All posts by fgreenagel

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.

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.

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 –

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 –

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 –

September 11, 2018 – A Soldier and a Wonderful Leader –

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

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.

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.

Disenfranchised Grief Amongst Individuals Returning from Incarceration

by Anthony Gallo


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…’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.


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.

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


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.



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.

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.