All posts by fgreenagel

04May/20

Ethics Interview

A young woman who is in graduate school reached out to me with some questions about ethical and legal aspects in the mental health profession. I liked the questions and decided that I would just share my responses with my readers.  

  • What does being a legal and ethical mental health professional mean to you?

It is important that I follow federal and state laws and regulations regarding my work. I have multiple licenses in NJ, NY, and PA, and each state is a little bit different. The laws are there to protect the client: their care and confidentiality are of utmost importance.

I think there are a lot of awful programs and bad providers out there. They cut corners, claim an expertise that is not there, over bill, over diagnose, don’t get or engage in supervision, and really seem to put themselves and their programs ahead of the clients.

For me, I have to maintain an ethical and legal standard that not only far surpasses the average citizen, but provides a model for other health care professionals. I was trained to put patients first, document everything, and act like anything I do will be reported in the Star Ledger or New York Times.

  • What are some firsthand legal and ethical challenges you encountered in your clinical practice? How did you handle the situation?

I had finished up my first year of graduate school in 2005 and was offered a counseling job at a small private practice. On my third or fourth day there, I learned that the owner and head therapist was employing a number of the clients in a side cleaning business. This was a clear violation of boundaries. I asked her about it and she said that she provided a good job for clients that had a hard time finding work. I brought up the NASW code of ethics and she said that the client’s ability to put food on their table and pay their bills was more important. I quit and reported her to the licensing board.

In 2012, I chaired the NJ Heroin and Opiate Task Force. We held hearings around the state. We wrote a report in 2013 that included recommendations to the Governor and the Legislature. Governor Christie’s office sat on the report for almost a year. Frustrated, I began to criticize the Governor on the radio and in various newspapers. Around that time, a complaint was filed against me with the the State Ethics Commission about how I used my role on the Task Force to advance the interests of Rutgers. Upset about this horrifically vile lie of a charge, I reached out to Gov. McGreevey. He was on the Task Force and had been providing me with political guidance for a couple of years. He told me that “this is great. You’ve done nothing wrong. There is no sex, no money, no contracts. You’ll be exonerated. In the meantime, you are going to learn a great deal about the dirty nature of politics.” It didn’t feel like a great experience. It lasted a year and I was fairly stressed out about it. Ultimately, I was found to have not engaged in any wrong doing. Rutgers was wonderful too – they said that if I had done anything wrong, it was Rutgers fault and not mine. To my great satisfaction, the individual who filed the false complaint against me lost his state job and was barred from future public service.

About five years ago, there was a program that I did some part time work for that had a new clinical supervisor that was not providing weekly supervision to the counselors that worked underneath her. I expressed my concern to the owners on multiple occasions through text, phone calls, and emails. I was told that it would be addressed. It wasn’t. I anonymously reported the situation to the state. A day or two later, a state worker reached out to me to let me know there had been a complaint at an agency I worked at and that they were giving me a courtesy heads up. I was infuriated, and told them that I had made the anonymous complaint. Nothing was done. I filed a second complaint on the state’s website. Someone reached out and eventually, the supervisor started provided weekly supervision to the workers. This whole process took three or four months.

A couple of years later I was asked to provide consultation for an outpatient treatment program in NYC. I learned that all of the front-line counselors had been trained to type that their individual and group counseling sessions used motivational interviewing or cognitive behavioral therapy, even when the counselor had little to no idea about those techniques. I expressed my concern to the administrative supervisor and the owner and was told that they do this to stay in compliance with NY’s OASIS regulations and the insurance companies. I told them that it was unethical and that staff needed to be fully trained on these techniques and then to actually implement them. There were other issues; soon, I reported the company to OASIS and resigned.

I don’t expect most mental health professionals or social workers to act like I do. It would be nice, but it is unrealistic. I left jobs and put myself in situations where the state and corporations (a couple of very rich ones with lots of lawyers) came after me. I’m willing to do the right thing even if it puts me in financial danger – I have found that a vast majority of people are unwilling to do that. A lot of times people will say “I have a mortgage to pay” as the reason why the go along with something bad or “I can’t deal with the drama” as to why they don’t report something. Those are terrible excuses. Other times people will say they have a spouse and kids to provide for. This is a bit more understandable but still ultimately wrong.

  • From your perspective (whether or not you work with insurance companies), what are the advantages of insurance panels, what are the struggles? Any legal and ethical implications arise as a result of working with insurance companies?

I dislike the insurance companies. I’ve spoken and written about this for over ten years. Insurance companies make money by (a) not paying claims or (b) paying as low an amount as they can.

From 2005 to 2010, I worked at a non-profit intensive outpatient program in Western NJ. I conducted evaluations there and made treatment placement recommendations. More often than not, when I said a client needed to go to inpatient treatment, their insurance company would come back and say that they would approve intensive outpatient only. But if they failed at that level, then they would consider inpatient. This was upsetting to me. I would argue with them, and I usually told the insurance people that I would have no problem writing a letter on behalf of the client’s family if the client overdosed or died that would be used in court to show the negligence of the insurance company that went against my recommendations. Sometimes it worked. Over the years, I have acquired more licenses, more certifications, another masters, and several titles. Insurance companies fight me less and less on these issues, but it is only because of my rank and that I am profoundly aggressive with them.

I have a lot of disdain for mental health professionals who work for insurance companies. Their job is to go against the treating professional’s recommendation and to lower the cost of treatment (and thus securing more profits for their paymaster). I am sure there are some ethical licensed professionals that work for insurance companies and advocate for clients, but I think they are quite rare. Quite rare. For the last ten years, I have taught at the Rutgers School of Social Work. I tell my students that they can always reach out to me, unless they work for an insurance company where they deny or reduce claims. If they do that, they are dead to me. Unless they took the job in order to become a whistle blower.

I am not on any insurance panels. I don’t want insurance dictating how long or how often I can see someone. I don’t want to get on the phone and talk to some officious bean counter about how the client is progressing and to take marching orders about how they want me to proceed. I am also very much against insurance companies telling me how much they will pay me. I understand that most clinicians need to be on panels in order to get clients and make a living, but they have ceded a great deal of power and authority to those insurance companies.

This has happened throughout the medical profession. Doctors really screwed things up by giving in to the HMOs and insurance companies in the 1980s. But that is a story for another time.

  • What does a good case note look like, what should be included or excluded? What advice can you give about effective record keeping in general? Is there information that you may reconsider recording due to legal and ethical reasons?

It depends. I tend to not take notes in the Army or with the NY State Police, as I don’t want command to use the notes against those that I treat. Those are unique jobs and unique situations, and not something that I would advise new professionals to get involved with.

But I think that good notes are really, really important. One should write down the day and time you saw a client, how long the session lasted, what was discussed, what plans were made, and a separate analysis of how the client seemed (grooming, language, facial expression, affect).

Over the years, I have reviewed my notes with clients when they are stuck on something. For example, if someone said they were going to write their mom and letter and then didn’t, I would go back to the notes and say, “Hey, seven weeks ago we talked about this and you agreed to it. Then we discussed it again four weeks ago and you said you would do it. These are your words, not mine.” It can be effective at getting clients to move forward.

If you treat a lot of people, the notes are also helpful to the provider as to the client’s history, situation, and plan.

I’ll leave it at this – if you don’t document it, it didn’t happen.

  • What factors contribute to your decision of terminating the provision of therapy? How do you approach this process? What ethical aspects must be considered when introducing the idea of therapy termination to a client?

When I’m treating people, I constantly ask how the sessions are going for them. If they are seeing any benefit. What is hard for them. We discuss how long we might work together. Sometimes it is time limited and other times open ended. We regularly discuss it though. When I was in Poland last year with the Army, it was clear that my sessions with clients would end once our deployment was over (that said, I told soldiers they could reach out to me via phone, email, or online if something came up). We discussed what we worked on and their plan going forward and whether or not they would seek additional counseling from someone nearby when they returned to the States. Those are the topics that a mental health professional must cover when they begin to terminate with a client. At the very least, termination should start being discussed when you are halfway through. I do it from the start of treatment though and continually review it.

30Mar/20

A COVID-19 Reacction: Most Public-Service Minded Peoples’ Roles Come Later

This was not an article I planned to write. It is in response to conversations with a half dozen people who feel guilty/useless about being at home while health care workers, cops, and some National Guard service members are on the front lines during the initial phase of the 2020 pandemic’s wave.

Some people are able to help from home: sewing masks, coordinating volunteers at food pantries, or providing counseling or support via phone or Zoom. Most aren’t though, and so they are left to logging crazy hours online, wandering around their house, opening and closing kitchen cabinets, trying not to freak out at their spouses or kids, and beating themselves up that they aren’t doing something to help other humans during COVID-19.

To be brief: let the health care workers, law enforcement officers, and activated National Guard soldiers and airmen do their thing. They are needed now and have a very distinct purpose. Most of us would just get in the way and muddle things up.

Our part comes later. A former student of mine is currently getting his Masters in Public Policy at Princeton. Before going back to school, he worked for the government examining ways to reform and improve healthcare delivery and find ways to save the public money. On Saturday morning, he wrote me: “The only difficult part is that I’m not in public service right now, which makes me feel a bit useless.” I told him that his role in this comes later. Whether it is evaluating our Federal government’s horrific preparation in January and February or the pre-pandemic lack of needed medical supplies or devising programs to help people deal with the long term health and economic aftermath, he’ll do something necessary and good. Just not right now.

I continue to teach and counsel. I’m able to do so from the comforts of my home, where I have power, heat, internet, plenty of food, books to read, plays to write, and a garden to use as a calendar to mark the procession of time. I am providing counseling and support to about two dozen NY State Troopers and soldiers who are on the front line, as well as a few nurses and doctors that are working crazy days in NYC hospitals. I’m able to work and help, but not like I really want to.

My part comes later. As of this morning, there are over 141,000 Americans that have tested positive for COVID-19 and at least 2,300 that have died. This is just the start. Some models predict that tens of millions Americans will be infected and that over 200,000 may perish. No one knows for sure. But one thing is clear, the stress from the job losses and the massive economic hit that we’ve already taken (and which will worsen) is and will be incredible. Odds are that most of us will know someone who dies from this. There will be a great need for grief counseling and support. I expect it will be much of my work for the next two years.

So, please don’t fret or beat yourselves up over what you aren’t doing now. Stay home. Think about what comes next or after. And make sure you are able to do your part when called. You will be sorely needed.


Two resources:

The New York Times answers questions on COVID-19

An excellent source of COVID-19 information for NJ, NY, PA, and CT

31Jan/20

How Teletherapy Will Suppress Social Work Wages

Teletherapy is the online delivery of therapeutic services (addiction, mental health, basic counseling) through Skype or Facetime or preferably a more secure video conferencing site. I have been at a few conferences and symposiums where the the subject of teletherapy was discussed.

Every single person that brought it up waxed about the benefits, which include: (1) allowing people in remote areas to access care; (2) allowing people who have a difficult time leaving their homes to speak to a professional (disability, obesity, agoraphobia); (3) connecting with a specialist who lives very far away; and (4) convenience.

The strongest arguments for teletherapy that are usually put forth are those first two points. While I have some concerns about privacy, security, and safety, I deeply believe that therapy needs to be an in-person experience where people can give each other their complete attention and full heed can be given to body language. But I am neither writing nor arguing about that today.

Teletherapy right now is being offered up as a counseling solution for people in remote areas or that can’t leave their home. A few programs and therapists are currently using it as a supplemental service after someone leaves an inpatient program or are traveling. Over the next few years, large health care corporations will establish themselves as the primary providers of teletherapy. Because they do not need to pay for a physical space and can hire remote workers, the cost of providing teletherapeutic services will be lower than in-person sessions. A MBA or some other bean counter whose sole focus is profit will then say, “We shouldn’t just offer this service to people that are disabled or in remote locations. Rather than being a special service, we should make teletherapy the norm. Think of the profits!”

Social work is a field that is well over 80% female. Because of both the nature of the work (helping the sick, poor, downtrodden, oppressed, cast aside) and the gender of the workforce, American society has put a low value on the labor. Despite its importance. The wages are extremely low compared to almost every other field, especially when we consider that it generally requires a Masters level education. In addition to their full time employment, many social workers work a part time job (some even have a third or fourth job, or a second full time job) in order to make ends meet.

Increasing the amount of teletherapy will suppress wages further. Ours is a field that really can not permit further wage suppression. Social workers and their professional organizations (NASW, ASWB) need to be aware of this. If they don’t, they sign their own professional death warrant.

09Nov/19

On Veterans Day, Consider Armistice Day

In 2015, I answered some common questions about Veterans Day. Last year, I wrote a story about a moving conversation that I had with a soldier who had overcome an addiction to opioids. Because I’m serving in Poland with the US Army this fall, I’m looking at Veterans Day a bit differently.

The eleventh hour of the eleventh day of the eleventh month of 1918 marks the unofficial end of World War I (the Treaty of Versailles in 1919 officially ended it). A few weeks ago, I noticed that the British soldiers on base were wearing red paper flowers. I recognized them as poppies and asked them why they were wearing them before November 11th. The red poppy is one of the two defining images ‘In Flanders Field,’ the most famous poem written about those that died in the Great War. One officer said that they wear them everyday for a few weeks leading up to Remembrance Day. An American sergeant in the room blurted, “That’s the same day we celebrate Veterans Day.” I stifled a glare and withheld a withering comment and said that both commemorate the end of World War I. Over a century later, Great Britain, Canada, Australia, New Zealand, France, Belgium, and a few other allies and commonwealth nations continue to remember the day and solemnly hold ceremonies. I’ll come back to this.

Poland recognizes November 11th as their National Independence Day. While the culture is well over 1,000 years old, Poland was partitioned in 1795 between Russia, Prussia (part of modern day Germany), and the Hapsburg Empire (modern day Austria). The country ceased to exist, at least as a form of government or on a map, but the language and proud culture survived during that 123 year period until Poland re-emerged out of the ashes of the Allied victory at the end of World War I. They had been partitioned two earlier times in the 19th century and endured previous invasions from the Russians, Teutonic Knights, Prussians, Tartars, and Swedes. Poland was often defeated but never truly conquered. In 1939, Germany invaded from the west and Russia invaded from the east. 85% of Warsaw was destroyed by 1944. The Germans were eventually driven out but the Russians turned out to be another cruel despot that directly or indirectly controlled Poland until 1989. Of the 195 countries that are recognized by the United Nations, only a few may have suffered the horrors of war worse than Poland. One can argue that no country has had more menacing neighbors. Today, Poland still casts a wary eye eastward.

World War I was originally known as the Great War. It was once called ‘The War to End All Wars.’ The total deaths suffered by the allied forces were about six million while the central powers numbered around four million. One must note the additional 20 million servicemembers that were wounded; as well as the civilian casualties that were so difficult to determine. The numbers are staggering (they would be dwarfed by the death toll of World War II; which because of the stark villainy and the recency has pushed WW1 to the background of most peoples’ minds). Families were shattered; towns were emptied; cities were destroyed; the western world suffered a collective trauma. The end of the war led to mass celebrations around the world. More significantly, people hoped that humanity had learned a lesson through this catastrophe and would keep the peace. Armistice Day would not just remember the end of the Great War, but it was supposed to be a yearly reminder that everyone loses in war and that we must strive for peace. The British soldiers I spoke with still know this lesson.

Not so in America. Armistice Day eventually morphed into Veterans Day. Now it’s a national holiday where people drink beer, save money when shopping, post near-meaningless support  on social media, and some veterans get a “thank you for your service” (which less than half of them like to hear).Civilians often express compassion, gratitude, or guilt when they see the Marine with one leg or the soldier with no arms and one eye. They wonder or suspect or fear the hidden wounds of PTSD (or C-PTSD). Most Americans only think about veterans when they watch a war movie or a politician uses them on a stump speech or they bump into one or on Veterans Day. Ask people about veterans and you’ll usually hear enthusiastic bellowing. Businesses trip over themselves to say that they are veteran friendly and they outdo each other by flying giant flags to show just how much they care and demonstrate their level of patriotism. Because they utter some words and because they fly a flag. Servicemembers and veterans have become a pretend sacred cow in the United States; they are supported with token words. And ovations at sporting events (this intersection of sports and the military is particularly galling, because it doesn’t address the policy problems in the Department of Defense and it serves as a vile recruiting tool for children and teenagers in the stands). The military perpetually screws over those that serve (instead of a “thank you,” ask a servicemember or a vet if their military branch ever fucked them over). The VA continually churns out disaster stories.

And yet. Veterans Day. Despite the holiday (such a bad word choice for November 11th), the movies, and the gratitude & guilt, we, as a nation, seem to be failing at recognizing the real reason for pausing on November 11th.

War is horrible. For those that serve; for those that wait for them back home. For the nations that lose. For the nations that supposedly win. For everyone. We need to do better. We must work harder to attain and maintain peace. Not just between nations but also between individuals.

This problem is as old as human kind. Plato wrote “Only the dead have seen the end of war.” He died well over 2300 years ago and those words still ring true.

For those of you reading this as an anti-American verse, you are painfully mistaken. For those that think this is a full-throated cry for pacifism, again you are mistaken. Sit with me and I’ll tell endless true tales that will erupt sorrow and rage in even the sunniest plastic patriot. I want us to be better. To not debase others. Or dehumanize them. Or use the military as a knee jerk response. If you speak with violence, talk of invasions, celebrate fighting, or glorify war, I invite you to spend some time on the front lines helping with the aftermath. Ponder the father who outlives his son or the child who grows up without a mother. Think on the veteran who mourns his fellows. Picture a spouse in a forever lonely bed. Visualize the soldier who is jarred awake from near-nightly nightmares. Consider the cities that have been razed, the cultural artifacts that have been destroyed. Wonder about what books the dead might have written or the diseases they may have cured. Meditate on the folly of it all. And work towards peace. Among nations. Among yourselves. This Veterans Day. This Armistice Day. Be better.

09Nov/19

On Suicide, Part Three

I’m currently deployed with the US Army in Northeastern Poland where I’m serving as the lone Behavorial Health Provider for over 800 US soldiers. I see anywhere from 20 to 35 servicemembers a week for therapy and give a few briefs a week to troops (all my briefs either focus on or touch upon suicide). At least ten of the soldiers I’ve been treating are survivors of suicide.

I use that phrase carefully. Survivor of suicide. Being close to someone who completed suicide is like having a metaphorical bomb dropped on one’s life: in addition to the sorrow that accompanies death, there are almost always additional feelings of confusion, guilt (unreasonably and unfairly), and anger. I’m also continuing to treat several clients back in NY and NJ  by phone who are also survivors of recent suicide (counseling by phone is something that I really advise against and only agree to in cases similar to this). To sum it up, I am working with at least a dozen people every week who are the survivors of suicide. This is, by far, the largest amount of survivors I’ve treated at one time. It’s heavy work. But it’s allowed me to see some stark themes that I have not written about in my previous articles (my first article in this series was about how one feels like there is something deficient about them when someone they love commits suicide; part two discusses the suicide domino theory and how it betrays our future selves by eliminating all possibilities). This third piece discusses the two lines that survivors repeat in our sessions.

Why did they do it?

That’s a question that every survivor utters. Everyone. Clients query me. Some ask God. All of them run it continually through their mind, especially in the early days, weeks, and months. It’s agonizing. And it can not be answered. Even in cases where a note (or notes) are left behind, it still remains a mystery. Sure, some completions lead to easy speculation (a recent end of a romantic relationship, astronomical debt, incurable health problems, substance misuse), yet we can never truly know. Mysteries are frustrating; suicides go far beyond the scale of frustration.

People want answers. Some find solace in figuring out some reason. It may give them peace. But discovering some hidden debt or secret pain usually leads to more questions. Thus further agony. I tell my clients this. Despite my advice, I’ll even play detective with them for a bit, cautioning them all the while that we’ll never really know as I try to move them forward in the healing process and to pick up the pieces of their shattered lives.

If you are a survivor, it is natural to ask “why?” We all do. But we eventually need to move on. If you know a survivor, do not ask them why they think their loved one did it. It’s a radioactive question. Do not ask it. If you are a survivor and someone asks you, rather than erupt (which is absolutely your right but isn’t helpful), tell them, “No one knows. Please never ask that again.”

How come I didn’t see it? (or worse, after the fact, “I should have known because of….”)

I had a soldier say to me recently, “Maybe if I didn’t get off the phone the way I did six weeks before she wouldn’t have done it.” To borrow from Shakespeare, we take “trifles light as air” and seek to link them to the suicide. A lack of eye contact in March, a sullen expression three months earlier, a muted voice at Thanksgiving, a shorter conversation one Thursday, a missed call, an unreturned text, a gift not given, a dinner that was cancelled, a party not attended, and other trivial life instances become fodder that is raked over and despairingly examined. It is a sisyphean task that leads to false and disastrously unfair guilt.

If we put every interaction with people we care about under such a microscope, not only would we have no time to live our lives, but those in our lives would become exhausted and infuriated with us for speculating upon every word and gesture.

This is easy for me to see, because I’ve dealt with so many of these cases. These bombs that shatter the survivors lives. I see the commonality of the responses and I can let those with whom I work know that these thoughts are natural and horridly unfair. And that they need to stop.

18Oct/19

How We Continue Gaslighting Survivors of Psychological Abuse

by Shannon Cheung

When Frank asked me to write a piece for his website at the beginning of the summer, I was honored and horrified. Somehow, communicating to an audience of more than just a single professor (sorry) changed how I viewed my writing. Paralyzed by perfectionism, I waited a long time to decide on what to write. When Frank extended the offer, again, I sat down to critically analyze why I had put it off. Everything I was passionate about seemed to vanish from my consciousness to prevent me from putting my voice out. Why?

Being seen, read, or heard by an audience leaves you vulnerable to being scrutinized. I anticipated that my subject of choice would invite that bitter, reactive, and unfair scrutiny. That was exactly why I needed to write about it.

Content warning: This piece discusses domestic violence, sexual coercion, rape, and emotional/psychological abuse, gaslighting, and invalidation of survivor experiences.

 

The past years have seen a considerable increase in widespread conversation about sexual assault and abuse, with the Harvey Weinstein assaults, the Larry Nassar case, People v. Turner (the “Stanford Rape Case”), and the R. Kelly trial, along with many others. During the Kavanaugh-Ford hearing, the National Sexual Assault Hotline experienced a 201% spike in its call volume. Social media campaigns swept Twitter and Facebook, calling attention to the prevalence of sexual assault and domestic violence, as well as the many barriers that prevent survivors from coming forward with their experiences.

While cases of sexual assault and sexual abuse occupy the foreground of our collective attention, it is equally as important to remember that there are issues that we are leaving in the background. October is dedicated to Domestic Violence Awareness and the effects of relationship violence. For the most part, society has come to agree that violence between partners is bad, but we continue to see gaps in understanding what the word “violence” actually covers. When the mainstream definition of partner violence is shoehorned into meaning only physical and sexual violence, we fail to capture – and in doing so, end up gaslighting – the experiences of those whose lives have suffered or are suffering through psychological abuse.

Often used interchangeably with emotional abuse, psychological abuse is often a type of violence that is brushed aside or minimized. Survivors of psychological abuse will hear the same victim-blaming statements made to other survivors. These responses serve to rationalize the abuser’s decisions; minimize the severity of the abuse and harm done to the survivor; blame the survivor for the things said or done to them; and, ultimately, dismiss the uncomfortable idea that someone we know could actually be abusive. The one victim-blaming statement that most often comes up for survivors who try to tell their story of being psychologically abused, however, is one that pits their experience against that of other survivors: “It’s not like he hit/raped you.”

Gaslighting” is a common manipulative tactic that abusers use with their victims. By withholding, countering, diverting, trivializing, and “forgetting” and denying, an abuser leads an individual to question their own feelings, instincts, and sanity. Of course, an abuser has a lot of power to gain in a relationship with someone who feels as though they cannot trust their own perceptions of reality.

Gaslighting, however, is not limited to romantic partnerships. It happens within families, friendships, and professional relationships. In fact, gaslighting is a cultural phenomenon in the context of how we treat people who have been disempowered in general. As a society, the way we treat survivors continues this pattern of gaslighting – the very pattern we applaud survivors for escaping. By trying to qualify the severity of the abuse, we question and trivialize survivors’ experiences. By equating the call for accountability and justice to a “witch hunt,” we are blocking and diverting. In doing so, we are complicit in carrying out the same goals that all abusers have: we silence survivors; we force them to question their reality; and we isolate them.

In early 2016, the second half of my freshman year in college, I found myself grieving the loss of a 3-year relationship. I knew it was normal to feel sadness after a break-up, especially a “first,” but the pain I felt seemed unbearable. I began to avoid any place around campus that I might see him – dining halls, dorm lounges, even buses. I missed meals and skipped classes. I was always watching my back. An outsider would likely attribute these behaviors to a different state of mind. I was afraid and I did not know it.

Two months later, a sudden realization hit me: my partner had coerced me into having sex with him multiple times. He had also raped me. After years of work to treat symptoms of posttraumatic stress disorder, I still live the aftermath of that relationship. Coercion and manipulation were thematic elements of our relationship, and they transcended our sexual interactions. I reported to my partner at all hours of the day. Where was I? With whom? Until when? My social network dwindled. I kept all friends at a distance because it was the easiest way to placate my partner. I desperately wanted to avoid accusations of cheating and lying. I became adept at reading his tone and emotions, and yet, I still cried daily because it seemed that I was always making mistakes and stressing my partner out to the point where he would threaten to kill himself.

While I will never know whether my behaviors and thoughts today are more a direct result of my sexual trauma or psychological trauma (it very well may be both in equal parts), I can say this: I hide behind my sexual assault because I know that it gets taken more seriously than psychological abuse, however marginally that may be. In the early days of my healing, when I chose to open up to my friends about what had happened, I was met with “You should’ve fought harder and stood up for yourself,” “You gave him too much power,” and “Why didn’t you just leave?” Certainly, survivors of any type of abuse are no stranger to any of these statements. Still, we continue to conceptualize psychological abuse as something that poses no imminent physical danger or threat, and therefore, is less severe and possibly even “easier” to escape.

This Domestic Violence Awareness Month, we need to acknowledge a truer, more accurate definition of violence – one that honors the many forms that abuse takes on to wreak havoc on people’s well-being.

If you are currently in a psychologically/emotionally abusive relationship, here are some steps you can take, whether you are seeking to leave the relationship or not:

1) Get support. There is a reason one of the hallmarks of an abusive relationship is isolation. An abusive partner has much to gain by making you solely dependent on them. If you are limited in your network, you are also limited in the people you can look to for support. Building this system of support will help you stay safe.

2) Set boundaries. While it may be difficult to maintain boundaries in your relationship, it is still important to maintain boundaries with your support system. Be clear about the role that you would like your supports to play. If you are not open to advice, let them know.

3) Be prepared for strong reactions. Disclosing your experience to loved ones may be upsetting or shocking to them, and they can react in ways that were mentioned earlier in this article. Remember to communicate what you need from them. If they are reacting in a way that is hurtful, let them know.

4) Create a safety plan. Typically, domestic violence advocates promote safety planning that revolved around physical safety, but emotional safety is particularly salient in psychologically abusive relationships. In addition to building a supportive network and asserting boundaries with safe people, take time to identify and work towards achievable goals such as calling a local resource and being mindful of available services. Take steps as you find appropriate for yourself.

5) Remind yourself of your value and be kind to yourself. It is all too easy to forget this about yourself in the face of a partner who seems to be sending the opposite message. Find a space you can call your own. Make it your safe space.

6) Call the National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224 to speak with a confidential advocate about domestic violence, resources or information, or to discuss potentially unhealthy aspects of relationships.

If you have a loved one who you suspect is in an abusive relationship, refer to this list of common warning signs:

  • Partner is constantly putting them down or insulting them in front of others.
  • They are constantly worried about making their partner angry or upset.
  • They make excuses for their partner’s behaviors.
  • Their partner is extremely possessive or jealous.
  • They have unexplained marks or injuries. They may dress differently to cover them up.
  • They have stopped spending time with friends and family.
  • They seem depressed or anxious, or you notice changes in their personality.
  • They are attached to their phone or seem to be in a hurry whenever their partner is not around.
  • They seem less engaged.

If any of the above is true for your loved one, call the Call the National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224 to speak with a confidential advocate about how you might be able to help. Do not confront the abusive partner. Express concern to your loved one, listen to and respect their decisions, and ask how you can best support them.

If you are in neither of the above categories, chances are that you actually do know someone who has experienced or is currently experiencing some kind of partner violence. In the U.S., nearly 3 in 10 women and 1 in 10 men have experienced rape, physical violence, and/or stalking and report some related impact on their functioning. The numbers for psychological abuse are staggering as well: nearly half of all women and men in the United States (48.4% and 48.8%, respectively) have experienced psychological aggression by an intimate partner in their lifetime. Given this, steps that the general public can take to contribute to a community free of partner violence revolve around ridding ourselves of a culture that normalizes gaslighting:

 

  1. Throw away idea of the “perfect victim/survivor.” We have all internalized myths about violence: who perpetrates it, who is on the receiving end, how both parties act, and what it looks like. Anyone can be an abuser, and anyone can be abused. While domestic violence is known to disproportionately affect women, it does not only affect women. Similarly, while examples of abusive relationships are often given in terms of heterosexual relationship, abusers in LGBTQ relationships make use of the same tactics and can weaponize sexuality and gender identity to gain power and control over their partners.
  2. Believe survivors. The recent scandals, allegations, and trials have invariably been responded to with the cries of a crowd favorite red herring: what if we ruin innocent people’s lives as a result of false accusations? In the context of the past 20 years of sexual assault accusations alone, 2-10% of them were proven to be fake. Although these false accusations occupy so much of our attention, it turns out that these accusations very rarely lead to convictions or wrongful jail time. Remembering that these statistics are presented in the context of sexual assault, the numbers for psychological abuse are less certain. Believing survivors does not require us to abandon our judicial system. Rather, it is a call to listen to our experiences and respecting what we have to share, without questioning our perceptions and behaviors – to not be dismissive. When vulnerability is met with skepticism and vitriol, we learn, again, that we are not accepted as we are and that we are not safe.
  3. Challenge the normalization of abusive behaviors. Possessiveness, jealousy, and surveillance are frequently framed as indicators of a loving and romantic partner, as opposed to a controlling and manipulative one. As a consequence, we misrepresent abusive relationships and fail to pay attention to signs that are likely already there.

 ———————————————————

Shannon Cheung is an MSW/PhD student in the Addiction Counselor Training Certificate program at Rutgers University School of Social Work. A survivor of sexual assault and dating violence, she is passionate about advocating for marginalized and underserved populations. She currently interns at an addiction treatment facility. Shannon’s intersectional identity as an Asian American survivor with various mental health diagnoses pushes her to pursue a career in research on cultural stigma surrounding mental illness and treatment-seeking among children of immigrants in the U.S. She is particularly interested in the underutilization of mental health treatment services among Asian American diaspora. Shannon enjoys rock climbing and reading about cultural sociology.

04Oct/19

My Favorite Articles About the Military and Veterans from the Last 18 Months

I’m currently in northeastern Poland, where I’m attached to the 3-278th Cavalry as the squadron’s behavioral health officer. When I’m not treating soldiers, I work out, read, write, and travel like mad on the weekends. I am continuing to do some work via the internet and telephone back in NY and NJ, and I (of course) am teaching an online course for Rutgers. I receive a lot of email each day; I was recently asked questions pertaining to the military by a few former students/supervisees.

I joined the Army on February 29, 1996 and went off to Ft. Knox for basic training in late April. I served with the 2-102 in NJ for the next six years. My unit was activated shortly after 9/11 to guard four Hudson River crossings (and really, provide assurance to commuters in a region that had experienced an intense collective trauma). I sat on the inactive ready reserve (IRR) list for another two years before earning my honorable discharge in March of 2004. That same year, I began working as a counselor and started treating veterans who were in treatment for addiction.

Basic training was wonderful. I adored my drill sergeants and learned that the single most important aspect of leadership is being a role model. I met two life long friends and one wonderful mentor. But I didn’t like getting up early, shaving, doing menial tasks, getting shit from people, cleaning my boots, and cleaning weapons. The Army was good for me from 19 to 21 and then a bit tiresome after that. I was glad to get out when I did.

I rejoined the Army in August of 2014 because I was so horrified by the story of one of my students at Rutgers. I was directly commissioned as a first lieutenant in the US Army and PA National Guard. My unit these last five years has been in Elizabethtown, which is about 20 minutes east of Harrisburg. There have been moments where I’ve been able to really help soldiers and do some excellent work, but much of the time has been spent reading and being slightly irritated that I was not being utilized more. On Aug 31st of this year, I was placed on active duty and sent to Ft. Bliss, Texas, for premobilization tasks before arriving in Poland.

I served six years as an enlisted soldier. I was a tanker who only saw the inside of a tank two or three times after basic, as I spent the remainder of my time in the battalion’s S-2 (intelligence) and S-3 (training/tactical operations center) sections. Then two years on the IRR and now a little over five years as a medical officer. In my 13+ years in the Army, my only active duty time (aside from annual summer training) since basic training was during that aforementioned period following 9/11, the 2015 Papal visit to Philadelphia, and my current time in Poland. My experience has provided me with a fairly limited view of the Army, but I believe I have a strong understanding of the institution and its strengths and flaws. That is certainly helped from talking to other soldiers, treating veterans, reading books, watching documentaries and movies, and devouring first hand accounts, news, and opinion pieces.

I have at least one play in me about the Army. I don’t know if I have any other military books in me, but I am sure that I’ll be talking and writing about the service for the rest of my life. All of this is a prelude to the purpose of this piece, which is to compile a list of my favorite articles from the last year and half into one place. For people who have a family member whom is in the military (or was in, or is thinking about joining), you might find this helpful. For current or aspiring therapists who want to work with servicemembers and veterans but have no background, I urge you to read all of them. And then contact me about books and other media to absorb.

I wrote four of the articles, and all but one of the rest come from either the New York Times or the Washington Post. You should be aware of my background and biases – I’m a social worker and college professor. I lean left on most social issues. I do not see glory in warfare but I am supportive of necessary killings. I am concerned about the politicization of the military and I get particularly irritated by politicians who claim to be supportive of servicemembers and veterans but then don’t pay those servicemembers properly and fail to fund the VA as well as other educational benefits. The modern fetishization of the military alarms me, because it ruins the term service and creates an elevated class – one that can neither be properly debated nor criticized.

When I rejoined in 2014, the Army specifically told me that the institution was serious about addressing untreated PTSD, sexual assaults, and suicide. I was thrilled to be a part of the potential solution. I soon realized that while the military pays strong lip service to alcohol problems, heavy drinking is still very much part of the culture. If it is not outright encouraged, it is often glossed over or covered up. From what I can tell, drinking, sex, shopping, gambling, playing video games, and working out seem to be the top methods of relieving stress. No major progress can be made on untreated PTSD, sexual assaults, and suicide without confronting alcohol abuse. I remain unconvinced that there is a change coming.

While these articles focus on some positives (three of my four do), most discuss the issues I’ve raised in the last several paragraphs, but in a more detailed and eloquent fashion.

I wince when thinking about my views when I was 20, but then, I was 20 and had met few people, hadn’t read many books, and seen little of America and almost nothing of the rest of the world. And I suffered from the virility, arrogance, impulsiveness, invincibility, and ego-centrism of youth. My focus is not just on what are military does or how servicemembers experience it, but how it affects them and their families. And our society. And what comes after.

October 4, 2019 – After the Niger Ambush, I Trusted the Army to find answers. Instead, I was Punished – New York Times

September 23, 2019 – What Civilians Can Learn From the Army About Death Planning – Greenagel.com

September 6, 2019 – The First Marine in My Battalion to Die by Suicide – New York Times

July 23,, 2019 – As the world grows hotter, the military grapples with a deadly enemy it can’t kill – NBC News

June 1, 2019: Horrifying Responses on Army Twitter – Greenagel.com

May 25, 2019: A Battle in Falluja, Revisited – New York Times

April 24, 2019: VA and Officials: Battling an Unrelenting Tide of Suicides – New York Times

April 13, 2019: Reading ‘Slaughter House Five’ in Baghdad: what Vonnegut taught me what comes after a war – Washington Post

December 17, 2018: Even a War Hero Is Not Above the Law – New York Times

November 3, 2018: A Veterans Day Story – Greenagel.com

September 11, 2018 – A Soldier and a Wonderful Leader – Greenagel.com

September 7, 2018 – Veterans Don’t Get to Decide What ‘Respecting the Flag’ Means – Washington Post

April 14, 2018 – The Warrior at the Mall – New York Times

27Sep/19

What Are Loot Boxes?

I’ve sparingly treated people with video game addiction for almost a decade, but until last year I did not know about loot boxes. When the World Health Organization (WHO) officially stated in June of 2018 that video game addiction was a mental health disorder that would be included in ICD-11, I took notice. Over the last 21 months, Andrew Walsh and I have researched the topic and opened up a program to treat people in NJ with this disorder (we have a book coming out in October of 2019 titled Video Game Addiction 101 that you can purchase on Amazon).

Loot boxes have become ubiquitous in video games. Imagine you are playing a sword and sorcery fantasy game (something like Lord of the Rings, Conan the Barbarian or Game of Thrones). You would like to acquire a new sword that is valued at 1500 gold pieces in the game. You only have 567 old pieces. You can go and purchase five loot boxes for 100 gold pieces each. You don’t know what is in the loot boxes. You could get a terrible item, an average item, or a wonderful item. You might end up with a dagger that is only worth 50 gp (likely) or you could end up with the exact sword you are looking for (unlikely). The gold pieces you have in the game could be acquired either though (a) completing tasks in the game or (b) using a credit card to buy them (so using actual money to buy virtual money that is only good for the video game).

This is an 86 second video where kids explain loot boxes to their parents. This is a 22 minute video of a young child opening loot boxes and discussing them. He knows what is coming out of them by the sound and color before we can even see the object. Clearly he has opened up a great many loot boxes. Besides the initial concern about the actual money that is being spent on virtual items, there is a much greater problem: loot boxes are gambling. Worse, they are exposing millions of people to gambling at a young age. It is well known that the earlier someone uses nicotine, alcohol, or drugs, the more likely they are to develop an addiction to it. This also holds true for gambling. We believe that loot boxes are potentially priming two generations of young people for gambling problems.

Andrew and I are not screaming from the edge of the woods on this. Belgium banned loot boxes in 2018 and the British Parliament, which seemingly can agree on nothing right now, is discussing banning them in the entire UK. Loot boxes are a booming business that non-gamers have no idea about. In 2018, the gambling revenue from all of the Las Vegas casinos was a little over $6 billion. Loot boxes brought in over $30 billion dollars in 2018. It is because of this massive revenue generation that games like Call of Duty have recently added loot boxes.

Loot Boxes are not just in pc games or console games (like Playstation or Xbox), but can also be found in mobile games (which make up over 50% of the worldwide market for video games). If you have a loved one that plays video games (child or adult), ask them about loot boxes. Ask if they purchase any and if so, how are they coming up with the in-game money to buy them.

23Sep/19

What Civilians Can Learn From the Army About Death Planning

Back in April, I had to attend the first of two, two-day pre-predeployment sessions with the Army (don’t even get me started on the wisdom of having two of them). One day was spent on medical exams and the other day was dedicated to a massive variety of administrative paperwork.

One station dealt with death. It wasn’t labeled the death station (I’ve asked around – it doesn’t have a formal name. I think it was station three that weekend). The first person I checked in with updated my military insurance information. We discussed who gets money if I die, including a backup recipient in case that person is dead. We reviewed the beneficiaries’ names, addresses, and various contacts. I had to sign several copies of the forms and they were witnessed.

The next person I talked to at the death station asked about who gets my last paycheck. I was also asked if I had a will (at that time, I didn’t, but I had one made during the summer).

The final person at the death station inquired about who gets my remains upon returning to the states and who is my health care proxy.

All of this was asked in a very direct, matter-of-fact way. There were easily 150 soldiers that went through the station that day. No one got angry. Or cried. Or, from what I could tell, was filled with despair. It was similar to reviewing our vaccines or our educational history or other military records. Every year that I’ve been in the Army I’ve had to go over the military insurance and the beneficiaries. But the last paycheck, the will, the remains, and the health care proxy were all new queries.

A close friend of mine had a bit of a difficult time when her father died. There wasn’t a health care proxy or an advanced directive, and it made a stress period in the hospital much harder as her family members argued over what should be done.

Having this paperwork done well in advance ensures that the decisions are made rationally and that the guidelines are in place. It also makes sure the person dying is treated the way they want (and not the way the loudest/most difficult family member wants).

I have been teaching at the Rutgers School of Social Work since 2011. Dozens of my students have interned at nursing homes or convalescent centers. Many of them were tasked with asking the residents questions about their will, funeral plans, advanced directives, and/or health care proxies. My students were regularly berated for bringing these topics up (“she wants me to die!” one octogenarian yelled). Granted, part of it may have been their delivery (mostly their discomfort with it), but these are very important discussions that need to be held. Younger family members usually hesitate to bring these up, as they don’t want to cause their loved ones distress. And that is a massive mistake. These are hugely important matters that must be settled.

Stunningly, the military does an excellent job at this. The civilian world can learn a lot from that process. So, to be clear:

  1. people need to have a will and name an executor (you should name a backup, but not co-executors – some people with two children do this and it’s really foolish)
  2. people should have an advanced directive written out
  3. people should have documentation signed that names a health care proxy
  4. people should have life insurance and have it regularly reviewed and updated
  5. people should make sure that their loved ones know about the existence and location (of copies) of items 1-4

For those of you that are looking for a simpler solution, this document (thanks April Cardone) covers the advanced directive and health care proxy (you still have to work out your will and insurance). If you are over 40, you should have these done. If you have elderly family members, you should get on them to get these things done. But be mindful of how you bring it up. You might want to enlist the help of a social worker.

13Jul/19

Disenfranchised Grief Amongst Individuals Returning from Incarceration

by Anthony Gallo

Forward

The following article is based upon an interview conducted by the writer with an individual who served a brief sentence in federal prison. It describes the feelings of disenfranchised grief experienced by this individual after his release. All names have been changed to protect the individual’s identities. Due to a dearth of scientific research on disenfranchised grief in this context, many of the opinions expressed are based upon anecdotal evidence and extensions of related theory developed in other contexts. The article serves as an introduction to this form of disenfranchised grief for both the counselor and the ex-offender, as well as a call to action in expanding research on this topic.

Coming Home: Disenfranchised Grief

Unable to sleep, John stared up at the ceiling feeling the strangely soft sheets against his skin. The room was quiet, and the night was uncomfortably still. John thought of the men he considered brothers, sleeping far away in less luxurious accommodations. The brothers he had left behind, who had grown to know him better than anyone had before. Though he had to go, John still felt pangs of guilt for leaving. Everyone told him how lucky he was to be out, but he wanted to go back. A tear trickled down his cheek. “What is wrong with me?” he thought as his mind raced back to the night before, when his brothers and he celebrated his last night being “down.”

Suddenly the bed rustled, and John glanced over at Jenna, the woman that he loved, sleeping peacefully at his side. She had stayed with him through thick and thin, to the envy of his friends, and faithfully visited every two weeks. Now they were finally reunited, in a luxurious resort no less, yet John only felt sad and alone that night. He thought of waking her and sharing how he felt, but she was happy to have him back and he didn’t want to risk hurting or worrying her. John also knew that he could never fully convey what it was like in there, or who he had to become to survive. There were so many things John couldn’t, or wouldn’t, tell her out of fear that she wouldn’t understand.

After a sleepless night John woke Jenna and they walked together to the resort’s fitness center for his daily lifting routine. Working out was familiar, and John wanted to feel a little bit of normalcy again. He picked dumbbells off the rack, finished a set of curls, and placed them down to use the restroom. John returned to find that a man in his late sixties, with thinning white hair and a frail frame, had commandeered his weights to do lunges in the corner. Taking another man’s weight was a major disrespect and John quickly began formulating a plan to save face.

John clenched his fists as anger boiled inside of him, threatening to spill out of his mind and into action. Sensing John’s tension, Jenna tugged his arm and asked, “Is everything okay?” With Jenna’s touch the spell was suddenly broken, and John’s rage melted into shame and embarrassment at what might have just happened. John dismissed Jenna’s inquiry, afraid of what she would think if she knew that John had planned to confront this man. How could John expect her to understand his thoughts to assail someone older than their fathers over such a minor slight? John was caught between two worlds. His reaction would have made sense to his brothers but would have been deemed highly inappropriate by Jenna. John didn’t know where he fit in anymore.

Released the day before from Federal Correctional Institute Ft. Dix, John’s time being “down,” a slang term for incarcerated, was now over. John had dreamed of this day and coming home was supposed to be glorious. Yet he felt alone, depressed, and overwhelmed readjusting to society. Unknowingly, John was grieving over the loss of some elements of his time incarcerated. John kept most of this grief inside, feeling as if others wouldn’t understand or care. He was experiencing a type of grief called disenfranchised grief.

Introduced by Dr. Kenneth Doka in 1989, the term disenfranchised grief refers to any grief that falls outside the norms and rules that society sets for which losses are appropriate to mourn, who can mourn them, and for how long the losses can be mourned. For example, society would allow someone to mourn the loss of a spouse but generally would not accommodate someone’s grief over the death of a mistress or lover. While the relationship with a spouse is accepted to be legitimate and significant, a person’s relationship with a lover or mistress is taboo and therefore unacceptable to grieve over. Grieving over the return from incarceration generally falls outside the norms of acceptable grief in our society as well.

Despite having goals of reforming the inmates they house, prisons are generally regarded as horrible places that subject inmates to purely punitive and negative experiences. Few people choose to go to prison and many spend significant resources in the fight against being incarcerated. Incarceration physically restricts an individual’s freedom, puts employment on hold, removes them from their family and friends, and subjects them to elevated risks of bodily harm. Being incarcerated also often strips them of their personal identity, rights, and life purpose while drastically lowering their standard of living.

With incarceration being perceived so negatively, being released from prison is often visualized to be a wholly positive experience for the ex-offender. They have theoretically paid their debt to society and now get to return to their family and friends, re-assume their identities, regain their personal autonomy, and resume their lives and careers. They can more freely navigate the world and make their own decisions and also regain most of the rights they had prior to their time incarcerated. How then, do some inmates grieve over what should be a wonderful moment in their lives?

To answer this, we must begin by acknowledging that not all aspects of prison are bad, and not everyone has the type of traumatic experience that society expects to befall them while incarcerated. This is not intended to minimize the negative impacts incarceration has on many inmates’ lives or to justify the major issues caused by the US prison industrial complex, it simply recognizes that some inmates may find parts of their experience to be positive and fulfilling. Ignoring this fact leaves little room for understanding or empathizing with the disenfranchised grief experienced by some inmates returning to society.

In 1943, an American psychologist name Abraham Maslow developed an overarching theory of human motivation titled the Hierarchy of Needs. Adapted to the context of incarceration, his theory helps shed light on why some inmates might miss prison. Maslow theorized that humans have different needs that must be met in a sequence he ordered by physiological needs, safety needs, love and belongingness needs, esteem needs, and self-actualization needs. Physiological needs are the biological requirements for the body to function and were viewed as essential to have met before satisfying higher needs. Safety needs refer to the protection of the human from the elements and from physical harm, while love and belongingness needs include developing friendships, intimacy, trust, and acceptance. Esteem needs include aspects such as personal dignity, feelings of competence, and status or prestige. According to Maslow, the ultimate goal of meeting a human’s self-actualization needs include achieving fulfillment “to become everything one is capable of becoming.”

John’s experience shows that prison may be capable of satisfying most, if not all, of these human needs. Physiological needs are always met, even if the food and drink are sub-standard, and safety needs are generally met via consistent housing, rules, and structure in the inmates’ lives. Many love and belongingness needs can also be met inside the prison walls, either through gang involvement or close friendships. Esteem needs are sometimes met when inmates develop valuable roles in the inmate community, either informally or via their work assignments. Lastly, self-actualization needs could possibly be met through finding one’s calling within the walls of the prison, such as the jailhouse lawyer that helps overturn his fellows’ cases.

While interviewing John for this article, he shared that he had indeed felt like all his needs, other than self-actualization, had been met while incarcerated. He never had to worry about food or shelter while incarcerated. John also shared that his love and belongingness needs had been met by the close relationships he formed with a select few of his fellow inmates; men he came to regard as brothers more than friends. John also felt that his esteem needs were met through the value he brought to the community by cooking, working in the gym, and serving as a confidant for many inmates who felt comfortable speaking with him about sensitive matters.

John’s physiological needs remained satisfied upon release. However, despite having a close-knit family and the presence of Jenna in his life, John consistently expressed that his love and belongingness needs went largely unmet upon his return home. To illuminate his point John made comparisons to the experiences shared by Sebastien Junger, a journalist who spent his career covering military conflict, during a TED talk on why military veterans miss war.

In the talk, Junger describes an interaction with a traumatized soldier named Brendan who had experienced death and vicious fighting on the battlefield. When asked if there was anything he missed about the war, the soldier responded, “I miss almost all of it.” Junger theorized that it was not the violence, death, or the trauma that this soldier missed, but the feeling of brotherhood he had left behind on the battlefield. Brendan missed the human connection he experienced by enduring intense hardships with his fellow soldiers, who he also came to consider as brothers. Junger went on to explain that brotherhood is a mutual agreement in a group that an individual will put the welfare of the group over the welfare of the individual. Humans are intensely social creatures and we tend to immensely enjoy such interpersonal connections. Unfortunately, civilian society’s luxuries of independence rarely afford such opportunities for true brotherhood.

John shared that he felt this sense of brotherhood amongst his closest friends in prison and he was unable to replicate it in life on the outside. John had grown to rely upon those men for his safety and emotional well-being. He trusted them to share their limited resources when in need and to expose themselves to physical danger to protect him, and they knew he would do the same in return. Spending so much time together, with nothing to do but talk, he had formed incredibly close bonds with these men and felt that they knew him better than anyone had before. When he returned home, he questioned what his friends at home would really do for him when the chips were down. How could he ever hope to feel as intense of a connection with friends who wouldn’t be willing to give their life to protect his? He wondered whether they could ever understand him and worse, whether they would judge him for the humor and customs he had developed while incarcerated.

It is not known how common John’s experience is amongst inmates returning from the criminal justice system. In researching John’s experience this writer was unable to locate any scholarly research on disenfranchised grief relating to release from incarceration. There is significant work showing the impacts of maladapted traumatic grief on incarceration and recidivism but seemingly none on the grief experienced after release. There is also much study of the similar concept of “institutionalization” but the articles reviewed largely focused on recidivism rates due to mental health, substance use, traumatic grief, and unemployment. However, this writer did find ample anecdotal evidence that John’s experience was shared by other ex-offenders by reviewing posts in online forums. The following excerpt is from one of those forum threads:

“I just think sometimes how dam stupid it all sounds…. I mean being down for 5 years in a basically max security prison and getting out and missing it. I think to myself what the hell is wrong with me? I do love my freedom I don’t want you to misunderstand me. And when I was locked up I wanted to get out so badly. And I do love life and freedom…..it’s just….I am so changed in every way and feel so alone sometimes. What’s weird though is being surrounded by people bothers me and all I can think about is leaving where I am.” – Skitten1208

John’s and Skitten1208’s experience of wondering “what is wrong with me?” struck the writer as extremely poignant examples of the difficulties posed by disenfranchised grief. When individuals experience an acceptable loss, society has already set an expectation of grief and they understand that it is okay to feel and express sadness. Additionally, they enjoy the healing benefits of empathy and understanding from friends and family, as well as an ability to engage in social mourning rituals. With disenfranchised grief there are no such expectations or emotional support for the grieving individual. These grievers therefore may not understand their grief or that their emotions are in fact natural and healthy. They may also feel intense alienation and shame for missing something that society deems that they shouldn’t.

With no research available on this specific form of disenfranchised grief, work with ex-offenders should focus on the general therapeutic concepts of treating disenfranchised grief. The counselor should stress that the grief is indeed valid, despite falling outside of societal norms, and that there is nothing wrong with the individual for grieving. Furthermore, the counselor should take time to listen to the individual and allow them to express their feeling of loss. The time in session may very well be the individual’s first opportunity to do so. It is also important that the counselor expresses an understanding of the loss through techniques such as reflecting, paraphrasing, and summarizing.  The longer an individual’s grief goes without acknowledgement or legitimacy the longer it may take to resolve.

In addition to working with the affected individuals, this writer believes it is vitally important to begin conducting research on disenfranchised grief in this context. If this experience is not recognized or studied by the very professionals who make a living examining such concepts, then how can we expect impacted individuals and mental health professionals to recognize or understand it themselves? In fact, the lack of research seems to prove exactly how disenfranchised this type of grief truly is. We need to understand how common this type of grief is, how it impacts the individuals affected by it, how to treat it, and how it may play into the larger examination of recidivism in the criminal justice system.

It is this writer’s hope that this article can spur conversation and research around the topic. At the very least, the writer hopes to have shown individuals like John and Skitten1208 that there is, in fact, nothing wrong with them at all. Though society might not yet accept it, this article can play a small part in validating their experience and right to grieve.

__________________________________

Anthony Gallo is a Licensed Social Worker and Licensed Clinical Alcohol and Drug Counselor Intern with a Master’s Degree in Social Work from Rutgers University. Anthony’s experience with direct patient care complements his passion for macro social work, enabling him to promote practical legislation and outcomes focused business practices. In his personal life, Anthony is an avid auto enthusiast and enjoys theater, photography, and polishing opals.