Tag: stress

The danger of “nobody else can understand”

If you are in public safety or the military, as well as some other fields, you know that some people insist that there it is pointless to talk about work to any “outsider.” Often, big agencies have this attitude toward smaller, less busy, ones –  “We are the only REAL firefighters, police, medics, etc., around here.” So they close themselves off from  support by people who otherwise might be peers.

The walls even go up within agencies – specialized, elite teams form a “tribe” mentality that says if you haven’t been part of a similar unit, there’s no point in talking to you about stresses and challenges, even if do the same kind of job.

No doubt, there is some truth to this. Working at a big, busy, urban agency certainly is different from smaller ones. Combat experience absolutely has unique aspects. Being part of an elite or specialized team really is different. People who haven’t walked the walk truly cannot understand. Experience is the only instructor – words quickly fail if we were to try to fully communicate it, especially the emotions around high-stress events (which can directly impact the brain’s speech center).

For a number of years, I have suspected that organizational isolation – that’s this is about – could be as toxic as individual isolation. We know that social support is the most important factor in resilience under stress or recovery from trauma; isolation aggravates stress. In fact, almost any trauma expert will agree that people will continue to suffer as long as they remain isolated –  connections with others give us strength and healing.

I recently began reading Ellen Kirschman’s book, I Love a Fire Fighter: What the Family Needs to Know, which has been sitting on my nightstand for a while. Dr. Kirschman, a well-regarded therapist in public safety, is also regularly involved in the West Coast Post-Trauma Retreat, where I have volunteered and learned.

Here’s the light bulb that went off as I read Kirshman’s introduction – the “nobody else can understand” attitude cuts us off from our friends and family. If you are certain that even a co-worker who isn’t part of your elite unit can’t support you because “they don’t understand,” then how can your friends and family who are civilians, possibly support you?

Here’s one of Kirschman’s observations about going through a fire academy (emphasis mine).

No one acknowledged how the emotional courage fire fighter families need or the independence that is forced on them contributes to the fire service mission. This is extremely puzzling in light of the many studies that confirm how family and friends are the heart of a fire fighter’s emotional support system.

Her books (she wrote a similar one for law enforcement) are for families, but the message to public safety is just as important. Your social support outside of work is also critical to your strength and resilience in the face of occupational stresses, and recovery from critical incidents and other injuries that aren’t physical.

The following words are why it does not matter that outsiders can’t understand the job.

Empathy does not require understanding.

It’s true – if you are an outsider, you will not understand. If you’ve never been there, I can’t explain what it was like to talk to a patient one minute and then do CPR on him, unsuccessfully, the next. You won’t understand how difficult it was to walk past his wife in the ER waiting room, seeing her comforting another wife, not knowing her own husband was just pronounced dead. If you’ve never done anything like helping a family bury their dogs who couldn’t escape a wildfire, nothing I can say will make you understand. If you haven’t been part of a rescue that went all wrong and killed the victim, I don’t have words for the emotions. If you haven’t done shift work, you don’t know the toll it can take.

Even if you cannot understand, that doesn’t have to stop you from supporting a responder if you are a trusted friend – because empathy does not require understanding. They may spare you details. They probably won’t repeat the sick jokes that helps many get through the day. But if you are willing to simply walk beside them, your presence can be healing.

You don’t need to understand responder experiences to know that they are painful. You don’t have to work shifts to that it is hard to be exhausted and miss family events. Everyone has experienced pain and frustration, he stress of an event or life going out of control. Co-workers can appreciate it more than outsiders, so co-workers are an essential part of any responder’s network of social support. So are spouses, friends with completely different careers, pastors and may others.

Camaraderie is powerful. Every agency – and groups within them – benefits from friendships, mutual support and teamwork. However, the idea that only our co-workers or people like them can support us is a misguided obstacle to wellness. We should not want anyone, from new recruits to  seasoned veterans, to believe that their friends and family have little to contribute. As Ellen Kirschman says, that idea cuts t them off from the heart of their social support system.

Paramedics with social support sleep better

An article in the Journal of Occupational Health Psychology earlier this year described a one-week study of paramedics’ sleep and their social support. Those who saw themselves as having more social support reported better sleep. The researchers also observed that the sleep quality of paramedics who perceive more support isn’t as impacted by job stress.  On the other hand, they reported “Those with low levels of support displayed poor sleep quality in the face of high occupational stress.”

In recent years, it has become quite clear that good, deep sleep is vital for coping with stress – poor sleep is associated with increased risk of developing PTSD.  The correlation between social support and coping with stress has also been observed repeatedly in studies. It’s unsurprising to find a link between social support and sleep quality – this reinforces the importance of both.

News report: Meditation reduces stress, changes your brain

Many studies have shown that meditation can be a powerful way to reduce anxiety and raise the body systems that calm us down after exposure to stress. The Washington Post last May reported findings of Sara Lazar, a neuroscientist at Massachusetts General from brain scans that showed that some parts of the brain expanded and others became smaller after sustained meditation.

This is part of a big change in thinking about our brains, which until recently were assumed to be fixed, unchangeable. Now we we have a word for the brain’s ability to change – neuroplasticity – as well as increasing evidence about what kinds of attitudes and activities encourage positive changes.

We should stop teaching “eustress and distress”

Stress management often teaches that there are two kinds of stress – distress, which is what we usually think of as stress, and “eustress” – stress that is good for you. The idea of eustress – the word itself – came from Hans Selye, a pioneer in understanding how our bodies respond to challenges. Selye was an endocrinologist, focusing on hormones and the systems that regulate them.

One of Selye’s great insights is that when we experience a change or other challenge, we will have a physical stress reaction, whether we see it as positive or negative. For example, graduation from high school or college – an event the graduate certainly considers positive – is stressful. And of course it is – a fresh graduate faces uncertainty about what will happen next. Their social support network, a key source of resiliency,  is disrupted as they lose touch with classmates.

Selye’s fundamental insight, that both positive and negative events are stressful, has been demonstrated to be true in many, many research projects. Cognitive neuroscience is unveiling more of the mechanisms and complexities of our physical and emotional responses to stress.

Talking about “distress” and “eustress” is confusing. Psychologists use them because in casual talk, ee use the word “stress” to refer to both the cause and our reaction. “Graduation is stressful” and “I’m stressed about graduation” are both reasonable sentences, but they are saying two different things. The first is about what happened, the second is the graduate’s reaction to it.

Let’s swap in the other words. “Graduation is distressing me” sounds reasonable, but means the same thing as “Graduation is stressing me.” Let’s try the other one. “Graduation is eustressing me” not only sounds awkward, it doesn’t make any sense, since “eustress” is about the graduate’s reaction.  The accurate way to use the word would be “I am having a eustressful reaction to graduation” – a sentence that could only be pleasing to a psychologist.

Using these words was been based on the belief that the difference between eustress and distress is the intensity of our reaction.  We taught people that too much stress is bad for their health, so we should reduce and avoid stress in order to avoid crossing the line from eustress into distress. Now we know that there is no such line.

In recent years, convincing evidence shows that our perception makes a big difference in how our body reacts to stress. If we see a threat, our bodies react in ways that probably will cause illness in the long run. If we see a challenge, stress becomes our friend, we perform better and don’t undergo the physical reactions that cause health problems.

Our perceptions of whether we are facing a threat or a challenge are influenced by how much social support we have. When we are alone, almost anything will look like a threat. Isolation is toxic to our health. Values and spiritual beliefs also make a difference in whether we perceive stressful occasions as threats or challenges.

Instead of talking about distress and eustress, we should be teaching people that they can handle enormous amounts of stress and thrive, then give them tools – attitudes and actions – that transform how they think and react to life’s challenges.

 

Article: Middle School Suicides Reach All-Time High

NPR reports that the suicide rate for middle schoolers doubled from 2007 to 2014, reaching an all-time high. More of them now die by suicide than car crashes. The article describes six common myths about student suicides.

For those of us who do crisis intervention in schools in the aftermath of suicides, the statistic is all too real. Our Bay Area Critical Incident Stress Management Team helps schools with notifications, resources for the child’s family, students, the school staff and the community. Administrators are almost always focused on what they can do for teachers; the teachers are mostly focused on what they can do for the students. Nearly everyone is asking themselves what they could have done to change the outcome. It is a tough situation to walk into.

Eva Bee/Getty Images

Although schools know in theory that children sometimes kill themselves, when it actually happens, they know it in an entirely new way. We sometimes call this “crossing a line.” One you have crossed that line, you can never go back and “un-know” the reality. Although school has to go on, it’s not going to be the same again. You will never be the same again.

One of the most difficult parts of all suicides, but particularly painful for teachers and school staff, is to recognize the warning signs afterwards, when it is too late to intervene. There are almost always warnings when you know what to look for. Suicides are rarely impulsive and are preventable. (Nevertheless, we often tell friends and family afterwards that if someone is absolutely determined, they will probably succeed no matter what you do – and acknowledge how incredibly pain that helplessness is.)

Suicide is preventable because – and this might seem strange – it is a solution to life’s problems. The suicidal person unfortunately, mistakenly, comes to the conclusion that suicide is the only solution. It is absolutely possible to help them postpone their decision, giving them time and resources to recognize that there are other solutions. I have seen it happen – we regularly discover and intervene with other suicidal students in the aftermath.

Schools have to walk a fine line after a suicide – honoring and acknowledging the grief and suffering of the student who died, while avoiding activities that would send the message that suicide is an acceptable solution to life problems.

I’ve seen a pattern in many of the student suicides to which I’ve responded in recent years. There’s nothing scientific about this observation, but my instincts suggest it is not uncommon. The student who took their own life was often quite successful academically, involved in many activities, leading a very busy life. They become attracted to or involved romantically with another person, who rejects them. These are typical teenage experiences, except that these students seem to have become deeply, deeply invested in this one relationship, so that when it fails, they are left emotionally adrift. They are so busy with school and activities that they didn’t have time and space – and little encouragement – to develop a social support network with depth; instead, they “bet everything” on the one person. This pattern doesn’t always lead to suicide, but many teen and young adult suicides seem to fit it.

I believe that we will fail to truly address the problem if we only blame suicides on academic pressure, which often is the immediate reaction. Stress doesn’t have to be bad for you, but it certainly is when you are socially isolated. Disconnection is toxic for anyone who lets work or school become so important that they let go or fail to develop the kinds of relationships that we increasingly recognize are crucial to thriving under pressure.

We should not focus so hard on what is happening to these students; we have to remember to look for what is missing. To cope with stress effectively, we need strong connections to the people around us, to ourselves and nature, and to our spiritual values. When schools focus too much on academics and accomplishments, the stress-coping resources can easily lose priority.

Technology hasn’t helped – it has given us myriad new ways to connect with others in shallow ways, contributing to sedentary lives that disconnect us from our bodies and nature, disrupting traditional communities, and devaluing spirituality. In fact, spirituality has been so devalued and confused with religion that I feel as though any time I mention it, I also need to define it – spirituality (in the context of thriving under pressure) means having values and a sense of awe and wonder., bigger-than-self goals and purposes. Religion can be a source of spirituality, but schools can instill values, selflessness and care for others without crossing the line into religion.

The usual wrong conclusion

A press release from earlier this summer (Seventy-five percent of U.S. employers say stress is their number one workplace health concern) offered the unsurprising statistic that a huge majority of businesses consider stress their No. 1 priority.

Three-fourths (75%) of U.S. employers ranked stress as their top health and productivity concern, but employers and employees disagreed on its causes, according to surveys by Willis Towers Watson. Employers and employees had just one factor in common in their top three choices: inadequate staffing, which employees ranked number one and employers ranked number two. Opinions diverged after that — on some points, dramatically.

So far, so good – identifying workplace stressors is a positive step.  Some of the report’s identified sources of stress can be reduced.

Employees and employers seem to agree that low pay and inadequate staffing are big stressors. But what exactly is an employer supposed to do with that information? Is there a business anywhere that can simply decide to hire more people and pay everybody more? Highly profitable companies may have that option, sometimes, if they aren’t under great pressure from shareholders.  I’m not at all sure that there’s anything most businesses can do.  This seems to be a social and political problem more than a business issue.

“Lack of work/life balance (excessive workloads and/or long hours)” was employers top stressor, but only No. 6 according to employees, ranked behind the long hours and low pay, along with company culture, unclear job expectations and excessive organizational change. Employers were also much more concerned than employees about technologies such as cell phones and laptops that keep employees “on duty” more of the time.

Perhaps employers focus on their employees’ work/life balance because they believe they are powerless to increase their compensation, thanks to competition.

The reason I titled this post, “The usual wrong conclusion” is that it is almost entirely focused on the idea that stress management only means eliminating the stressors. To be fair, the press release acknowledges that “the demands of work and life will always cause some stress for some employees.”

Well, I’m not sure we would call our jobs “work” if they didn’t challenge us.

Here’s the bright nugget in the midst of the survey: One of the two ways employees tend to choose to deal with stress is “connecting with friend, family members and colleagues.” Bravo. That’s one of the three kinds of “connecting” that enable us to take on challenges and thrive.  I call it “connecting out” and it’s also called social support or fellowship. Many, many research studies show a strong correlation between social support and resilience.

The second preferred employee option is mixed – “activities such as exercise, stress-reduction techniques or sedentary activities including indulging in comfort foods or watching TV.” Exercise, particularly activities that activate the vagus nerve, such as yoga and tai chi, help turn down the damaging stress response. They help us connect to ourselves and the world, staying more present and grounded. I call this “connecting in.”

However, as relaxing as watching TV or eating comfort foods might be, they are certainly not helpful to balancing stressors. Quite the opposite, especially high-carbohydrate foods – which are quite tasty when you are stressed and not sleeping enough.

There’s a third kind of connecting that isn’t directly addressed in this report, which I call “connecting up.” In addition to our relationships with people and creation, we all need to be spiritually connected. Wait, before you assume I’m talking about religion, I’m not. Religion can be a source of spirituality (and it is for me), but what I mean in this context is any activity that helps you find meaning. Spirituality has to do with values such as honesty and kindness, which we typically take on faith rather than logic.

I can’t help but speculate that perhaps the reason low pay and under-staffing are huge employee concerns is that the concentration of wealth in the modern world has been accelerating. Would people perceive their pay as too low and their workload excessive if inequalities were not so great? I doubt it.