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Eruptions and Disruptions

Ever wondered why a specific tone of voice can send you through the roof, or why you want to shrink away when a certain person walks into the room? Does your family want to stick you in the shed outside because you get surly every September? You may not realize it, but these could be flashbacks.

It is usually assumed that flashbacks develop after an extreme trauma like war, assault, or a life-threatening crash. The person must endure a replay of the event, fully immersed in the worst moment of the trauma as if it is happening in the present. These excruciating periods of sheer hell do exist but that is not the only form flashbacks take. They can be forms of dissociation or panic attacks, or subtler types like the emotions of dread, fear, anxiety, and shame. Flashbacks in the latter categories rarely have accompanying images or recognized as memories so a person is left with unnerving distress, confusion about “why” they are feeling/behaving a certain way, and clarity.  Whatever form it takes, the single most important component is the inability to experientially separate the past from the present.

It’s understandable that these nuanced forms go unrecognized. The triggers themselves can be hard to spot because they may be commonplace or even undetectable: a facial expression, a specific word, a tone of voice, a smell, an age, gender, time of day, or even a time of year can serve this purpose. Whatever the cue, the flashback comes on suddenly, seemingly out of nowhere, taking the person by surprise. It is also hard to spot a flashback when the trauma itself is not recognized, such as events that are repeatedly experienced or seen as part of life. (See my article on Big T versus Small t traumas). There are some traumas we can all relate to: repeatedly enduring criticism/shame, being deliberately left out/rejected, or dealing with a string of broken promises. While they may be familiar to many, we cannot ignore that for some, they leave a legacy of pain. Finally, flashbacks may fly under the radar because they do not come on as sudden eruptions, but lingering disruptions. Frequent feelings of inadequacy, social anxiety, shame spirals, or visceral aversions to trusting others are examples. An expert in the field, Janina Fisher, refers to these as chronic flashbacks. Whether dramatic or parasitic, these intrusive, re-experienced memories range from unnerving to debilitating. 

Trauma research has unearthed fascinating information about our beautiful, complex brains and nervous systems that offers some explanation. The front part of the brain, the prefrontal cortex, is where our sensations, emotions, thoughts, and images are integrated into a meaningful narrative. During a time of threat, this area goes offline, freeing us to act out of instinct without being bogged down with attempts to reflect. For example, my brain does not care if the shark I am suddenly swimming with is one that finds me tasty….. it only cares that I survive. My body will catapult me out of the water so I can go pant, scream, and possibly throw up. Once the danger has past, the prefrontal cortex will resume functioning, but it will not have access to the traumatic chunk of history. Instead, the memory will be stored as disconnected data; a record of what happened absent of any ability to retrieve or understand it.

The good news is healing is possible. It starts by recognizing when a flashback is occurring, not some indication of madness. Even though it feels like the danger is real, there remains recognition that this is really an echo of what has already happened. With the help of therapy, the work also includes identifying triggers, gathering up memory shards that offer clues to the experience it is connected to, clarifying what the body needs to realize the past is over, and creating new experiences that promote a sense of safety. It is work, but with support, patience, and perseverance, it’s possible to find solid footing in what has felt like chaos. If this kind of work is something you are interested in, please feel free to contact me.

Meanwhile, for those who have not had to endure flashbacks but know someone who does, this information is also for you. Even with good intentions, beware of any messages that suggest to someone highly upset that their experience is not real or they are overreacting. You might suddenly find yourself locked out of the house staring at a “do not disturb” sign hanging on the door.

Developmental Needs of the Elderly, Part II

The Complex Issue of Control

The desire for control is a something we can all relate to. We can see this displayed in little kiddos who struggle to find independence in a world run by adults. Given the patronizing label of a “temper tantrum,” kids can become overwhelmed with distress when things don’t go as hoped. They may cry, throw their toys, or run off to hide in their closets. For my generation, our need for control may not be as apparent because we usually have it, we know it, and we use it. (But when I don’t have control I am also prone to cry, throw my toys and run off to hide in my closet). For an elder, control takes on greater importance. Not only do they want to maintain independence and the ability to direct their lives, it is also a biproduct of loss. At this stage of life, loss is a constant presence that can come at any time, both in subtle and life-altering ways. The stakes are high so the natural tendency is to try to control whatever possible. If the connection between control, independence, and loss is unclear, people can unfortunately label the elder as difficult, bull-headed, and unreasonable, yet if time is taken to understand the factors/priorities at play, their responses may make a whole lot of sense.  

Loss

I can honestly say that when I think of what elders face each day, it can take my breath away. There are so many losses younger generations rarely have to consider let alone navigate. Here are just a few:

  • Physical strength and energy. I love this quote from Bob Hope, “I don’t feel old. I don’t feel anything until noon. Then it’s time for my nap.”
  • Time spent on medical issues: think of how much time is spent sitting on the phone to get assistance, talking to insurance companies, and driving to and from appointments. I’ve heard some elders talk about managing their health being as demanding as a full-time job
  • The capacity to heal. “You don’t know what it is like to wake up each morning and realize today I will be the healthiest I will ever before the rest of my life.” The man who spoke these words said his days are spent preserving what he has, not looking forward to some new, inspiring achievement.
  • Relevance. There are all kinds of messages that say the world has moved on- elder’s music is no longer playing on the radio, advertisements are geared towards working families, with the exceptions being prescription or other physical needs.
  • Moving from having a voice to being unheard. A form of agism, this can be particularly scary when providers ignore the words of the very people they are trying to help.
  • The death of peers, siblings, and parents. One person told me, “I look in my address book and there are pages upon pages of people who are no longer here.” An author mentioned that older people, as their parents die, become orphans. What must it be like to when the only person(s) who have known you for your whole life are gone?
  • Touch. So many people go days without this form of caring and connection.
  • Mental capacities. Memory challenges, infections that impact cognitions, slower brain processing, all impact the ability to navigate the world and make wise decisions. not understanding the unfamiliar, and the impacts of help can complicate making informed decisions. George Burns playfully remarked, “By the time you’re 80 years old you’ve learned everything. You only have to remember it.”
  • General safety. Small things we usually do not think about can have major impacts. An uneven sidewalk , stairs, climbing onto a chair to get something off a high shelf…. There is no way to address them all. 
  • Their nest. A home is tied to the familiar, is part of a larger community, and holds memories like a living scrapbook. All that changes when a higher level of care requires a move.  
  • Privacy.
  • Financial independence.
  • Dignity.

I urge you to close your eyes and picture what it might be like to live with these kinds of realities! What does this show you? Imagine how you might respond to in these conditions.

What We Can Do

Here are some strategies to help you and the elder person navigate challenges that come up.  These are basic skills to use in any relationship- we are just being extra intentional with our elders.

Respect– their values, beliefs, and opinions are important. Remove any ideas of “less than.” For example, I have heard adult children talk about become parents to their aging parents. Cohen and Eisendorfer emphatically stated, “You are not and can never be a parent to your aging parents!”  You may be their advocate, confidant, nurse, housekeeper, etc., but you will never be their parent.

Honor Self-Determination– Becoming less independent does not remove the right to make decisions for oneself as much as possible. “So long as we still possess it, the power to carry out simple intentions is one of the many unnoticed pleasures of life.”  Wendy Lustbader, Counting on Kindness.  Action may be necessary in times of immediate threat to life or safety, but control should be returned to the elderly person as soon as possible.

Maintain Your Boundaries – Just like an elder has a right to take care of themselves, we have a right to to determine our priorities, preserve our health and sanity, and follow our own values. Please speak up and advocate for yourself.      

Listen– If you want to try to understand the reasons behind their decisions, don’t be afraid to ask questions about what they want, what is at stake, and what values are at play. You may discover some choices are wise, even admirable. That said, you may not see eye-to-eye. In those cases, times, go get a massage.  The situation may not have changed, but you’ll feel better.

Adapt a New Vocabulary– We want to begin speaking the language that will resonate with them.  Consider words that recognize that they hold control: choose, direct, elect, determine, etc. Ex:  A primary care doctor saw that after heart surgery, her patient’s chart was empty. When the elder came in for her appointment,  the doctor reflected, “It’s a bit mysterious why you stopped seeing your cardiologist.”  The patient shared that she takes her blood pressure regularly, has no symptoms, and didn’t want to go to the doctor to get meds that made her sick.  Instead of chastising or dismissing, the doctor acknowledged her decisions.  “My only question would be: since you are in such great control of these conditions, is it possible there are some other factors you may not be aware of and thus may be out of your control?”  When she asked what she should do the doctor said, “I’m not sure, but you might choose…”

Interacting with elders often requires new skills and perspectives to ensure we can operate from a place of compassion. I hope that through this concerted effort, we not only have more satisfying relationships, we also learn lessons about how to approach this chapter in our own lives. Here’s to opportunities for both elders and those who love them to practice empathy, gain wisdom, and appreciate what these relationships have to offer.

Reconsidering Our Christmas Gift Spending

Are you facing piles of catalogs, radio commercials, and emails/texts offering “Black Friday Discounts” at every turn? Do you have mailbox anxiety every time you open the lid and see stacks of ads? AAAAAHHHHHHH!!!!! There is a wonderful podcast by Tim Harford, called “Cautionary Tales.” In his December 2022 episode called, “The Company That Cancelled Christmas“, he highlighted that our Christmas culture is not only relentless, it is also based on assumptions and unhelpful traditions. For example, how many times do we receive gifts we do not want- that basket of soaps that smells like a JC Penny perfume counter, or the singing fish gag gift we took home after the office elephant gift exchange. Rather than rethinking what we are doing, we just do the whole thing again the next year. Research suggests that if we quantify the amount of enjoyment produced for every $20 spent, we are consistently losing $2-4 dollars! Even worse, our wallets suffer to keep up. According to the book, Scroogenomics, economic waste equates to eighty-five billion dollars each winter!

If you’d like to a chance to consider the assumptions and traditions we have around this time of year, I urge you to listen to the podcast (you can get away with listening to just the last ten minutes and get some really great perspective) or read the book mentioned above. They provide insight and ideas for how to enjoy gift giving without losing our minds or our wallets. Hopefully, each of us can rethink our approach so together we can reclaim the true meaning of the holidays.



The Developmental Needs of the Elderly, Part I

I was sitting in a hot tub on vacation and happened to have a gaggle of teenagers within earshot, talking about their adventures and relationship dramas of the day (Warming: I’m about to sound really, really old), when I was struck by the cyclical experience of human development. The conversations were so similar to the ones I had at that time in my life- the same concerns, the same pressures, and the same hopes. It was fun to see the world through their eyes, but I also had huge relief that over the decades, my priorities have changed. I couldn’t help but wonder what it might be like for elders, who have even more wisdom and experience under their belt. How might that change what it is like in later years?

Like those teenagers, younger generations have certain priorities. Many of us are busy juggling multiple demands so efficiency and quick decision making are key to keeping up. With elders, this is not the focus- they have a different relationship to time and pressures we may not be able to fathom. What life is like and all they juggle is hard to fully comprehend until it is our turn.  My hope is that in the next two articles, I can provide a peek into one facet of their experience: the two developmental tasks they must address. Hopefully, this perspective will increase understanding so we can find common ground and enjoy meaningful connections.

The first important work elderly people address is a life review. This is when someone determines where their life has taken them and the legacy they are leaving behind. It can allow joy in those moments of success and adventure; and bring up regrets and unfinished business. As the person listening, these conversations can be rich, learning about historical facts that have shaped the dynamics in your family. You may learn about a time in history you would never get to hear in nuanced detail. It may also be a chance to clarify your own values and underscore the legacy you’re going to leave behind and how that might direct our decisions at this point in our lives.

One of the most prominent traits that are part of this process are non-linear conversations. Rather than having a clear story arc or even a connection to the topic previously being discussed, topics may arise in unexpected moments. It’s going to be this messiness that allows the raw material for creation and connection to occur. The focus is on the meat, not the journey to get there. (At the bottom of the article is a great example of this developmental work.)

Some particulars to this process-

  • There may not be a clear sequence.   They may seemingly go off task, but often, these tangents are rich.  Things may surface at given times because they have a specific connection to what was before, yet it may not always be clear what that connection is.
  • They repeat the same stories:  there may be several reasons for this. They may not remember they’ve told the story before, they keep emphasizing the stories because there is high significance, or there is something in the story that points to something unresolved that they are trying to make sense of.
  • Embedded in the stories are core values and central themes, the raw materials used to later define a sense of legacy.
  • The speaker may know that a story is important but may not be aware of how it fits into the legacy. 

Actions We Can Take:

           

Take Time to Settle In

There are many types of people who need time to warm up to a topic with other dialogue first.  They are getting comfortable and gauging how receptive we are.  Ex: a man on medical rounds at a nursing home noticed that one of his patience loved to knit.  When he began bringing her small balls of yarn, she began looking forward to their interviews rather than resisting his intrusion.  By adapting to her settling rituals, she was able to focus more quickly, making the time spent together more productive.

Slow Down

They may be thinking back years ago and taking time to get a clear picture before sharing more. Sometimes there may be cognitive challenges that make it hard to find the words needed to convey the message.  Learn to go with the flow and accept topics as they emerge.  Pauses and quiet moments will occur- resist the urge to fill the space.  Allow it to unfold.

Reflect

Listen for themes and patterns.  What is being emphasized?  Summarize the lesson or moral significance.  Share observations; ask questions that prompt further review.

Don’t Fix

Strong emotions may surface. Please work against the urge to “fix” anything or offer platitudes. It’s important not to whitewash the past. Instead, listen with compassion, remembering that this is part of the work they must do to find some kind of peace.  

Be Present and Intentional

This is the time when you are giving them a gift; to be seen and heard, something that may be less common as their world shrinks and they feel invisible. You might be that loving presence they are hungry for. Whenever possible, keep in mind the important work they are doing. With a deep breath, practice curiosity, gentleness, and caring.  As often as possible, be without an agenda.  What elders most likely want from you is for you simply to be with them. Ultimately, this is the best gift you can give.

The holidays are on the horizon so there is no better time to practice the strategies listed above. Best of all, the very work you are doing to be part of the conversation will enrich conversations you have will all the people in your life. Here’s hoping that you have moments of genuine connection and enriching perspectives.

Here is a beautiful story that highlights exactly what I’m talking about, provided by a client without a source included:

GRANDMA’S  HANDS

Grandma, some ninety plus years, sat feebly on the patio bench.. She didn’t move, just sat with her head down staring at her hands. 

When I sat down beside her she didn’t acknowledge my presence and the longer I sat I wondered if she was OK. Finally, not really wanting to disturb her but wanting to check on her at the same time, I asked her if she was OK. She raised her head and looked at me and smiled. ‘Yes, I’m fine, thank you for asking,’ she said in a clear voice strong…. 

‘I didn’t mean to disturb you, grandma, but you were just sitting here staring at your hands and I wanted to make sure you were OK,’ I explained to her. 

‘Have you ever looked at your hands,’ she asked. ‘I mean really looked at your hands?’ 

I slowly opened my hands and stared down at them. I turned them over, palms up and then palms down. No, I guess I had never really looked at my hands as I tried to figure out the point she was making. 

Grandma smiled and related this story: 

‘Stop and think for a moment about the hands you have, how they have served you well throughout your years.  These hands, though wrinkled shriveled and weak have been the tools I have used all my life to reach out and grab and embrace life. ‘They braced and caught my fall when as a toddler I crashed upon the floor. They put food in my mouth and clothes on my back. As a child, my mother taught me to fold them in prayer.  They tied my shoes and pulled on my boots. They held my husband and wiped my tears when he went off to war.’They have been dirty, scraped and raw, swollen and bent.  They were uneasy and clumsy when I tried to hold my newborn son. Decorated with my wedding band they showed the world that I was married and loved someone special They wrote my letters to him and trembled and shook when  I buried my parents and  spouse. ‘They have held my children and grandchildren, my beloved pets, consoled neighbors, and shook in fists of anger when I didn’t understand. They have covered my face, combed my hair, and washed and cleansed the rest of my body. They have been sticky and wet, bent and broken, dried and raw. And to this day when not much of anything else of me works real well these hands hold me up, lay me down, and again continue to fold in prayer. These hands are the mark of where I’ve been and the ruggedness of life. But more importantly it will be these hands that God will reach out and take when he leads me home. And with my hands He will lift me to His side and there I will use these hands to touch the face of God.’ 

I will never look at my hands the same again. But I remember God reached out and took my grandma’s hands and led her home. When my hands are hurt or sore or when I stroke the face of my children and husband I think of grandma. I know she has been stroked and caressed and held by the hands of God.


Six Week Class: Adventures in Eldercare

Starting September 10th, I will be leading a six week Sunday School Class on Eldercare. I hope to help people learn, share, and support each other as we explore the unique experience of caring for loved ones during this stage of life. Please feel free to join us!

September 10th: Developmental Perspectives

September 17th: Legacy Work ****We do not meet on 9/24/23

October 1st: Avoiding Power Struggles

October 8th: Hard Conversations

October 15th: Grief

October 22nd: Self-care

Location: Arvada United Methodist Church: 6750 Carr St. Arvada https://www.arvadaumc.org/

Time: 9:10-9:50 a.m.

Healthcare: Challenges for Women

Awhile back, I was sitting in my OBGYN’s office, anxious to hear what could be done about the night sweats that were significantly impacting my sleep. (One night with interrupted sleep is enough to make me grumpy. A few nights in a row, I may be found growling in the corner with a box of Nutterbutter cookies held protectively in my lap). I will never forget HER words…. “Welcome to your forties.” There were no blood tests conducted, nor an exploration of nutrition or behavioral changes that could be contributing factors. If she had dug a little deeper, she would have been able to identify side effects from a medication that could easily be addressed with a few tweaks. Instead, my plea for help was simply brushed off, told this is the inevitable suffering women must endure in their midlife. In utter shock, I realized I had just been given a cold blast of reality- women’s health is notoriously not taken seriously and it only gets worse with age.

For some reason, science and medicine have largely ignored half of the human population. According to an article in Women’s Health, they found a pattern of women feeling their symptoms are minimized, they feel judged by staff, language is used by providers that does not ensure understanding, and they are given recommendations without discussing the full range of options and the pros/cons involved. How does a woman advocate for herself when there is so much working against her?

Behind the scenes, this experience is the outcome of many factors and attitudes. Here are a few examples:  

  • Women have been excluded in higher education and research, removing the very voices who would speak to this gap and have a vested interest in learning how to address and care for women’s needs. **If you are interested in reading a fictional story highlighting roadblocks female researchers experience, read, “Lessens in Chemistry” by Bonnie Garmus.
  • Contradictorily, researchers have also assumed that women basically share the same anatomy as men. Never mind major differences in bone structure, center of gravity, sex organs, distributions of weight and strength, etc. This has major implications. When studying for car safety, for example, crash dummies have largely had a male physique. This has been seen as a major contributor to the statistic that women are 73% more likely to be injured and 17% more likely to die in vehicular crashes.  (See link below)
  • Women’s experience has been pathologized. In mental health, Freud labeled the distress his female clients described as “hysteria”. This comes from the Greek word meaning “uterus” and refers to ungovernable emotional excess. Despite repeatedly hearing about traumatic experiences, he chose not to trust their reports. Instead, he developed theoretical ideas like “penis envy” to explain what he was seeing.

We have some major challenges ahead of us, so let’s face them head on!!!! Let’s claim a major role in our health, seeing ourselves as part of a team and not just the passive recipients of care. For women and people with uteri, the stats show this is especially true. You are your greatest advocate!  Here are a few ways you can do this:

  • If you have any hunches about what is going on, do your research. Find out about the diagnoses, what symptoms and severities exist, and treatment options are available. Include holistic treatments (ex: acupuncture, exercise, diet, lifestyle) and services (ex: case management, support groups). Pay special attention to recent developments to ensure you know all you can. I love this quote, “An educated patient is an empowered patient.” (Source unknown)
  • Compile a list of questions before your visit. Don’t be afraid to have articles at the ready or at least sources to reference when you bring up something from #1.
  • Consider an online or in-person support group. They may have suggestions or experiences with insider intel that may be invaluable.
  • When you talk with your provider, consider the quality of the interaction and relationship. Do they ask questions to get a good understanding of your experience? Do they invite collaboration? Do you feel heard? Do you feel your knowledge and boundaries are respected?  Do they talk to you in a way you can understand? If you have concerns, take this seriously. Even if they are experts in the field, a problematic relationship will impact the care you receive.
  • When you leave, there should be “next steps” outlined. Sometimes providers rule things out but do not state how to move forward. Other times, the provider may have done all they can and feel their work is done. Push for direction so you do not have constant dead ends to contend with.
  • Do not be afraid to ask for a second opinion. Doctors are human and can make mistakes. When you are uncertain, it is better to be safe than sorry.

We are blessed to have so much knowledge and treatments available like never before. Yet it is so important to not forget that human beings are a major part of the equation. To ensure you get the care you need, advocate! We are still dealing with inequalities, so let’s use our spunk, fortitude, and voices to make sure we are always taken seriously!

“Each time a woman stands up for herself, without knowing it possibly, without claiming it, she stands up for all women.”     -Maya Angelou

Resources

https://www.northwell.edu/katz-institute-for-womens-health/articles/women-overlooked-in-medical-research

https://fortune.com/2021/03/09/womens-health-research-fda-trials/

https://orwh.od.nih.gov/toolkit/recruitment/history#:~:text=In%201986%2C%20NIH%20established%20a,to%20include%20women%20in%20studies

https://amp.cnn.com/cnn/2022/12/15/world/female-car-crash-test-dummy-spc-intl/index.html://forthttps://psychnews.psychiatryonline.org/doi/full/10.1176/pn.36.14.0009

Happy Pride Month!!!

This is a time when we get to celebrate sexual and gender diversity, a reminder that human beings embody rich varieties of experiences and identities. The community also invites reconsideration of norms; norms that are so embedded in our culture that they are largely invisible. For the LGBTQ+ community, this process requires breathtaking courage, especially now. There is a surge of hostility in our society that is moving into public policy. According to the Human Rights Campaign, there have been more than 400 anti-LGBTQ+ bills introduced this year in states across the country. If I look beyond the political benefits of energizing groups through scapegoating, I genuinely cannot understand the fervor around restricting rights and rendering an entire group of people invisible. These bills remove freedoms, meddle with evidence-based medical treatments, restrict self-expression, ban literature, and even forbid schools from acknowledging the existence of LGBTQ+ families.

 My friend also showed breathtaking ignorance that sexual orientation in the form of heteronormativity is taught from the moment we are born. Rather than give a list of examples, please watch this youtube video. Through an exercise in empathy, the segment highlights what it means to grow up in our society and the myriad of ways someone is required to hide, pretend, and feel shame about themselves if they do not fit into what is deemed the “norm.” (If you wonder what kind of impacts this has, here is a glimpse: mental health impacts). 

Regarding HB 1557, there is no question that it is a barely concealed attack on the LGBTQ+ community since its nickname is the “Don’t Say Gay Bill.” Florida’s ACLU chapter writes:

[The Parental Rights in Education Bill] is a government censorship bill that would ban classroom discussions related to sexual orientation and gender identity in schools. It would silence students from speaking about their LGBTQ+ family members, friends, neighbors, and icons. It would also bar LGBTQ+ students from talking about their own lives, experiences, and families and would deny their very existence. The dangerously vague provisions in the bill would have a chilling effect on support for LGBTQ+ youth by creating new costly liabilities for school districts. Under the bill’s provisions, parents unsupportive of a district’s policies would be given broad powers to sue for damages and attorney’s fees.

What is not included in the ACLU’s statement are the dangers that emerge within the school community.  What might happen if a homophobic/transphobic parent gets wind of any student, family, or teacher who has a different sexual orientation or gender identity from them? What kind of hostility might emerge? How might the community turn on them? What if that student ends up being the child of that parent? Ironically, HB 1557 gives us a taste…

I stated earlier that Pride Month is a time to celebrate, but it is more than that. It will hopefully be the continuation or the beginning of the time to take a stand: stand with our LGBTQ+ friends and their right to live full, rich lives; stand against the efforts to vilify and oppress the community; and stand tall when anyone tries to diminish you for your advocacy.   

Definition

Heteronormativity- a set of assumptions that suggest that what is normal and natural is heterosexuality. Heterosexuality is deemed superior to other sexual orientations and can lead to the actions that restrict, shame, and dehumanize anyone who does not fit into this category.

https://www.hrc.org/campaigns/the-state-legislative-attack-on-lgbtq-people


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