Let there be light ...

 

There is always a glimmer in those

who have been through the dark.

Atticus

Hello everyone - greetings of light-in-the-darkness to you all!

I would not have believed Atticus' ancient words in the dark, depleted days following years of family caregiving, the death of my husband, my mother's death 3 months later and all the mind-numbing tasks that inevitably follow the death of loved ones. I had given more than I had to give and was utterly spent. For months after the first rounds of bereavement tasks were complete, I did little more than sit in a chair by the window and breathe. And even that was an effort some days.

It was close to a year and a half before I regained sufficient physical strength to engage my grief in a meaningful way. And, to be quite honest, there were many days when I wished I had died, too, I felt so bereft and had so little life force left to fuel my living.

Some would have said I was depressed but, in fact, I was exhausted, grieving and traumatized. But, deep within me, invisible to the naked eye, healing was already beginning to take place. First came the s-l-o-w restoration of physical strength wrought by weeks and months of simple rest, good nutrition and short daily walks. (Though those initial "walks" comprised nothing more than a few steps to the front door where I stood on the porch with my face to the rain.)

Then, in the long silent hours of sitting by the livingroom window, staring at the garden, came quiet opportunities to re-connect with my Self, my memories, my feelings and the many sources of strength greater than my own - the healing rhythms of nature, the beauty outside my window, the wisdom gleaned from poetry and prose and a deep spiritual connection with Mystery. As my energy rose sufficiently to reconnect with people, the love of cherished relationships, old and new, sustained me through new choices in life and vocation. The glimmer that had desperately endured the darkness was fanned to a new brightness by my willingness to let healing take as long as it took and to accept the loving support of family and friends.

For some of you, 2020, (this strange, COVID, "year-out-of-time"), is ending in a similar state of grief, trauma and depletion.  You are full of unexpressed pain and sorrow and have not an ounce of strength left to give.  It feels like there is nothing left of you or in you. But please don't allow that to be your truth for long. Choose, instead, to gently and persistently fan the flame of your own life force.  Seek the things that have renewed you in the past and allow them to do it once more - even in the smallest "doses" and most unusual ways, given COVID's limitations.

As Atticus knew, way back in second century Rome, there is a tiny glimmer left in all of us who have been through the darkness, be that darkness the countering of COVID's grim effects, the fearfulness of not being able to work, the anxiety of becoming ill yourself or the exhaustion of caring for loved ones at home who were already ill or injured before the pandemic. This remaining glimmer can be buried so deeply that it seems all but lost - but it IS still there. And, with gentle fanning and exquisitely tender nurturing, it can break into flame and give light once more - first to yourself and then to the world around you.

When you do choose to heal, you may find you have sufficient energy to fan your own flame but, more likely, you will need some help. So, please do ask for that help. Even if it's hard at first. (You may have noticed that we nurturers are not always great at asking for nurturing, ourselves.) There will always be others who have walked the healing path before you who are willing and able to help you find your way.  Keep looking until you find the right ones for you - supportive friends, somatic therapists, spiritual advisors, meditation leaders, support groups and others. This care and support will make all the difference.

Festivals of light across cultures - Diwahli, Winter Solstice, Christmas, Hanukkah and others - remind us that there IS light in and after the darkness and that it can be fanned to a new intensity with time, care and exquisite attention. 

So, at this particularly dark moment in time, for each of us individually, and as a wider community, "Let there be light ...".

Enduring Somatic Threat ...

Once you ... put the pieces back together, 

even though you may look intact, 

you (are) never quite the same

as you were before ...

Jodi Picoult

Hello, Everyone,

Over the summer as I was writing an article on Chronic Sorrow, I tripped over some interesting new medical research on a proposed subset of posttraumatic stress called enduring somatic threat (EST). Have you heard of it? Well, to be honest, neither had I -  though in retrospect I recognize aspects of it in my husband's seven year journey with heart failure.

Physicians and psychologists in the cardiovascular field have been studying the 12 - 25% of people who have posttraumatic stress disorder (PTSD) responses after life-threatening medical events such as heart attacks, unstable angina, TIA's and strokes. The response they describe is similar to traditional posttraumatic stress disorder but is said differ from it in four ways:

1. The initiating event and continuing source of threat come from within the body rather than the external environment so there is nowhere to go to escape the threat. 

2.  The person's threat-oriented thoughts and intrusions are focused more on the dangers of the present and future than memories of a past event. Because the underlying illness persists, there is constant concern regarding a present or future recurrence of the life-threatening event or something similar. 

3.  Avoidance behaviours focus on reducing reminders of current and future cardiovascular risk rather than triggers of a past event. (eg Patients may avoid prevention medications and physical activity because they are reminders of the continuing threat.)

4.  Hyperarousal behaviours and their consequences are also different from traditional PTS. People become hyper-aware of internal body sensations vs external environmental cues (fear becomes velcroed to an increased heart rate, irregular heartbeat, breathlessness, the first stirrings of chest pressure or pain, slurring of speech, loss of balance, numbness, tingling etc).

While I'm not completely sure that all the above distinctions are true distinctions - perhaps it's more a matter of both-and than either-or when it comes to past and present/future somatic threat - it will be interesting to see how this research progresses and whether it begins to explain some of the differences we see between "patient" and family caregiver manifestations of Chronic Sorrow.

I think it is wonderful that medical and psychologically-oriented folk are working together to explore the traumatic impact of life-threatening events on their patients and families. I am hopeful that they will include previous research on Chronic Sorrow and Somatic Experiencing in their explorations and models so that grief and trauma can be addressed together (they're usually entwined in serious chronic illness) and that somatic treatments will be considered for this somatic distress.

If you are interested in reading some scholarly articles about enduring somatic threat, perhaps begin with the articles below:

Edmondson, Donald E.  An enduring somatic threat model of posttraumatic stress disorder due to acute life-threatening medical events. Soc Personal Psychol Compass. 2014 Mar 5; 8(3): 118-134.

Edmondson, DE et al. A challenge for psychocardiology: Addressing the causes and consequences patients' perceptions of enduring somatic threat.  American Psychologist. 2018 Vol. 73, No 9, 1160-1171.

NEW CF WORKSHOP: Compassion Fatigue: Going Deeper - Trauma, Spirituality and Resilience

Every moment is a fresh beginning...

TS Eliot

Hello, Everyone! 

A slightly belated Happy New Year to you all! I'm later than usual with my first post of the year because I have been pouring my creative juices into one of TS Eliot's "fresh beginnings", a new workshop designed to follow the now familiar Caring On Empty: Creative Tools for Compassion Fatigue Resilience.  

After Christmas, what began as the light revision of an earlier, second-level CF workshop turned into the development of an altogether new workshop, Compassion Fatigue: Going Deeper - Trauma, Spirituality and Resilience. It will be offered for the first time February 1st for the wonderful folk at Canuck Place Children's Hospice and again on June 7th in the form of a multidisciplinary community workshop at the Granville Island Hotel in Vancouver.  I'm so excited to be taking our basic CF understandings just a little deeper!

Spirituality is at the forefront of trauma research these days. There have been more research papers written on the topic of spirituality and trauma resilience in the past 5-10 years than in the previous 100. Why? I'm not really sure but I wonder if a general thirst for authentic, healthy, personal spirituality; psychology's recognition that it has too often avoided the topic; and the realization that our current trauma treatment strategies are not always enough, haven't led us quietly but steadily toward this research focus. 

You will find the following description of spirituality in several (unattributed) places on the Internet:

Spirituality is a broad concept with room for many perspectives. In general, it includes a sense of connection to something greater than ourselves and it typically involves a search for meaning and purpose. As such, it is a universal experience - something that touches us all. We all have spiritual experiences, whether or not we label them as such. Some people describe these experiences as sacred (connected with the holy), some as transcendent (outside the range of mere physical existence), and some simply describe them as a deep sense of aliveness and interconnectedness.

However we define or describe spirituality, we are learning that spirituality and trauma are often inextricably intertwined. Trauma affects our beliefs in the sacred/transcendent in ways that may interrupt or even jettison those beliefs. At the same time, or alternatively, trauma can affect us in ways that strengthen them. As a result, trauma recovery and resilience is inherently spiritual and must include a focus on our belief systems.

Christine Courtois, PhD, a respected, longtime complex trauma expert, says that a damaged spirituality is at the core of traumatic injury.  If this is indeed the case, we need to shine a brighter light on the role of spirituality in both perpetuating trauma and supporting its healing and resilience, something the field has been reluctant to do until relatively recently.

This new workshop is designed to introduce helpers to the topic of spirituality and trauma resilience and, through poetry, story, artwork, self assessment tools, mini-lectures and discussion, to help you to:

- Define spirituality, trauma and resilience

- Better understand the impact of traumatic stress on personal spirituality

- Clarify the role of positive personal spirituality in promoting resilience and vitality

- Reflect upon your personal state of spiritual wellbeing 

- Become better acquainted with a variety of practices found to promote spiritual wellbeing while working in high stress, high risk environments

- Consider ways of incorporating spiritual practices/activities in your personal resilience plan

- Review and use exercises learned at the Caring On Empty workshop to help you return to the Window of Tolerance during the day  

If you loved Caring On Empty, do plan to join us as we "go deeper" into our conversation about Compassion Fatigue resilience. (Registration brochures are available February 4 at caregiverwellness@shaw.ca)

Or choose to bring this new and engaging discovery-based workshop to your own organization!

The Hard Heart of Compassion Fatigue ...

We seem to value "strength". We want "hard" bodies, "strong" minds, "tough" wills, "hard-as-nails" determination,"rugged" personalities, "sturdy" character and so on. ...  But let us praise softness. ... Let us seek a heart that is not hard, but soft.

Omid Safi

Hi Everyone!

This is a story about hard and soft hearts written by life coach, Darren Poke, in 2011, in Melbourne, Australia. I'd like to share it with you today as we approach Valentine's Day:

There was a young man named Tom who lived in a small village.

He was an angry young man, overreacting to every offense and keeping others at a distance.

 In desperation, his parents asked Tom to go and see the eccentric old priest who lived in the village.

The priest was renowned for his unorthodox methods that somehow worked.

When Tom saw the priest, the older man told the youth to go away and come back with two lumps of clay.

He returned a few hours later and then was told to make a vase out of one of the lumps.

The young man thought that this must have been part of the therapy, so he threw himself into the task with enthusiasm, believing that the opportunity to create art would help him with his temper.

He made the vase, decorated it and put it in the kiln to harden.

Upon completion, Tom presented the beautiful vase to the priest. He was proud of his accomplishment and believed that he was now cured of his anger issues. 

The priest smiled approvingly and gave the young man a hammer.

"Now hit the vase with this hammer," the priest commanded.

"But it will break my beautiful creation!" Tom protested.

"Hit the vase with this hammer," the priest insisted.

"Don't you like it? Isn't it good enough for you?

"Hit the vase with this hammer," the priest continued.

Annoyed, the young man snatched the hammer from the priest and tapped the vase firmly.

The vase immediately smashed into pieces.

"Now look what you've done," Tom said angrily. "You've wasted all of my hard work."

The priest ignored the outburst and left the room for a moment.

He returned with the second lump of clay and placed it on the floor next to the young man.

"I suppose you want me to waste my time by making another vase? Well you can forget about it!" Tom said rudely.

 The priest looked at him with kindness and said,"Hit the clay with the hammer."

"With pleasure!" the young man responded.

He swung the hammer with all of his might and it hit the clay with a thud, leaving a large mark.

"Happy now? What was the point of that?"

The priest picked up the broken pieces of the vase and held them in his hands before the young man.

"See this vase? This is like your heart. You think that you need to be hard to cope with the inevitable disappointments that happen in life. You respond with anger, bitterness and violence, keeping people at a distance, but it doesn't work. Your hardness makes you more fragile. Adversity breaks your spirit too easily."

The priest then picked up the lump of clay, it had a mark where the hammer had hit it, but it was still in one piece.

"You need to soften your heart and be more like this clay. It is still impacted by what happens to it, but it can be restored more easily. A soft heart forgives, loves and uses soft words. It understands that pain and suffering is a part of life and instead of fiercely resisting, it absorbs the blow. It still feels the pain, but isn't broken by it."

The protective hardening of our hearts is a common way of dealing with over-exposure to others' trauma and suffering. Some people make a conscious decision to create a wall of coldness, withdrawal, anger or prickly behaviour, (I know someone who calls this her "force field"), in order to save themselves from further pain. Others don't even notice that their hearts are becoming stony. It happens so slowly and insidiously that they are shocked when others point out that they no longer seem to care.  However it occurs, this hardening eventually takes its toll and we pay the price in the irritability,  brittleness, reactivity, cynicism and emotional fragility that are hallmarks of Compassion Fatigue.

So, how is it with you right now? Is your heart so hard that, instead of feeling protected, you are shattered by any bad call, hard session or emotionally intense event? Are you wondering where the caring person inside you has gone? Are you wishing you could soften your heart and become the person you used to be? Are you afraid to try for fear of being shamed in a workplace culture that only seems to value strength and toughness?

In the next post we will look at some useful practices for beginning to soften our hearts ( - just in time for Valentines Day!).

 

Trauma and Aging ...

Last month The Canadian Press reported that Canadian military chaplains are experiencing high rates of burnout and compassion fatigue. That, in itself, is not news. Military chaplains have been experiencing primary and secondary posttraumatic stress forever. What is new and encouraging is that the problem is being recognized and addressed at official levels.

My husband was a British Army chaplain who, within six months of signing up, was posted to active duty in the Aden conflict as the British withdrew from that country with the populace at their heels. In the years that followed, he occasionally told stories of scanning rooftops for snipers whenever he left his rooms, of comforting boys terribly wounded by the equivalent of today's IED's, of writing personal letters home to their families after they died and of driving exposed through the desert to bury them, protected only by a single gunner on the back of his jeep. (Chaplains were not issued firearms.) Over time, his body succumbed to the effects of the stress and he was sent back to England with chronic pneumonia.

Despite the impact of these experiences, my husband coped quite well, from a psychological standpoint, until his mid-sixties when he developed heart failure after a viral infection. This event, with its traumatic onset, triggered the same feelings of fear and vulnerability he had felt forty years before in Aden. (And as a child in London during World War II.) As his illness progressed, so did his posttraumatic stress symptoms. In fact, during the final months of his life when he experienced increasing sleep apnea, (periods without breathing that occur during sleep), he would vividly "revisit" Aden during the breath-less periods then "return", disoriented and frightened, to the present each time he began to breathe again. This cycle would continue for hours on end, exhausting and terrorizing us both.

Fortunately, I was aware of the "new" research of the mid 1990's, research which helped us to understand and cope with these harrowing episodes. These studies of older combat veterans, holocaust survivors and Dutch resistance fighters showed that trauma survivors who were otherwise functioning well could experience a late onset or worsening of posttraumatic stress symptoms secondary to the stress of physical illness or injury, changes in environment, or medical interventions. This was what was happening to my husband and it is important information for all of us to know for a number of reasons:

1. As World War II and Korean, Vietnam, and Gulf War veterans; immigrants of war torn countries; and other trauma survivors and their families age, we will see increasing numbers of older adults in our health care, addiction and social service systems affected by late onset or exacerbation of PTS symptoms. They deserve, and will require, knowledgable and compassionate trauma-specific diagnosis and care.

2. As more of these trauma survivors enter our support systems, the possibility exists that more helping professionals, volunteers and family caregivers will experience secondary trauma exposure, creating the need for more compassion fatigue resources.

3. As both groups - helpees and helpers - age, there is also concern that cognitive impairment could keep them from identifying the sources of their symptoms and working through their trauma. This could leave numbers of survivors acting out unresolved trauma because they are no longer able to understand or express it directly.

The moral of the story for us as caregivers? As a long term care aide once said, with tears flowing down her cheeks as I finished a talk on "Trauma and Aging"-

"Listen to her. If you have trauma to heal, do it now. You never know when it's going to be too late. I see it in my patients all the time. They're in pain but I can't figure out why or what to do to help because they can't tell me what's happened to them any more."

(Caveat - This doesn't mean that we should sign up to heal our lives during the middle of a caregiving crisis. It just means that we could all do well to recognize that posttraumatic stress can worsen with age and to plan to do some appropriate therapy when the time is right - a time that is preferably sooner than later.)