Wednesday, November 20, 2013

Survivor: The Isle of Holiday Celebrations

Television etiquette experts recently suggested routes to avoid potential family conflicts at our upcoming holiday celebrations. I had to laugh--my extended family celebrations don't end UNTIL there's a conflict a-brewing, just hopefully not involving firearms or flying crockery. (My mother still publicly mourns the death of her favorite gravy boat each time we sit down for Thanksgiving dinner). The (clearly) more civiled pros offered ideas like "focus on what the family is grateful for this year" or rehearsing conversation-diverting remarks designed to thwart Aunt Rita's criticism of cousin Jordan's green Rasta locks from evolving into a full-on family throw-down. "Avoid contentious topics" was another gem tossed out by the Etiquette Mafia. No talk of religion, politics, or sensitive social issues once the bird is on the table. Yeah, good luck getting my clan to sign on to that plan. What are we left with: should baby Jessica be enrolled in the Montessori school or the arts academy that requires child AND parent interviews? My family has had more heated debates over loyalty to the Sox versus the Cubs, or fake vs. real Christmas trees than about any political stance. Seriously, we suffered a decades-long cutoff when my uncle challenged my aunt's claim that Frank Sinatrs was the finest singer who ever lived. (To this day, I experience searing pain behind my eyes at the first bars of "My Way.") I can't imagine the stares of incomprehension I'd receive if I tried to whittle down the topics of "acceptable" dinner conversation. That act, in itself, would guarantee a few choice hand gestures in my direction. But, before you go thinking my family is a bunch of boorish, backwards heathens without the sense to come in out of a snowstorm, I maintain that we are also fiercely devoted to our -- and each other's -- kids; always willing to bring a meal or run an errand for a sick sister or nephew; and slavishly committed to a range of sentimental, heart-tugging rituals and traditions that brand our family as uniquely our own. This holiday season, I've decided to make one change, and like the church hymn says, "let it begin with me." Rather than dictate others' discussion parameters, or take responsibility to diffuse an insult from hitting its intended mark, I've decided to approach this year's festivities with an energy of openness. All the rules and recommendations, ultimately, come from a place of fear and anxiety, and we all carry enough of that baggage already. Sure, gathering around the table is akin to an open invitation to fisticuffs in my families' domiciles, but I doubt I help the process when I approach my family girding for the worst. I can't change them, and I'm not respecting their autonomy when I try to run interference. But perhaps, stepping across the threshold with an air of positive anticipation and joy at our motley gathering, rather than adopting the protective stance of a defensive lineman, may alter the course of the evening's energy for the better. Still, I'll probably choose the seat closest to my older brother: his bodybuilder girth is good cover if the salad plates go flying.

Tuesday, November 12, 2013

The Scars of Self-Injury

Few of us can imagine inflicting the kind of physical pain and damage that self-injurers inflict on their own bodies. For many people, the concept of self-injury is as foreign as imagining picnicking on the moon. But in our counseling rooms, we see the reality of self-injury far too often. Cutting, burning, poking, slapping -- these violent behaviors can be regular occurrences in the lives of some of our clients. What would drive someone to hurt him- or herself? Isn't self-injury just a bid for attention? Is there a difference between self-injury and suicidal ideation? Loved ones of those who self-injure struggle with these questions. And while the specific instigating factors behind one's self-injurious behaviors are as varied as the individuals themselves, some commonalities can be noted. People who hurt themselves often engage in an addictive-like relationship with this behavior. They initially find some sort of emotional relief -- either in the form of distraction or a sense of release from psychic pain -- from the harming behavior. Later, either due to a lack of appropriate coping resources, or the relative speed with which self-harm usually provides relief, the person continues to use these actions to deal with more distressful life situations over time.

Most of us can recall a moment of self-loathing or a period of hopelessness in our histories. For those who self-harm, self-hatred, a sense of continuous personal failure and a fear of relinquishing the tool that has brought them relief are constant companions. And while the behavior can appear dramatic and attention-seeking, self-injury is rarely a casual choice by the individual. Due to the addictive nature of the dynamic, someone who hurts himself can quickly become reliant on this maladaptive coping skill. We can understand someone getting a sense of relaxation, increased well-being, a distancing from their problems, by drinking alcohol. Tobacco smokers often report feeling instantly calmed and/or energized, not just from that first puff, but even through the rituals of igniting their lighter or smelling the sulphur of a dying match. Similarly, self-injurers can experience a lowering of stress via the habit of self harm.

People who self-injure are at a higher risk of suicide, not only due to their struggles with depression and hopelessness, but because the risky behaviors associated with self-harm could inadvertently creat a risk to one's life, even if she isn't intending to end her life. Self-injurers have mistakenly nicked a major vein or artery, causing them to hemorrhage before help could be obtained. Some wounds can get so infected they can lead to sepsis, a potentially life-threatening blood infection.

The treatment for self-injury almost always involves a holistic approach, including individual therapy, medication, group therapy to teach skills like stress management, frustration tolerance, emotion regulation and appropriate self-care. Centering skills like mindfulness and meditation are other helpful tools that can help clients to learn to manage their painful life experiences without resorting to self-harm. Occassionally, hospitalization is necessary to ensure an individual's continued safety.

Self-injury is always a sign of deep distress and a loosening of one's ability to manage their pain in effective ways. But clinical and medical intervention can help these clients regain control of their lives, and offer a path of hope and recovery into a life marked by positive self regard, rather than haunting scars.

Wednesday, November 6, 2013

The Gifts in Gratitude

November is marked by colorful leaves, falling temperatures, an abundance of turkey-related products at the supermarket and the varied modes giving thanks takes. Recently online, I've seen groups of people daily enumerating the things in their lives for which they are grateful. From sentimental to sublime, folks are counting their lucky stars for their spouses, a warm home to return to after a busy day, a full refrigerator, health and autonomy, even a close parking space at the crowded Target on a rainy Saturday. These sentiments are not meant to be a Pollyanna approach to dismissing or minimizing the suffering that goes on in our world everyday. Rather, they are a reminder that there is, indeed, a yin and yang to our lives, times when we are deep in shadow countered with periods of lightness and grace. Being conscious of our blessings will never negate the losses and sadness that mark some days. But those bright spots do provide us with an opportunity to connect with grace, to be reminded that good and love and hope are around us if we choose to look for them. Some days we may need to look long and hard to find the glimmers of sweetness. They may appear hidden deep in the loam, barely visible save for the one small glint that we catch only if the light is right. Or they may appear as evident as a gold star on a spelling test. Resilience is found in remembering to grasp the good, risking the reaching. By training our eyes to view life through the lens of gratitude, we discover, like the many-hued leaves at our feet, gifts unending.