to die always signify depression?

In 1975 the Karen Ann Quinlan case went to the U.S. Supreme Court before the right to die with dignity for those in a vegetative state was established.  It might be said that Karen Ann’s parents fought for the right to “commit suicide for her”.

The 1981 film starring Richard Dreyfus, Whose Life Is It Anyway?, addresses a quadriplegic’s right to die by refusing nourishment – a passive suicide.  The film presents the moral, legal, ethical arguments that are often arrayed against individual choice.  Not much has changed: decades later over 90% of states don’t allow for physician-assisted suicide, what is euphemistically called death with dignity.  

Our society lags behind other industrialized nations regarding physician-assisted suicide.  Here the rule is that the illness must be terminal with physician intervention occurring only when death is judged to be imminent.  Rather than being enlightened, our nation’s religious, legal, and medical institutions are queasy at best about death, and hands-off at worst.

The result is that lots of suffering happens well before a physician provides assistance.

Reason 4:  To suicide or not to suicide, that is the question.   Without human resilience the rate of suicide would skyrocket.  That this is true is demonstrated by people who don’t commit suicide even though they share circumstances with others who do and even though their mood is likewise affected.

In the case of minors and adults with diminished intellectual capacity, it ought to be our business.  But all American institutions consider all suicides their business, acting in many ways to prevent it.

Death of any kind seems to be owned by the living, whether it’s scary or exciting or mourned or praised.  The morals of the civilized world seek to prevent death at any other hand than its own.  It’s a great irony that once a life is saved little energy may be expended in assuring the quality of that saved life.  Society sends double messages:  suicide is prevented but it all too often doesn’t accept the burden of providing for care or being respectful and inclusive to those who’ve been saved from a fate-worse-than . . .

Reason 4:  Suicide can be just a matter of time.  Robin Williams’ death illustrates that suicide can be the result of many factors, not just depression.  He was loved around the world with an enormous talent and humanity that made a difference in many lives.

It wasn’t enough.

Robin Williams carried the burdens of Bipolar Disorder, so his death ought not to have surprised anyone who knows about the illness.  It wasn’t just the depressive side that Williams’ displayed, although that’s what most news reports covered.  I suspect it’s because most everyone is familiar with depression as causal in suicide.   A rare opportunity to educate around the world about Bipolar Disorder, which includes periods of depression and mania, was missed.

While most everyone knows that depression can lead to suicide, poorly understood may be the role of mania, which is more than mile-a-minute speech and behavior and includes impulsivity, especially relevant here:  Williams’ final impulsive act was to hang himself with his belt, not a well-thought out suicide.

Reason 5:  Stress can result in suicide.    Any problem in an individual’s system – chronic or acute illness, situational or inherent mental illness, social or environmental factors, the ways in which we think – can provide the potential for distress.   Lots of straws have to drop into place before the camel’s back is broken.

Even so, suicide isn’t a slam-dunk.

But know this:  chronic illness or disability increase the odds of being negatively affected physically, mentally and socially by distress.  An already-stressed system is already part of the way there.

And while some of us are more exquisitely tuned to stress than others, it’s familiar territory for everyone.   Even so, from prisoners of war, to marathon runners, to cancer survivors, many of us display a resilience we didn’t know we had.

Robin Williams was carrying financial problems, mental illness, and a fairly new diagnosis of Parkinson’s disease into an upcoming year of hefty professional commitments.  Despite the affection of the world, Williams ended his life alone.

 

For the abundantly stressed, chronically ill, or ultimately alone, like he was, suicide may be the most understood act of all.

 

This blog was first published by Disability.gov.  

Kathe Skinner has been diagnosed with multiple sclerosis for over 35 years, which has compounded genetically predisposed depression.  She knows first-hand what suicidality feels like.  Ironically, she finds her work as a Marriage & Family Therapist anything but depressing.   She is in private practice in Colorado where she lives with her husband, David, and their 2 hooligan cats. Read more about Kathe at www.beingheardnow.com or ilikebeingsickanddisabled.com.

Kathe welcomes your comments and can be reached at 719.598.6232.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net
 
©  2014, Being Heard LLC
 

INVISIBLE DISABILITY GOT YOU SIDELINED THIS WINTER?

Even if I walked away, I wouldn't be able to walk very far.

Even if I walked away, I wouldn’t be able to walk very far.

For those of us who are disabled, invisibly so, preparing for  weather that turns wintry follows a simple self-care rule:  stay inside.

As multiple sclerosis has progressed in me, simple tasks loom large.

Accumulation of simple tasks makes negotiating my environment literally hazardous to my health.

And I’m not alone in what can happen:

Impaired mobility.   “Give me something to hold onto, like a railing, or a walker,” I said confidently, “and I’m good to go.”  This from a woman who managed the unbelievable – falling down and taking the shopping cart with her.  Not just with her, on top of her.  The same woman who stepped off a sidewalk and fell face-first on her rollator into Chicago traffic.

Adding ice, snow or both increases  the danger, whether I want it to or not.  Cold temperatures stiffen already-Frankenstein-like limbs, reduce feeling, and can even shut down body functions altogether.  For me, any extreme of temperature, hot or cold, and I look and act like a zombie.

Impaired senses and abilities. When it’s cold, the body’s heat is centralized to protect the core.  Extremities function poorly, if at all.  Try counting change at the grocery store, or picking up something you dropped.  Even bending over is dicey and can result in a tumble.  Even worse?  Getting up again.

People with breathing difficulties may struggle, even with little or no exertion.  Arthritis sufferers are crippled all the more.  And the head-injured’s thought processes slow. way. down.

Anything already stressed responds negatively to even more stress.  Think of the knees of someone overweight:  when chubby becomes obese, knees already weakened break down when more weight is added.

Of course not everyone will have such a dramatic response to arctic-like conditions, but some will.   For me, balance and strength, ability to write, well-being and fatigue, mood, motor skills, bladder control, cognitive functions, like word finding, are some of what fall to unacceptable levels.

It’s just plain dangerous.   A wheelchair-bound client of mine was hit by a bus when the driver’s vision was impaired by a snowstorm – he didn’t see her crossing in front of the vehicle.  My massage therapist suffered brain damage when she hit the pavement after slipping on ice in the parking lot.

Our focus on independence may cost us, like the guy who refuses to leave when the flood waters rise.  Thinking about who picks up the pieces doesn’t cross our minds.

Can you afford to get stranded for hours?

Can your heart or lungs hold up to strenuous efforts to free your car from a snow bank?  What happens when your body’s attempts at staying warm mess with your blood sugar?  Or the stress of the whole ordeal brings on pain and diarrhea?

I have a highly polished ability to ignore what I don’t like.  I especially don’t like staying home on those arctic days when others are doing ordinary things, like going to work.  This is true even though experience tells me how I’ll hurt my body, mind, and self-esteem by ignoring how the m.s. in me behaves in harsh conditions.

Instead, control what you can.  Don’t know about you, but I already know what happens when I ignore what that is.

Kathe Skinner is a Marriage & Family Therapist and Relationship Coach working especially with the invisibly disabled.  She looks for real-life adventures in Front Range Colorado where the environment’s sometimes restricted by weather extremes. Currently, she’s cleaning up her home office while groovin’ to the oldies. A pirate’s treasure is stacked on the floor; who knows what she’ll find in all that paperwork?  Learn more about Kathe Skinner and the Couples Communication Workshops taught by Kathe & David at http://www.BeingHeardNow.com

©2014, Being Heard, LLC

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THAT GIRL KEEPS FALLING ON HER BUTT

fall-down-stairs.jpgMy balance, isn’t.

So when I head straight toward the bushes at the entrance to my building it isn’t surprising.

Bushes are a trigger in picturing my first (and only) experience as a new MSer in an MS support group.   Recommended by my neurologist, the group experience was meant to help me cope with the way-past-due-diagnosis of my disease.

Instead, it freaked me out.

Walkers, wheelchairs, canes, crutches – and me, invisibly disabled, in high heels looking at a future unable to wear them.

Big time downer.

Especially when a guy lost his balance and landed on his butt in a bush. That he laughed it off was horrifying.

I understand, now, the reason he laughed.  Not only is laughing at the faux pas around the commonplace common, but situations that elicit that kind of response are also all too common.

The reality he must’ve experienced then is one I now share.  Today I laugh, too.  Because it’s truly comical at times and also because laughter is socially reassuring.  “It’s alright, folks.  I’m alright.  Nothing to see here, move along.”

Knock wood, I’ve yet to experience anything dire in my navigational mistakes.  Embarrassment to be impaired in public is what hurts. Most of us don’t know what to do in a situation like that.  I put lots of effort into looking unimpaired, but when I catch sight of myself in a shop mirror, the reality of how I walk, for example, isn’t normal at all. 

When I use an assistive device, a rollator in my case, parents scold their children for staring.  I’ve yet to hear mommy or daddy use the opportunity as a teaching moment to talk about disability; rather it’s “don’t stare” before hurrying away.  No wonder society hasn’t made much progress in accepting the disabled community who, except to children, remain largely invisible.

Recently, Disability.gov blogged an article about steps to take when being newly disabled.

It’s worth a read, especially if you’re not.

Specializing in couples work, Kathe Skinner is a Colorado Marriage & Family Therapist and Relationship Specialist.  She works especially those couples where invisible disability is present.   For over 10 years, she and husband, David, have been Certified Instructors for Interpersonal Communication Programs .  Find the schedule for their next Couple Communication Workshop at http://www.beingheardnow.com© 2014 Being Heard

How Come It’s “We’re Pregnant” But It’s Not “We’re Disabled”?

I don’t know when it became fashionable to identify pregnancy as an adventure à deux.  It always seemed lopsided that pregnancy excluded men from throwing up, having swollen ankles and shrewish moods.  I’m not even talking about all those forever changes like stretch marks, a bigger butt, and wider hips.  With the possibility of gestational diabetes, postpartum depression, or miscarriage, the adventure becomes a challenge, albeit one that affects the relationship although it is physically experienced only by the woman.

Not to make it one-sided, men’s experiences are extraordinary, too, and may include being the target of a woman’s whacky moods or being the late-night junk food scrounger.  For guys, it hits that the two of you are now a family, with all the attendant expectations to be the one who forevermore protects and provides.

Without a doubt there are many, many women for whom pregnancy is a delightful experience. The glowing, the growing, and giving life is an experience like no other.  Pregnant women and moms belong to an exclusive club that has unbend-able  membership rules.  So even if it was the two of you being pregnant, only one of you, in the strictest sense, is a mom.

It’s the same when a woman is disabled or chronically ill.  Only one of you is impaired even while both of you — your relationship — can be impaired.   Having an invisible disability can be the worst of all.

Our society looks for proof; needs to name it; needs to touch it or otherwise experience its reality.  You can’t be “a little bit pregnant”; you either are or you’re not.  Pee on a stick and you prove it.  With invisible disabilities, there’s no pee test.  For some people, taking it on faith is harder than believing that what isn’t seen is true.  For example, not being able to prove the existence of god doesn’t mean god doesn’t exist.  Obviously, it’s the emotion surrounding belief that counts; to disbelieve or doubt a person’s physical or emotional perceptions is tantamount to discrediting someone’s very existence.  The truth of it is immaterial, while the emotion surrounding such thoughts is what counts.  The thoughts may even be rooted in jealousy of a sort – “What, so you get a break but I don’t?”  “Buck up, you’re just being lazy.”  “I worked all day but I still have to make dinner and do the laundry and get the kids to bed before I can sit down and catch my breath and where are you? in bed.”

Quantification when invisible disability is present requires a different yardstick but most of all it requires belief, support, and compassion.

Adding a stress load to any system that is already compromised results in a predictable, and usually disastrous, outcome (think of how a building with cracks in the foundation responds to an earthquake).  The same thing happens when an already dysfunctional body system is unable to respond well when stressors are piled on.  Such stressors may include walking through a mall or having relationship difficulties.

“We’re pregnant” or “we’re disabled” is an implicit bonding between partners.  Life-changing events happen from which there is no return.  Legal sanctions apply in both situations:  the 20% of women, nationwide, who are disabled are entitled to lifetime support; children until they reach the age of majority.  Society doesn’t seem to have recognized that the “we” of marriage with children and the “we” of disability in a relationship are the same thing.

To say “we’re disabled” says that both partners are in it together, that there is emotional and physical support of the partner who is less capacitated. Pregnancy usually involves the active participation of both partners while acquiring disability isn’t chosen by either partner.  Parenthood never ends, just as disability does not; a major difference is in the expected trajectory – that parenting gets more pleasurable once the nest is empty, while disability often does the opposite.  Disability is different in that there is no consent, no pre-planning, and certainly no enjoyment in acquiring the condition.

Kathe Skinner is a Relationship Coach in private practice.   Specializing in relationships, especially those with invisible disability in the mix, she offers both in-person and web-based programs for couples.  See http://www.BeingHeardNow.com to find the right program for you!

©Kathe Skinner, 2012

“If you have multiple sclerosis, you’re treated with respect.”

The following assertion was made by Maxine Cunningham, founder and director of Empowered Walking Enterprise/Ministries.  My response follows.
“Dignity is not a word that we often hear in connection with how we treat persons with a chronic mental illness – YES if you have cancer, ALS, multiple sclerosis, etc. Dignity and full personhood – that we might be whole.”

As a therapist with multiple sclerosis, and a Board member of the Invisible Disabilities Association, I can assure you that those with physical illnesses, esp hidden ones like cancer, ms, lupus, Crohn’s diseaes, fibromyalgia, anxiety, depression, etc., are not always treated with dignity.  There are still people who will not hug someone with cancer for fear of “catching it”.  An ms client was escorted from a grocery store after she fell into a display; the assumption was she was drunk, not that she fell because of balance problems.  Read about my own experiences with people’s assumptions, misperceptions, and misunderstandings on my blog, ilikebeingsickanddisabled.com. and in my article for the government’s site, disability.gov, http://usodep.blogs.govdelivery.com/2012/07/25/looks-can-be-deceiving/.   Mental health issues are as much a part of invisible disability as physical health issues are.  Parsing them dilutes the effectiveness of advocacy.  Without ignoring the special needs of any group under the umbrella of “disabiltiy”, it might, at some point, be worthwhile to give up the “me” in exchange for the “us”.

Kathe Skinner is a Relationship Coach specializing in coaching couples whose relationship is impacted by invisible disability.  She lives in the Front Range of Colorado with her husband of 26 years, David, and their 2 hooligan cats, Petey & Lucy.
© 2012, Kathe Skinner