29Jun/19

How To Talk to Someone with a Terminal Diagnosis

I had been working as a counselor for less than six months when a guy on my caseload told me that he was dying from AIDS. He wasn’t sure if he contracted it from sex or sharing needles. It was late at night and he couldn’t sleep. He told me it took him a few months to feel comfortable enough to open up to me about it.

“It’s hard to focus on staying clean sometimes because I know I’m going to die soon. Every day I have moments where I ask what’s the point.”

He talked about how he had wasted so much time. He was angry at himself and others, but mostly himself. “I’m fucking scared Frank,” he said as his eyes welled up.
“I put it out of my head and once in a while I have a nice moment or a laugh, and then it comes roaring back.”

I stayed later than usual. After that, we fell into a routine. I worked until 11 pm a few nights a week. Usually he’d come into my office around 9 or 930. We’d talk about music, sports, and old movies. Usually we’d delve into some aspect of addiction and/or recovery. He didn’t talk about his diagnosis every night, but when we did, it was pretty deep. I felt inadequate to the task. I had never read anything about how to talk to someone that knew they were going to die. I had not be trained on it. I felt powerless. And then I figured out that my presence was a good start. I learned quickly to mostly listen, though I did ask questions. I never gave him advice or my perspective on his case (or death in general), unless he specifically asked. Eventually another man with a terminal diagnosis joined us. They raged, cried, and occasionally laughed in my office. As time passed, I was touched and honored by how much they shared and trusted me. Both died within two years.

One of my favorite clients ever got sober off of pills and heroin in the summer of 2007. An older male, he had trouble identifying with all the twentysomethings in group that were mostly court mandated. He hung around in an outpatient group for two years. At graduation, he gave me a water color painting that he made for me. “You told me I had to fill my time and I started fishing again. Remember when I went to Alaska late last summer with those other guys in recovery to go fishing? Well, I painted this for you. Do you recognize it?” I did. It was of the Coast Mountains. I had been dazzled by the orca-like patterns of snow on rock when I was in Alaska in the late summer of 2001. I was moved (ever since, the painting has hung in an office or at my house).

In 2011, he was diagnosed with terminal cancer. He relapsed and his health problems rapidly deteriorated. He reached out to me and I met him at an AA meeting in Clinton. I struggled to recognize him, for he had lost so much weight and his skin was ashy. We talked about anger, fear, unfairness, regret, pain, numbness and depression. I tried to help him get and stay clean, but he couldn’t put substances down for any length of time. He died a little over a year later. I went to his funeral and talked to his family. All these years later, I still carry the prayer card from his funeral in my car.

There have been others. There are two people in my life who are not yet 40 that have been diagnosed with terminal cancer (one brain, one breast). I visit my friend with brain cancer every two to three weeks. We have multi-hour discussions that touch upon everything, but we always talk about dying and death. His death. I ask questions. And listen. Sometimes he rages, though it’s rare. We laugh far more than you would guess.

One of the things that really aggravates him is when people ask if he got a second opinion or tried a specific remedy. A few months ago, I told him about my friend’s wife (breast cancer) and how one person reached out to her and told her that if she drank a certain concoction that it should help. And that it really pissed her off. He laughed and said, “It’s amazing how stupid people can be.”

My advice (the don’ts are pretty easy):

1) Unless you are members of the exact same religion and go to the exact same church/temple/wat/mosque with the exact same spiritual leader, refrain from saying it’s “God’s plan” or “God’s will” or offering up some other religious platitude. I write this as someone who has softened on religion over the last decade (I think it can be a wonderful way to be part of a community and engage in service work). Since humans organized into tribes and towns, we’ve had some kind of spiritual or religious belief system. Religion has attempted to explain (or make sense of) death and comfort both those that are dying and those left behind to mourn. But I think you should be very, very careful about using your religious explanation to help someone you know that is dying. Unless you go to the exact same religious building.

2) If you were dying, I assume that you would read a lot about the diagnosis on the internet (and hopefully books). I expect that you’d do everything you can to get cured or try to prolong your life. And yet, every person with a terminal diagnosis that I have ever spoken with has told me of at least one person who offered them medical advice. The advice could be crystals, potions, medications, Western methods, Eastern methods, eliminating some food, eating specific foods, or something else that evades me right now. I know that you mean well, but everyone I’ve talked to with a terminal diagnosis was irritated by this. Do not try to solve their problem, unless they ask you.

3) Ask them what you can do. If they say nothing, offer to give them a ride to the doctor’s office or the store. Bring food over. If they have kids, offer to watch them one afternoon or evening (if you are the responsible type). A writer that I admire lost his brother to cancer when he was 13. He talked about being on “planet cancer” and how everyone avoided him and his family. Be present.

4) Don’t make it about you.

5) Don’t talk about other people’s experience with the same diagnosis, unless they specifically ask you. They deal with their diagnosis all the time, and they have talked to lots of people about it.

6) Tell them you don’t understand what they are going through. But you will listen to them if they want, without advice. Ask them what they need from a conversation. To yell, cry, laugh, distract, mourn, ache, or plan. Everyone is different. There is a lot more here, but this is a good primer. If you find yourself in this position and want to know how to listen and talk to someone about this, we can have a quick chat about it.

The first five are easy. You just need to be aware of them. The sixth one is difficult, and most people aren’t up to it. That’s ok. If you can do 1-2-3-4-5, you are a good friend or competent family member.

22Jun/19

What Spouses, Family Members and Friends Should Know about High-Stress Jobs, Part One

Many Americans feel very stressed, and a lot of people worry about burnout at their jobs. While I sympathize with those schedules and stressors, there are a few jobs that are in a different class all together. I have counseled thousands of people from all types of vocations, but over the last decade, I have done a lot of work with law enforcement officers, correction officers, current service members and veterans, and social workers. These are high stress jobs that affect both the workers and their families. I have a very strict definition of a high-stress job (full disclosure: none of my work meets my criteria for high stress). It means:

A) one’s physical safety is under regular or constant threat

and/or

B) one sees/deals with horrible things happening to people under 18 years old

To be clear, horrible things can mean malnutrition, verbal abuse, physical abuse, sexual abuse, burning, mutilation, and/or death.

Most correction officers meet the criteria for A. Many law enforcement officers do as well. Some service members do. Social workers who are working in prisons or child protective service agencies certainly do. PTSD or complex PTSD (C-PTSD, which the public and even most professionals don’t know about) are more common than not in people with those jobs who meet criteria A.

Unless the correction officers work in a juvenile detention facility, they won’t bump into criteria B. Law enforcement does, particularly those who deal with domestic violence calls, car crashes, and most horrifically, child sex crimes. Almost all child protection service workers come across neglect and physical abuse, and many have to deal with the fall out from sexual abuse. Those who are in the military and come upon dead children in war zones are usually haunted by those images (I’m not even going to write about those who had to take the life of a child soldier or child suicide bomber, as I doubt I have the power to explain that situation to civilians). In the summer of 2017, I spent some time talking to an Army sniper who worked as a fire fighter when he wasn’t on active duty. He told me about how difficult it was to come across the bodies of burnt up children. I asked him how common it was. He said it didn’t happen much, but that most firefighters he knew that spent 20+ years on the job had seen that. Of course, I asked him if he or other firefighters had a chance to process it with a therapist who understood trauma. He laughed and said, “Of course not.” To be clear, anyone who meets criteria B over a sustained period of time is very likely to have symptoms of PTSD or C-PTSD.

I have grave concerns for these professionals and public servants, because their work is vital to our society. They are the ones with their hands in the muck. And the work does a number on them and their families. And their families. The jobs can be overwhelming, and there usually isn’t mental health and community support to deal with the side effects of the work.

In the aforementioned professions that meet one or both of the criteria, the following conditions are more common than in the general population:

substance misuse, anxiety, depression, PTSD, C-PTSD, disorganized gambling disorder, suicidal ideation

Those public servants are also more likely to have poor spending habits (using money to feel better), act out sexually, put themselves in dangerous situations (driving a motorcycle with a helmet, engaging in extreme sports, going into buildings without backup), isolate at the end of the day, and have marriages that end in divorce.

Because most are in jobs where being tough is a value, therapy is usually not offered and often looked down upon. “People who go there are weak” I often hear or “Other people have it worse.” I tell them if they meet the criteria for A or B, that very few people actually have it worse. They usually don’t tell their spouses about their work. They might utter “rough day” or “the usual” or “you don’t wanna know” or just sigh and go silent. Some variation.

The job changes them (how can it not?). They become quicker to anger and quicker to isolate. Spouses may resent how their partner has changed. And their partner doesn’t know how to explain it. And there is a strong chance that they aren’t any good at listening to their spouse talk about their less stressful job.

To be clear, I’m not asking spouses and family members and friends to excuse bad behavior that these professionals use as coping skills. I don’t want you to be their therapist. I just want you to understand that the work is horrifying. Here is what you can do:

1) Encourage the professional to go to therapy. Continually. They need at least one person in their life that they can process these terribly experiences with continually.

2) Monitor their sleeping and eating.

3) Encourage them to exercise regularly.

4) Monitor their substance intake.

5) Come up with a way for them to signal to you that they had a particularly rough day on the job.

6) Try to understand that they will probably be poor at listening to you talk about the stressors of your job and day. This is often a common complaint from couples where one person is in a high stress job.

7) For those of you that are spouses, it is imperative that you spend time together outside of the house, at least two days or nights a month. This is important for both their stress level and your relationship (all too often, a decade into a romantic relationship, it seems like you are running a daycare/housing/taxi service with no downtime for yourselves or each other…this leads to stress, resentments and potential awful fights).

I’ll get back to this before the end of the summer. For those of you that are friends of someone in those jobs, you can play a significant part in their well being. Please do so.

 

 

16Jun/19

Patrick M – An Appreciation of a 2019 Recovery High School Graduate

I have Patrick’s permission to share this photo and a bit of his story.

This picture was taken on Wednesday, June 12 at the 2019 Recovery High School Graduation (the full name of the school is the Raymond J. Lesniak Experience Strength and Hope High School). The high school’s recovery support is staffed by Prevention Links, a non-profit that I have worked at since the summer of 2017. The administration and the academics are provided by Union County Vo-Tech. It has been a wonderful and unique partnership between those organizations. The school has been located at the Prevention Links building in Roselle for the last few years. In 2019, Morgan Thompson became the CEO of Prevention Links. She is a Rutgers graduate (twice over), a person in long-term recovery, and (allow me to brag) a former student of mine.

Patrick struggled with substances during his freshman year. Things got worse. He bounced in and out of treatment. Switched schools. He was nasty to his parents and surrounded himself with negative peers. His grades plummeted. He was constantly in trouble. And usually high. Many people worried about his trajectory – the outlook was grim.

Patrick entered into recovery in August of 2017. He came to the Recovery High School in the fall. There were only a handful of students. While he missed the robust size of Metuchen, he worked closely with his recovery mentor, got a sponsor, spent time with his sober uncle, and began to apply himself in school. I would show up every couple of weeks and take him for a walk, regardless of whether it was hot, cold, or raining. We talked about school, his parents, girls, addiction, recovery, music, and his post high school plans. I enjoyed our walks.

The school grew and grew. This year we had almost two dozen students. Patrick was a leader and a role model. He had a bit of early senioritis, but he finished strong. And stayed sober the whole time. Patrick is going to college out of state (I wish he was going to Rutgers, but he is going to help his school develop their own recovery housing program).

At graduation, Patrick gave the student address. The NJ Commissioner of Education was there, along with some state legislators, several Union County Freeholders, the County superintendent, and a number of other officials who normally are not at high school graduations. The school has been able to thrive because of our diverse and powerful group of supporters. Patrick didn’t realize it, but he was under a bit of pressure to make a good impression. There were several speeches before him, and I could see that he was getting a little bored. From the audience, I have gave him a number of facial and hand signals to smile and bear with it.

When it was his turn to talk, he slayed it. He spoke about his addiction and the problems he caused his family. There were several moments that I teared up. He took us on a rollercoaster ride. It started quite sad. Painful. Then I felt hopeful. And pride. Near the end, he made us laugh a bunch. It was a killer speech (you should have been there).

I’ve been working in the addiction and recovery field for 16 years. There have been a lot of hard moments, in both the clinical and policy arenas. I’ve seen a lot of despair and death. I need moments like last Wednesday, when I get to see someone who has gotten sober communicate to others the joy and power of the journey. People can get clean and sober at any age, but the younger they do it, the less wreckage they have to clear. They also have a higher ceiling. I’ve been working with college students for a long time and will continue to do so. But getting sober in high school? Crazy. Inspirational. Life changing.

Great job Patrick. I’m so proud of you. Keep helping others.

01Jun/19

The Horrifying Responses to a US Army Question on Twitter

Right before Memorial Day, the US Army’s official Twitter account asked the question “How has serving impacted you?” Swiftly and devastatingly, the answers poured in. While there were some positive stories, an overwhelming majority were lettered with fury, lamentations, regrets, pain, and mourning. These responses ring true to my experience as a therapist who has treated veterans for many years. As a current Army Behavioral Health Officer, I won’t comment on what I am seeing from servicemembers today. But as United States citizen, I was deeply disheartened by the sheer number of the tragic responses. I didn’t read all 12,000+ comments, but I probably got through 4,000 of them. I have selected about two dozen to give you a sense of it.

28May/19

The Market is Flooded with MSWs

Image result for flood

A former student of mine graduated with a BA in 2016 and then the MSW (Masters of Social Work) in 2017 from Rutgers. He got his LSW (his license to practice) shortly after graduation. For the last two years, he has worked a couple of different jobs, slowly developing both his macro (policy, writing, program design) and clinical skills. He recently decided that he would leave his job in search of a straight clinical position so that he could accumulate the 3000 hours he needs to earn his LCSW (licensed clinical social worker).

The LCSW is the top license a social worker can get. It allows a person to supervise other social workers (though one needs three years at that level, plus a certificate in clinical supervision in order to supervise LSWs). I know this is a lot to take in for non-social workers. You are welcome to continue reading, but this is a rare post that is directed at the social work population.

My former student is having a hard time finding a position (it is easier for males to find clinical social work jobs than females, as the field is largely made up of women and programs like to have at least one male therapist for diversity’s sake — this is a common theme in fields dominated by women…men continue to have a leg up). He was recently offered a job where he would work a mixture of hours 9-5 and 12-8. Ok. A few nights a week are to be expected, especially early on in a social worker’s career. He was told that he would have to work both weekend days. That’s brutal. Here is where it gets even worse – the days would be M, W, F, S, S. So the days off aren’t even bunched together. Then he found out that he couldn’t even get supervision from the supervisor in order to earn his LCSW, as the supervisor hasn’t had the license long enough. Horrific. One more thing – the pay wasn’t very good. He turned it down.

But the program had dozens of people applying. And here is why:

Over the last 10 to 12 years, many of the various schools of social work have rapidly expanded their programs (Rutgers either tripled or quadrupled the size of their student body). The University of Southern California created an online program several years ago and they’ve quickly become a national behemoth (I’ll write another time about the horror show that is online education, particularly for professions that rely on face-to-face contact). In their race to increase revenue by adding students, these schools have absolutely flooded the market with MSWs.

A flooded market means that there is a large labor pool. Too large. There aren’t enough jobs for all of the MSWs that are being produced. Schools will argue that there are jobs – but besides the aforementioned position, many of the jobs that people are offered out of school are either part time or per diem. Usually well beneath their skill set. Usually without much of a chance for clinical hours. Usually without a qualified supervisor.

The lack of jobs has led to a secondary problem. Because there is such a large pool of educated workers, it has led to wage suppression. And for people with student loans or housing costs (so basically, almost everyone), the money is untenable.I see this problem only getting worse.

The schools have done a huge disservice to their students. But wait, there is more. Because of grade inflation, many students are graduating with high GPAs thinking that it is the key to a good starting job. The schools are relying on either overworked adjuncts or researchers who don’t really understand the field to teach students and prepare them for their career. And still, there is more. For the last decade, a majority of my students (both undergraduate and graduate) report getting substandard or little to no supervision at their field placements (the internships tend to be 16 hours the first year and 22 hours a week the second year, usually of course, for no money). This is true for schools of social work around the country.

It’s a galling situation, and pretty depressing for any newly minted MSWs or current social work students. The schools aren’t going to pull back and give up all of that sweet tuition. I am hoping that I can convince some of the professional organizations to begin to address this problem (full disclosure, I’m on the Board of Directors for NASW-NJ, and to be very clear, my views are my own and not NASWs).

If you are a new MSW or are currently a student, there are a few actions you can take to make yourself more likely to survive in this awful labor market.

1) Pick a supervisor, not a job/internship. Find someone that loves teaching and mentoring and that will always find time for you each week to review your work, have you present cases, and continue to develop your skills.

2) Join your state NASW chapter and go to the monthly meetings in your county. Take service and leadership positions within your local and state units. Develop and expand your network (find as many ways as possible to do this).

3) Make a list of the skills that you have. Counseling skills include:

  • Engaging
  • Exploration
  • Sustaining the Dialogue
  • Refocusing
  • Seeking Clarification
  • Reflection
  • Sharing Information
  • Validation
  • Appreciation
  • Review/Summarizing
  • Contracting
  • Role-play
  • Confrontation

Clinical skills include:

  • Clinical Expertise (Anxiety, Substance Misuse, ADHD, PTSD, C-PTSD)
  • Counseling Special Populations (spectrum, veterans, criminal justice, seniors, children)

Clinical modalities include:

  • Individual (the most basic, and therefore, the easiest to find)
  • Couples  (for over a decade, I viewed this as Dante’s 9th level of counseling hell…now I do a lot of this with law enforcement, military and veterans)
  • Group
  • Family
  • Multi-family (the rarest skill)

Other social work skills:

  • Case Management (again, very basic and very replaceable)
  • Assessments and Diagnosing
  • Written reports
  • Grant Writing (incredibly valuable)
  • Article Writing
  • Public Speaking (incredibly rare)
  • Training
  • Supervision (fairly rare)
  • Public Policy Formation
  • Program Evaluation
  • Data Collection
  • Teaching
  • Coalition building
  • Administration
  • Billing
  • Reviewing paperwork
  • Outreach/Marketing
  • Recruiting
  • Program Design

Find an internship/job that will teach and develop some of these skills. They can only be taught by someone who can actually do them. When you apply, don’t talk about your degree or your GPA. Talk about the skills you have. And be specific about the ones you want to learn.

4) Do you have any other specialized skills? Are you good with Excel or SPSS? Can you write code? Do you have advanced computer skills? Can you speak a second or third language? If so, let your prospective employers know. Put it at the top of your resume. If you don’t have any of these, consider taking more classes (I know, I know) to make yourself a better candidate.

5) Accept that you will probably work some nights and weekends. Tell your family, friends and significant other that this is how the field works. If you are a clinical person, make a careful plan on how long your hours will take you and don’t deviate from your plan. Get your licenses as quickly as possible. If you are a management/policy social worker, you want to develop a number of those aforementioned skills. Remember that the more rare and stronger your skillset, the more likely you’ll get the kind of job you want. You’ll also get paid more.

6) This one will irritate many people: to really get ahead, you may want to consider working a full-time job and a part-time job. They should be very different. You’ll develop a better understanding of the field. You’ll learn new skills. You’ll expand your network much quicker. This comes with a sacrifice though, as time is a zero-sum game. You’ll need to have some serious (and difficult) conversations with people in your life. (To be very clear, I’m not advocating that you work 60+ hour weeks for 10 years. That is a relationship killer, and the best predictor of happiness is the amount of time spent with people that you care about. I’m suggesting that you work a nutty schedule for 2-5 years and then scale back.)

I wish it weren’t this way. Between the nature of late-stage American capitalism and the flooding of the market by the schools, students and recent graduates are in a terrible bind. This is the path forward.

12Apr/19

On Suicide, Part Two

I’ve spent a lot of time over the last year reading books and articles on suicide. One book is Stay, which was written by Jennifer Hecht. She chronicles the history of suicide and the philosophical, religious, and civil arguments for and against it (post renaissance philosophers were the only ones that advocated for the right to kill oneself). I won’t rehash them here.

But I do want to summarize her two main arguments against suicide.

  1. “We owe it to society at large, and especially our personal communities, to stay alive.” (6)

The death of a friend or loved one causes great pain. There is the searing emotional agony, as well as growing recognition of permanent absence. Depending upon how present the departed was in another’s life, the more empty time is left. For many, it is a dreadful struggle back to a regular routine. That person’s pain and hardship is passed on to others, even those that didn’t know the deceased. The shockwaves ripple outward.

Ms. Hecht also wrote about the domino effect of suicides. “One of the best predictors of suicide is knowing a suicide.” (x) I would argue that there are proximity and mass domino effects as well: The closer that a completed suicide is to you, the more likely one is to attempt. And the more people you know that completed suicide, the more likely you are to attempt as well.

2. We owe it to our future selves.

Over a decade ago, I read Nick Hornby’s A Long Way Down. It is a novel about four people who meet at the top of a building in London on New Year’s Eve. They all planned to kill themselves, but didn’t because they were in the presence of others (suicide tends to be quite private). Mr. Hornby’s book (which has numerous comic moments) was well researched and took the subject very seriously. A key point was made, which is that most people that contemplate suicide move on if they survive the next 90 days. Many of us know cases where people considered suicide for years, even decades, but they tend to be outliers.

Since 2010, I have been telling friends with children that they should make deals with their kids. “I’ll buy this toy for you now, but you must promise to work five hours every Saturday in the garden at ages 14, 15, and 16” or some deal like that with their seven year old child (and get them to sign a paper and video record it). Kids have little to no sense of the time and long term consequences. Imagine how irritated your 14 year old would be when you produce the contract and the video.

“I can’t be held to what I wanted when I was 7!” they’d probably shout. The same probably goes for a deal made at 19 that is called in at 27, and so on and so on.

Back to suicide. I’ve worked with well over 100 people who were truly suicidal that did not kill themselves. Most of them are long past those thoughts and impulses, and have expressed gratitude that they did not go through with it. I have heard some version of the phrase, “I’m really glad that I didn’t kill myself. Things are so much better these days” then most will probably believe. But hopefully you will believe me.

____________

Ms. Hecht’s book concludes with this:

None of us can truly know what we mean to other people, and none of us can know what our future self will experience. History and philosophy ask us to remember these mysteries, to look around at friends, family, humanity, at the surprises that life brings — the endless possibilities that living offers — and to persevere. There is love and insight to live for, bright moments to cherish, and even the possibility of happiness, and the chance of helping someone else through his or her own troubles. Know that people, through history and today, understand how much courage it takes to stay. Bear witness to the night side of being human and the bravery it entails, and wait for the sun. If we meditate on the record of human wisdom we may find there reason enough to persist and find our way back to happiness. The first step is to consider the arguments and evidence and choose to stay. After that, anything may happen. First, choose to stay.

 

16Dec/18

On Suicide, Part One

I’m finally ready to start writing about suicide.

This year alone, I’ve read a number of books and hundreds of articles about it. My original plan was to write a single piece, but I found that I just have too much to say about that confounding and complex topic. Suicide. It evokes a range of powerful thoughts and emotions.

It is different than other deaths. Accidents, overdoses, and murders are also tragic and painful. In no way am I trying to diminish other ways of dying or rank them in some kind of ridiculous scale.

My mother lost three of the other four members of her nuclear family when I was 2 1/2 years old (she was not yet 40). Her sister, whom she shared a room with when they were growing up in Minneapolis, killed herself by drowning in the Mississippi river. I was immediately told what happened, despite my young age and the inability to really comprehend death at that stage of life. I think my parents did the right thing telling me. They explained that she was sick and took her own life and that my mother was very sad. Mom was a trooper though. She talked about it a lot (I was embarrassed as a child how often it came up in her conversations with others), but she was highly functional. I have no memories of her staying in bed, wailing away or silently brooding while looking out a window. I was a young adult before I really understood how much of an impact her sister’s suicide must have had on her. My mother’s process provided a model for the work I encourage others to do in the face of loss: talk about it, spend time with friends and family, and continue to move forward in life.

Earlier this year, my mom wrote about her sister for my first book. I was startled by something that I had never previously thought about: they shared a room growing up for over a decade (maybe two decades). That type of proximity over such a long period of time suggests a close relationship, or at the very least, a deep knowledge of one another. Late night conversations after the lights go out. Familiarity with early morning routines. Everyday exposure to what they are reading. Intimate understanding of facial expressions and physical gestures.

A couple kids in my high school committed suicide. I knew their names but I didn’t know them. It was a shock. I grew up in a time and place where nothing bad seemed to happen; put better, nothing bad happened to me. There were kids who had private hells that we didn’t know about. The morning in a high school after a suicide is an eerie place. The collective pep and bounce of teenagers has been drained. The day seems long and in slow motion. Laughing and planning feel guilty. The adults stumble with what to say.

There has been a lot of death in my life (that is eventually true for all humans, but usually weighted towards the end of our lives when we have more experience and wisdom to process it). My grandmother when I was 19. Fraser from an overdose when I was 26. Eric suddenly when I was 41. Dozens of students and clients. Soldiers and veterans that I have treated. I also work with the survivors. Hundreds of parents. A few young children of cops.

All of this is prelude to the only point I really want to make today, and one that I may have been able to get to in the third paragraph. I had a close friend complete suicide. I felt a deep sadness, confusion, and a bit of anger. That is almost the universal human response. There is something else though: a feeling of deficiency.

What is wrong with me and my relationship that someone I was so close with sought to kill himself?

It hangs on the edges of our brain and is rarely uttered. This was an invasive thought that popped into my head in the early weeks after my friend’s suicide. It must be far worse for a romantic partner or family member. I suspect that it is unfathomable and unbearable for a young son or daughter. “What is wrong with me?” Perpetually thought but almost never spoken.

It must be said out loud. It must be processed. Because I have an answer. There is nothing deficient about you. Suicide is terrible. Horrible. Do not make it about you, even if every waking instinct tells you to do so. It isn’t. This is why we must talk to other people about it.

27Nov/18

Do You Have To Be in Recovery to Help Someone with Addiction? (and other myths)

Do you have to be in recovery to help someone with a drug problem?

No.

That is the unequivocal answer, but I am happy to make my case with another 958 words. There are a few other foolish assertions that should be addressed as well. Over the years, I have heard the following statements out of numerous AA members, paraprofessionals, and licensed therapists:

  • Only you can decide if you are an alcoholic
  • No one shows up to an AA meeting by accident
  • Only an addict can help another addict
  • If you haven’t lived it, you don’t know it
  • People in recovery are better at working with substance abusers and others in recovery

Let’s address these one at a time.

  • Only you can decide if you are an alcoholic

This is a ridiculous assertion. We do not allow individuals to diagnose their own depression, anxiety, diabetes, cancer, HIV, or heart disease. One of the most common defense mechanisms that people with alcohol and/or other substance misuse disorders use is denial. A common form of denial is blaming others (I had a rough childhood, my girlfriend is mean, marijuana should be legalized, the cops were out to get me, school/work cause me a lot of stress). Another major form of denial is minimizing: they will say I’ve never been arrested. If they’ve been arrested, they’ll say I’ve never been to jail. And so on with prison. We can play this game with alcohol, then pills, then heroin, then needles and then sticking needles in the neck. Waiting for a person to admit they have a substance abuse problem is a poor plan, whether you are a family member, friend, member of AA, or professional counselor. Licensed medical professionals are trained in assessing and diagnosing. Some are clearly better at it than others, but they can do an excellent job at getting past denial.

  • No one shows up to an AA meeting by accident

I showed up to a Gambler’s Anonymous meeting by accident once. The GA members welcomed me, asked me 20 questions in the middle of the meeting and then eventually said, a bit disappointedly, “you don’t have a gambling problem.” Over the last 10 years, I have sent hundreds of nursing, pharmacy, communication, social work, and law students to open 12-step meetings to learn more about addiction, recovery and the power of communities. Courts have forced people to attend meetings who made a mistake or committed a crime, but don’t meet diagnostic criteria. There are dozens of young people I’ve met whose parents forced them to attend meetings because they caught their son or daughter smoking pot or were outraged that they came home drunk. People show up to meetings by accident, and they are sometimes sent to one when they don’t have a problem.

  • Only an addict can help another addict

I got clean and sober at 19 (I’m 40 now). When I went to treatment, every counselor and paraprofessional there was in recovery themselves. They talked about their own experiences a lot. Because of their openness, I felt both less alone and less like an outcast. I thought everyone that worked in the field should be in recovery. I had a psychologist who was not in recovery. He helped me with improving relations with family members, discuss college life, navigate job conflicts, point out my faults in romantic relationships and generally become a better version of myself (and better person). After graduating from Rutgers, I took a job in a long term treatment program. Every counselor and paraprofessional was in recovery. Many didn’t attend 12-step meetings outside of work, most had a lot of countertransference issues and there were several with real boundary problems. I remember thinking, “man…people in recovery really shouldn’t be in this field.” I left that job for an outpatient program where less than half of the clinicians were in recovery – I found there were some really good therapists in recovery, really good ones not in recovery, not so good ones in recovery, and not so good ones not in recovery. I am going to belabor my point. We don’t ask suicidal people (or formerly suicidal people) to work with those with current suicidal ideations. Most cardiologists are not in remission from heart disease.

  • If you haven’t lived it, you don’t know it

I figure I’ve used over 2,000 toilets around America and in 21 other countries on four different continents. I can’t fix toilets for @#$%. This is the kind of folk wisdom that you might hear in a 12-step meeting sometime, but I turn it on its head by claiming ignorance in the face of experience rather than expertise from experience. Experience with a problem can be helpful in dealing with an issue or treating someone else, but it isn’t a requirement. I have never had depression, been bullied because I was gay, gotten cancer, overdosed on opiates or lost a child, but I’ve helped people with those problems over the years. And I’ve been very effective at it. I find that people that claim an expertise because of their own recovery most likely don’t have other knowledge, education, training, or skills that they can utilize to help people.

  • People in recovery are better at working with substance abusers and others in recovery

I used to believe in this. Then I worked at that aforementioned program where everyone was in recovery and many of them were terrible at their job. If someone is in recovery, they might be able to use their personal narrative to connect with someone. But there are people who are not in recovery who have stories that can also connect with others and help get them to open up and consider making behavioral changes. I’ve known a number of great clinicians who are not in recovery, and the statement that people in recovery are better than them is not only offensive, it is false.

 

*I wrote this for Hazelden back in October of 2016. It was recently taken down from their website, so I have republished it here.

03Nov/18

A Veterans Day Story

My close friend and colleague Eric Arauz died in March. I wrote about him everyday for one month. Others followed suit. I took a bunch of the stories and made them into a book, which was published last month. Eric served in the Navy during Gulf War I, back in the 1990’s. He described himself as “a poor sailor but a great veteran.” He loved talking to other veterans and he was an excellent advocate for them, especially those with mental health and/or addiction issues.

Near the end of October, I traveled to the Psych Congress annual conference in Orlando. I was invited by the organizers to come down and talk about Eric. They honored him by naming the kickoff keynote after him and also creating an award in his name. Very cool. I read a few sections from the book. Before I closed with my chapter on Eric at Elizabeth High School, I mentioned how I really would have liked to tell him the story about an Army veteran that I met a week earlier in Philadelphia.

Independence Blue Cross of Pennsylvania put on an all day event about the Opioid Epidemic at the Kimmel Center in Philadelphia. There were four panel discussions and a keynote speaker. I was impressed with the event, and every panel had at least one truly impressive person. The keynote took place just after lunch. The speaker was retired U.S. Army Master Sergeant (MSG) Justin Minyard.

MSG Minyard is a big guy (over 6’5″). He wore a suit, no tie (I approved). His hair was short but he had grown a beard. MSG Minyard began his talk with an apology. “I had a traumatic brain injury,” he said, “and there are times that I can’t get my mouth to say what I am thinking. As frustrating it is for you to watch me pause and stumble, it is even more frustrating for me. Please bear with me.” It was a powerful introduction, and my heart went out to him. I think that most of the audience had a similar reaction.

MSG Minyard was stationed near Washington, DC in the late 90’s and early 00’s. He was on details for both President Clinton and President Bush II, and he also had the honorable task of guarding the Tomb of the Unknown Soldier. Within a couple of hours of the attack on the Pentagon on 9/11, MSG Minyard and his unit were at the site trying to rescue people trapped under the rubble. “I was trying to reach a woman who was trapped under three floors of debris and while trying to reach her a load bearing wall collapsed on me and I had spinal damage and had to have several discs removed.” He was 21 years old.

MSG Minyard was a good soldier but a terrible patient. He cut his physical therapy time by more than half and demanded to be returned to the field. He served multiple tours in Iraq and Afghanistan (at least five) and was injured on several occasions. He told a story about how he and a half dozen other special forces operatives were tasked with attacking a bunker in a city. The helicopter was 60 feet above the target. Just as MSG Minyard jumped out of the chopper and went to grab the rope to repel down, they took incoming fire and the helicopter swerved. MSG Minyard was not able to grab the rope and he fell the entire 60 feet. To compound matters, the soldiers that came after him (down the rope) landed on him, exacerbating his back injury.

To deal with the pain and trauma, he was prescribed Oxycodone and Valium. During his speech, MSG Minyard filled a glass with his daily drug cocktail. Then he filled up a glass vase with his monthly dosage. It was a powerful effect and the audience gasped. He lived this way for almost three years. It devastated his wife and his daughter.

“It got to the point that when my four year old daughter asked me to read her a bed time story, I would respond to her with the worst words possible at the highest volume, just inches from her face. Because if I read to her, that was 15 minutes that I could not spare because the CVS would close and I would not be able to get my medication and I’d go into a horrible withdrawal.”

Silence. And then, “I did that. I’m responsible for that. I can never undo what I put my ex-wife and daughter through.”

He talked to therapists and doctors. More than two and half years into his prescribed addiction, someone talked to him about alternative ways to deal with pain. “Why am I just hearing about this now?” he asked.

More silence. And then, “Think about this. I’m just a big dumb Army guy, but I did guard two Presidents and the Tomb of the Unknown Soldier. I was deployed multiple times and worked on highly important missions. I had access to care and support. If this can happen to me, it can happen to anyone around America.”

MSG Minyard was given spinal cord stimulation and got off his pills. The recovery process was difficult. He has been clean and sober for about eight years and now works for Boston Scientific (the company that developed the spinal cord stimulation technology). He said that he still has pain, but it is mostly manageable. He finished by talking about his 11 year old daughter and how she still wants to hang out with him (“at least for another year and a half”). He takes her to “an expensive park in Orlando” and they walk around all day and evening. The all day walking causes him pain, but he does it for his daughter.

He earned a standing ovation, even from me (I rarely do that). I left my seat and forced my way backstage, past staffers and security. MSG Minyard was drinking water and was guarded by two off-duty Philadelphia police officers. I went up to him and introduced myself. We shook hands. I told him what I do and I thanked him for his talk.

And then I asked him if he wore cufflinks. He said yes.

“Do you have a pair of Army cufflinks?” I asked him.

“No.”

I started to take mine off. He saw what I was doing and said, “Sir, I can’t possibly take those.”

“Sergeant, you’ve earned them. Wear them with gratitude and pride.”

One of the cops turned towards MSG Minyard and said, “You have to take them. He outranks you.” Then the cop turned to me and saluted.

With tears in our eyes, we all shook hands. I gave him my card and told him that I’d like to connect and possible bring him to Rutgers for a talk. As I started to walk away, my first thought was that Arauz would have loved that guy’s speech and my gesture. It was a resurrection story.

A Veterans Day story.

 

14Oct/18

On Death and Grieving

In early October, a very close friend reached out to me via text to tell me a friend of his had died that day. Just 39 years old, the man had succumbed to his substance misuse disorder after many years of complete sobriety. When my aforementioned friend lost someone very close to him in 2014, I sent an email out about what he (and others) might want to do in both the immediate and long-term aftermath. He asked me for that advice again. I sent him a longer version, which I’m posting here for the public (I’ve edited out the deceased name).

What you should do:

  • Write down everything you can about him/her. Things he said, things you did together, jokes played, things that pissed you off and little gestures. Your mind will be flooded with memories over the next two weeks, and then they will slowly fade. You will never remember him as well as you do right now. Write it down. Also…it will help you grieve. Do this every day, for 30 days, without fail.
  • Keep up your exercise routine. If you don’t exercise, you should start.
  • Consider seeing a therapist who specializes in grief and loss.

What you should avoid:

  • Avoid isolating after the first 24 hours. Humans (and animals) have a tendency to crawl into a hole when injured or sad and avoid contact. It is a terrible instinct for grieving. Having people around, even if you don’t discuss the death, is helpful. Maybe not 24/7, but certainly daily. I am incredibly grateful for my friends who realized that they should stop by for a meal or watch baseball or just hang around during my various periods of grieving.
  • Do not take in more caffeine or nicotine than usual.
  • Be aware of your eating. Some of you may have no appetite, while others will seek comfort in food. Both options have negative consequences. Try to keep up your regular diet.
  • If you are someone who uses eating, drinking, drugging, sex, gambling or shopping to feel good or self-treat, be very wary over the next three months. If you are in recovery from one or more of these issues, consider talking to friends who are also in recovery or upping your support group attendance.

What you should be aware of:

  • I was angry at Fraser for dying and then I would feel bad about being angry at my dead friend. It was confusing. It took me a while to reconcile all of those feelings.
  • You have the right to talk with who you want about this, and you can also tell people that you are sad and just need some space. I found that I talked about it a lot with a couple of close friends, shared about it at every meeting I went to and discussed it in therapy. But I didn’t have it in me to talk to everyone. Some people just pissed me off or didn’t “get it.”
  • Everyone grieves differently. Everyone. Don’t fight with those close to you because you don’t like the way they grieve.
  • Remember that his/her family’s pain is worse than yours. Writing a letter to them about how much he meant to you, as well as some funny/good stories will be valued more than you can possibly know.

I’ve written a lot about death and grieving over the last four+ years. I have provided some baseline advice in this article, but for more specific situations, you might want to check one or more of the pieces below.

In the spring of 2014, Rutgers published a story about my work and how I was inspired after the death of my childhood friend Fraser Curry. I wrote a follow-up piece about my reaction to his death and what people can do if they have a friend or family member with a drug problem: http://greenagel.com/what-to-do-when-your-friend-or-family-member-has-a-drug-problem/

When my friend Pat died, I wrote this in 2014: http://greenagel.com/our-friend-pat/

This is a (near) copy of a speech I gave at an Overdose Vigil to 350+ parents who lost a child to addiction: http://greenagel.com/to-the-parents-who-have-lost-a-child/

A long-time patient of mine died in December of 2016 and I wrote this for myself and other counseling professionals: http://greenagel.com/on-the-death-of-my-patient/

A cousin of mine lost a baby in 2017 and I wrote this: http://greenagel.com/to-the-parents-who-lost-a-young-child/

I lost one of my closest friends (and my closest co-worker) this past March. I followed almost all of the advice that I’ve laid out (I didn’t work out for three weeks and I over ate). My writing turned into a book and it was released on October 8th on Amazon. It is titled The Book of Eric and it provides an example of how to deal with loss and grief.