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Men and depression

Recently, we’ve been seeing quite a few stories in the news about men and depression, how depression affects men,  and what causes depression in men. 

There are certain aspects of our emotional make-up which are influenced by hormones.  It’s important to understand that both men and women have emotions.  They simply experience emotions differently.  In many ways, culture influences how emotions are experienced by men and women.  From a very early age, girls get taken care of if they cry.  Boys are told that big boys don’t cry.  Women are rarely told that they need to just suck it up.  Men, on the other hand, are constantly told in one way or another to suck it up, man up, and get on with it.  Women are expected to be emotional.  Men are expected to be steady, strong and silent.  Even in our modern days of new thought, these standards still seem to be in the background.

Testosterone is a powerful hormone.  It is one factor that affects aggressive behaviour.  The level of testosterone present in the body, especially during the teens and early twenties, can directly impact on such behaviours as violence, aggression, anger, and competitiveness.  Testosterone causes men to be drawn to action films and video games.  In turn, watching action films and playing action-based video games increases levels of testosterone, which in turn can result in increased levels of aggression and anger.  High testosterone levels result in more powerful muscular build, and lower testosterone levels make muscles softer.  Early on, studies had shown that men begin to lose muscle tone and hair as their levels of testosterone begin to reduce after having peaked around the age of 18.  What is perhaps even more interesting is that people have long known that after a man marries, he tends to go a bit “soft”.  He loses muscle tone a bit, gets a bit of a soft tummy.  I’ve heard people over the years attribute this to getting home cooking, being spoiled by his wife, etc.  In fact, when men are in a positive relationship with a woman, the testosterone level reduces almost immediately.  When men become fathers, their testosterone level reduces.  These things allow them to have more mellow and generous behaviours toward wife and children.  They no longer need to compete for a woman’s attention, and the brain takes the cue, reducing the levels.

So, how does depression affect men?  When men are in positive relationships, with a strong family, successful work environment, etc., their testosterone levels are calm.  However, when they’re in a negative place, the testosterone level rises, and with it, the feelings of anger, aggression and competitiveness.  They will experience irritability and lack of control over their temper.  They can be verbally aggressive, and sometimes violent.  They tend to be tired, and are no longer interested in things that they used to enjoy, similar to women when they’re depressed.  However, because of the different way that men experience depression, many around them won’t even recognise that they are depressed.  Most crucially, the men themselves won’t recognise that they’re depressed.  Because men are discouraged from talking about their feelings, they’re less likely to admit that they need help or to get help.  In terms of suicide, women will attempt it.  Men will succeed in doing it, making men and depression a fatal mix.

There are many questions around what causes depression in men. Men are more likely to become depressed after losing a job than women are.  Men who have lost a long-term partner are more susceptible to depression.  Men can become depressed if they don’t feel that they’ve been as successful in life as they wanted to be due to the competitive spirit of testosterone.  If you’re a man experiencing these things, talk to someone.  Don’t ignore it.  It does not go away until you get help, and there’s no shame in that.

Being depressed doesn’t mean that you’re weak.  In fact, it takes more courage and strength to face depression and do something about it than it does to let your depression end in your death.  Stand up to it and get your life back.

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What causes depression in women?

There are many different things that can cause depression in women. Physical illness can cause depression, especially if it’s long-term.
The imbalances of hormones that are associated with the menstrual cycle can cause depression as well as physical pain. However, women have many external reasons for depression, too. For instance, women tend to be taken less seriously by their GP, and are frequently laughed at for being silly, imagining the illness or depression, etc. They are actually still often told that they just need to take a nap, go to a spa, or buy themselves something nice, as if they couldn’t possibly have any serious reason for being depressed. People can say things that are neither true nor kind, such as accusing her of just being “hormonal”. This points to another major cause of depression in women….the almost constant ridicule that comes at them in one form or another just for being a woman. Women get the message in a million different ways through the course of a day that they are less valuable as people than men are, in spite of the strides being made in crashing through that glass ceiling.

Women are under a great deal of pressure from society and the fashion industry to be a “perfect 10”. It’s long been established that the fashion industry has much to answer for in terms of the extreme body images that it promotes, using women who are dangerously thin. Malnutrition causes vital vitamins and nutrients to be missing from the body, which can result in depression. The pressure to live up to that impossible ideal leads to women being left feeling like fat, ugly failures. For women, depression can lead to comfort eating, excessive sleeping, and weight gain, which in turn leads further into reduced self-esteem. Women do cry more, mostly because they’re expected to. Women are under pressure to be the perfect partner, perfect mother, perfect lover, perfect 10, successful at work but still able to have a perfect home and cook the perfect meal. Since one would have to be at least four perfect people to reach that ideal, failure is guaranteed. Women already dealing with hormones that do more up-and-down swinging every month than a rollercoaster ride and the pressure to fit into that size 0 dress are dealt a further blow by a global, cultural idea that women only have enough braincells to figure out how to put on mascara, and that their main functions in life are sexually focused. Women are under a great deal of stress at work from bosses who look down on them and say/do inappropriate things, colleagues who do the same, and a culture that requires them to look amazing for 10 hours a day standing on high heels. They have stresses at home, where most of the domestic chores still fall to them, and where, if children are involved, they still take on most of the parenting, including time off for appointments and parent/teacher meetings. They also take on the bulk of any work involved in caring for elderly parents, including the in-laws. All of these demands leave them with little or no time to give to their own mental and physical well-being.

Women may physically have thinner skin than men do, but they have to be pretty thick-skinned to get through daily life as a woman. In spite of all of the many news articles, blogs, books and videos about how women are treated around the world, not much progress has been made in terms of the “subtle” kinds of disrespect and abuse that women have to put up with. One of the things that cause depression in women is actually the fact that they realise that on a global scale, they’re often viewed as little more than property. Violence against women and children is shocking in its global scale. Women still have far fewer rights than men do in many countries around the world, and due to the modern age of technology, women see more things in the news or on the internet that promote the attitudes behind that violence. The idea that no one in the world cares about you is part of deep depression. When that idea seems supported as fact by everything that a woman sees in her life and in the world around her, it becomes more so. Women who demand their rights are seen as pushy. Women who try to do things that they can do but which are usually considered a man’s thing are bullied and ridiculed, and if they stand up for themselves and stick it out, they get labelled as troublemakers. They aren’t expected to demand things for themselves the way men are expected to; but more to the point, they aren’t allowed to demand things for themselves the way that men are. This can reinforce a feeling of powerlessness that causes depression. Hopelessness, powerlessness, lack of a sense of value or worth, and a sense of being undesirable are some very significant causes of depression in women.

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How do I know if my friend is depressed?  

Most people who are depressed have difficulty talking about it.  People can be very good at hiding depression, but there are little changes that you can be aware of. 

A person who usually has a bubbly personality can still present as bubbly when depressed, but if he begins to turn down social invitations that he ordinarily would have accepted, starts only engaging only in “small talk” where he used to be more involved in conversation, doesn’t listen to music much anymore, or any other small changes in behaviour are present, and you notice these changes have been present almost daily for at least two weeks, then your friend could be depressed.

Talking to a friend who is depressed can be difficult.  There are some helpful and unhelpful things to be aware of before you attempt it.  It’s helpful if you tell your friend how important they are to you, and that you’ll be there for them if they ever need you.  It’s not helpful to tell them that others have it harder or that that’s life.  Make yourself available for them in ways that make them feel safe and comfortable talking to you.  Don’t tell them to stop feeling sorry for themselves and get on with it.  Telling them that they’re not alone, depression is quite common, is one thing; telling them lots of people are depressed, just get over it, is quite another.  Telling them to try not to be depressed isn’t helpful.  It actually implies that it’s their fault that they’re depressed.  Don’t turn the conversation to yourself by talking about how you’ve been depressed before, or have known someone else who was depressed, and describing those experiences in detail.  The friend will need you to listen, not hit him with tales from the dark side.  Don’t tell them to stop crying and get back into the fun life, because that will make it all better…..it won’t.

It can be difficult to stop yourself from trying to “fix it” for your friend, but the one thing that you can do which has real value is listen and let them know that you value their friendship.  Tell them why you value their friendship.  Help them to understand that you really do get positive things from having them in your life.  Then, talk to them about getting help, but keep it simple.  The first port of call should be their GP.  Sometimes, depression is the result of physical illness, chemical imbalances, or hormonal changes, so it’s always good to be able to rule out anything medical.  The GP might try a course of anti-depressants, but that isn’t where it stops.  As your friend is taking them, he should also be talking to a therapist.  These days, doctors who are stretched to the limit with heavy caseloads insist on patients doing self-referrals for therapy, which takes time, phone calls, and paperwork, and the waiting lists are miles long.  This can be difficult for anyone, more so if the person is struggling with self-worth.  Private therapists who are willing to work with your budget are available if the waiting time seems to be too long; but again, it takes a little time to find them.  You probably can’t find the solution for your friend, but you can continue to support him while he is going through that process.  The main thing for people who have friends who are depressed to remember is that it doesn’t help if you overwhelm them with advice, healthcare tips, or lots of things you’ve downloaded from the internet on the subject.  Don’t try to educate them on what depression is or how to fix it.  Just be there for them and listen.

It’s also important to remember to take care of yourself.  It’s not often talked about, but a person can get what is known as “compassion fatigue”.  This is a form of burn-out experienced by people who give support to others, whether that’s for mental health, physical illness, or disability.  If the supporting person doesn’t take care of himself, he can become fatigued.  This causes people to start avoiding the person they’ve been supporting if at all possible, to lose patience with the person, and to perhaps sometimes say or do things that they later regret.  Self-care is important for all of us, but if you’re helping to support someone who is depressed, it’s even more so.  Make sure that your friend has the number to mental health support lines so that he has other options for support besides you, and set boundaries for yourself so that you have time to rest.  This will help you both.

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Causes of Depression in Men

Once upon a time, the world was a simple place in which everyone’s role in life was spelled out.

Gender roles were very specific, and there wasn’t any question about what men were expected to do or be like. A man could feel secure in his role because of that. On a global scale, men were and still are expected to be strong, silent, successful and stable. However, these days, there are many questions. Nothing is spelled out, and nothing is concrete. A man can have difficulty figuring it all out and finding his place in the world. As a result, men are often left trying to grapple with the mixed messages that the world sends them, and can feel lost and adrift. They can be left feeling very insecure about themselves, and about what it means to be a man. Everything about them as men is tied into things that no longer have real relevance in this ever-changing world. The ambiguity of their situation can be a root cause of depression in men.

Big boys don’t cry. Man up. Suck it up, buttercup. From an early age, boys are taught that they aren’t allowed to express feelings like girls do. They’re not allowed to be vulnerable, to have emotions, or to be seen as weak. In spite of all of the changes in our world regarding equality between the sexes, there really hasn’t been any concrete change in these areas of a boy’s life growing up, or in a man’s life. Even in modern sitcoms, a man who shows his feelings and allows himself to be vulnerable is called a “girl”, as if he has somehow compromised his masculinity by expressing these things. Women have made great strides in changing the way the world views them, and that’s as it should be. The problem is that somewhere along the way, men got left behind. Their place in the world no longer being clear-cut leaves them somewhat out on a limb, hanging rather precariously over a lake of muddy water.

What causes depression in men is much more easily understood by taking a step back and looking at the whole picture. Many men still tie their sense of self-worth to their job, their ability to be successful at work. This can be very difficult, especially given the instability of the current employment market. Jobs are hard to get and harder to keep. Toxic work environments, low pay and excessive workloads can bring stress levels to the breaking point, and they aren’t allowed to talk about that. They’re expected to suck it up and get on with it. Being a man in these circumstances can be a very lonely and trying experience. When you can’t win no matter what you do, it can be very tempting to just give up.

Many men don’t actually realise that they’re depressed because men experience depression differently from women. Men will suffer more from irritability, sudden anger, loss of control, greater risk-taking behaviours, and aggression. Their behaviour will often be mistaken for anger issues. The pressures that they face are made worse by the feeling that they’re unable to talk to anyone without appearing weak. Far too often, the end result is suicide. For men, depression often is fatal. It’s a huge step for a man to actually admit that he needs to talk to someone. The person that he chooses to talk to will need to be someone who gets what it means to be a man, what depression is for men, and how to help men to regain their sense of self-worth. This is where men’s groups and counselling for men can be a vital resource for them. It might not be very often that a man would find a female therapist that he could talk to, and many men feel that talking to a woman would inhibit their ability to talk openly. They can also feel that a woman just wouldn’t understand what causes depression for men or how men experience depression, and for the most part, they could be right. The main thing, though, is to find someone to talk to that you’re comfortable with, talk, get help, and take action to get out of the grip of depression.

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PTSD: not just for soldiers any more

It took decades for PTSD to be recognised in soldiers, so it really isn’t surprising that it took a few decades for it to be realised that soldiers aren’t the only ones who can suffer from it.

There are many different traumatic situations that can result in PTSD. After soldiers had finally been recognised as suffering from PTSD, it gradually began to be realised that women who had been in severely abusive relationships were suffering the same set of symptoms that soldiers were.

Victims of extreme domestic violence develop the same hyper-vigilance that soldiers on the combat field do, and will have nightmares, night terrors, flashbacks, triggers, dread that something awful is going to happen. They will actively avoid any place or activities that remind them of the abuse or that the abuser had forbidden while they were with him. They will be unable to stop their minds from spinning around in constant worry, unable to sleep, unable to concentrate. It is sadly more difficult for soldiers to get treatment and support than it is for women who are victims of domestic violence, and men who are victims of domestic violence can have a more difficult time getting help. It seems rather ironic that the first group to be acknowledged as suffering from a disorder that was thought of as “just for soldiers” is now left behind to a large degree in terms of treatment and support.

I have found soldiers to be very accepting of others who suffer from PTSD, even if theirs didn’t come from combat. In seems that to soldiers, the suffering, the wound, is what counts, not whether or not you were wearing a uniform when it happened. The camaraderie of soldiers is a unique bond of shared experience, but they also can share with others who experience PTSD in the same way that they do. I’ve never heard a soldier say that PTSD is “just for soldiers”. PTSD in victims of domestic violence is still very often misdiagnosed as depression due to the fact that PTSD is considered to be “just for soldiers” by many in the medical field. Doctors simply don’t recognise what they’re looking at in many cases if they aren’t looking at a soldier.

PTSD is a disability. It’s crippling in its intensity and scope, affecting every aspect of the person’s life, every breath she takes. Movement is restricted. Just as a soldier wouldn’t necessarily consider taking a day trip out to the battlefield where the bloodiest conflict took place, domestic violence victims will try to avoid any area or activities that remind them of the abuse. Flashbacks and triggers are a nightmare to live with. They can be terrifying and embarrassing, especially when the victim realises that no one is reacting to the situations in the same way she is, and that people think she’s lost the plot. Going out can be nearly impossible due to the fact that the brain is spinning in so many directions that she forgets where she is and ends up miles away from where she meant to go. She gets lost just walking down the street. It can be terrifying to look up and down a street that you know you’ve been down a million times, but at the same time not recognise it. She won’t be able to finish a thought, a sentence, a book or a film. Lack of sleep because her brain won’t stop spinning, as well as the fact that everything going on in her mind is worse at night, makes her life exhausting. Under such circumstances, social activities or employment are virtually impossible. Outbursts of anger that don’t make sense to the people around her, irritability, sudden sobbing or coldness that doesn’t make sense to the outsider make it very difficult for people to be around her, which makes her just as isolated as she was when she was with her abuser. In the case of soldiers, the war isn’t ever really over. This holds true for the victim of domestic violence, as well. Leaving the abuser doesn’t change anything. Her mind is stuck in that time period, and she is completely unaware of the passage of time. This of course means that for the soldier, life is stuck on the battlefield and never really moves forward. Each category of sufferer will experience the same symptoms, even though their nightmares and flashbacks will centre around different causes. The symptoms can be just as severe for each category of sufferer.

In addition to soldiers, people who can suffer from PTSD are victims of one-off terrorist events, victims of robberies, people who are involved in a car crash, pedestrians who have been hit by a car, or anyone who has suffered any kind of traumatic event. People who have been raped or who have been sexually abused as children can have PTSD, and in most of those cases, they won’t recognise that this is what they’re suffering from. PTSD for soldiers is readily recognised now, but many people who have been sexually abused as children do not realise that they’re suffering from PTSD themselves, and most will wait until they’re middle-aged before asking for help anyway due to the shame and secrecy around the entire subject.

The fact remains that even though PTSD isn’t just for soldiers, soldiers are the ones most likely to commit suicide because of it. For them, the severity of it can be overwhelming, the lack of help and support unendurable. They fight hard to get heard, to get a few pills thrown at them. The pills don’t work on their own, but a soldier can travel long distances trying to find support only to be put on waiting lists a mile long. Some turn to online groups in desperation for some kind of support, and though many groups are good, there is that risk of anonymity that can allow trolling by fakes who got in with an agenda in mind. The soldiers who returned home from the Vietnam War not only had their as yet unrecognised PTSD to contend with, they also had to endure abuse from people who were against the war and needed to punish the soldier for having gone. Some of the abuses that returning soldiers endured are unbelievably horrible, and the introduction of the internet didn’t help. It can be difficult to find someone to talk to who can handle whatever they have to say, and they can feel that no one who hasn’t been a soldier could really understand. This can be very isolating if they don’t have a support group readily available. Most of them do reach out to each other in a buddy system, but when the buddies are all suffering as well, it can be a downward spiral that seems to have no end. Soldiers who come home from the battlefield don’t always survive the war. The first group to be recognised as having PTSD has been left behind, and in many ways, has been failed.

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PTSD: Not just for soldiers, part two

In the late 1950s, the American government became curious about the affects of imprisonment and torture on POWs during WWII.

German war camps had exposed the prisoners of war to ruthless and relentless torture and labour, but the men were not broken. They kept fighting back, kept strong. However, those who were captured by the Chinese during the war were left so brainwashed that they could be left unguarded and would still feel that they couldn’t escape. What caused this difference in the behaviours of the prisoners? Biderman investigated and found that whereas the Germans had resorted to simple, brute force in every aspect of their war crimes, be it the concentration camps or the prisoner of war camps, the Chinese had utilised a more focused methodology of torture that wore the prisoners down and made them controllable. Biderman’s research produced what is known today as the Biderman Chart of Coercion.

In German camps, the prisoners were still able to stay together as a group and offer each other support. They strengthened one another, kept one another’s hope burning, and were able to withstand unbelievable torture, hard labour, and malnutrition. They were allowed to sleep, even during brutal marches, because their captors needed sleep. Their captors also didn’t understand something that the Chinese did. Group support and even small amounts of sleep kept the prisoners strong. United we stand, divided they fall. Even in the concentration camps, groups of Jews or groups of Jehovah’s Witnesses, or any other communities being imprisoned would stick together and encourage each other to stay alive and hope for rescue. The Chinese had a different way of dealing with prisoners. Biderman’s research showed that the Chinese had used different tactics to break the prisoners, and the first one was isolation.

Extended periods of isolation weakens a person’s ability to resist, and makes the victim dependent on the interrogator. Sleep deprivation was also used, as well as threats of death, threats of never being allowed to go free, threats that that the interrogation would never end, vague threats that would keep the prisoner guessing, and threats against the prisoner’s family. The interrogators would occasionally give the prisoner some small indulgence which would provide positive motivation for compliance and interrupt the adjustment to deprivation. The interrogators would suggest that they were omnipotent and that resistance was futile. They would use degradation to make resistance appear more damaging than giving in, and they would enforce trivial rules. The prisoners were most often eventually broken by this mental and emotional torture, while the prisoners of the German war camps could not be broken even with the most brutal beatings.

Modern researchers who were studying domestic violence and how it was affecting victims came to realise that these were the methods that perpetrators were very successfully using against their victims. The prison was their home instead of a war camp, but the methods were every bit as cruel….and at least as successful. Just as the soldiers had come back from the war broken, the victims of these coercive behaviours were also broken, and it isn’t hard to understand why. An abuser will use a number of related tactics to keep her focused on him and his demands so that he can have complete control. He can give her detailed instructions for doing impossible tasks while he’s away, telling her that he has a secret way of finding out if she followed the instructions or not, and that she’ll be punished if she doesn’t.

Sometimes, he’ll deliberately set her up to fail so that he has an excuse to punish her. He’ll keep her guessing as to what the punishment will be, but she knows that it will be horrible. He keeps her in a state of terror. If she is allowed to go out, he’ll do little things to make her know that he can be watching her, and she wouldn’t know it. Anything from a random text message to a bunch of flowers sent to the place where she’s supposed to be can show her that she’s under his watch. At night, he can pick an argument to keep her from sleeping, or sometimes wake her up to accuse her and argue with her over some imagined transgression. Eventually, she won’t be able to relax and sleep because she’ll be worried about what he might do next. He will occasionally buy her something nice in order to keep her obligated to him, and then tell her she’s ungrateful and horrid.

He might destroy the gift because he says that she didn’t deserve it after all. He might destroy things that she’s attached to and leave them for her to find later. There is always an unspoken threat in the air. She can come to feel that no matter where she goes, he can see what she’s doing, and she could be punished. He can pop up sometimes during the day just to show her that he knew where she would be and that he’s watching her. She then reaches the point where she’s looking over her shoulder all the time, waiting for him to show up. He gradually takes control of the finances and won’t let her have any access to money, no passport, nothing essential unless she has “earned” it or “deserves” it. He’s the one who decides if she has. He eventually has so much control over her that she has no other life and no other thought. She can’t risk falling asleep because he might do something to her while she’s asleep. She has to keep watching him to know what she might be up against from moment to moment. He could even reach up suddenly and slap her while they’re quietly watching telly, just to keep her on her guard. She can never relax. He isolates her from her family and friends, not letting her visit them or talk to them anymore unless he’s listening in.

He reads her emails, monitors her phone. He can even make threats against her family. The most common threat is that he will kill the children if she tries to get away. He will make her feel that anything the children suffer will be her fault, and that if she “makes him” kill the children by leaving him, it will be all her fault and no one will love her anymore. He will convince her that no one will ever have her again, and that he’s doing her a favour just by being with her. She will eventually have the same symptoms of PTSD as soldiers do who have been in frontline combat. She will be hyper-vigilant, will have nightmares, will be highly anxious, and will have constant dread that something awful is about to happen. Every moment of her life will be about surviving every moment of her life, and she is never allowed to let her guard down. This doesn’t end just because she managed to get away from him and to survive doing so. Her brain is locked into this never-ending spin. Just as it is for soldiers, where the battle never really ends, so it is for the victims of extreme domestic violence. They get stuck in that time frame, and can’t move out of it.

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PTSD: Mental health disorder or mental illness?

PTSD is classified as a mental health disorder. Mental health disorders are changes in an individual’s thinking and feeling that have significant impact on the ability to function in everyday life.

These changes can be the result of an external circumstance, such as trauma in the case of PTSD. Mental illness, on the other hand, has a biological basis, such as with schizophrenia. People tend to use the two terms interchangeably, which leads to stigma and confusion.

When people who have been the victims of domestic violence are diagnosed with anxieties, depression or PTSD as a mental health disorder, it can be very difficult for them to accept. When it’s referred to as mental illness, it’s easy to understand why they would be inclined to reject that completely. In the past, I’ve advised well-meaning people working with the NHS to put up information whilst leaving any reference to mental health off of the flyers, posters, etc. that they create in order to reach out to victims. I’ve had many victims protest to me that they are being told that they have mental health problems, and they insist that they don’t because “this was done to me”. The interchangeable use of the terms mental health disorder and mental illness have led to the popular understanding that if it’s damage caused by someone else’s actions, then it can’t be a mental health problem. Until the correct understanding is more universally known, there’s no point in trying to use the term mental health in your outreach programmes. It will continue to get rejected.

So, how do we approach the problem? I would suggest that it would be beneficial to approach it from the victim’s point of view. We can approach it from the perspective of their symptoms being an injury that has been inflicted on them by the behaviour that they’ve been subjected to over the long term. This is easier to accomplish with PTSD. Complex PTSD is recently being argued to be in actual fact a physical injury to the brain. In the cases of very significant PTSD or complex PTSD, there are sometimes “scars”, or residual symptoms that aren’t ever completely cured. With proper treatment by a well-qualified psychologist specialising in PTSD, the remaining symptoms will be very mild and quite easily managed. These occurrences would happen very infrequently, with most symptoms completely cured. This can be compared to a significant scar from major surgery, which even decades later will still sometimes be sensitive if touched. It will occasionally remind you that you once had surgery, but the memory won’t be traumatic anymore. Most people who suffer from PTSD will be completely cured, so the prognosis is usually quite good.

AVA (Against Violence and Abuse) are doing some amazing work in this area, training mental health professionals to be able to recognise and understand what’s happening for the victims. However, victims of very severe domestic violence don’t have places where they can go for support. I’ve found that support groups not affiliated with AVA but which claim to support victims of domestic violence will “silence” the victim whose stories are harrowing, telling him/her not to talk about the experiences because they would be too upsetting for the others in the group. Not being allowed to talk about it not only violates the reason they go to the group, but it also reverberates with echoes of the abuser telling them to be silent because no one would listen anyway, or that people would think they were mad. My domestic violence experiences were extreme, so I was told not to talk about my experiences because it would be too upsetting to the other women. Understandably, I decided to stop going. It didn’t seem to me that the domestic violence workers were able to really support the full range of experiences. I was told repeatedly by different professionals that my complex PTSD was the same as that suffered by soldiers who had been in front-line combat for years, so I asked about going to a soldiers’ support group. I was told by these same professionals that this wouldn’t be appropriate, either, because I hadn’t actually been in a war. That was actually a rather narrow view. The soldiers to whom I’ve spoken are actually very supportive and open to the suffering, regardless of where it came from. I was more welcomed by them to open up than by any area of the domestic violence programming. This leaves a gap that surely must be addressed at some point. Like soldiers, I had to fight for a few years to finally get the specialised help that I needed, and I still to this day know of no group where victims who had similar experiences to mine can go. For someone who is suffering from a mental health disorder to have nowhere to go and no one to turn to is surely not acceptable.

A person who has been subjected to severe experiences of domestic violence has no one to turn to. She doesn’t talk to anyone because she doesn’t believe that they would understand. Many of them wouldn’t. I had people ask me why I didn’t just stop having nightmares. I had a psychiatrist who was untrained in these things ask me, “but it’s over now….why don’t you just get over it?”. This really shows why the work that AVA do in training these professionals is so very vital. Mental health disorders, such as PTSD, have a significant impact on the daily lives of those who suffer from them, which is why they are classified as such. People who suffer from PTSD are unable to concentrate, sleep, read a book or finish a film. They are plagued with flashbacks, and triggers can cause them to melt down. People don’t understand what they’re going through, so when they have to call in sick from work, it can cause problems.

I’m qualified to work with PTSD, depression, and anxieties. I offer help to soldiers who need someone to talk to whilst awaiting any other treatment options that are on offer for them, and I offer help to victims of domestic violence and sexual assault. I can also work with people who have unresolved childhood traumas, or unexplained anger issues.

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PTSD: What not to say and why

Things not to say:
1. It’s ok now, move on.
2. I know someone else who went through the same thing, and they didn’t act this way.
3. Aren’t you just over-reacting?
4. Why don’t you just stop thinking about it?

Let’s address these one at a time. The first one is, it’s ok now. Move on. The reason that we shouldn’t say that is because it isn’t ok now, and the person would clearly move on if they could. When someone has suffered an event which brings on PTSD, it isn’t ok and they can’t move on. They are physically stuck at the point in time when the event took place. They are usually completely oblivious to the amount of time going by since the event, and are unable to ignore the impact that the event is having on their lives. If someone was in a serious accident and had to have their lower arm amputated, no one would even think of telling them that it’s ok now, move on. People would clearly understand that damage has been done and healing needs to take place. They would recognise that counselling therapy as well as physiotherapy would be needed before the person could even begin to “move on”.

With PTSD, the injury isn’t that visible, so people can be fairly callous to the impact that it actually has on the sufferer. It has in recent studies been recognised as a physical brain injury due to the way it changes the brain’s processing of events in life. The brain is unable to process the information of the event, and gets “stuck”. Imagine telling your brain not to recognise the colour blue. I think it safe to say that we all realise that not wanting to see the colour blue any more will not change the fact that the colour exists, and we will see it. We might try to avoid seeing the colour blue by refusing to look up at the sky, but that won’t change the peripheral view of the sky that we will see regardless of our desire not to. Everywhere we look, the colour blue will be noticeable, and any efforts to stop seeing the colour blue will only make that colour that much more noticeable. You can not force your eyes to stop registering the colour blue. In a similar way, the person suffering PTSD can not force their brains to stop remunerating about the event, having nightmares about the event, or having flashbacks when triggered by something that reminds their brain of the event. The brain is in complete control. They are not.

The second one is, “ I know someone else who went through the same thing, and they didn’t act this way”. Just as every person is unique, every experience for every person is unique. It’s also true that we don’t really know what a person is feeling or experiencing if they don’t choose to tell us, and some people might choose to keep it hidden as much as they can so that they can avoid having to talk about it. Some people are numb to an experience until a similar experience happens. In any case, we should never judge anyone for the way they react to any traumatic experience. One thing to remember is that we never truly know how we ourselves would react to the same experience until it happens to us.

The third one is, “aren’t you just over-reacting?”. This question not only diminishes the experience of the person they are asking it of, it also judges. The implication is that the person has chosen this course of behaviour; perhaps as a way to get attention, but certainly for not any legitimate reason. No one who has suffered from PTSD would choose to live like that. Unless you’ve experienced PTSD, you really can not imagine how painful, terrifying, and embarrassing it actually is to live with. It’s an enemy that takes you over, and it can make life so difficult that death can be preferable. This is why so many soldiers commit suicide. There truly are some things worse than death. There are some traumatic events that we can all agree are traumatic, such as a terrorist attack. However, any event that causes a significant impression of being in fear of one’s life will have the same result.

It’s true that you might not consider that the car crash you only just survived was a traumatic event, but it’s just as true that someone else would. I’ve treated people who survived a crash that they shouldn’t have, and the crash itself wasn’t the problem. They could remember every detail of it years later, but it had no impact on them. I knew another person who just had a prang and was so affected that they couldn’t drive again, even years later. They were able to ride in a car reasonably well, but could not drive. Every person, every event, is unique, and no one would choose to have PTSD as an over-reaction. Each person’s experience deserves respect and dignity, not judgement.

Finally, “why don’t you just stop thinking about it?”. This question is based on a lack of information about what PTSD actually is and does. When we ask questions to diagnose the condition, the question addresses intrusive thoughts, or thoughts that are unwanted but persistent. Have you ever had a song in your head that you just could not get rid of, and it drove you potty until it decided to go away? Well, PTSD is similar, but much worse. Just as you couldn’t make that song get out of your head, the person suffering from PTSD can’t just stop thinking about the event. The thoughts are there, unwanted and determined. The person suffering from PTSD can not control their dreams, either, so will wake up with a start thinking they heard the brakes screeching and glass shattering. People can wake up in a cold sweat, or screaming….at no time is “just stop thinking about it” an option.

What not to say is easy enough. What is the right thing to say might be another matter, and many times, people really have no idea what to say or do to help the sufferer. In reality, the reason why soldiers just hold on to each other sometimes is because sometimes, that’s all you can do. Just hold on to each other. I read about one soldier who went into meltdown in public, and his wife went down to the ground with him, just holding onto him tightly the same way another soldier on the field would’ve done. Sometimes, that’s all you can do. Just be there. Get as much information about the condition as you can. Get the advice of a professional, if you want to. One thing to remember is this: If you think you might say the wrong thing, saying nothing at all is a perfectly acceptable option, as long as you just make sure that the person knows you’re there and want to understand.

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The Marriage Effect

I’ve always been intrigued by the way relationships morph from the joy of the wedding to the screams of anger and hatred of divorce.  What causes a couple who once couldn’t keep their hands off each other to realise one day that they can easily go for days ignoring each other?

 

There is an old proverb that states: Familiarity breeds contempt.  What this means is that people start taking each other for granted and then behave towards each other with a disrespect that can begin to border on contempt.  After a time, they can go so far as to actively hate each other.  It would seem from all that I’ve seen and heard that it all boils down to forgetting to do or say the little things that can make a big difference.  Forgetting to say please and thank you, forgetting to apologise for spats, forgetting to treat your partner with respect, can lead gradually to hating each other.  Conversely, remembering these simple things can keep a marriage going happily for decades.  The interesting thing is that for familiarity to breed contempt is actually more of a choice than a foregone conclusion.  There can be a certain amount of intimacy that comes from being close to someone.  One doesn’t treat one’s best friend with contempt, or they wouldn’t be one’s best friend for long.  We all seem to recognise this fact.  Perhaps you might point out that best friends don’t live together, and families do.  This is true, but families don’t begin despising each other until the core of the family, the couple in the centre, do.  Caring and loving attitudes radiate from that core, as do hatred and disrespect.  So, why do couples go sour when best friends can go happily on for decades, forging an ever stronger bond around shared experiences, stories about the kids, and gossip about the people we knew in school?  What causes couples, who used to describe themselves as best friends, to become mortal enemies?

 

I’ve often heard it said that sex ruins a perfectly good friendship.  I’ve actually known best friends who decided to get married, and then decided that they’d better get divorced so that they could remain best friends.  However, I can’t give much credence to the statement that sex ruined their friendship.  Or can I?  Best friends from school who remain best friends for life don’t have sex.  They have certain unspoken and untouched boundaries between them.  They rarely if ever see each other naked, they don’t share a bed, and they don’t live together day in and day out, year after year.  Even room-mates, who do live together day in and day out, have certain boundaries.  They rarely if ever see each other naked and they don’t share the same bed.  They may occasionally break wind, but they don’t do so without asking pardon for the infraction.  I think that’s where the crux of the matter lies.  Married couples, or those who consider themselves to be in a permanent partnership, sleep together, share the bathroom in the morning, and more importantly, consider themselves to be more than room-mates.  However, if each of them went home to visit the parents they grew up with, they wouldn’t proceed to come out to the kitchen to pour a cup of morning brew in their underpants, farting and belching for England.  Without it needing to be spoken, they would realise that this wouldn’t be courteous or respectful.  Most of us were taught manners as children, and we were taught that manners were important in the home as well as out in the world.  These family members aren’t seeing each other naked, and sex with them is forbidden.  We don’t do it in normal society.  It would almost seem, then, that there is a connection between the familiarity that exists between an intimate couple and the possibility of losing their respect and fondness for each other.  There’s something different about the long-term sexual relationship and how it affects our view of each other.

 

What is it about living with someone as a couple that is different from living with our families?  What is it that causes us to remember from our upbringing that we don’t fart in front of mum, but to forget such courtesy and respect when it comes to our wife? There might be a clue in the idea that the individuals seem in the collective mind of community and society to cease to exist and they become part of a couple, a whole.  Two in one, or one split in half.  Perhaps that idea can subconsciously translate into the idea that you’re not really in the presence of a family member….that’s just your wife.  Without realising it, perhaps we begin to feel on some basic level that we and our partner are one and the same.  We might then translate that into the concept of being two parts of one person living in the same house, which means that we don’t have to have manners.  If you were the only person in the room, you wouldn’t be likely to apologise to the empty room for some discourtesy.  It would seem to make some sense to move from there to the idea that perhaps as we consider our partner to be part of us (part-ner), then we don’t have to be courteous.  Once the boundaries of courtesy and respectful behaviour and speech are done away with, we’re off.  We feel without actually thinking about it that we can say whatever we like because it’s like talking to ourselves.  Mind you, I think most of us wouldn’t talk to ourselves the way we’ve all heard some long-term couples talk to each other.  So, we must dig a little deeper.

 

Becoming part of a long-term couple, sharing a bed and each other’s bodies, causes the couple to feel like a unit.  This is natural.  The people around them see them as a unit, as well.  They’re no longer considered to be single individuals.  They even refer to their mate as their other half or their better half.  However, in reality, they are still two individuals.  They are unique, and they each bring a certain amount of baggage into the mix.  They also have little ways and habits that don’t really show up until they live together.  If in their subconscious minds, they’re thinking of themselves as one unit, with each one being the “other half” of the other, it stands to reason that they would feel, on a very subconscious level, that the other half should be the same as they are.  Hence, the little ways and habits that are different become annoying.  Over the years, couples that have come to me have confirmed that the reason that first year is the hardest is because they’re two individuals learning to live together as one unit.  Room-mates accept that they’re going to be different, and even though they might occasionally have a row over something, they don’t usually have a problem accepting that they’re two different people.  As Prince once said, marriage changes expectations.  He was spot on. Somehow, after a couple become a genuine, committed couple, they stop being two people and become one, which means that they’re both supposed to do everything in exactly the same way, and there shouldn’t be any courtesy or formality because we’re a unit, two parts of the whole.  It’s a feeling, not a thought.  It’s not recognised as a construct, because no one even recognises it as existing.  It is more like an unexplained condition that happens to married people.  The problem with trying to cure something that has gone wrong is that you can’t really cure the symptom unless you know the cause.  We can teach people to communicate better, but wouldn’t it be great if we could actually help them to understand what went wrong to begin with?  If couples were able to understand before they committed to each other that they were still two different individuals, and that this is actually okay, I believe that we would see far fewer of these problems.  Room-mates understand that they’re going to have different ways of doing things.  So, when it’s room-mate A’s turn to do the washing-up, he does it his way, and when it’s room-mate B’s turn, he does it his way.  There’s no question of one moaning about the other one not holding the sponge correctly.  Chores are divided out, with each one taking turns doing each thing, and there’s no argument between them about how the chores should be done.  Things are organised, the bills are paid, even free time is organised so that each one gets to do something that they want to do on different evenings.  Couples don’t do that.  They should.  Couples should remember that even though they’re now a family unit, they’re also two individuals who deserve to be treated with respect and courtesy.  If they remembered to talk to each other the same way they did before moving in together, no one would be tempted to move out.  What sex does to ruin a good friendship is change the construct in the subconscious mind.  Sex changes the two into one in the subconscious mind, and that’s when it all falls down.  To make the point, it isn’t actually sex that ruins the friendship.  It’s the subconscious idea that the couple are now one unit, which means the same person, which means more liberties can be taken than are actually acceptable.  Over time, that lack of respect wears the individuals in the couple down and turns them on each other, so that they so begin to resent each other that they do nothing but row, and they begin to hate each other.  The gap between them grows as they become more self-focused.  They each think more and more about what they perceive the other person doing, what wrongs they feel have been done them, and how this is unbearable.  We start seeing more extreme blame, where every little infraction leads to full-on war.  Suddenly, slights from years gone by are remembered in minute detail and brought out for air, and they actually begin to try to destroy each other.

 

When they come for marriage counselling, we treat the symptoms by teaching them how to communicate,  and how to have constructive disagreements.  What we don’t do is teach them what went wrong so that they can make sure it doesn’t go wrong again.  If we have headaches because our glasses are out of date, we don’t just take pills.  The pills might help the headache to go away, but it will come back if we don’t get new glasses.  In the same way, helping the couple to get through this rough patch and start communicating again will make things better for now.  However, we fail to remember that they were communicating well at the beginning of their relationship, and that soured.  We need to add another layer to it by helping them to understand the underlying viewpoints that brought them to that place to begin with.  Otherwise, it can happen again.  They might sit down and try to remember what we taught them in the counselling, but what they won’t be able to do is figure out why they “let” it happen again.  I think part of marriage counselling should be helping them to realise why they got to this point, and then talk about how to rearrange their lives and attitudes toward each other so that they can show and receive respect.  Being intimate, close friends, and partners all rolled into one is possible.  It’s not some idyllic dream.  However, we have to be clear with ourselves about what we want to achieve and how to go about it.  We have to remember that if two room-mates are going to need to talk about a lot of stuff in a negotiating manner in order to fully respect one another, married couples need even more to do so.  We need to be fully cognisant of each other’s need for respect, space, and dignity.  We can still be playful in the bedroom, and in fact, couples might realise that allowing their relationship to die because of the subtle shift in attitude toward each other is what caused the death of their sex life to begin with.  It’s a vicious circle….the sex causes the attitude shift, which kills the sex, which kills the marriage.  It would be amazing if people had marriage courses to go to before they got married which would teach them how to stay married.  Having an annual marital health check as an anniversary gift probably wouldn’t be a bad idea, simply because daily life can make us take things a bit for granted, and we can start slipping.  We accept that we have to take our cars for servicing every year to pass the MOT.  We should do no less for our marriage.  Perhaps marriage counselling has been going at it the wrong way round.  Perhaps we should give marriage counselling before the marriage instead of when divorce is on the horizon.  It could shave years off the war and save millions of lives.

 

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What Does Marriage Mean, part 1

Many people would say that marriage has changed over the centuries.  In fact, marriage hasn’t changed at all.  Peoples’ perceptions of it and attitudes toward it have changed.  Due to these factors, there is an appearance of marriage itself having changed.  Increasingly, people are asking the question, “what does marriage mean?”.

 

Marriage is certainly less popular these days.  In fact, based on their questions around what marriage means, fewer people are even finding a reason why marriage is necessary to formalise their relationship.  There is an argument that this change in attitude around the meaning of marriage, resulting in fewer people actually getting married, has brought about an increase in broken homes.  However, broken homes were becoming more common before people stopped bothering to get married.  Instead of marriage becoming less common, divorce rates grew at an alarming pace.  Some governments have actually created and enforced legislation around marriage and divorce in an effort to encourage marriage and make divorce almost impossible in the attempt to alleviate the social burden of broken homes.  Those laws really didn’t change anything.  They didn’t answer any of the questions new generations were asking regarding the meaning of marriage, and they gave no reason why marriage should be part of the equation other than penalties imposed.  Laws don’t tend to have much of an impact on attitudes.  Where the laws are accused of not keeping up with the times lies in the problems that couples who aren’t formally married have.  Partners who aren’t formally married find that they have difficulty accessing medical insurance coverage for their significant other.  Pensions are denied to a surviving partner, regardless of how long-term the partnership was.  If partners become homeless, only the vulnerable mother and children are housed….the father of the children is on his own, and the family is separated.  The real impact of not getting married isn’t felt until some tragic event takes place which shows the disparity between formally married couples and those who have entered into a long-term, co-habitating relationship.  In spite of any attempt at forcing marriage through legislation, people are going to court in ever increasing numbers to demand the same rights for themselves and their long-term partners as married couples have, and the questions around what marriage even means play a significant role in those cases.  Their position is that they’re every bit as committed to their relationship as a formally married couple are.  The government’s position is that if that were so, they would go through the process of being legally married.  The partners argue that weddings are expensive.  The government argues that a simple trip to town hall gets it done.  It’s a piece of paper, they say, not a huge event.  Some people may argue that it’s down to divorce laws being too difficult, with the process of formal separation recognised by a court as taking too long.  However, people still move out of the marital home and take up residence with the next partner whilst awaiting the finalisation of the divorce process.  That partnership simply isn’t recognised legally as long as they’re married to someone else.  So, it’s as if both sides of the argument have dug their heels in, with each side actively ignoring the will of the other, and neither side is really addressing the elephant in the room:  What does marriage even mean?  Many people say in defence of not getting married that marriage actually changes the paradigm of a long-term relationship, destroying the arrangements and expectations that had worked so well for the couple prior to the formalisation of their relationship.  They use as the excuse for leaving a marriage the change in their partner’s attitudes toward them regarding their respective roles in the relationship as defined by marriage.  They are also known to bring to the court as their reason for divorce the fact that they’re no longer happy or fulfilled in the relationship.  Summing up, all any of this means is that homes will either stay stable or break up whether formal marriage takes place or not.  This gives evidential support to the conclusion that marriage legislation will not change attitudes, and that attitudes are what have changed.  It also gives weight to the questions surrounding the meaning and importance of marriage itself.

 

Some changes are good and necessary.  For instance, men are no longer seen as absolute ruler in the home.  Decades ago, I heard police officers telling a battered wife that her husband probably would be less inclined to hit her if she cooked better or tidied up more often.  I’ve actually heard people say to the wife that she wouldn’t have problems in her marriage if she would be more accommodating to her husband.  No one ever said any of those things to the husband.  I remember a particular episode of the old, black-and-white television series, “I Love Lucy”, in which the husband, Ricky, took the wife, Lucy, over his knee and gave her a spanking because she had “misbehaved”.  At that time, this was considered a man’s right and his duty in order to maintain order in the home.  Thankfully, the law has stepped in to a large degree to alleviate abuse, as this kind of behaviour is now recognised to be.  These days, even though the bulk of the work around the home and the care of family still falls too often to the woman, many young couples are recognising that this isn’t actually fair or tenable.  Both partners have to work outside of the home in order to make ends meet in most cases.  That being the case, for the woman to then come home from work and be responsible for all of the housework, the cooking, the shopping, and the care of the children whilst her husband lounges over the paper is not a fair or tenable situation.  Young men these days are finding that they’re expected to do more around the house, and that the children are just as much their responsibility as the mother’s.  Their own attitudes determine how well they’re able to adapt to the new expectations,which in turn has a dramatic impact on the sustainability of the long-term relationship.  These attitudes are more often shaped by parents and school activities than by peer groups in general, where the ideas of power and masculinity are still greatly intertwined, so progress has been slow.  The questions around whether the life-cycle paradigm have changed the attitudes around marriage or the attitudes around marriage have impacted the life-cycle paradigm are intriguingly similar to the question of which came first, the chicken or the egg.  In that sense, the two questions are linked together inseparably; and those two questions are also impacted by the answers to the question, “what does marriage mean?”.  I’ll go a little deeper into that in my next blog.

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