Handling Strong Emotions When the Unthinkable Happens—To Someone Else

Warning: this post refers to the December 2, 2015 shooting at the Inland Regional Center in San Bernardino, California. It is meant to help people who were not directly involved in those events, but who are nonetheless experiencing emotional distress.

On the morningof December 2, 2015, the unthinkable happened here in the Inland Empire. Two armed people entered the Inland Regional Center, killed 14 people, and wounded over 20 more. I was talking to Sherry in the waiting room when Jill came out of her office and told us the awful news of what was happening just a few miles away. Stunned as I was, I had clients to see and that's what I concentrated on. As long as I was busy with the problems of others, I was fine. Only when I was about to drive home to Redlands and my husband texted me that the FBI was investigating a house on Center Street did I feel any fear. I arrived home safely, of course, watched the news and took phone calls from family and friends. The next morning I drove past Center Street on my way to an early appointment. The street was cordoned off with yellow tape and police cars. According to the morning news, the house on Center had been a "bomb factory." I was suddenly so nauseated that I had to stop and get a soda to settle my stomach. When I got home I curled up on the couch under a blanket, cried, slept for hours, and woke up feeling like I had been hit by a truck. I watched a little news, talked with my family, went to sleep very early and had nightmares. The next day I was functional again. The whole event seemed surreal.

As a therapist I recognized these as normal stress reactions. I was not at the Regional Center, and I don't know any of the dead or wounded. But this happened in my community and it hit me hard.

Each person reacts to terrible things in her or his own way, and everyone has a different threshold for what constitutes a traumatic event. Some will shake their heads and go on with their day, others will go to a vigil, hug their kids, look at the sunset, or have a stiff drink. Others may react as I did, but think, "I wasn't there. Why am I feeling so bad?" or worse yet, "I shouldn't be feeling so bad." But the fact remains that they are feeling bad. In the wake of a public trauma, it's important to be honest with ourselves about how we are doing. Here are some common reactions:

Depression

Anger

Crying

Emotional numbness

Insomnia or sleeping more than usual

Nightmares

Loss of appetite

Being easily startled

Feeling fearful for no reason

Hypervigilance

For most people, these feelings will soon fade on their own and life will go on. Self care practices such as exercise, time spent with family and friends, meditation, prayer, volunteer work, reading, hobbies, and focusing on the here and now can all help. However, if symptoms persist for more than a few weeks and interfere with your daily life, then it's time to see a therapist to discuss your level of anxiety and/or depression. It's ok to need a little extra help, and talking with a therapist can be very reassuring.

In short, even if you are not directly involved in terrible events, you can still be affected by them. It's part of being human. 

Multitasking is a LIE

It's a Lie we tell ourselves...

We have all heard that multitasking is the best way to be highly efficient and it's the way smart people get things done. We are always trying to find a way to get more tasks accomplished within our 24 hours and multitasking seems to be the answer right? Wrong. We all have been sold a bill of goods; really, we have.  The word multitasking was first used in 1960 to described a computer’s ability to perform many tasks seemly all at once; ultimately, multitasking literally means multiple tasks alternately sharing one resource in this case a CPU. Due to a computer’s fast ability to read code it “looks like” it is doing more than one task at a time. However, even the CPU cannot read two lines of code at a time. What the CPU is actually doing is alternately reading and executing the code by switching back and forth between the codes until the tasks are done.

 

Overtime, this lie of multitasking became synonymous with people doing multiple tasks. Now I hear what you are saying “Hey wait a minute humans can multitask; we can walk and talk, or chew gum and walk, or even drive and listen to music all at the same time.” Yes, you are right those small tasks can be done simultaneously. However, not with equal attention and more importantly our attention bounces between the two tasks. If the tasks have greater focus the harder they are to complete together. Think about driving and talking on the phone. This activity is responsible for over 6000 deaths annually and is the number one cause of death in teens even over alcohol use. http://bit.ly/1LOfHPH Additionally,  I see people that come into my office stressed and feeling over whelmed and I will ask about their sleep schedule, their commute time, family time, personal (alone) time and about their working time. They tell me that almost every moment of their day is planned out and yet they still want to do more. They want to be able to add other things to their schedule or they feel they just can’t juggle anything more. They feel depressed, sad, overwhelmed and stressed, with little life satisfaction. They can’t understand why, “if only I could get more organized they say it would all work out.”  I am here to give you the freedom of doing one thing and doing it well.  No more multitasking; now doesn’t that feel good? So why is multitasking so bad for us? According to a 2009 study at Stanford University, multitasks pay a big mental price. The study found that:

• Reduces the amount of information you can remember; decreased overall memory
• Unable to filter out irrelevant information; so tasks actually take longer
• Unable to focus on the goal at hand
• Always thinking about  other things but not able to complete the task
• Inability to concentrate for long periods of time  
• We become less efficient as we lose time by switching between tasks
• The stress hormone cortisol increase in the brain when we multitask
• We actually lose 10 functional IQ points

World expert on divided attention and Neuroscientist, Earl Miller, at MIT states it this way...

                “Our brains are not wired to multitask well.” When people think they’re multitasking, they’re actually just switching from one task to another very rapidly. And every time they do, there’s a cognitive cost in doing so.”

 If you suffer from the “shiny object syndrome” or if you're still not convinced to give up multitasking I challenge you to just try for a day. Work on one project until it’s completion. Put the phone on mute, turn off the email pings and solidly work on the task. See if it takes you less time, you have more focus, if your brain is less fatigued and you may even have more energy and a bigger sense of accomplishment.     

Symptoms of Dementia

Dementia: What is it? Why hasn’t my doctor addressed it?

What’s confusing about dementia is that it’s not actually a disease by itself. Rather, it’s a collection of symptoms such as impairments to memory, communication and thinking.

While the likelihood of having dementia increases with age, it is not a normal part of aging. Before we had today's understanding of specific disorders, "going senile" used to be a common phrase for dementia ("senility"), which misunderstood it as a standard part of getting old. We simply assumed as we aged we would lose our memory and it was normal. Some mild cognitive impairments such as poorer short-term memory can happen as a normal part of aging (we slowly start to lose brain cells as we age beyond our 20’s). This is known as age-related cognitive decline, not dementia, because it does not cause the person or the people around them any problems.

Dementia describes two or more types of symptoms that are severe enough to affect daily activities. The leading cause of dementia is Alzheimer’s disease. Dementia can also be caused by brain damage incurred from an injury or stroke, and from other diseases like Huntington’s, Vascular Dementia, Cruetzfeld-Jacob Disease, Frontotemporal Dementia, Lewy body dementia, Mixed dementia, and Korsakoff Syndrome.

Why is Dementia not addressed by physicians?

First, if you or a loved one are concerned about memory loss, you have to say it. Clearly. Provide some examples to illustrate your concern. Then, be aware of the following:

•  Dementia symptoms can be so subtle initially that your loved one will acclimate to them, as will you.

•  Patients frequently recognize they are having symptoms, and are so scared by them that they won’t tell anyone. The stigma and fear of dementia is so great they won’t tell their doctor- or you.

• Doctors may not know they are seeing dementia. They may not know all the symptoms because you haven’t written them down, and when you arrive it’s so overwhelming that you forget some of what you wanted to say.

• Doctors may see the symptoms separately, and misdiagnose. Depression mimics many of the early stage symptoms. Patients may react badly to being told this is “all in their head.” It really is in their head, but it’s dementia. And some dementias are accompanied by depression because of the impact on the brain. Lewy Body is one of those.

• You may not get the referrals you need because you didn’t know to ask for them. You should have a neurology referral, at a minimum, to a specialist in dementia and cognitive disorders.

• Symptoms can increase and change in an hour or a day or a month. If a patient has already been sent home being told this is normal aging or depression, they are unlikely to want to return to try again and to have to list more symptoms in the hope that they will be heard and listened to. LIST EVERY SINGLE SYMPTOM. DEMENTIA AFFECTS THE BRAIN, WHICH REGULATES THE ENTIRE BODY. YOU MAY NOT KNOW YOU ARE SEEING A SYMPTOM.

• Some doctors do not want to tell your loved one they have dementia. Dementia is not treatable like other illness. There are some medications that have a chance to slow it down for a time, but decline is inevitable. Doctors, like the rest of us, don’t like facing that some things are simply hard to accept, and that they can’t fix them. They want to keep patients positive and hoping for the best so they fight the symptoms. It’s done with the best of intentions, but families need to know if they are facing difficulties, and patients need to know this is real.  

We are here to help. If you or a loved one are trying to cope with the onset of dementia and the stress it creates, we have an expert at CCS who can provide support, education, and a safe place to talk. Call us.

5 Easy Depression Buster

Depression is often defined as a feeling of hopelessness, loss of energy that nothing matters or you’re not good enough.  For people that suffer mild depression engaging in the activities listed can help renew your energy and lift your spirits.

Even a simple walk can help with depression

Top 5  Easy Depression Busters:

1.      Take a walk even as little as 10 minutes as been shown to increase one’s mood. Aim for 30 minutes every day.  Do have time? The good news is the minutes can add up so take three 10 minute breaks if you just can’t fit it all in at once.

2.      Watch a comedy. Laughter release endorphins in the brain that make you feel good and provide sense of wellbeing. Laughter also reduces stress and can even increase your immune system. Laughter also adds happiness and joy to our lives.

3.      Get enough sleep. Aim for 7-8 hours of sleep a night. Sleep effects everything in our lives, it regulates hormone production, provides us with mental alertness, emotional balance and creativity.  Sleep is restorative to the body and helps with repairing cell damaged caused during the day.

4.      Spend time with friends and loved ones. Social interactions help us live longer and happier lives. Telling your best friend about your day reduces the stress hormones and promotes feelings of being supported and understood.

5.      Get a little light, sunlight that is. Sunlight is essential to a healthy lifestyle. Not enough can make the depression worse. We needs a little each day. So take your walk outside, enjoy a lunch with a friend in the garden a little goes a long way.

This may sound simple but little changes really do add up. Our body and mind are meant to move and the movement adds with hormones that make our bodies happier. Try the about for at least a two weeks and let us know what helped you.

Anticipatory Grief

Grief and loss doesn't start after your loved one has died. It begins when the realization becomes real that their death is approaching, whether far in the future from a long-term illness, or when a death occurs with little notice. In the ER, the ICU, at home… when that realization happens grief begins. It’s called “anticipatory grief” but, in reality, it’s grief, with all its emotion and sadness.

In the time before death occurs, there are things that need to be considered, both from the loved one’s perspective and to address your concerns. This will address the dying person’s needs. I’ll follow it with a blog about your needs as you support your loved one.

What Does A Dying Person Need at that point?

·       The need to “settle up” with the people so as to die in peace, with them and with myself.

Settling up emotional accounts

All of us have unfinished business left over from our years on Earth. Approaching death is the last time to make amends, check in, or say the things that have been left unsaid.

If someone can’t be reached, letters can be left, and even dictated. Elaborate isn't necessary. Peace for the person dying is.

·       An advocate for their end of life decisions

End of life decisions need to be written well in advance of the dying process. They aren't valid if you aren't of sound mind without a doubt.

Enforcing a living will or other decision making documents can be difficult if there is division in the family.

It’s hard to not provide hydration of nutrition if it’s been days or weeks. Someone has to ensure the dying person’s wishes are followed. That may have to be you.

·       The environment the dying person desires

Some people are extroverts, even when dying. Some are private, even if the family wants access. The dying person should have the kind of environment they lived with and following their wishes. And someone has to ensure it happens.

Things to consider:

•  music 
•   TV or movies
•   Bedroom or living room 
•   Home or hospital
•  Family 
•   Friends
•  Pets
•  Spiritual folks
• Lighting
•   Scents

·       A safe space to talk or a safe person to talk to about death

Family and friends are often reluctant to face up to the reality of the terminal illness and death: even if they are not, their experience is not the experience of the dying person. If they are still capable of talking, they may need someone to talk to about their fears and terrors, hopes and vulnerability. It may not be family. It may be a nurse, a friend… it’s up to the person who needs to do the talking. They don’t need their decision to create conflict. It’s their decision.

·       Spiritual support- or NO spiritual support.

Some find it comforting. Some find it presumptuous to assume they need spiritual support. Some do not have a faith they rely upon or believe. The dying person needs, and deserves, to have their needs followed at this point. If family needs to listen to religious music, say prayers, light incense… no matter- if it’s not something the patient wanted or participated in, it belongs outside the door. It’s the patient’s death- nobody else’s.

·       Pain management/comfort measures

A dying person deserves to have pain and discomfort resolved. They may not be able to tell you what they are feeling, but their body can to some degree. Blood pressure, fever, grimacing, tightened muscles, low oxygen saturation, irregular breathing. Those and so many more are indicators of the patient’s body being uncomfortable. Can you fix the breathing? Probably not. But you can add oxygen. You can administer pain medications and anxiety meds through sublingual administration. You can add a subQ IV to administer meds without adding fluids that could create respiratory distress. You can massage. Make the bed softer. Use a cool washcloth. Turn on a fan. Add a blanket.

Families tend to be especially distressed about morphine and other meds. They are not going to kill a dying person. They make the muscles relax so breathing is less stressed. They relieve pain. If your loved one has asked for comfort measures, they don’t want to die in pain. Allow the medical professionals to guide you. Ask questions.

·       Food? Fluids?

At the end of life, the body has a process of its own as the systems shut down. It no longer needs food. It doesn't thirst. The mouth may need moistening. Oral care is still necessary. But if a dying person says they don’t want food or fluids- believe them. It’s hard to watch. You are still hungry. You are still thirsty. They are not. Honor their body and their needs. Forcing fluids can cause choking and even pneumonia, hastening death.

·       Visions supported

Many people who are dying will report that they are seeing loved ones who died before now, or angels.  Don’t question or deny that. There have been studies that say they may be caused by hypoxia or changes in brain chemistry. The studies, however, cannot include dying people. We don’t know this experience. We do know it’s common and brings comfort. Tell them you are glad they are there.

o   Your voice

The last sense to die is hearing. If your loved one would want you there, talk to them. To the end.  

o   Permission

This is most likely the hardest of all. No matter the disease or the pain, very few of us really want our loved one to really die. The fact is they are going to die. Tell them it’s ok. Tell them you’ll be ok; you’ll take care of business they left behind; you’ll carry their memory. Tell them what you will miss most and how much you loved them. But tell them they can go.

It’s not easy to sit while someone you love is dying. It’s a gift if you can.