Shock, Trauma, PTSD - The Basics Without A Lot Of Technical Waffle

 

Malaysia is a very safe country to live in. We have no wars, no terrorist attacks, and no riots. This is terrific but as a client pointed out last week, it also means that many of us don't really understand how shock/trauma/PTSD works. So I am writing this piece at their request, in the hope that it helps promote understanding.

Story One: Kim

When Kim was small, his mother would beat him every time she didn't score an A at school. His mum would make him wait while she got the rotan.

Today Kim is a grown man with a job in HR. Her colleagues like him, he has lots of friends, but Kim has a secret.

He jokes that he has shares in Foodpanda because he never cooks. Secretly, he doesn’t cook because when he enters a kitchen, his breath catches in his throat, his palms sweat, and he feels sick. 

Story Two: Nora

Nora is a police officer. Three months ago, she was part of a team that investigated a missing man. The family claimed he'd gone off for an outstation job, but the neighbours reported a lot of fights.

Her team was suspicious, so they looked into it. They found the man's body hidden in a patch of rough ground near his family home.

Nora was physically sick when she first saw the body. Then she was okay again.

During the rest of the investigation, the family confessed that they'd beaten and tortured the victim. Nora wrote up her reports, consulted with the prosecutor, and moved on to the next case.

But somehow, this incident has stuck with her. Three months later, she still has bad dreams. She feels disconnected from her family. Sometimes, she catches herself looking at her cousins and wondering if they are secretly judging her.

Also, she can no longer enjoy her favourite Netflix cop show. Whenever on screen they go into an interrogation room, she remembers how normal that family looked as they told her how they'd killed their son.  

What do Kim and Nora say?

Both Kim and Nora worry that they're going crazy. Kim can't figure out what his beef is with kitchens. He thinks he might have kitchen phobia, or a cooking phobia. Nora thinks that police work is tough and maybe she just isn't cut out to be a cop. Both are embarrassed, and so they don't tell anyone about their secret.

What's really going on?

Kim and Nora suffer from shock or trauma. 

Kim suffered from repeated trauma when he was small. His mum often made him wait in the kitchen, and little Kim learned to associate the stove with being beaten. He forgot exactly how it all hung together because more than ten years have gone by, but the body remembers. When Kim sees a stove, his mind goes straight back to the trauma of being beaten.

Nora witnessed a tragedy, a family who actually killed a loved one. Seeing the body and hearing the story over and over again from the family, and writing the report, and discussing it with her colleagues, has traumatised her.

In her shock, Nora wonders if the whole world is secretly nasty and dangerous. And every time she sees something that triggers her memory, like an interview room on TV, she's reminded of the past and traumatised all over again. 

Shock, Trauma, and Posttraumatic Stress Disorder (PTSD)

Experts argue over distinctions and exact definitions are different in various countries. You can get into that if you like it's not necessary for grasping the basics.

What you should know is this. Shock or trauma is upsetting. If you are frightened, angry or scared when it happens, that's a healthy reaction. If someone beats you, or you see a crime, you should have emotions!

In a lot of cases, time will heal. Many of us cry, have a few bad nights, and then the emotions fade and vanish.

But for others, these thoughts and feelings stick around. Sometimes they last for years. Sometimes they actually get worse over time.

What it is not

It's not because people are weak, silly, or being dramatic.

Saying that is victim blaming which is mean.

Note: for the Kims in this world, they are often told, "Oh well, everyone is beaten and they're okay with it." No, they're not. Violence is never healthy.

Why exactly does it happen?

That depends on the model you follow. Me, I think it's not one-size-fits-all. There are several models that work well, but none are universal. Again, I don't think it's important outside of the profession.

Give me a list of possible trauma events

Childhood physical abuse and violence

Being the target of sexual violence

Being the target of a crime

Witnessing a crime

Being in or witnessing a war or terrorist attack

Physical assault

Being in or witnessing an accident

Being threatened with a weapon

 

When should we look for help?

If you've had a recent shock, talk it through and be kind to yourself. If you're having flashbacks, trouble sleeping, crying jags, or overwhelming feelings after a month, have a chat with a mental health professional. If it's been more than three months, definitely go.

Note: when you do see one of us, we'll help you figure out if it's anxiety, shock, depression, PTSD or a combination, okay? So don't worry.

How do we fix it?

First, we talk it through and figure out how your experiences affect you today. Then we figure out triggers and we help you learn new thinking and behaviour. Useful approaches include cognitive behavioural therapy and exposure therapy. <- you can google these

We do this very gently and we avoid reliving the experience. In the past, people thought bringing emotions to the surface was healing. Now we know that it can be as traumatising as the original experience. So we are very, very careful.  

Note: as a client, you have total power to say stop, to call for a pause, and to put in boundaries. In fact, it's part of the process.

My friend has trauma/shock/PTSD, what do I do?

On TV it's all about hugging and being there but frankly, everyone has different needs.

So my best advice is that you wait until you two are talking quietly together, and you ask, "What do you want me to do?" Then listen.

I hope this helps. If you need to talk to a mental health pro, PM me.

 

 

 

Thinking Of Being Self-Employed? Some Thoughts From An Independent Private Practice Therapist

A photo of Target, because he's handsome

I've been self-employed for over 25 years now but there's one thing that still gets to me: an unplanned free day.

Crazy, right? Year in and year out I've made my business targets, fed myself, housed myself, and made enough to put money aside. Success by any standard.

But show me a day with no deadlines or planned income and my radar goes off. If there are two days, I'm nervy.  Three days, and I'm deep in backup plans.

Last time I had three unplanned free days was about 10 years ago. That's when I was still freelancing as a writer or content provider as people call it now.

I was sitting by the pool on a Wednesday, a happy luxury benefit of being your own boss, and there was no work for the rest of the week. So, I did some cold calling.

Usually, I plan on one in ten returns, so I called five new companies and pitched, expecting five fails and having to hit another five. Much to my surprise, three of them hit, and I didn't see the pool again for months :-)

Back in 2013, I saw the writing on the wall for content writing, and put myself through school to add a Masters in Counselling to the Degree in Psychology. I reckoned a portable job in that market would suit me, and took the risk.

I put a year's writing profit into the education, and gave up some of my time for two years as well. In total, I reckon I paid some RM50,000 in direct fees and lost writing income to get that education and new career set up.

Overall, it was the right move. I have a sustainable business that's portable, and I love what I do. I'm still writing on the side as well.

Today I have an unexpected day off. I had one last week too. I did consider worrying but decided against it. Now that I'm older and wiser, I'm watching Midsomer Murder, writing a chapter of the next Trigger Cullen novel, cooking a fancy schmancy dinner, and clearing out a drawer that's been bugging me. 

Because I've had several months of having way too much work, and I expect that in a week or so, I'll be pressed again.

Why am I telling you all this? Because the economy is tanking worldwide, because salaries are insanely low and so many people are thinking that it's better to go it alone.

I love being self employed but it's not for everyone. Here's three tips I think make the difference between make and break.

#1 Know what you do. As a therapist, I make complicated things simple. I'll work with you to figure out what's going on, and to lay out options. I'm also incredibly secretive, so you can talk and nobody will know what we talk about.

As a writer, I sell reliability. Once I say yes, you can leave me to do my job. Whatever it is I said I'd deliver will be on your desk. And probably early.

#2 Be able to sell yourself.  If you can't tell people you're brilliant, and exactly why they need to hire you, you won't get business.

#3 Be ruthless about money. You have to chase payments, or know how to weed out clients who don't pay. Otherwise you get work but no income.

If you're thinking of going it alone, I hope this helps.

And if you want tips from friends who are also self-employed, check out the FB post and add your own tip too

How To Be Happy: Culture Filters How We Think About And Treat Depression And Anxiety

 

Tic Tac's idea of happiness is a paper bag

Feeling dull and can’t get out of bed? Must be depression. Can’t sit still or stop talking? That’s anxiety. Ticking boxes makes it all seem so cut and dried, but did you know that culture influences how we experience mental health?

Mental health practitioners working in melting pot communities (like Malaysia!) talk among themselves about how different groups experience and treat mental health.

 

With the pandemic fuelling public interest, this is an excellent time to open up discussion. That way, we can all make more informed decisions.

 

I’m a counsellor and psychotherapist working online with private clients from Malaysia, Singapore, Hong Kong, Australia, the USA, and other countries. Since I opened my practice in 2016, I’ve worked with some 250 people over roughly 4500 hours.

 

Here are three insights from this work about depression and anxiety.

 

Losing your pleasure in food. When your friend tells you about a fantastic laksa stall and you’re normally a fan but are not champing at the bit to check it out, figure out why.

 

If just the thought of taking time out has you worried about work or chores, it may be a sign of stress, burnout, or anxiety.

 

Not having the energy to go, skipping meals because you’ve lost your appetite, or deciding for no reason that it probably isn’t that good anyway, can all be signs of low mood or depression.

 

At prayers or meditation, you focus on your faults. Reflection can be a powerful force for good mental health, but if you find you are skipping celebrating the little joys, and going to town with hypercritical self-analysis, you risk pushing yourself into a spiral of negativity.

 

Spiralling and catastrophising, imagining the worst possible outcomes in your imagination, are associated with anxiety and depression. This is why journaling, an excellent exercise for many, can backfire if you suffer from these issues.

 

A practical first step is to restrict yourself to prayers and meditation designed to uplift, while you figure out what’s going on.

 

You are constantly scolding or quarrelling. Irritation, annoyance, and anger are key emotions that give us insight into ourselves and our environment. Usually, we feel angry when we perceive injustice. If you’re queueing nicely and someone pushes in front, feeling irritation is perfectly healthy!

 

But constant anger is uncomfortable and a sign of trouble. As the body and mind work together, a simple first check is to make sure you are drinking enough water and eating properly. It’s amazing how ratty we can get on a hot day when we’ve skipped a cup of tea and a snack.

 

If it’s not that, consider that anger can also be a reaction to feeling powerless or hopeless. These feelings may arise from specific events in your life or be symptoms of depression and anxiety. Sometimes, it’s all of the above.

  

Therapy approaches are cultural too

In the world of mental health, medication is the province of psychiatrists, medical doctors who specialise in diagnosing and treating mental illness.

 

Everyone else, therapists, counsellors, and psychologists like me, are not medical doctors. We specialise in talk therapy. We cannot prescribe medicine or sell you supplements. (Anyone who tells you that supplements are part of talk therapy is scamming you.)

 

When you see a psychiatrist and take a pill, the medication works the same no matter if you’re a Buddhist from Miri or a Christian from Penang.

 

But with talk therapy, it’s useful to build approaches with culturally appropriate elements.

 

My number one tip is based on the fact that Malaysia favours group culture. Therefore, connecting with your support group is valuable.  Working out which friends can help you with what, while maintaining privacy, is practical and effective.

 

As for anxiety, I'm a huge fan of the traditional cup of ginger tea.

 

Studies show that ginger has medicinal properties thanks to gingerol, its main bioactive component. While the jury is out on how much gingerol soothes nausea and promotes mood stabilising hormones, it’s simple, cheap and, for many Malaysians, associated with feel-good memories.    

If you have medical conditions, check with your doctor first. But otherwise, drop a slice of fresh ginger into your next cuppa. Alternatively, a half teaspoon of plain powdered shop-bought spice will work just as well. 

Put your feet up, embrace the moment, and be happy.

Job Hunting? Joining in the Big Resign? Some Thoughts About CV Writing My Clients Found Helpful

In therapy sessions where clients are changing jobs, we talk about career objectives, learning from past career experiences, and we model tricky conversations so you go into your interview empowered. Sometimes, we also talk about CVs. 

Note: In my other life, I worked as a freelance writer from 1996 and 2014, selling more than 3000 articles in over 12 countries to clients including Women's Weekly, Her World, Cleo, South China Morning Post, Japan Times, and the Straits Times. My work was syndicated by Planet Syndication in the UK.

Today I write columns for the Star newspaper in Malaysia and boutique content for corporations.  

So writing is something I love, and sometimes a session devolves into coaching where we work on wording CVs. 

This blog post is a quick chat about some useful web sites for that.

Today's CVs are achievement oriented. Also, more companies are using artificial intelligence to sift through applications, so your submission may never be seen by human eyes.

Don't worry!  You've got this. It's just a matter of getting into the right headspace.

Step #1: it's all about 'what can you do for me' and 'show me the money'

Specifically, they want to know what you accomplished, how you did it, and what benefit it brought to the company.

So not: managed a team of three responsible for streamlining accounting process
But: my team developed an inhouse app that cut accounting costs by streamlining accounting process

Adding numbers helps!
Ideal: my team developed an inhouse app that cut accounting costs by 8% saving the company $40,000 by streamlining accounting process

Google calls it the XYZ rule. You can read about that here

Get at least one achievement sentence down per job or position.

To slide through AI: think SEO

Step #2: check sample CVs for your industry to see what's hot

Cruise LinkedIn and see who's just landed a job you want. Peek at their CV or ask to see it. Then edit your CV.

You can also get sample CVs here, and a list of Malaysian headhunters organized by industry

Step #3: O*NET is a free career web site that has cheat sheets listing skills that are needed to ace jobs. You can use these to help push the AI to love you

Look at the search box in the top right corner and type programmer

Click on any job title, eg software developer, and click on the tab that says Details. Then cut and paste what works for you, e.g., Data base user interface and query software and Collaborate with others to resolve information technology issues

Also note, if you want to move into a related field, O*NET is a useful place to start exploring where you can go

PS O*NET is based on John Holland's career theories that were hot in the 1950s. In terms of scientific theory, there are issues. Therefore, don't take it as Science or Fact. Instead, see it as a useful start for thinking things through

I hope you find this useful. If you want some help with prepping for a career change or interview, you know how to find me

Credit: Image by Oli Lynch from Pixabay

"My house flooded. Why do I feel guilty?" A Psychotherapist Explains

When the rain started, it felt like just another monsoon. Inconvenient, but not particularly worrying.

But this year, the water just kept on coming. And coming. And coming.

Cars were swamped. First floors were inundated. Some second floors went under too. Old folks died of cold and exposure. Pets were killed, some horrifically trapped by cages or chains and drowned slowly.

In the aftermath, a whirlwind of emotions. Why did this happen to me? And It is my fault. I should have known this would happen. Maybe you are angry too, especially if you flood again a day later.

While your rational self should point out that you don't have fortune telling powers, the emotions can be overwhelming. So here are some thoughts about what's going on.   

Just World Guilt
As sensible adults, we know that the world is a dangerous and random place. Good people are stricken by disease, and evil dictators live long, happy lives. It's not fair and we have to suck it up.

However, a part of us continues to believe that good things happen to good people, and that we reap what we sow. Mainly, it comes down to lessons from our elders when we're little.

The idea that we control our future starts really early. Remember hearing, "If you study hard, you'll pass your exams"?  When we're kids that advice seems true because pre-uni school is mostly a memory game. If you put in the time and learn to parrot, you get an A.

The idea that we control good stuff is constantly reinforced. "If you get enough sleep, you will have energy in the morning" and "If you practice at tennis/football/swimming, you'll get to be really good."

Subconsciously, this leads to the idea of a Just World. In this Just World, good things happen to good and careful people. Which doesn't seem a big deal, except that it has a nasty sting in the tail: if bad things happen, is it because you are a bad or careless person?

Logic says no, but the heart isn't always reasonable.

Just World thinking leads to self-blame. It's illogical but it's so deeply ingrained, that it's hard to shift. What's worse, it affects how others treat us too.

Victim blaming pushes the wrong message home
As we tend to share the same background, growing up with thinking that we invited bad luck, a second nasty effect of Just World syndrome is victim blaming.

When others see that bad things have happened to their good friend, they don't like it. It's a reminder that the world is random and that bad stuff can happen any time to anyone.

When random disaster strikes, sensible types think rationally and say, "Shit happens. How can I help you?"

Sadly, the not so bright ones try to figure out how you 'broke the rules'.  <- yes, you read that right. Some people act as though you can charm away bad juju.

The most common example involves the person who is mugged, raped or attacked. A sensible person says, "A predator targeted you. Are you okay?" whereas the not so bright person asks, "Where were you? What were you wearing? What side of the road were you on? Didn't you spot him? What time of day was it?"

A kind interpretation is that they're hoping that to avoid being attacked themselves. But when you're tired and you're a victim, it's tempting to say, "Bog off, you victim-blaming moron." And if you do, people complain that you're the bad one, which is doubly annoying.

My take: when someone is hurting, don't ask damn fool questions. Offer help or shut up.

So, why am I angry? And feeling guilty?
In times of stress, our emotions surge. We typically feel fear because there is danger, anger because there is injustice, and helplessness because we're all caught up in events.

Other feelings like guilt and shame may come join the party too. The guilt it totally misplaced. Because of Just World ideas, we believe on some level that we invited trouble. Same goes for the shame. It too comes from that false idea that we deserve our bad luck.

Basically, you have emotions because you are reacting to the events in your environment.

But I suggest that you cannot trust these emotions.

Furthermore, stress, anxiety and depression are linked. When you're really tired, you get mood swings. You soldier through, energetic as you cope and clean and appear cheery, but then there's a dip.

And when you're in that dip, it can come with low mood thinking. That's when you believe you're a twit, you're doomed, you're making a mess of your life….  It's nonsense. Dark thoughts brought on by being over-tired and over-stressed.

Generally speaking, women are socialised to weep at this point and men are socialised to become angry. (I won't go into why, that's for another time) Practically speaking, we can do both, which is why quarrelling is always mega during disaster times. Also when putting together furniture, which is why IKEA fuels so many divorce level fights.

Suggestion: feel what you feel, but try not to take it to heart. If you're feeling snappy, sleep, eat and take a walk. And go easy with people who are snippy.

Help yourself by remembering the big truths:
Life is random.
People who order war and genocide tend to live in lovely homes. You are not being punished by the universe for whatever sins you've committed.
You are not clairvoyant.

And remember the practicalities of trying to predict weather:
Yes, we have floods. Can you predict them? Meh.
You might live on a hill and in the centre of town and have a blocked drain, leading to your hilltop home flooding.
But you might live by the beach or river and be okay.
Or you might live in an area that was once dry, but shifting rivers, destroyed forests, and other events have changed that.
Or your home has been okay for years, and it will be okay for years to come, except for when it rains more than normal. And this year you were just damn unlucky.

Bottom line: it will pass and you will recover. Also, with so many people losing homes and suffering property damage, there should be a shift in water management. Hopefully. Agitate for change in this area. Insist politicians do some work.

When to seek mental health aid
Generally speaking, you should be upset. This is a horrible time and you are quite right to feel nervous, sadness, grief, helplessness and anger.

However, prolonged stress can lead to anxiety, depression, and various forms of shock, now fashionably called PTSD.  

If you are having trouble with your feelings for more than two weeks, check in with a psychologist, therapist or mental health practitioner. Two to three sessions over a fortnight should result in some effective positive change.

And if you want, discuss if you should chat with a psychiatrist, a medical doctor who deals with mental health issues. A decent mental health professional will always tell you if in their opinion it's worth having a chat about meds. And although we're not doctors, we can suggest a few things to read when considering medication, so you can ask good questions and make informed decisions.

I hope this helps.

Note: Image by Tri Le from Pixabay