Book Review - Fried: Why You Burn Out and How to Revive by Joan Borysenko, Ph.D.

I have been under the weather the past couple of days and was fortunate to have Fried by Joan Borysenko at the top of my reading pile.  Dr. Borysenko used the social network, Facebook, to gather input from her Facebook Friends (FBFs) to write about people’s experiences with burnout.  By combining the input of her FBFs with research about burnout she was able to give a comprehensive view of the experience of burnout and the possibilities that come with surviving the experience.  The information she provides would be extremely helpful to anyone working in the field of domestic violence and sexual assault. 

Dr. Borysenko uses the allegory of Dante’s Inferno to map the progression of burnout from the descent into hell to the rise to Paradise.  In the first chapter she provides the stages of burnout with the first stage being “Driven by the Ideal” and the last stage as “Physical and Mental Collapse.”  I was extremely affected by the quote she provided from Thomas Merton’s Letter to an Activist which I think is very applicable to the work we do in our work to end violence against women and children.

“Do not depend on the hope of results.  When you are doing the sort of work you have taken on, essentially apostiolic work, you may have to face the fact that your work will be apparently worthless and even achieve no result at all, if not perhaps results opposite to what you expect.  As you get used to this idea you start more and more to concentrate not on the results but on the value, the rightness, the truth of the work itself.”

In this first section on the stages of burnout, Joan Borysenko provides writing exercises to help determine where a person may be on the continuum.  In other chapters she addresses the “depression industry” that fails to recognize the effects one’s life history and prefers to medicate symptoms rather than address trauma and grief and may have actually done more harm than good.  I found this section particularly interesting.

Dr. Borysenko also discusses the Adverse Childhood Experience studies of Dr. Vincent J. Filletti  and outlines how childhood experience effects out ability to maintain our physical and mental health.  She also encourages the use of McClelland’s Thematic Apperception Test and the Meyer’s Briggs to determine temperament and how one responds to stress.  It was not necessary for me to take the TAT to know where I would fall and I found it helpful in validating the work I currently do.  Dr. Borysenko recommends the use of such tests as a means of finding out whether or not one is working in a situation that will lead to increased risk of burnout. 

Dr. Borysenko’s wisdom and stories from her own life are beautifully intertwined with the wisdom of the FBFs that she invited to participate in discussion regarding burnout and the revival that occur once a person makes the journey from Hell to Paradise and the recognition that we can let go and move one to a new life with even greater excitement and productivity. 

I hope readers will find this book as wonderful as I did.  I plan to refer to it often

I will end with a quote Dr. Borysenko  included by John Milton (from Paradise Lost):  “The mind is its own place, and in itself I can make Heaven of Hell, a Hell of Heaven.”

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Trauma and Anticipated Loss – Why do Survivors Sabotage Their Own Efforts for Change?

When I am consulting with advocates about survivors with whom they are working, I often am asked “why does it seem like just when everything is going right for someone, that it all falls apart again? or “why is it so hard for some trauma survivors to plan for the future?”  This post is going to describe two phenomena that occur in the minds of complex trauma survivors and will hopefully explain why.  These phenomena also apply to persons in recovery from long term addictions.  This is not surprising, since most persons with severe and long term addictions are also survivors of trauma.

Anticipated Loss

Trauma survivors are experts at loss.  The first traumatic event was also the first loss.  Losses may include death or absence of a loved one, loss of a sense of safety, loss of important beliefs, loss of a home, or loss of a job.  As these losses pile upon each other, the victim begins to anticipate new losses around the corner.  This leads to attachment issues: either lack of attachment or clinging to relationships or both (the come here/go away relationship).  When loss is seen as a common occurrence, the person begins to anticipate loss even when there is no evidence that loss will occur. 

Anticipated loss can lead to sabotaging one’s own efforts to move forward.  Anticipating future losses can feel like walking on eggshells.  The anxiety and fear is so great that the person will subconsciously take action that will cause the loss to occur sooner.  This often occurs in relationships.  The person may be so sure that the relationship is going to end that he/she will end it or take action that will cause the other person to end it.  Anticipated loss can also keep a person from doing anything to move forward.  They may not look for a job, apartment, or a relationship because of the anticipated loss of the job, home, or relationship. 

Persons addicted to substances and who have had a long history of cycling in and out of recovery, experience the same thing.  The anxiety of possibly relapsing, having life change, and experiencing success and then losing it, can cause some people in recovery to relapse just before the positive change occurs.  This has often been called “giving up before the miracle happens.”  I once counseled a woman who had lost her nursing license due to stealing and using drugs from the hospital where she was employed.  She was working hard to maintain her recovery and working closely with the licensing board to regain her license.  However, just before she was due to regain her license she would relapse and would have to start the process all over again.  This happened twice and we talked about anticipated loss as part of her relapse prevention plan.  Her fear of the unknown and the potential loss, though, won out over her desire to regain her nursing license.

Anticipated loss of a counselor, advocate, case manager or other important person can also lead to subconscious sabotaging of efforts to move forward.  It is very important to ensure the person that support services are still available as a person moves on into their positive future.  The best thing that we can do to help a trauma survivor move forward is to talk about the possible anticipated loss and provide support.  If a person is aware that what they are experiencing is due to the past trauma she may be able to use skills and support to be able to move through the anxiety without taking action that could lead to loss.

Sense of a foreshortened future

The other phenomenon that occurs in many trauma survivors is a sense of a foreshortened future.  In other words, some trauma survivors are very aware of their mortality after having their life threatened on numerous occasions.  When someone subconsciously believes that her life is in danger and that she will die at any time, it is difficult to plan for the future.  This emotional state continues long after the threat of death has passed and can lead to poor follow through when making plans for the future.  A person who has a sense that they are not going to live long will find it difficult to make long range plans.  She is completely focused on her day to day and moment to moment survival. 

When working with someone who is a trauma survivor it is helpful to recognize that anticipated loss and a sense of a foreshortened future can lead to behaviors that may be defined as difficult, manipulative, or non-compliant.  It is more productive to recognize that the person is fearful of the future since her only experience has been negative.  It may even be helpful to discuss what is possibly happening with the person. Give her kudos for being able to survive so far and let her know that support will be available to help ease losses in the future.  We cannot guarantee that losses will not occur.  They are a part of life.  However, we can help the person recognize their own fear of loss and provide a sense of safety and support.

Violence, Mental Illness and Stigma

Since the shooting in Arizona on Saturday, I have noticed a lot of press attention given to the possibility that the young man who shot Rep. Giffords and killed six other people has a mental illness. This has led to conjecture on the part of the press and others that the mental illness is what caused Jared Loughner to engage in such a horrific act. This is concerning because it continues to perpetuate the myth that mentally ill people are violent.
SAMHAS (Substance Abuse and Mental Health Services Administration) provided the following information on their website.

“A consensus statement signed by more than three dozen lawyers, advocates, consumers/survivors, and mental health professionals reads in part: “The results of several recent large-scale research projects conclude that only a weak association between mental disorders and violence exists in the community. Serious violence by people with major mental disorders appears concentrated in a small fraction of the total number, and especially in those who use alcohol and other drugs.” (Monhan, J. and Arnold, J., 1996)

In addition:

• “Research has shown that the vast majority of people who are violent do not suffer from mental illnesses.” (American Psychiatric Association, 1994).

• “Clearly, mental health status makes at best a trivial contribution to the overall level of violence in society” (Monahan, John, 1992).

• “. . . [T]he absolute risk of violence among the mentally ill as a group is still very small and . . . only a small proportion of the violence in our society can be attributed to persons who are mentally ill.” (Mulvey, 1994)

• “Most people who suffer from a mental disorder are not violent — there is no need to fear them. Embrace them for who they are — normal human beings experiencing a difficult time, who need your open mind, caring attitude, and helpful support.” (Grohol, 1998)

• “Compared with the risk associated with the combination of male gender, young age, and lower socioeconomic status, the risk of violence presented by mental disorder is modest.” (Policy Research Associates, December 1994)

People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. (Appleby, et.al., 2001)

“A study by researchers at North Carolina State University and Duke University has found that people with severe mental illness — schizophrenia, bipolar disorder or psychosis — are 2 1⁄2 times more likely to be attacked, raped or mugged than the general population.” (— Chamberlain, Claudine. “Victims, Not Violent: Mentally Ill Attacked at a Higher Rate,” ABC News “

Societal attitudes toward the mentally ill, including stigma, tend to increase discrimination. President’s Freedom Commission on Mental Health found that stigma leads persons not living with mental illness to avoid living, socializing, or working with, renting to, or employing people with mental disorders – especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopeless. People with mental health issues internalize the public attitudes and will often conceal symptoms or fail to seek treatment.

There is still much work to be done in regards to the effects of the media pundits’ and politicians’ hate speech on the minds of vulnerable people, people who have been raised in an atmosphere of abuse, bigotry, and violence. However, I encourage the media to put aside the possibility of mental illness existing within the perpetrator and explore instead the effects of negative and hateful rhetoric on minds that have been isolated due to media’s own perpetuation of the stigma of the mentally ill. It is so important to remember also that most violent people are not mentally ill and few mentally ill people are violent.