The stories of Katie, Calvin, Rachel, Frank, Melody, Wendy, and Eben show that, even though nature gives us the ability to cope with crises, coping is not automatic. In fact, obstacles to healing are so common in our society, many people need help to recover from their crises. Indeed, many of us harbor false beliefs and maladaptive mental habits that create a wide range of obstacles to healing.
If you have studied this book and performed the exercises it suggests, and you still can't recover from your crisis, you need to find additional help. This chapter explores what kind of help you need, and suggests how to find it. Several kinds of barriers to healing can be overcome with help from one (or more) of four categories: counseling, psychotherapy, medication, and self-help groups.
Counseling or psychotherapy are the two most common kinds of help needed. These methods are similar, in that both are educational. However, the education occurs at different levels. Counseling is teaching the basic skills of grieving and how to use them. This book counsels, and most people can learn to heal with its counseling. That's because the most common barriers to healing are false beliefs about anger and unrealistic guilt feelings. For example, I counseled Katie, Rachel, Frank, and Melody.
Psychotherapy is a deeper educational process, focussing on bringing our unconscious habits and thinking patterns into our consciousness. Healing is often complicated by obsolete, unconscious mental habits, and changing these habits usually requires psychotherapy. For example, people with long-standing habits such as those of Calvin and Eben typically require psychotherapy to heal.
The third kind of help is provided in self-help groups. Social support can facilitate healing, but social isolation can create serious obstacles. People at risk for such obstacles include people who are usually loners, those who are away from their homes, and those whose friends and family burden them with unhealthy superstitions about grieving. To overcome these barriers, many socially isolated people can find social support in the national network of self-help groups that others have developed in recent years.
The fourth kind of help involves the use of prescribed medication, usually antidepressants, to correct imbalances of brain chemistry. These serious obstacles to healing are fundamentally different from psychological obstacles. Since they interfere with our ability to learn and to reason, they can't respond to counseling, psychotherapy, or social support. Therefore, before healing can proceed, the chemical imbalances must be corrected by medication. Moreover, this medication should be prescribed by a psychiatrist.
The most common obstacles to healing, anger and guilt, result from harmful lessons we learn in growing up. Counseling is frequently sufficient to reverse these lessons. Katie, for example, didn't know how to recognize or express her anger, and counseling was adequate to overcome her handicap. Similarly, Frank and Melody needed only counseling to help them learn how to share their grieving for Melody's expected death.
On the other hand, counseling is rarely sufficient for guilt feelings that create self-reproach and depression. Mastering this kind of guilty conscience usually requires psychotherapy. For example, from the time he was a child, Calvin carried unrealistic guilt feelings that made him feel worthless and depressed. Psychotherapy helped him to uncover his buried memories, to relive his reactions to them, to understand their significance to him, and to learn new ways of coping with losses.
Psychotherapy is also needed to overcome unhealthy mental habits whose roots are buried in unconscious memories. For example, Wendy suffered because she used hypochondriasis as a "defense" against painful feelings. This mental habit was pervasive, interfering with many aspects of her life, including her marriage. Moreover, until she began to uncover the roots of her harmful mental habit during psychotherapy, Wendy didn't even know that she had been trying in vain for years to cope with earlier crises.
Disorders of brain chemistry are not illustrated in the stories of this book, but they are important to recognize as obstacles to coping. When our brains are working well, we think, feel, perceive, and learn normally. On the other hand, when our brains don't work well, our mental tools can be dulled. Alcohol, for example, disables our minds by crippling our brains: We lose our ability to think clearly, to trust our emotions, to learn new information, and to perceive our surroundings accurately. That's why stopping this damage is necessary before we can begin to learn adaptive ways to cope with our crises.
Similarly, we must stop the damage done by imbalances of normal brain chemicals before we can adapt to crises. Our brains use chemicals to operate normally, and imbalances of these chemicals can also cripple our minds. The depression that is caused by abnormal brain chemistry is called biological depression--a term that distinguishes it from the depression caused by guilt or other psychological factors.
The most common types of biological depression are Major Depression and Bipolar Disorder (also known as Manic-Depressive Illness). These illnesses, which often occur in families, are disorders of brain chemistry that can be triggered by the stresses of major crises. They usually respond well to antidepressant medications.
The effects of biological depressions differ from those of uncomplicated acute grieving in one critical way: If we are grieving normally, we can think clearly, even though it is difficult. Counseling or psychotherapy can help us to discipline our reasoning minds to relieve our symptoms. In contrast, if our brain is crippled by biological depression, it is impossible for us to think clearly: We simply can't use our reasoning to apply our coping skills, or to learn new ways of coping.
No amount of counseling or psychotherapy can change correct biological depression. Medication is necessary to help depressed persons recover the use of their reasoning minds. Despite this, many people struggle for months, or even years, trying to find relief from their biological depressions with no more help than "talk therapy."
On the other hand, medication can't do the job of talk therapy, either: It can't make us learn to correct our false beliefs or change our harmful mental habits. That's why a combination of medication and talk therapy are often necessary for meeting the challenges of blocked grieving when it is complicated by biological depression.
It is crucial to recognize and treat biological depression when it exists. Otherwise, you may waste a significant part of your life languishing needlessly. Worse, you may consider ending your life to end your suffering. If you are suicidal, seek help immediately. Don't apply a permanent solution to a temporary problem.
You may suspect that you suffer from biological depression if you experience the so-called "vegetative symptoms" of depression. Ask yourself if your sleep patterns are disturbed, your appetite is poor, you lose weight, your energy level is low, and you can't find interest in things that ordinarily interest you. You may also feel hopeless, helpless, and worthless. If these symptoms extend for many weeks or months after your loss, you may be suffering from biological depression. To find out, you definitely need professional help to evaluate your symptoms, and to determine whether you need medication.
Professional evaluation is necessary because the vegetative symptoms don't always signal biological depression. Remember that loss of appetite, troubled sleep, low energy, difficulty concentrating, and general loss of interest are also the normal symptoms of acute grieving. In other words, people in crisis typically experience the vegetative symptoms even if their brain chemistry is in balance. The main difference is that the symptoms of acute grieving remain only a few days to a few weeks (depending on the severity of the crisis) but the symptoms of biological depression may persist for months.
If you think you are suffering from a biological depression, your best course of action is to find a psychiatrist to evaluate your condition. Psychiatrists are physicians (MDs) who have been well trained in psychological and biological mental disorders, and they are the only mental health professionals who prescribe medications.
If no psychiatrist is practicing in your home community, you can find a suitable alternative to help you. For example, you may find help from a psychologist (PhD), licensed clinical social worker (LCSW), or marriage, family, and child counselor (MFCC). In any case, your helper must work closely with a psychiatrist in case you need medication.
In general, you should not ask your family doctor or internist to evaluate your depression, for these specialists are rarely well trained in these disorders. Yet, if you can't find a psychiatrist near you, finding help from any trusted physician is far better than not seeking treatment at all.
Tranquilizers are also sometimes helpful for temporary relief after a crisis. However, these drugs must be used prudently, for they can be abused. As with abusing alcohol or other drugs, abusing tranquilizers can block healing, particularly when they are used to eliminate painful emotions. Moreover, most tranquilizers are addictive. That's why you shouldn't borrow tranquilizers from friends or relatives. Instead, these medications should always be prescribed by a psychiatrist or other physician who is alert to their drawbacks.
You may be reluctant to consult a mental health professional, concerned that others might think you are "crazy." If you don't seek help for this reason, you may have another serious problem: You may allow the opinions of others to dictate your life. Or you may be your own worst judge: You may deny that you need help. Whatever the reason you may give for not seeking help, remember this: This is your life and your health. It would be foolish to let anything or anyone stand in the way of your living your life well.
Finally, if your psychiatrist prescribes a medication for you, don't avoid taking it because you are concerned that you might become dependent on it. Antidepressants are not addictive drugs that cover your feelings. Nor are they mind-bending chemicals. Quite the opposite: They reverse the mind-bending effects of the brain disorder, and allow the reasoning mind to operate normally.
Moreover, antidepressant medications have saved thousands of lives. Many people who suffer from biological depression consider suicide as their only imaginable source of relief. Yet, this lethal thinking disappears after their brain chemistry is brought into balance.
Severe problems with coping almost always originate in our mental habits. Like alcohol, the mental habits of denial, isolation, and dissociation numb the pain of anger, fear, and sadness. Ironically, however, these so-called "defense mechanisms" encourage converting the temporary pain of grieving into permanent depression. Obviously, it is a poor trade-off to invite long-term depression to avoid the short-term distress of grieving.
We don't easily recognize our mental habits because they are unconscious. That is, we don't know they exist. For example, some people automatically use the mental habit of isolation to hide their emotions. These people hide all their feelings, including joy, by committing them to their unconscious minds. As a result, their emotional life is bare. They not only resist changing, they waste the potential energy and information their emotions could provide for helping them cope.
People who use the habit of dissociation, on the other hand, don't hide all of their emotions. They segregate their good feelings from their painful ones, responding to sadness with happy faces. These people appear to have wonderful lives because they seem eternally cheerful and entertaining. Yet, many of them are lonely because others see them as emotionally shallow and lacking in sensitivity. Nevertheless, they resist changing their mental habit because they believe they can't tolerate unpleasant feelings.
Obviously, if we don't change our harmful mental habits, we relinquish any hope of improving our lives after crises. Yet, even knowing this, we can't expect to change our habits immediately. Mental habits are exceedingly difficult to change. They are the backbone of our personality, and we strongly resist changing our personality. That's why one of the most important aspects of psychotherapy is overcoming our resistance to change.
Our resistance isn't conscious, but if it were, it would be summarized by the argument, "This habit has worked for me all these years, so why should I change it."
The reasoned answer is, "Because it isn't working for you now."
Unfortunately, however, reasoned arguments don't change habits. Habits are learned by practicing, and they must be changed by practicing. If we learned habits by reasoning, none of us would persist in any habit that we know is harmful to us. Still, we can use our reasoning mind to develop new ways of thinking, and to practice using them. In that way, we can change our mental habits.
We also resist changing habits because doing so requires hard work. Thus, deciding to change a mental habit means dedicating time and effort to the cause. We don't want to make this effort. That's why it's important to realize that not changing also requires hard work. In fact, the unconscious effort required to resist a change is often far greater than the conscious effort that would be required to make the change.
Finally, it is important to know that overcoming our resistance to changing our mental habits requires self-examination in areas that we have spent years covering up. We often judge ourselves by thinking of these areas as our dark side. Remember, however, they are dark only because they haven't been exposed to the light of understanding and reason. A mental health professional who is warm, understanding, and empathic can help you illuminate your dark side.
Catastrophes such as fires, floods, earthquakes, tornadoes, and hurricanes have shown us that we can unite to survive our most severe crises and revive our dreams for the future. For example, in 1992, in the aftermath of Hurricane Andrew in southern Florida, the people whose lives were devastated spontaneously pulled together to rebuild their lives. Many were delighted to find a new sense of "family" with their neighbors, a phenomenon that seems astonishing in our urbanized country. Interviewed on national television several months after the crisis, one woman said they were "like a whole new breed of people."
In fact, we don't need to create a new breed of people to cope with our crises. By nature, we are social animals; our instinct tells us to work together for the common good. That's why instinct is correct in urging us to seek social support to recover from our crises.
Crises challenge us to break out of our routines and perform at our best, but they also rob us of our normal abilities to reason, concentrate, and perceive reality. Disabled in this way, we are extremely vulnerable to further injury. Yet, other people can help us to constructively express our anger and sadness, master our guilt feelings, and talk through our plans for the future. Such support helps us to maintain our bearings, and to negotiate our upheavals.
As individuals facing crises, we usually want to turn to our closest loved ones and friends for support. However, we must be careful in doing this. The quality of support we receive often determines how well we cope with our crises. Ideally, the support of loved ones and friends is positive, but it is sometimes negative. As indicated in Chapter 5, "Mastering Guilt," those closest to us are often ignorant of grieving skills, and they may undermine our healing by burdening us with their false beliefs and superstitions. In other words, we can be isolated, even though we are surrounded by loved ones. That's when a self-help group can be most valuable.
If you are isolated, or if you believe sharing with others would be helpful for any reason, you can find social support in one of the many self-help groups that have grown throughout the nation in the past few years. Collectively, these groups provide help for casualties of a wide range of crises. For example, The American Self-Help Clearinghouse in New Jersey lists more than 700 organizations that are dedicated to specific types of life crises. These topics are divided into eight major categories, including addictions, bereavement, disabilities, health, mental health, parenting/family, physical/emotional abuse, and miscellaneous.
To find an appropriate self-help group in your community, the clearinghouse invites you to call their volunteer referral service at (201) 625-7101, or via TDD (201) 625-9053 between 9am and 5pm Eastern Time. The clearinghouse is not a hotline for crisis intervention, so calling them for emergency advice or support won't help you. And you should contact them only by phone, not by writing. That's because their volunteers can best help you if they can ask you questions.
Alternatively, you might want to purchase The Self-Help Sourcebook. This book lists hundreds of national self-help groups, as well as model groups in case you want to start your own group. You can buy it for $10.00 for return by first class mail, or $9.00 for book rate mail. Make your check payable to St. Clares-Riverside Medical Center, and send your order to:
American Self-Help Clearinghouse
St. Clares-Riverside Medical Center
Denville, New Jersey 07834
The benefits of self-help groups are underlined by the success of Alcoholics Anonymous (AA). For nearly 60 years, AA has helped alcoholics to resurrect their lives by achieving and maintaining sobriety. In fact, studies have shown that no type of medical or psychological treatment is more effective in this than AA.
Sobriety is necessary for healing, because it renews dull mental tools. Remember, however, that staying sober is only the first step. Sobriety does not cure the effects of blocked grieving, resolve the miseries of post-traumatic stress disorder, or reverse the disabilities of biological depression. That's why many sober alcoholics require individual psychotherapy or medication to help them to recover from past losses or traumas.
Self-help groups are often helpful as an adjunct to individual treatment. Though their therapists may provide valuable support, some people find that their healing is facilitated even more by sharing with others who have been confronted with crises similar to theirs. Indeed, many professional helpers refer their clients and patients to self-help groups for this reason.
Whether you need medication, counseling, or psychotherapy, the first thing you must do is protect yourself. Unfortunately, the mental health field has attracted many quacks who feed on vulnerable people in crisis. Worse, these swindlers are protected by laws in most states, which permit virtually anyone to claim counseling expertise and to open their offices. Don't be exploited by a quack. Ask to see the diplomas and the license of your potential helper. If that person is evasive about this, find someone else. Remember, if you can't trust a person to reveal his or her educational background, you can't trust him or her with your health.
The safest way to find a professional helper is through a referral from your personal physician. Most physicians are careful with their referrals because their own reputations can rest on the performance of those they recommend.
Alternatively, you can ask a trusted friend or family member who has had positive experiences with a psychiatrist, therapist, or counselor.
Or you can ask for a referral from your local medical association, psychological association, or hospital. These institutions keep lists of psychiatrists and therapists who are in good standing in their respective professional communities. However, "good standing" usually means no more than "no disciplinary actions," so this method is only a little better than browsing through the yellow pages.
If you must resort to the yellow pages, avoid the quacks by seeking help only from licensed professionals. There are two minimum requirements to look for: First, your potential helper must be licensed by the state in which he or she practices. Second, he or she must have earned a recognized professional degree: an MD with specialty training in psychiatry (denoted as "board certified"), a PhD in psychology or counseling, an MSW (or LSCW) in social work, or an MS in psychology with a license in marriage, family, and child counseling (MFCC).
These credentials indicate that the person has passed minimum tests of competence in their respective fields. Beyond these credentials, however, mental health professionals vary considerably in their interests and levels of competence.
To discover whether a particular professional will match your needs, interview that person about his or her areas of interest. If you are considering a helper who is not a psychiatrist, make sure that he or she works closely with a psychiatrist who can prescribe medications if you need them.
It's important for you to know that some psychiatrists prefer to avoid counseling or psychotherapy. Other psychiatrists practice all of the methods of treatment: counseling, psychotherapy, and pharmacotherapy (prescribing medications).
Some psychologists perform counseling and psychotherapy, but others limit their practices to administering psychological tests. Psychologists are not trained in medicine, nor do they prescribe medications. Nevertheless, many of them understand the significance of biological depression, and collaborate with a psychiatrist.
Some social workers are outstanding psychotherapists, but don't know much about the uses of medications. Like psychologists, however, many social workers work closely with a psychiatrist for consulting about medical issues. So it is with marriage, family, and child counselors.
In the final analysis, choosing a helper for yourself is a highly personal decision. Assuming that the potential helper is well-trained and licensed, your choice should ultimately depend less on professional qualifications than on intangible qualities. Your helper will become a very important person in your life, and this relationship may save your life. Therefore, your selection should be based, not only on trust, but also on how well you relate with him or her.
Finally, don't be reluctant to ask questions. Interview the potential helper as well as you can. If you start sessions with a particular helper, but become uncomfortable later, don't be shy about finding someone else. If you don't trust your helper, you will waste your time and money. You may even waste your life.