The Bitch Ditch

1) Don’t try to make the grieving person feel better. YOU CANNOT. For many grievers it only serves to make them feel guilty or worse. Grievers MUST experience the pain of grief for healing to ultimately occur.

2) Don’t tell the griever to give it time. Time has stopped for the griever. Life proceeds in slow motion. Life is too surreal to be identified with time.

3) Don’t try to divert the griever’s attention away from their pain by talking about something else. If you do, when you exit their presence, the reality will generally hit all the harder. Also, it may seem to the grieving that you are uncomfortable with them talking to you about their grief. If they sense this, they will alienate themselves from you.

4) Don’t be afraid to talk about the person who has died by name. If it makes you uncomfortable, it may want to assess your preparedness for helping. To recover from grief, the griever must have a realistic picture of the dead.

5) Don’t be frightened by tears…the griever’s or your own. Tears are apertures of release and help the griever express their sorrow in healthy ways with your presence as a cushion of warmth and empathy.

6) Don’t be concerned about saying the right things. Let the grieving person talk. Just listen and encourage their talking. Your presence is more meaningful than anything you can say.

7) Don’t argue with grieving individuals. Instead, reassure. You may hear statements such as, “I wish I had done this or had been more considerate” and so forth. Reassure them that they did what they could have done at the time not knowing _______ (name of deceased) would die when he/she did.

Don’t use euphemisms and flowery language. Generally, it only makes the situation seem more artificial and unreal. For example, don’t say “passed away” or “expired” when you mean “died.” The griever need to hear “dead.”

9) Don’t be afraid of silence. Silence on the helpers part show that you do not have all the answers and do not feel the need to pretend that you do. Furthermore, it gives grievers time to process thought and express feelings.

10) Don’t make general statements of help such as “If you need me, give me a call.” Chances that they will call are almost nil. Instead, be specific. For example, tell them about a group support group being conducted in their area; or tell them you will stop by next week to see if there is some housework you can help them with; or ask if you can bring dinner by tomorrow.

11) Don’t isolate grievers. Don’t cut your conversation or visit short because you are uncomfortable or because you are too busy. (Never look at your watch or the clock in their presence). Be ready with gentle words and a listening ear. Your sincerity and concern is the best proof to the griever that he/she still has resources to draw from.

12) Don’t become impatient. Many grievers ramble on and on and repeat themselves in their shock and confusion. Supporting with patience, empathy and compassion reveals your care.

13) Don’t be judgmental or rejecting. Grievers are hurting badly. They do not need your judgments and abandonment at this difficult time in their lives.

14) Don’t tell grieving people you know how they feel. YOU DON’T. Even though many helpers have also experienced loss due to death, each experience is different and felt differently. Your pain is never someone else’s pain.

15) Don’t let your own needs determine the experience for the griever.

16) Don’t push the bereaved into new relationships before they are ready. They will let you know when they are open to new experiences.

17) Don’t impose your value system on the bereaved. Your beliefs or ways of doing things may not be theirs.

18) Don’t elaborate on your personal experiences of loss to the bereaved.

19) Don’t let the griever forget their children’s grief and special needs during this time.

20) Don’t be afraid to touch, hold, hug (etc.) the griever. The feelings generated is worth more than a thousand words.

Rev. Saundra L. Washington, D.D., is an ordained clergywoman, social worker, and Founder of AMEN Ministries. http://www.clergyservices4u.org She is also the author of two coffee table books: Room Beneath the Snow: Poems that Preach and Negative Disturbances: Homilies that Teach. Her new book, Out of Deep Waters: A Grief Healing Workbook, will be available soon.

Men and depression, women and depression, it doesn’t matter. Depression crosses all genders, ethnic groups and economic classes. The Centers for Disease Control studied the importance of integrating the mind with the body in our healthcare system. It is a fabulous study. I want to share the key points as they affect every family, family member or loved one.

The separation of mental and physical health that exists in our health care and public health systems belies the fact that both exist within individuals in an exquisitely integrated fashion. This April issue of Preventing Chronic Disease explores that integration. Preventing Chronic Diseases is published by the government’s Centers for Disease Control and Prevention(CDC).

The definition of health provided by the constitution of World Health Organization is unambiguous in this regard: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (1). If we are to achieve this goal of complete well-being, we will have to bridge the chasms within our health care and public health systems.

“The Carter Center has undertaken these same strategies to address barriers to care among people with mental illness, many of whom have a chronic mental illness. An article on The Carter Center Mental Health Program (8) describes an impressive set of activities focused on reducing stigma and achieving parity in insurance coverage for mental illness. We would do well to form close collaborations with partners like The Carter Center and to join forces in developing policies and communication strategies that benefit both the mental and physical health of populations. We can claim success when the mental and physical components of our health care and public health systems are as integrated as they are in the people we serve.”

I concur 100% with this terrific article. After suffering from depression for 20 years and trying countless treatments, including ECT, it was vagus nerve stimulation that completely changed my life. Vagus nerve stimulation changed my life from one of utter despair to genuine happiness and joy. I am so grateful for this remarkable medical breakthrough. My body got better; lost 35 pounds, chronic pain diminished, cholesterol returned to normal and I have taken responsibility for my health-emotional and physical.

If you are suffering from chronic depression, you should discuss this new therapy with your doctor. Vagus nerve stimulation was just FDA approved, so the medical community is also learning about this treatment option.

Vagus nerve stimulation will be presented at the American Psychiatric Association’s Annual Meeting in late May. The book I wrote Out of the Black Hole: The Patient’s Guide to Vagus Nerve Stimulation and Depression will be exhibited at this meeting, which is the largest gathering of psychiatrists in the world.

If you want to learn more about vagus nerve stimulation for depression, I would encourage you to visit http://www.VagusNerveStimulation.com web site. It could change your life or the life of a loved one.

Charles Donovan was a patient in the FDA investigational trial of vagus nerve stimulation as a treatment for chronic or recurrent treatment-resistant depression. He was implanted with the vagus nerve stimulator in April of 2001. He chronicles his journey from the grips of depression thanks to vagus nerve stimulation therapy in his book:

Out of the Black Hole: The Patient’s Guide to Vagus Nerve Stimulation and Depression

His all inclusive book prepares depression sufferers to make an informed decision about this ninety-minute out-patient procedure. It is a “must read” before you discuss this treatment with your psychiatrist. A prescription for the procedure is required from an M.D. and it is covered by most insurance plans.

He is the founder of the http://www.VagusNerveStimulation.com Web Site and Bulletin.

If you have been diagnosed with depression or feel that you are dealing with depression on a daily basis, you may feel that depression is consuming your life. You worry about everything. You don’t want to do anything. The things that used to make you happy, well, they just don’t seem important anymore. You need to realize that depression is a serious condition and that without the assistance of a doctor, depression just won’t go away.

But, you can learn to deal with the effects of depression within your daily life. Yes, it is hard. Yes, it would be much easier to try and forget about it all. But, if you ever want to be happy again, you’ll want to find a way out of your black hole. In order to deal with depression on a daily basis, you may have to force yourself to do things that you do not enjoy doing anymore. You may have to surround yourself with people and places that are positive. You may have to seek out a therapist to talk to about your depression.

No one said that dealing with depression on a daily basis was easy. It is not. But, if you have this disease, then you must find a way, even if it is deep inside you, to pull through the day. Remind yourself of the positive things that you have within your life. Your family, your job, your friends can be a few. For more ideas on how to surround yourself with good things, and for ways to avoid depression in your daily life, visit websites like www.avoiddepression.com. You’ll learn how to get through the day. While it is not a medical website, it is a great outlet for finding resources to help you.

S A Baker is staff writer at Depression.

A major approach to the treatment of posttraumatic stress disorder (PTSD) involves narrative processing of the traumatic memory. This is designed to undo the distressing continued effect of the traumatic experience that intrudes into the patient’s present life as PTSD symptoms, depression, and dissociation. The narrative processing collects and organizes the fragmented images and perceptions of the trauma into a coherent verbal structure with beginning, middle, and end. Now the person can assimilate the gathered fragments into verbal memory as personal history. The shock of the trauma is no longer stunning in present time and no longer felt as unfinished threat. The experience finally can be examined in the light of present consciousness as a remembered past event.

It is exceedingly difficult to simply recite a traumatic experience. Outside of verbal consciousness memory fragments fester like “memory shrapnel” and prevent narrative closure. Enlisting the help of the “mind’s eye” and the imagery of the right brain can facilitate the assimilation of these nonverbal images into verbal memory. It is not just what the mind’s eye sees but how it beholds and reports. When the mind’s eye serves narration it is observing and describing through the perspective of a hidden observer. It is helping to protect the person from reliving the experience.

The methods to recruit the mind’s eye to the work of narrative processing depend on visual imagery even though many of the memory fragments may not be visual. They may consist of bodily sensations such as pain or pressure or feelings of terror. Whatever the content, their presence can be detected by the mind’s eye and reported by the hidden observer. It is the duty of the hidden observer to give an objective narration while resisting the subjective pull of unfinished experience and avoiding reliving of the experience. Once narrative closure is achieved there is no more pull into the traumatic experience.

The Hidden Observer

In the 1970’s the research psychologist Ernest Hilgard experimented with the hypnotic induction of analgesia and discovered that a hidden observer could be elicited in those subjects claiming to feel no pain. He asked for a report by a part of the subject that did feel the pain and could rate the severity. Some subjects responded from a part of themselves that was aware of the pain and could rate it on a scale of ten during the time the subject had claimed analgesia. These elicited parts were very much alike from subject to subject. The part was normally hidden from the subject’s awareness although the part claimed to have always been there. The part was aware of the experimentally induced pain (produced by ischemia of the arm deprived of circulation by the tourniquet effect of a blood pressure cuff inflated to a pressure above the systolic pressure) but the part denied suffering. Dr. Hilgard designated these parts “Hidden Observers.” The Hidden Observers claimed to be onlookers of the person’s experiences at all times, whether the subject was hypnotized or not. They played no role in executing action and did not participate in the emotional experience of the subject.

More than 90% of the patients undergoing hypnosis in an intensive trauma therapy clinic were able to liberate a Hidden Observer. Following hypnotic induction by progressive relaxation the patient visualizes an imaginary scene and executes the imaginary action of stepping out of the body and observing the body from the outside. The therapist refers to the onlooker as the Hidden Observer and points out the capacity for emotional distance from the patient. The Hidden Observer then temporarily leaves the patient in the imagined scene and goes to the time of the trauma to observe the traumatic event as it unfolds. The Hidden Observer narrates the event impassively, referring to the self in the trauma in the third person - as “him” or “her” - and telling the story from beginning to end. The narration is recorded by videotape for subsequent review by the patient in a normal waking state. The hypnotic session ends after the Hidden Observer returns to the self left in the imagined scene.

Reviewing the videotaped narrative in the waking state completes the hypnotic narrative processing. The patient and the therapist watch the replayed videotape together. Now the patient no longer has the emotional distance of the Hidden Observer. The patient may only dimly remember much of the narrative and there is a risk of being triggered into a re-experiencing of the trauma. If this happens the therapist will stop the tape and help the patient become grounded.

Usually there is little or no triggering or abreaction with review of the tape. This is positive because abreaction interferes with verbal narrative assimilation. There may be an element of desensitizing in the review. Emotional desensitization can also diminish assimilation because the patient might escape full avowal or owning of the experience and feel instead as if it happened to someone else. If this failure is not corrected, the entire narrative processing must be repeated.

Usually when the narrative processing is repeated the second narration is more detailed and complete and makes it possible to fill in gaps that were not detected during the first. When this still does not relieve the intrusive symptoms of PTSD the cause might be that the symptoms arise from earlier traumas. The patient may have to search for unremembered traumas, such as preverbal ones or overlooked traumas due to medical or surgical procedures, for example.

Processing traumatic memories with the mind’s eye and the Hidden Observer makes it possible to do trauma therapy rapidly and safely without re-traumatizing the patient.

Louis W. Tinnin, MD
Psychiatric Consultant, Intensive Trauma Theapy, Inc.
http://traumatherapy.us