Bullying’s Victims: Profile of Vulnerable Children

A story of injustice mixed with justice hit the news yesterday. A Florida sheriff arrested 2 girls (ages 14 and 12) for cyberbullying. Their victim, 12-year-old Rebecca Sedwick, jumped to her death from an abandoned concrete factory.  The Facebook entry from her torturer: “Yes, IK I bullied her Rebecca and she killed herself and IDGAF” (=I don’t give a…..).  See “Sheriff: Taunting post leads to arrest and Rebecca Sedwick bullying death.”  This little sweetie is being charged with aggravated stalking–a felony.

After my initial anger and disgust (but not shock), I began to wonder about Rebecca.  What made her a target?  What kept others from protecting her? I reflected on the suffering of some of my young clients, who, although they fortunately did not suicide, have suffered life-long wounds.  Many drop or flunk out of school, fail to find a suitable career or life partner, turn to drugs or alcohol.  The following are two victims I’ve worked with; names and identifying details radically altered, of course.

Justin was a pretty savvy seventh grader cool. He dressed just so, used the proper 12-year-old lingo, performed adequately in school–not too well and not too poorly. He was a bit chunky but tall, and a good athlete.

We were all surprised when Justin was bullied–mercilessly–in junior high. Teased, put-down, called names, Justin was verbally attacked, but emotionally bullied, as well, with nasty notes and cyber bullying.  It took him a while to share his humiliation with his parents, who took the problem up with the school principal.

Justin’s parents and teachers were perplexed.

file3111258685095And with good reason, since he didn’t fit the profile of the victim.  Here’s what some classic targets look like.

  • The slow learner, the one who didn’t learn to read until third grade, who’s still struggling with multiplication in junior high.
  • Sadly, the child with the noticeable disability, perhaps as slight as thick glasses or a hearing aid. Imagine the poor stutterer.
  • The student who’s clumsy and awkward–a disaster in gym and a misery at pickup games.
  • There’s the crier;  the child who cries easily in public triggers cruelty.
  • The heavy child.  A woman who was overweight as a child reports other kids moo-ing at her in the halls.
  • Those who have few to no friends are open to bullying–and have no one to protect them once it starts.
  • The hyperactive student.
  • Some, to be frank, are just plain annoying, with behavior that irritates teachers and classmates alike. Others enjoy watching them be bullied.
  • Some are children with poor self-image and self-confidence, unsure of themselves, sometimes  girls who develop earlier than their peers.

So  back to Justin.  When the obvious things don’t seem wrong, how does the apparently average kid become the target?

His grade provides one clue.  Children that enter a new school in junior high take their chances. The in-crowd is already established, and the new kid may have no allies . The ice-breaking is more challenging if the family has changed geographically as well; what’s cool in suburban Georgia might be a disaster in suburban Maryland.  Justin moved from Minnesota to New York, where he fell victim to a bullying East Coast gang .

Moving provokes another of the hidden risk factors: neediness. A transplanted child is a lonely child. Trying too hard to make friends usually backfires.

What about the child who has been in the same school since kindergarten?  In Julie’s case, the bullying started many grades earlier. Because she was tormented and isolated in the early grades, this child became increasingly timid and withdrawn. Other kids were afraid to risk spending public time with her. Julie failed to learn the social nuances typical of her milieu.

Sometimes the issue is a family one–status, religion, poverty, or social cliques.  Justin doesn’t fit in because his parents are active in Greenpeace in a conservative community, or they’ve lost their jobs and can’t afford to keep up their property.  His mother embarrasses him by being a street preacher, or he belongs to the only divorced family. Julie’s the only girl without a cell phone or the internet; her parents don’t believe in the technology.

Sadly, a child can be bullied because of a special needs sibling or for befriending another victim.

What can we do as adults? At least be aware. When a child doesn’t want to go to recess, a field trip, or even to school, think of bullying as a possibility. If the child has no friends, no one calls or stops by, she doesn’t nag for a cell phone, see what you can find out. Asking often fails; the child is embarrassed and certainly doesn’t want you to go to school to report the bullying. Studying your child and earning her trust is the only way to proceed.  There are no easy answers, and you can’t solve the problem by calling the bully’s parents or reporting the problem to the principal. Those actions will earn your child’s distrust and are likely to increase the attacks.

You also can’t solve the problem by becoming your child’s substitute pal.  Much as you’d like to take her to the movies with you on Saturday, the shame of running into her peers at the same theater is too painful.

See my earlier post on the need for the victim to fight it out herself:  “Bullying: Changing the Mindset of the Victim.”

However, we all have to do something. Being bullied is something a child never gets over.

The Florida sheriff has put us all to shame. There’s someone who’s taken a stance.  Maybe we’ve got a beginning of a partial solution.

Getting Taken to the Cleaners, the Poorhouse, or Worse–to Jail

As much as your friends and family would love to protect you, it’s really your own job to avoid being betrayed financially, as you’re the one who has all the clues. Be your own detective regarding financially improper or criminal behavior.

But how do you read those clues, and what should you be looking for? My guess is that my readers have a number of ideas, and I’d love to hear them. I offer suggestions I’ve gleaned from my clients who have learned the hard way.

1. When you compliment your wife on her new dress, she tells you it isn’t new, it’s been in the closet for years, you just don’t notice stuff.  If this apparent confusion happens frequently, check it out.  Examine the credit card bills, especially for cash advances, which not only obscure the places where someone spends the money but increases the credit card fees.

2. Let’s say your husband bought you that $3500 purse you’ve been just longing for–with cash. Your antennae go up. If you find your spouse funding very expensive purchases with cash, he may  be laundering money.

3. Make sure that important documents—life insurance papers, certificates of deposit, brokerage statements—are available for you to see. If your spouse is resistant, that’s a clue, detective.

4. Don’t be the person who says, “I don’t get it. I don’t know anything about finances.” Don’t take pride in willful ignorance. It could cost you in many many ways. If you don’t understand something in the financial realm, use the library or  internet, ask friends, or buy an hour of an accountant’s time to ask for an explanation.

5.  If you’re dating and someone throws fairy dust in your eyes with all kinds of fancy stuff, beware, especially if you’re in a vulnerable financial situation yourself.  Yes, if he lends you his credit card, fills up the car with roses on his way to pick you up, and seems to have bought stock in Godiva–that is heavy-duty financial persuasion to win you over. Ask yourself why.

6.  If a person you are dating has no credit cards, be suspicious. Why would that be? It might have something to do with their being unable to handle money–either no credit or fear of losing control with credit cards.

7.  Notice well what kind of friends/associates your new love has. Ask yourself: Are these people I would admire and trust, or do they make me nervous.  Be honest with yourself–if the new man in your life presents as a financial hotshot, but all his friends are not, the situation simply doesn’t compute.

8. All major purchases—cars, large pieces of furniture, timeshares, large payments to adult children, loans to friends—should be discussed before any money changes hands. If you find yourself being left out of these transactions, you need to figure out why–and what to do about it.

And as you’re honing your detective skills, become aware of a few other signs that something’s just not right. If where your wife says she’s going and the computed mileage on the car are vastly different, think about what that might mean. And remember Jane of the gambling boats, whose story of her whereabouts simply couldn’t have been true, as her husband suspected? Well, that’s telling.  Small lies multiply. People might turn out to be somewhere else than where they told you. Use your common sense.

Common sense, more than anything else, can help you avoid getting taken to the cleaners, the poorhouse, or worse–to jail.

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“A Room Of Her Own:” The Saga of the Blended Family Continues

According to Virginia Woolf, for a woman to succeed in her ambition to write fiction, she “must have money and a room of her own.”

Granted your little one may not be attempting to compose the Great American [or in this case, I suppose, British] novel, and her allowance may suffice for now–but if you are to bring your daughters and sons into your new wife’s home, in order for them to feel themselves a part of that household, and thus a part of your new life, you must help them carve out a space that is theirs.

I haven’t shared any of my sparkling insights on step-families for quite some time (see “Blended Families Part I” for the beginning of a series I’ve written previously) , so I thought I’d return to the topic for some posts, in case any of you were suffering withdrawal.

And it’s a topic that keeps coming up in my life, both in session, and among friends, because, fundamentally, combining two different families under one roof is quite the challenge.

I thought about some of the major, recurring sources of tension that seem to plague blended families, and came up with the themes below:

  • Room and Space–who owns what and who has the right to what?
  • Household Rules–different households have different ones; by whose rules should the children abide when combined in a house with conflicting family laws?
  • The Clustering of the Children–who gangs up on whom, and who’s in the in-group or the out-group?
  • Competition–What to do when children are campaigning for more parental attention, post-second marriage, and how do the parents make alone time for their children–and their spouses?

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Before I attempt to address these issues, I’d like to leave off with “A New Family Bill of Rights” by Isolina Ricci, author of Mom’s House, Dad’s House, brought down by “Kids ‘n’ Dad Shared Support – Founding Partner in the Family Renewal Project:”

A New Family Bill of Rights

 • Each child has the right to have two homes where he or she is cherished and given the opportunity to develop normally.

• Each child has the right to a meaningful, nurturing relationship with each parent.

• Each parent and child has the right to call themselves a family regardless of how the parent’s time is divided.

• Each parent has the responsibility and right to contribute to the raising of his or her child.

• Each child has the right to competent parents and to be free from hearing, observing, or being part of their parents’ arguments or problems with one another.

• Each parent has the right to his or her own private life and territory and to raise the children without unreasonable interference from the other parent.

If you’re a divorcing or divorced parent, see if you can subscribe to this Bill of Rights–it will make all the difference in your child’s–and your own–adjustment to the breakup of your marriage.

See:

Changing the Ground Rules: Losing a Career

Before I leave the topic of issues to consider when you’re thinking of leaving your marriage, I wanted to bring up a few situations that make the decision to stay or go vastly more complicated.

What happens in a marriage, and are you obligated to stay, when the very ground rules of that marriage have been changed?

This can happen in horrible ways, or merely as part of life changes, or when one spouse finds a new path they’d like to follow that was certainly not part of the marital contract.

When Trish married Tom,* Tom was well on his way to achieving the financial and career success that would shape their married lives. After Yale law school Tom had joined a well-known law firm, had married Trish, and then had quickly moved up the career ladder to partner in probate law. He worked long and hard hours, but both agreed that it was worth it in order to continue to support their family in style. Trish was a great stay-at-home mom and wife, and the perfect partner when Tom had business affairs. They were a power couple, Trish and Tom–their names even complemented each other– with successful children, and their lives revolved around the family and the firm.

But when they first came to see me, Tom had been more distracted. When I had a session alone with him he explained. He had a billionaire elderly client, Byron, whose work he had been doing for almost a decade.  However, in the past years Byron had been failing, and more and more work was done regarding his estate via the new wife–the trophy wife, the firm called her.

Tom had gotten a call from Belinda, Byron’s new wife, to come to the house, since Byron wanted to change his will, but wasn’t well enough to come to Tom’s office. So he hopped in his car [good clients get good service] and headed over to Byron.  He found Byron shockingly debilitated, and unable to speak, so Belinda spoke for him, explaining that Byron wanted his will changed to reduce eldest daughter’s portion.

Tom had misgivings at the time, but he nevertheless drew up the requested documents on his laptop, and watched, feeling worse all the time, as two home health-care workers signed as witnesses.

Within a month of my conversation with Tom, the fear he couldn’t even manage to put into words in my office was actualized:  Tom was sued. The lawsuit hit the papers–Byron was not just rich, but well-known, as so often goes together–and in short order Tom was threatened with disbarment.

Tom is a broken man, who will never work in law again. And Trish, who dedicated her life to her husband’s career, watched as their investments decreased and then disappeared, as bills started to go unpaid, and as her husband, a former Tom-Wolfe-ian Master of the Universe, sat in his office chair and smoked, staring out the window.

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Gone were two components of the marital life Trish signed on to lead: the luxury and comfort procured by Tom’s work–and Tom himself, as she knew him. His confidence and reason for being dissolved, the man she loved seemed to disintegrate almost by the moment. Sometimes she could only see the vague outlines of his former shape–and there still today is little hope for re-constitution, given Tom’s refusal to return to therapy, to try a different job, to see a psychiatrist. She felt betrayed, furious, hopeless. This was not what she signed on for.

“All is changed, changed utterly,” as Yeats said. But there was no terrible beauty being born, as far as Trish could see.

So what now?

If you ask me, should Trish stay or should she go, of course I can’t answer that.

When people ask me questions like that, I often think of the wary narrator of the Cat in the Hat, “What would you do, if your Mother asked you?” But this isn’t a children’s rhyme, and every person must make his or her own decision.

I offer some general suggestions for how to handle similar situations in a later post, but I’ll tell you what Trish did, and I respect her mightily for her decisions.

Trish decided to stay–she and Tom had built a life together over decades, after all–and it became clear in therapy that starting a support group for spouses of professionals who had lost their jobs was a mission that really appealed to Trish.

I’d love to say that Tom is a cheery middle-aged man working, say, as a real estate agent, but his depression is unremitting. Trish, however,  has started a group that laid the groundwork for a whole new social network, and she gets out with her new friends regularly, to prevent her falling into Timothy’s mood morass.

And, after processing what she’d like to do now, in this second stage of her life– darned if Trish didn’t go to school, create a resume, go through the interview process–and start work as a paralegal.

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*As with all characters in my blog posts, there is no real Trish or Tom, whose names have been changed to protect their privacy.  They are teaching characters, composed of bits and pieces from real life humans plus details from my imagination which make the story more interesting and, hopefully, instructive.

Rescue Marriages

It probably seemed pretty clear how the first problem marriage structure, of the over- and under-functioning spouses, could lead to marital stress–although  many of these couples stay together for the long-term.

The second ‘problem marriage,’ in my view, though, is that of the rescue marriage, and oftentimes it’s harder for people to see the problem with this one.  There’s a certain highly romantic element to this relationship structure, and people feel, as they enter into it, that either they will be saved forever, or that they have the ability to rescue a drowning person–and the rescuer and rescue-ee will live happily ever after, once the rescued person’s life has been fixed.

There are multiple examples: a woman marries an alcoholic, convinced she can cure his addiction with her love and compassion. Or perhaps she marries a man who has never made a living, and is certain that her belief in him will help him be successful.  I had one client, with some serious commitment issues, actually, marry a woman with a terminal diagnosis. Again, his love and support, he seemed to believe, could cure her illness.

More commonly, the term ‘rescue marriage’ is utilized to describe one spouse saving the other from a bad family-of-origin set-up. This is one of Judith Wallerstein’s four models of marriage, written about in her book with Sandra Blakeslee, The Good Marriage: How and Why Love Lasts.   Wallerstein is a psychologist and researcher who has studied the long-term effects of divorce for over 25 years, and she actually writes about the rescue marriage in what I find to be a highly romanticized way.

For another pattern emerges that can be destructive in the relationship–and it’s one you might expect. Simply put, the rescuer often undervalues the contributions her spouse can make, and thus enables the ‘victim’ in his need to be rescued. Alternatively–and this makes perfect sense to anyone who has rescued a lot–sometimes the rescuer just gets sick of rescuing–to the point where she actually starts persecuting the victim–and the victim, sick of being in the role of the one needing rescued, becomes resentful–and, at times, takes on the role of persecutor himself, too.

It’s all clearly explained by Stephen Karpman’s work [he is  a psychiatrist who is Vice-President of an organization called the International Transactional Analysis Association (best if you check that out yourself)] by what became known as the Karpman Drama triangle, as depicted below, and is pretty fascinating to read, so I encourage you to take a look, especially if you believe you might be in a rescue marriage.

(image from http://www.my-counseling-site.com/codependence-counseling)

In the first post on the topic of whether you should stay or leave, before you walk away from a marriage you need to ask yourself how you’ll change your own behavior in the future so that you don’t fall into your pattern again. Because rescuers tend to be rescuers, no matter what the setting, and that applies to marriage, too. The outer construct of your second relationship may look different from your first–but if you don’t work through why you always need to be in the position of rescuing your mate, it’s a question of being doomed to repeat your destiny.

And the same goes for the ‘victim,’ or one who needs rescuing. If you believe in your heart of hearts that you are incompetent, or that the world has dealt you a bad hand and you can’t make it out there on your own without someone swooping in to save you from your own fate–well, it’s pretty clear to me the type of person you’ll marry next time, too–and then begin to resent.

I can’t answer decisively if you should stay or go in this marriage more than in any most  other ones, but I can strongly recommend that you work through your issues with the role you take up, or you’ll be repeating your pattern, no matter how different the surface of your next relationship may appear.

 

Cancer Survivors–the Good, the Bad, and the Neutral

There are only three possible outcomes after a major life event: things get worse, things get better, or things stay the same.  Once you’ve had cancer, it’s not too likely that your life will ever be the same.  OK, maybe with a tiny skin cancer.  But I mean the big, scary CANCER, where your existence is threatened, the treatment costs you every last hair, and the mental losses are unaffordable by anyone’s standards.

My background in family systems draws me to the relationship trauma of cancer.  Fear, pretending, supporting, depending–all may shift the expectations of love and care between family members.  Needing, crying, looking bad, feeling unsexy–pile it on. For children–young or grown, patients or family members–the fast track of family change involves new fears, new responsibilities, new secrets, new guilt.   Social isolation or its opposite–the in-rush of friend and family caretakers–changes the family dynamics too rapidly for at least some of the members.

Sometimes one adult sibling becomes the main caretaker, perhaps permanently magnifying or altering underlying family cracks.  A parent of college age children may keep her diagnosis a secret so as not to interfere with the student’s finals.  She may tell the sibling(s) living at home, requesting secrecy from them as well.  How do both choices affect future trust?  Guilt? How do you express anger to the irritable, moody, undependable cancer sufferer, especially the deep resentment you feel over having your life wrecked?  How do you live up to the heroic model of cancer patient or avoid judgment on the opposite type?

And money. Even for the insured, cancer costs. It might be the new experimental medical treatment; could you swing $140,000 for 9 drug-filled weeks?  Do you borrow from friends or family, mortgage the house, cash in the IRA?  Maybe your drugs are covered, but you have to leave work temporarily or permanently, another rapid, unplanned-for shift in family dynamics.  The smell of cooking doesn’t agree with your queasy life, so add in the cost of take-out, then childcare, more housekeeping assistance.  Financial planning telescopes into a few frantic months or years, while the consequence continue long after.

So what’s good about this? To quote Obama when the world economy trembled and quaked, “A crisis is a terrible thing to waste.”  Having exchanged everything you took as a given for a new set of realities, you’ve got an opportunity to make new.

Let’s start with the financial hit.  Cancer survivors may see a fresh new world in which the must-haves of the previous life seem trivial.  A simpler life maybe, where a day without pain is the new free lunch.  Raindrops on roses and whiskers on kittens;  they cancel out time in the X-ray dungeon.  Some clients, having quit a job, find a new way to spend the recently acquired free hours.  One wanted a small sewing nook in her tiny house–a dream her partner helped her to accomplish for under $50.

Relationships  can surprise during treatment. Many cancer clients tell me their disappointment over a special friend or relative who didn’t call, didn’t visit, didn’t cook–nothing.  That is often balanced by the unexpected giver, an unpredicted someone who means everything during the crisis.  I’ve worked with couples whose flat , uninspired  marriages received a permanent vitamin injection from the cancer crisis.  One woman who had struggled in marital therapy for years joyously experienced a “born-again husband.”  And the reverse can be positive in its own right–the woman or man who leaves a loveless marriage in the middle or end of treatment.  These too are victories, as one woman put it, “If I could survive cancer, I can survive being on my own. I’m not afraid any more.”

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Fear isn’t the only upside-down emotion in the cancer survivor’s jumble.  Guilt, depression, hopelessness? I’ve learned from clients who tell me they felt so blue they didn’t want to live, until they received a cancer diagnosis.  Fighting spirit revived, these individuals found life again.  Some revisit family issues, now more open and honest.  Some volunteer for support groups or continue with the health food, yoga, or tai chi they started during treatment.  An adult daughter of a woman with a family-linked cancer returned to grad school for a career in genetic counseling.  Some get religion, some give it up.

For you survivors– both the patients and friends or relatives of the patient–who now lead a more authentic life, today marks an anniversary of success.  Happy anniversary, and many more.

 

World Bipolar Day: the Birthdate of Vincent Van Gogh

After over a decade of – granted, very rocky – general stability, I suffered a mental health episode in my late 30s that both came as quite a shock to me and pretty much knocked me out of the playing field for quite some time.

I had to cause recently to list a number of the things that were different about myself – about my very essence – after that episode, than before.

They were pretty essential. They included things like, although I was a voracious reader, ever since the time I could read, and used reading as a form of escape and comfort, and was a literature major in college, writing a 100+ page thesis on a contemporary poet, today I can hardly sit and concentrate to read a book at all. My doctor has me on a regimen of 15 minutes a day–which I split up (I never asked if that was alright), into 3 sections, each of which pretty much involves reviewing the last.

My sense of time was fundamentally altered. I went from feeling a constant pressure that I didn’t have enough time, a pressure so intense I even felt it in my chest, to a feeling that time had expanded on me, like a hot air balloon, and that I would be unable to fill the minutes. That song from Rent plagued me–you remember the one.  The one that starts off, “Five hundred twenty five thousand six hundred minutes. . .”? That’s what each day felt like. No–each hour.

And then there was the matter of my intelligence. I actually – and I know you have to take this on faith – was once quite smart. And there are some people who say – you would know them if you met them, as their last names are Finkel –that my intelligence remains.

But sickness and treatments can take their toll, and a recent IQ test showed a number I wouldn’t care to share here.

All that is fascinating background to the following relevant change: I was compulsively early my whole life. I would get to class, say, 20 minutes before it started, and just twiddling my thumbs in the car. But, like I say, times of changed. today I find myself running around the house, usually with my water bottle with its top off spilling haphazardly, one shoe on come out one shoe in hand, my meds in my mouth, dissolving unpleasantly while I somehow don’t use the water bottle–& ways, always I am looking for the keys, is the time for a class or an appointment draws perilously close.

So last year I missed it completely.

So I am here to inform you that today is the second world bipolar day.

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Bipolar people, on average, suffer 10 years before receiving treatment231

Major Depression is the #1 reason for disability worldwide 235
Bipolar disorder increases suicide risk by 15X more than that of the general population 230
Less than 50% of bipolar disorder patients take their medications 236
Antidepressants are prescribed second only to analgesics (painkillers)54
15% of bipolar persons may not experience the usual clinical depression that accompanies bipolar disorder 232
Bipolar disorder is the 4th-highest reason for SSA disability awards62

That bipolar disorder is the sixth leading cause of disability in the world (WHO)?

That only 1 in 4 bipolar sufferers receives an accurate diagnosis in less than 3 years?

That all of the following people were thought to now have or to have suffered from bipolar disorder in their lives: Agatha Christie, Drew Carey, Edgar Allen Poe, Isaac Newton, Jim Carey, Larry Flynt, and Winston Churchill?

And of course, Vincent Van Gogh.

It’s good to be in such worthy company.

 

March Gambling Madness–The Addict and the Co-Dependent

More money is wagered on March Madness than on the Superbowl–an expected $9 billion this year.  Perhaps that’s why March is Problem Gambling  Awareness Month.

Betting on March Madness, or other office pools throughout the year, is socially acceptable.  More than that; it’s cool, trendy, and sociable. And that’s true even though the “professional gamblers” are, as always, out there to take advantage.  The family or friends with close involvement to the gambler–often referred to as the co-dependent–dreads the highly publicized March event.

For problem gambler and their families,  March Madness exhibits the painful rather than the “cute” sense of “madness”. Pathological gamblers hide the secret of their destructive urges, lying about losses, while boasting about big gains, which simply stoke the compulsion to “go again” as soon as possible. Preoccupied with past gambling adventures, or planning the next one, they can’t concentrate on work, friends, family, or chores.  They  destroy close relationships, manipulating spouses, family, and friends to obtain money. They beggar their relatives, wiping our credit cards and may turn to stealing to feel their habit.

Pathological gambling is defined by persistent and recurrent patterns of maladaptive gambling behavior, resulting in impaired functioning, poor quality of life, and high rates of bankruptcy, divorce, and imprisonment.  Suicide attempts are common, reported in 17% of people in treatment for pathological gambling (Petry and Kiluk, 2002).  And that doesn’t count lesser forms of self-injury, such as banging one’s head or fist against the wall.).

Depressed or anxious people may experience gambling as significant symptom relief, viewing the risk of financial distress or criminal activity (stealing, embezzling, writing bad checks) as a comparatively minor setback.  When the gambler attempts to cease or limit his impulsive behavior, he or she may become irritable and distracted. If someone close to him or her tries to set limits, the blaming, anger, and deceit increase.

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A indicator of the addictive nature of the compulsion is that huge losses  increase gambling activity.  Rather than teach the gambler an avoidance lesson, the loss urges the addictive person to make bigger bets to “get back to even.”  Perhaps losing is in a strange way satisfying, because the guilty gambler feels he deserves the punishment. Compulsive gamblers who lose large sums at the beginning of a gambling session often imagine that the entire loss could be recouped with a single large win at any moment. Their distorted thinking assures them that statistics are in their favor; if they’ve lost 10 times, they mistakenly believe the odds favor the next round.

Pathological gamblers may have abnormal reactions to stress.  A 2004 study by Brown, et al., found that such individuals were depressed (“negative pre-gambling valance”) before gambling. The kicker is that their mood significantly decreased if they lost but did not significant improve if they won. In other words, they lose emotionally even those few times that they win the money.

An additional ingredient in the pathological strew is impulsivity.  Impulsive individuals tend to be highly response to positive reinforcement (winning) but rather insensitive to punishment (losing). They have difficulty imagining negative outcomes. They also seem unable to divide their attention among competing stimuli, and therefore may be unaware of internal warning of restraint and danger (Adams and Kushner, 2004)

Individuals with addictions tend to share two common features: 1) being chronically under- or over-aroused, and 2) having experienced childhoods that led to feelings of inadequacy, rejection or guilt (Grant and Kim , 2002).  Perhaps these 2 features keep the the co-dependent (responsible spouse, relative, child, friend) more committed. The co-dependent feels needed, feels sorry for the gambler, hoping to compensation for the painful childhood by giving unconditional love.

The sad truth is that  you can never be in a healthy relationship with a pathological gambler.  The most important “relationship” in the addict’s life is with gambling.

When the co-dependent strategy fails, the co-dependent feels like a victim, becoming angry and resentful.   This individual is the fixer, the enabler, the excuser, the one who picks up the pieces of the gambler’s chaos, the one feels he or she owns the problem.  He or she lies for the gambler, pays the debts, makes up for the losses, and denies the evidence. The co-dependent believes the excuses, forgives, sets up new limits, which are inevitably broken. The tearful reconciliation scenes provide temporary respite, although both the addict and the co-dependent know deep inside that they only finished the more recent round of blame, guilt, and tearful promises to do better.

Why doesn’t the co-dependent leave before the money is gone and the stealing has gotten dangerous? Some of the same reasons the gambler stays stuck. Low self-esteem, self-blame, victim mentality, and often a family history of alcholism or other impulsive behaviors.  In a couple relationship, fear of being alone.  When the addict is a child or sibling, fear that the gambler will become depressed, publicly shamed, divorced, fired, imprisoned, or suicidal. And over-riding them all, fear of accepting the reality–that the person you love is in a diasatrous downward spiral that only he or she can control. Admitting you have no control over that outcome is the scary first step.

Because pathological gambling involves illegal or immoral behaviors, shame and secrecy often prevent or delay treatment.  The gambler may not be aware that he or she is struggling with a known disorder which has treatment options. Those options include group programs for impulse control and medications used for opioid addictions. Talking treatments seem to help initially, as the patient experiences relief from the secrecy, but impulsive patients often do not follow through on recommendations. Anti-depressants and 12-step programs haven’t demonstrated significant benefits.

The co-dependent, however, can benefit significantly from both individual and group coaching, including 12-step co-dependency meetings.  The co-dependent can change his or her life by accepting, setting boundaries, detaching, realistically evaluating what s/he can or cannot control, and making new choices.

One thing that surely doesn’t work is trying to control someone else’s pathological gambling.  While it’s critical to find out if someone you love is lying about his or her whereabouts and taking money out of bank accounts, credit cards, or even your personal stash, you won’t be able to stop the addict by cutting up the credit card, closing the bank account, or checking his or her pockets for receipts.  A compulsive gambler will find another source.  Confrontations, guilty admissions, and promises to reform are part of the pathological pattern. You need support to avoid getting sucked in. Take a look at some warning signs in my  series of blog pieces, “Getting taken to the Cleaners, the Poorhouse, or Worse–To Jail.”

Divorce will prevent future gambling debts from devastating your credit, but, sadly, it won’t release you from the debts racked up during the marriage. Debts are joint marital obligations, and the gambler isn’t going to have the goods when the creditors come knocking.

If you suspect or know you’re involved with a pathological gambler, this is a good month to ask yourself why you’re looking the other way.  It’s time to get some coaching help. You can’t tell anyone else what to do, but you sure can decide what actions you yourself are willing to take.

Eating Disorders–What’s In Your Mind?

Eating disorders come in a bunch of new flavors these days.  The DSM V (the newest version of the diagnosis and classification of mental disorders) offers an expanded menu, compared to our earlier choices of anorexia, bulemia, binge eating disorder, or the old DSM IV option, NOS (Not Otherwise Specified).  The following diagnoses will surprised some of you but maybe comforting to those who could use a name for their troubling symptoms.

Pica refers to the compulsive eating of nonfood substances.  The astonishing list includes dirt, soap, glue, paint, ice, toothpaste, hair, coffee grounds, and even cigarette butts and ashes. Yes, eating those things.

Patients with rumination disorder regurgitate their food, which they then either re-chew, re-swallow, or spit out.

Avoidant/restrictive food intake disorder manifests in one of three ways: apparent lack of interest in eating or food; avoidance based on the appearance, taste, smell, or texture of food; or concern about negative consequences of eating, such as choking or nausea.

NOS in the DSM V  is now known as “Other Specified Feeding or Eating Disorders.” There are 5 subtypes in this category:

Atpical anorexia nervosa, in which the patient has the symptoms of the disorder but, even with weight loss, remains within the normal weight range.

Those with bulemia nervosa (of low frequency and/or frequent duration)  meet the criteria for bulimia, but those behaviors occur less than once a week or for less than 3 months.

Ditto for binge eating disorder (of low frequency, etc).

Purging disorder refers to purging (vomiting, laxatives, diuretics) without binge eating.

And bringing up the rear is a disorder so many people complain about without realizing they’ve “got something”: night eating syndrome.  This syndrome is the name for excessive food consumption after dinner or eating at night after awakening from sleep.

So there’s the facts. Now I ask myself, as a coach experienced in helping clients with eating disorders: what do I know, and how can I help.

I’ve learned that eating disorders are a torment of the mind.  Looking at a client’s weight tells you very little about her thoughts.  A man or woman whose weight is within normal limits can still be driven to distraction by an internal critical  voice.  “You’re disgusting. Look how much you ate.”  “Why can’t you control yourself, Miss Lardbucket?”  “Your thighs/tummy/rear end are fat.”  “Look at your midriff bulge!” “Everyone in this room is thinner than you.”  “Everyone is fatter than you.”

The voice gives lessons and rules: “First work out on the treadmill and record how many calories you burned.  That’s the amount you’re allowed to eat today.” “Because you ate carbs today, tomorrow you’re allowed to eat only salad.” “You had a piece of pizza. You’ll increase your bike riding form 2 hours to 3 to make up for it.” “Don’t eat anything with more than 0 grams of fat.”” Be a vegetarian, don’t eat anything with gluten.” “Sugar? Addictive; once you start, you’ll eat the whole pie.”

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The voice  also offers comparisons:  “You ate more than anyone else today. Tomorrow, only water and plain yogurt.”  Or the “good news”:  “You’re the only only at the party who ate so little. Only 2 carrots. I’m proud of you.”

And the voice prevents you from hearing the words and feeling the needs of others around you.  You have no energy for relationships. Your main “relationship is between you and the voice.

The voices alienates friends, family, and colleagues. “I wish I could join you for a drink after work, but I’m so busy.”  Perhaps your friends are fooled when, for the 5th time you’re at a restaurant together, you announce you’re not ordering anything because you’ve just eaten. Maybe they don’t notice that you mash your serving of birthday cake around your plate so they’ll think you’re enjoying your party. The intense mental concentration required to avoid eating the cake–but make it look as if you did– brings you to a different space from others in the group–a lonely, painful space.

How do you recover, how do you shush that voice for good?  Begin by recognizing that voice isn’t you. I know it seems like you because it’s in your head.  But there’s much bigger, healthier you that knows how to take care of yourself and get well.  Read Jenni Schaefer’s Life Without Ed.”  Ed is what Jenni named her voice.  She offers clear advice on identifying the voice, separating from it, and gaining control. She recommends putting together a healing team of professionals to help in the journey.

If you’re ready to getting started on your healing journey, begin by interviewing the professionals you’re going to work with.  Avoid treaters who set rules for you.  Since eating disorders have so much to do with control, your inner critic is likely to sabotage people who tell you what to weigh, when to exercise, what to eat, how much, and when. Look for professionals who understand the bigger picture, the mental torment of the inner voice.

Today begins  National Eating Disorders Awareness Week.  A good week to get started.

 

 

 

Healthy Weight: A Continuing Crisis

Looked at from one perspective, eating disorders can seem the domain of the rich and famous, the models and the actresses, of Victoria Beckham and Princess Diana, in reality they are widespread–across financial groups, ethnicities, and genders (would you believe that nearly 1/4 of  preadolescent cases of anorexia occur in boys, with binge eating disorder hitting males and females equally?)–and are, in addition, deadly serious.

In fact, the numbers are hard to get your head around.  Approximately 24 million people in the U.S. have an eating disorder in one form or another. And–more challenging yet–a paltry 10% of those will receive treatment.

Whereas we like to think of ‘those with mental illness’ as other than us–think of schizophrenia or bipolar disorder; we prefer to see them as diseases that could never touch us–eating disorders are like European sparrows–common in every state and hard to eradicate.

We’re all familiar with the terrifying anorexia nervosa, which can turn into bulimia nervosa (a disorder on its own, characterized by binge eating and purging [usually by vomiting, although some use laxatives, or even extreme exercise. binge-purge cycle, using vomiting or laxatives] when the starving person can’t take it any more.

At first blush, it looks like bulimia is the get-out-of-jail-free card: eat all you want and stay skinny. This is not a slam-dunk, however.

Although bulimics are often ‘normal’ weights, they are usually extremely unhappy with their body shape and size and live in fear of gaining weight. Additionally, the purging causes a number of physical symptoms, ranging from a chronic sore throat to gastrointestinal problems to electrolyte imbalance to worn tooth enamel. (In fact, I have an aunt and a cousin–her daughter–who both suffered so badly from bulimia they had to have their teeth completely re-surfaced. Don’t fancy that insurance covers that either.)

Sometimes the patient binges without purging–binge eating disorder.  If you subtract the bingeing and eat mostly at night, you might have night eating syndrome.  Here the sufferer grazes all evening, sometimes waking up to eat. She feels she can’t eat in the morning but may have to eat in order to get to sleep.  Add to this people who restrict according to any number of current fads: gluten-free (for those without celiac disease),  sugar-free,  carbohydrate-free, etc.

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75% of “normal” weight women [which, I acknowledge, is a rather loosey-goosey kind of term] believe themselves to be overweight, while 90% overestimate their body size.  Reading fashion magazines wreaks havoc with women, both young and old. In an article titled “Still killing us softly: Advertising and the obsession with thinness,” researchers ran a number of studies on women after exposure to fashion magazines such as Seventeen.

In one of their surveys researchers told girls between the ages of 11 and 17 that they could have three magic wishes–anything they wanted. What came out as the number one wish, far, far ahead of number two? The winning wish for these young women was  to lose weight and keep it off” (Kilbourne, 1994).

When the same team surveyed middle-aged women (no age was provided, so I’m assuming these women were clearly years older than myself), asking them what they would most like to change about their lives, more than half of them said their weight.

Back to the those adolescent girls. Eating disorders is actually the third most common illness to be found in that population (it follows only asthma, and–ironically–obesity).

But there is more shocking news yet to come. I did a little unofficial survey amongst family members, asking which mental illness they thought had the highest mortality rate, and I got a plurality of “bipolar”s with a “schizophrenia” thrown in for good luck.  I actually give them partial credit, since bipolar disorder has the highest suicide rate of all the disorders (although eating disorders, are, tragically, giving it a run for its money)–but. . .

20% of people who suffer from anorexia, one of the more common of the eating disorders, will die prematurely due to complications related to the disorder, complications from heart problems to osteoporosis to gastrointestinal complications to dental problems. . .to suicide.

Suicide has become such a real problem that, if we include all eating disorders in the numbers, a the American Psychological Association highlights the findings of a 2003 Archives of General Psychiatry study which found that those with these conditions are 56 times more likely to suicide than their peers.

In point of fact, eating disorders have a higher mortality rate than any mental illness.  For anorexia alone approximately one in 10 cases ends in death.  If you narrow the scope to women between the ages of 15 to 24, the mortality rate from anorexia is 12 times higher than any other cause of death.

So. . .to turn to treatment.  Sadly, if you simply look at the statistics, it’s just bad news heaped on top of bad. A mere 10% of those with eating disorders ever receive treatment at all, and only 35% of those get treatment at places that specialize in treating eating disorders.

The costs to treat these illnesses are staggering in themselves. In the US, just outpatient treatment alone, which includes therapy and medical monitoring, can cost $100,000 or more. That’s cheap compared to costs of inpatient treatment, which can be $30,000 a month–or more. And–hold on to your hats here–it is generally estimated that those with eating disorders need between 3-6 months of care.  I saved the “best” for last: health insurance companies more often than not deny coverage–surely of inpatient stays, and sometimes of outpatient care, as well.

Those shockingly high costs stand in the face of distressingly lowgovernment expenditures on research into causes of and treatments for eating disorders. Check out the chart below, published by the National Institute of Health in 2011.

Research dollars spent on Alzheimer’s Disease averaged $88 per affected individual in 2011. For schizophrenia the amount was $81. For autism $44. For eating disorders the average amount of research dollars per affected individual was just $0.93.

Perhaps the lack of spending and the ineffective treatment are linked in a vicious cycle. Indeed, eating disorders are one of the most difficult of the mental illnesses to treat.  McAleavey (2008) writes that, “because eating disorders are often difficult to treat and the individuals who have them often exhibit significant comorbidities, the long-term success rate (3-5 years or more)–defined as recovery and abstinence from the disorder behaviors–is in the 40% to 50% range, at best.”

Of course it’s a matter of your perspective:  true, half of those treated don’t get better, but that means that half of those treated DO.  This absolutely obligates us to do our best to get our children, friends, spouses–anyone we love and care about who is suffering from an eating disorder–into treatment, and the quicker the better, as early diagnosis and treatment greatly improve chances of recovery.

And treatment takes Ms. Clinton’s proverbial village. Best practice usually requires a psychologist to identify the most important issues, help develop a treatment plan, and work with the patient to replace destructive behaviors with more constructive ones; a psychiatrist who might be needed to deal with what are often underlying depressive issues; and a family therapist.  Important theories of the “causes” of eating disorders include family triangles, history of depression and self-injury, and previous sexual abuse, although the experts are far from a definitive answer.

Because there is so much collateral damage from these disorders, the team isn’t limited to mental health workers. There is need for a primary care physician, to monitor the patient’s health–and a nutritionist may be on hand to  assess the patient’s nutritional intake and work to create a better nutritional plan.

And, fortunately, researchers have begun barking up new trees, looking into whether any DNA variations are linked to the risk of developing eating disorders, and utilizing neuroimaging studies to try to better understand eating disorders and possible treatments. In fact, already one study found different patterns of brain activity between women with bulimia and healthy women.  Clearly, looking for new avenues instead of relying on the same old treatments that have failed us in the past is cause for hope.

Should you yourself want to do something, there are many things to do, some maybe very close to home (which is a strong preference of mine), and a number of organizations that do good work. I just list one here, the National Eating Disorders Association.

Unlike so many organizations, NEDA is not just looking for money. You can volunteer, attend on of their walks, register to receive advocacy alerts–or, of course, donate financially (no one ever turns that away).

If it’s you, dear reader, with a “hidden” eating disorder, take a risk on treatment.  The tremendous physical and psychic toll the disorder inflicts costs all those whom you love and love you, not “just” yourself.  It’s a good week to take the first step.