1. What are the best ways to cope with stress?
Raising awareness is the first step toward healing. Awareness is a gift. Some have it naturally, and others must struggle to acquire it. Some can never hope to achieve it. Almost all patients I treat in my office have serious problem with awareness. Cultivating awareness is essential in coping with stress as awareness evaporates emotions to a great extent. Just becoming aware how angry you are could stop you from kicking your dog or yelling at your loved one. The main purpose of counseling is to raise one?s awareness about his inner painful emotions to facilitate expression; about the connection between the current stress symptoms and various present and past traumatic events and problems; about why and how these experiences led to certain faulty thoughts, irrational beliefs, rigid opinions and hateful prejudices and the like. Awareness of a painful emotion, say, jealousy, within us may help us to give it up. Awareness of our stress-producing inner weaknesses (greed, dishonesty, excessive attachments, etc.) could give us the impetus to overcome them. Awareness of our seemingly mindless behaviors (criticizing our loved ones; screwing up healthy relationships, etc.) helps us to behave in a more appropriate manner. Awareness of our life problems gives us the needed motivation to take appropriate action to solve them.
Cultivating awareness is not easy. It is an on-going struggle. It requires one to constantly ask himself: ?What am I truly thinking? What am I truly feeling? What am I truly behaving like?? Such questions could help us to overcome denial, self-deception and self-delusion. For example, if I don?t like a person and if I have to constantly pretend like I like that person, it would create mental tension in me. Sooner or later my behavior will reveal what I am thinking. To cover up that behavior, I will have to show some extra niceness to that person. This, in turn, could create unnecessary complications in the long run. Most people are acutely aware of others? faults but not their own. A father who is excessively close to his grown up, bratty daughter might say how terrible it is that so and so excessively caters to his grown up daughter. He does not think that his criticism of the other person applies to him. A ?Christian? businessman, who routinely rips off his customers, might lament on how badly fraud has entered into today?s business world.
When upset about a bad event (death, break-up, betrayal, etc.) one must raise his awareness about the seriousness of the event; about various painful emotions related to that event and quickly express them in words and gestures.
When upset about a bad problem (family, job, relationship, etc.) one must raise his awareness about it; admit to having a serious problem; assess the seriousness of it, and go about solving it.
Picture # 25: Awareness evaporates emotions
Denial is an attempt at making awareness go away (?I am not upset?). The original purpose of denial was to temporarily protect us from the shock of the upsetting event. However, many people abuse it to live in a make-believe world. Compare a chronic alcoholic who claims, ?I have no drinking problem,? to an reformed, ?aware? alcoholic who says, ?I am an alcoholic whether I like it or not. I am tired of fooling myself and others.? What a difference awareness makes! He regains respect of all around him instantly.
Here is a simple example of awareness-raising: A 32 year old woman complained of return of anxiety and depression shortly after she returned home from a two-week vacation to the Gulf Shore. She had done well on her antidepressant medication for several months. When asked directly she denied she was upset about anything. Suspecting a connection between her vacation and reappearance of her symptoms, I casually asked her about her vacation. She said she had a wonderful vacation with her family. She then casually mentioned that on the way back home she stayed with her elderly father in Mississippi. I asked her about her father. She said without showing any emotions that he had just been diagnosed as having terminal cancer. His liver showed a huge malignant mass. She had not known about this till she saw him on the way back from her vacation.
She appeared to be completely unaware of the impact of this major bad event. However, when I raised her awareness by saying, ?You must be devastated by this bad news!? she broke down and cried uncontrollably. Once she became aware of her inner emotions, I told her to go home and keep grieving over her father and shrink her balloon. She got well rapidly without having to add another medication.
As we discussed earlier, most people I treat in my office are unaware of the connection between their past experiences and their current misery. Much of my time is dedicated to teaching them, on an on-going basis, the art of awareness-raising. Every time they call me complaining of a new symptom, I ask them, ?What happened or what is happening to make you feel this way now?? The standard answer of a ?not aware person? is, ?Nothing!? Within a minute or two of conversation they reveal the truth: I had a fight with my husband; my dog died; my friend betrayed me..... and the like. Till that very moment they had no clue why they were upset! In the long run, people who cultivate the art of awareness keep feeling better over the years. The rest remain my permanent clients.
Talking, crying, sobbing, sighing, bawling, squalling, groaning, moaning, grunting, protesting, scolding, yelling, screaming, etc., in response to an upsetting event or situation, are some of the common healthful ways by which we express painful emotions. To do this, one must be aware of his inner emotions (?I am aware that I am angry at this person? ); be willing to admit them to himself and others (?I am so mad at him that I want to wring his neck!?); and be able to express them in an appropriate manner (?I am mad at you because of the nasty comment you made about me.?). Grieving over the loss of a beloved relative is an example of appropriate expression of emotions. Expressing painful emotions (?I am hurt,? ?I am sad,? ?I am mad,? ?I am disappointed,? etc.) causes emotional tension in the mind (balloon) to diminish. This reverses chemical changes in the brain. Symptoms disappear one by one.
Picture # 26: Expressing emotions shrinks the balloon
One can express his emotions by talking with a relative, a friend, a pastor, a counselor, a doctor or a psychiatrist. A daily walk with a trusted friend offers an excellent opportunity to release your emotions! Talking, not just walking, is a better way to cope with stress.
One can express his emotions by writing down his feelings on a piece of paper, on a computer, in a journal or in the form of a book. If you are very upset with some one and you can not ignore or forgive him, write a letter to that person expressing your displeasure, but don?t mail it. Wait for two or three days. If you still think it is appropriate, mail it. If not, file it someplace so someday you can have a good laugh about it.
Write an autobiography, a fictional story, a drama or a poem and try to cash in on your misery! Hundreds of thousand Americans are making a good living today by selling the story of their shenanigans, screw-ups, addictions, their chemical imbalance, misfortunes, tragedies, victim-hood, struggles, heroism in the face of adversity and the like. As a last resort, start a crusade or join one already in progress (E. G: MADD (Mothers against drunk driving) as a way of expressing your inner rage about something.
Another way of expressing one?s emotion, especially his rage, is to indulge in a socially acceptable action such as filing a lawsuit. The ?sue-happy? people we see around us are coping with their stress by asking for compensation from others as if the world owed them something. These days the first thing an injured person asks is not where to go for help but who is the best lawyer in town! An injured person who does not sue is considered by our society as an idiot.
Another way of expressing emotions is by getting into individual counseling. When you see an empathic, non-critical, nonjudgmental counselor, your guards would come down, and you would bring up emotions you have suppressed (aware) and buried (unaware). Support groups are also very helpful when you are trapped in a life situation for which there are no easy solution: breast cancer; a parent with Alzheimer?s etc. Support groups are two types: The first has to do with sharing information, listening to lectures, etc. (educational). The other has to do with people sharing emotions in intimate setting (healing). The second type of support group is far superior in outcome as it facilitates expression of painful emotions, sharing of experiences, intimacy, emotional support and a feeling of belonging.
Why are some people unable to express their emotions? Lack of awareness of emotions; fear of being ridiculed; belief that expressing emotions is a sign of weakness; fear of being betrayed; guilt over perceived disloyalty; extreme concern with privacy, etc. are some of common reasons why people don?t express their emotions. Sometimes, anger, guilt and shame could block flow of grief. Until these emotions are first expressed, grieving remains incomplete, and the balloon remains full.
To solve a nagging problem, one must be aware of the problem, must be willing to admit having it, and must have the skill and relentless determination to solve it. If one does not have the necessary skill, he must enlist the help of a professional (doctor, lawyer, accountant, etc.) to solve the problem. Invariably, one will be required to take certain actions and make certain sacrifices in order to solve a hounding problem:
Take a stand, make a move, cut a deal, confront, back off, give up, give in, walk away, run for life, change, demand change, let go, make a decision, sacrifice, move on, withdraw, act decisively, cut off, breakup, intervene, precipitate a crisis, expose, be more assertive, be more passive, or whatever it takes.
With or without the help of professionals, the problem must be solved so that painful emotions stop coming into the mind. The pump must be turned off. Once the problem is solved, one feels better immediately. If one stays trapped in a problem, painful emotions keep accumulating and, sooner or later, his balloon would pop and he would become sick.
Being trapped in a bad marriage or a bad job are common examples of a bad problem. Unsolved, both these problems lead to a stress-related disorder.
Taking certain steps in solving problems is easier said than done. Most who are trapped in a life situation are not even aware of it; those who are aware, do not want to admit; those who admit, do not want to pay the price to get out of the situation they are in. They come up with a number of excuses why the problem can not be solved: I have bills to pay; I will lose my health insurance; I am too old to do this; I feel too scared to do that; I feel guilty to do this; I am too weak to change that; I am too insecure to do this; I don?t want to hurt anyone, and what have you.
An insecure middle-aged man?s health started going down hill ever since a new boss was appointed over him two years earlier. He lived in fear of being fired anytime. He received unsatisfactory job reviews several times. No matter what he did, his boss was not happy. He developed numerous stress symptoms and went on a fruitless medical wild goose chase. When asked if he had any stress in life, he would say, ?No!? He felt trapped in his job for several reasons: If he left the job, he would have difficulty getting another comparable job; he would lose his health insurance, seniority, etc.; he would have to dip into his savings; so on and so forth. Unable to give up all these, he kept suffering month after month and year after year. He had neither the skill to solve his problem with the boss, nor the self-confidence to make it out there if he left his job; nor the willingness to give up his financial security to preserve his physical and emotional health. Obviously his priorities were not straight. His job performance deteriorated rapidly and ultimately he was fired from his job. The trauma of this popped his balloon and he was hospitalized for serious depression. Soon after that he declared himself ?totally and permanently disabled? and applied for Social Security Disability. I just could not save him from all this.
Here is an example of appropriate problem solving: An aggressive, insensitive and haughty administrator was appointed over a young, inexperienced and somewhat insecure doctor by the hospital board. No sooner was this administrator on board than he went around, like a bull in the china shop, making major changes in the hospital. He openly put down the staff, wrote critical comments on the patient charts, pitted staff against staff, and threw frequent temper tantrums in staff meetings. Intimidating the staff was his way of improving the hospital. All this was extremely upsetting to the young doctor as well as other staff members. As time passed, the administrator became even more hostile and intrusive. It was unthinkable for anyone to confront the administrator as they risked being fired from his job. As the young doctor?s balloon inflated, he began to lose sleep, have anxiety spells and other stress symptoms.
The young doctor finally realized that his choices were narrowed down to either leaving his job or confronting his boss. Leaving the job would pose a major problem as he just had his first baby and bought a new house in the country. A move would be a major setback financially and emotionally. The doctor decided to confront his boss with his behavior and face the consequences.
He went to his boss?s office and asked to talk with him. The boss asked him haughtily what it was all about. Just then the young doctor saw a wilted, almost dry Zebra plant on the side table. He had seen the same plant in its lush green glory just a week before. The doctor asked the administrator, ?I wonder what happened to that poor plant? Last week it looked so great!? The administrator said impatiently, ?Well, last Friday evening I watered that plant just as I left my office. The dirt under the plant was so dry I had to dig around it with a knife to make it absorb the water fast. I guess I cut off all the roots in the process! When I came to the office on Monday, it was like this!?
The young doctor gently slapped his own forehead with his hand and exclaimed, ?Oh! I see! I should have known better than ask you about it! That is your style!!!?
The administrator?s face became beet red. His eyes became tearful. He leaned back in his chair, took a deep breath and asked, ?Is that really my style??
The young doctor nodded and said, ?Well, for some time now I have been feeling just like that Zebra plant over there!? And then he left the office. The wizened administrator was never the same again. The problem was thus solved once and for all.
A bad problem can not be solved without one?s willingness to sacrifice something he cherishes such as money, time, relationship, security, etc. The main question is what is important to him. In his pursuit of solution, one hangs on to what he cherishes the most and sacrifices other things he cherishes less. A person to whom security is most important, all else, including his health, independence and self respect come next.
Here is an example of poor problem solving skill: A 50 year old man came down with a serious case of depression due to various stressful events and situations in life. Instead of getting psychiatric help, he promptly quit his job and applied for Social Security Disability. When asked why he never bothered to get professional help for his depression he replied, ?I don?t have the money.? He then went on to reveal that he had just bought a boat worth $ 5,000 believing that boating would cure his depression. I can give the reader countless such examples of stupidity that defy common sense.
Our problem solving skills are often passed on to us by important figures in our childhood and adolescence. Absent parents or parents who have little skills in problem- solving (E. g. teenage parents) means their kids would grow up learning little problem-solving skills. Explains why millions of people are growing up in this country today with poor problem-solving skills.
Canceling out painful emotions :
People with good coping skills are able to make painful emotions disappear from their mind by using one or more of several mental mechanisms listed below. People raised in functional, healthy families learn from their parents, relatives, teachers, pastors, siblings and other important people in their life many of these ?tricks? which help them to cope better. They also learn from reading books and religious scriptures how to cancel-out painful emotions.
- Reasoning: (Explaining away a painful situation by logical thinking). Using logical thinking, one is able to make some sense of a painful situation so that it becomes less threatening and more acceptable. For example, death of a loved one becomes more acceptable when one rationalizes that all living things have to die some day. We lose everyone we love by means of death, breakup or a move. A person with religious fervor might say that the dead person is now with Jesus. If your stocks go down in value, you will remind yourself that you knew the risks fully before you bought the stock, and you would think the stock price would rise once again. That is the nature of the beast. If you build your house on New Madrid earthquake fault, you will not panic when the earth starts rumbling. You will remind yourself that this is what you should expect to happen from time to time. One must keep in mind, however, that rationalizing a bad situation to cope with it is different from rationalizing a bad behavior. For example, a man having an extramarital affair could rationalize that his affair gave him a chance to make up for what he missed-out in his adolescence.
A young man retired from the army felt chronically guilty over the fact that his close friend died in combat trying to protect him. He had a long chat with his grandfather, a Korean war veteran himself, who reasoned with him that his guilt was irrational. The dead friend would have wanted him to do the same thing for him under similar circumstance. Feeling guilty would be an insult to his dead friend?s memory. The young man?s guilt disappeared.
- Changing perception: Looking at a cup as half full instead of half empty is a crude example. We try to see a situation in a different a light. A hostile and hypercritical boss is seen as insecure rather than evil. His behavior indicates that he has a need to cut down others to make himself feel better. An intrusive mother-in-law is perceived as not nosy, but lonely. A teacher angry at you for not attending his class does not hate you but misses you in his class.
A 58 year old woman was distraught over a situation with her elderly parents who were in their mid nineties. They both suffered from early Alzheimer?s. They refused to be put in a nursing home. Every day, when the daughter visited them, she found out that they had not eaten well, had not taken their medications and had not bathed. When she gave them their medications, they would scream, yell and scold her angrily. Everyday, she had to go through this painful ordeal. Their scolding and name-calling became unbearable to her. She felt very stressed and depressed. She did not know what to do.
I asked her, ?Who are these people?? She replied, ?They are my parents!? I argued, ?No. They are not your parents.? Baffled by my statement she asked, ?What do you mean they are not my parents! They are my parents!? I said, ?They were your parents. They are no longer your parents.? She asked, puzzled, ?Who are they now?? I said, ?Now they are your children. You will have to look at them as if they are your children. They don?t know what is best for them. Just as you put your foot down with your children, you will now have to start putting your foot down with them. Just as you ignored your children?s protests when you told them what they did not want to hear, you will have to ignore what these children tell you now.? A big smile of relief appeared on her thus far depressed and tense face.
- Putting things in perspective : One looks at the bad situation from a larger perspective and finds it not so bad after all. You might have lost some money in one stock, but you have made gains in other stocks. Having to quit a job might make things difficult for one for a short time. In the long run, though, it might be the best thing that ever happened to him. A student might drop out of school for one full year, but the lost year is only one of 80 years in his life span. The bottom line is one evaluates a situation as part of the entire picture as in, ?We have lost a battle, not the war.?
- Humor : One can laugh off one?s fear, anger or frustration by making a joke about the situation causing those emotions. Making jokes about a stupid boss is an example. When an irate lady friend of Sir Winston Churchill told him in half jest, ?If I were your wife, I would have given you poison!? Sir Winston is said to have replied dryly, ?If I were your husband I would have gladly drunk it!? People with good sense of humor live long. The next time your basement floods, make a joke about it: I never thought someday I could afford an indoor pool!
- Neutralizing emotions : We can neutralize various painful emotions in the mind by taking certain actions: Anger is neutralized with forgiveness; fear with faith, reassurance and courage; helplessness with action; hopelessness with hope and prayer; shame with public exposure; guilt with seeking forgiveness or by compensation; sadness with solace; humiliation with dignity; hurt with self-comforting or solace; frustration with patience; disappointment with acceptance; embarrassment with dignity; terror with fortitude; hate with kindness, etc. We learn these coping ways from our parents and from the religious teachings while growing up. Great religious texts such as Bible are treasures of these coping ways. To successfully apply neutralization, one must be spiritually inclined. For one to be able to do the above, one must be in touch with his inner goodness. Many stressed-out people are out of touch with their spirituality.
People with Absolute Faith in God or Destiny cope very well with stress. Faith cancels-out fear. Faith in Destiny gives one freedom from fear. For example people who think that they will go only when their time comes -no later and no earlier- go about their lives without worrying about their plane blowing up in the air or their train being sprayed with nerve gas by terrorists. They sleep soundly the night when their16 year old gets the license to drive his car. They know and accept that they are powerless to change what is destined to happen or what is God?s will. Such a belief system gives them peace of mind.
Emergency burying :
In an emergency situations, we are able to bury our emotions in the hidden mind so that we could deal with it effectively. Once the bad event is over, he brings up the emotions from the hidden mind, breaks down and expresses them out by talking, crying, sobbing, etc. Many heroes you read about in newspapers coped with sudden crises like this.
Driving on an interstate highway, a young man came across a pile of wrecked cars involved in a terrifying chain accident. He saw several bodies strewn around. His initial reaction was one of fear and horror. However, he buried instantly his emotions in his hidden mind and calmed himself down. He pulled over his car on to the shoulder, calmly called the state troopers on his cellular phone, methodically went about saving lives. He kept himself busy reassuring the injured and giving them first aid. He experienced no stress symptoms while he was doing all this. When interviewed by a television reporter, he said he was no hero, and that he had merely done what he had to do. After he went home, he broke down and let go of his emotions without any inhibition.
Of course, for one to be able to do this feat, his hidden mind (soda bottle) must be fairly empty. That is, he has not abused this burying mechanism to the point there is no room left there for him to bury anymore. If the hidden mind does not have space in it to bury, one could then get hysterical at the very sight of the accident or go into emotional shock resulting in his passing out in terror.
People who stuff their painful emotions in the hidden mind under crisis can suffer from post traumatic stress disorder if they do not get these emotions out immediately after the crisis is over. So, many war veterans suffer from this condition for that reason. In this condition, minor triggering events cause buried emotions to resurface (fizz up) resulting horrible nightmares, flashbacks, panic attacks, depression.
In summary, normal coping means one is able to get rid of painful emotions from the mind by being aware of them and by expressing them out (thus shrinking the balloon); by skillfully solving problems (turning off the pump) ; by canceling out painful emotions through various mechanisms (further shrinking the balloon); and, in an extreme crisis, by temporarily burying them into the hidden mind and expressing them out immediately after the emergency is over. A shrunken balloon is the best balloon.
Picture# 27 Normal coping