In an era of quick fixes and instant gratification, no one wants to talk about the anxiety that results from heartbreak. With the American worship of winning, many people believe that to admit loss, or the fear of losing, is a sign of weakness, immaturity, and failure. The wholesale denial of loss contributes to the epidemic of anxiety and depression.
The elderly are twice as likely as the general population to suffer from depression. One reason is the greater frequency of loss in this age group. The death of a spouse, friend, or family member, poor health, retirement, financial problems, relocation to a retirement community or nursing home, and confronting their own mortality are just some of the losses dealt with by people in the final chapters of their lives. Studies show that as we age, serotonin declines and cortisol levels rise. The result is often chronically high levels of stress among the elderly, and for those who are especially vulnerable, anxiety and depression. There is no segment of the population for whom benzodiazepine tranquilizers are more overprescribed than for the elderly. Too often these pills just compound their problems.
The relationship between the onset of anxiety and the occurrence of loss is well researched. Anxiety, stress, and often illness tend to occur around significant life events, transitions, and crises in people’s lives. Create a “lifeline”—a chart on which you note the major losses, changes, and turning points in your life. Is there an association between the onset of periods of anxiety and your major life changes?
In studying the relationship between life changes and bouts of anxiety and illness, psychiatrists Thomas H. Holmes and Richard H. Rahe attempted to depict this correlation more exactly by measuring the severity of change in the period before the illness. Of course, no two people respond identically to the same change or loss. Following a divorce, death of a close friend, or loss of a job, one person may have only mild feelings of anxiety and depression, while someone else may develop an anxiety disorder or major depression.
Holmes and Rahe did research among people of different countries, social classes, and ages and came up with forty-three common life changes, with their relative adaptive demands given a score on a scale from 1 to 100. Their Social Readjustment Rating Scale, published originally in 1967 in the Journal of Psychosomatic Research, was as follows:
|
LIFE EVENT |
MEAN VALUE |
|
• Death of spouse |
100 |
|
• Divorce |
73 |
|
• Marital separation |
65 |
|
• Detention in jail or other institution |
63 |
|
• Death of a close family member |
63 |
|
• Major personal injury or illness |
53 |
|
• Marriage |
50 |
|
• Being fired at work |
47 |
|
• Marital reconciliation |
45 |
|
• Retirement from work |
45 |
|
• Major change in the health or behavior of a family member |
44 |
|
• Pregnancy |
40 |
|
• Sexual difficulties |
39 |
|
• Gaining a new family member through birth, adoption, oldster moving in, etc. |
39 |
|
• Major business readjustment, such as a merger, reorganization, bankruptcy, etc. |
39 |
|
• Major change in financial state |
38 |
|
• Death of a close friend |
37 |
|
• Changing to a different line of work |
36 |
|
• Major change in the number of arguments with spouse |
35 |
|
• Taking on a mortgage, such as purchasing a home, business, etc. |
31 |
|
• Foreclosure on a mortgage or loan |
30 |
|
• Major change in responsibilities at work, such as promotion, demotion, lateral transfer |
29 |
|
• Son or daughter leaving home for marriage, attending college, etc. |
29 |
|
• In-law troubles |
29 |
|
• Outstanding personal achievement |
28 |
|
• Wife beginning or ceasing work outside the home |
26 |
|
• Beginning or ceasing formal schooling |
26 |
|
• Major change in living conditions |
25 |
|
• Revision of personal habits |
24 |
|
• Troubles with the boss |
23 |
|
• Major change in working hours or conditions |
20 |
|
• Change in residence |
20 |
|
• Changing to a new school |
20 |
|
• Major change in usual type and/or amount of recreation |
19 |
|
• Major change in spiritual beliefs or religious affiliation |
19 |
|
• Major change in social activities |
18 |
|
• Taking on a mortgage or loan less than $10,000 |
17 |
|
• Major change in sleeping habits |
16 |
|
• Major change in number of family get-togethers |
15 |
|
• Major change in eating habits |
13 |
|
• Vacation |
13 |
|
• Christmas |
12 |
|
• Minor violations of the law, such as a traffic ticket, jaywalking, disturbing the peace, etc. |
11 |
Apply the Holmes-Rahe scale to yourself. Check off each of the life events on the chart that happened to you during the year immediately preceding either your current or last significant bout with anxiety. If an event occurred twice in that year, it should be checked twice. The corresponding number values for the changes in that year should then be added up, providing your total score for the life changes and losses you experienced during that time period.
Since developing their original scale, Holmes and his colleagues have suggested that people assign their own readjusted values to their life changes. So go back over the scale, and estimate for yourself, compared to their scale of 1 to 100, how much each life change demanded or took out of you. For example, if you had a particularly horrific, contentious divorce, you might give yourself a score of 80 or 85 instead of the suggested 73 for the average divorce. Then recalculate your total score according to your own estimates. This will give you a more personally accurate reflection of the demands and losses you have faced.
Research on anxiety and stress has shown that the severity of the disorder is often correlated with a higher score on this scale. A higher incidence of physical illnesses, from diabetes to tuberculosis, has been associated with higher Social Readjustment scores. Even the incidence of accidents has been correlated with higher scores. Notice on the Holmes-Rahe scale that ten of the fifteen most challenging life events are associated with marriage and family (e.g., death of a spouse or family member, divorce, marriage, marital separation). This shows the importance of marital and family relationships to both emotional and physical health. It may be true that a person can literally die of a broken heart!
Knowledge of the scale can help you heal anxiety and prevent future recurrences. Become familiar with the life events and the amount of relative adjustment they require. Using this as a guide enables you to predict potential sources of difficulty. For example, let’s assume you’re currently suffering from anxiety and considering taking on a hefty mortgage or relocating to another city to begin a new career. Based upon your understanding of the stress that may be involved, you might defer these changes until after you have healed. Even if you decide to go for it, you will be better able to anticipate and prepare for the inner demands of these changes. You could, for instance, take a meditation course as part of a strategy to leave extra time for self-care.
THE STAGES OF HEALING
The top three items on the Holmes-Rahe scale are death of a spouse, divorce, and marital separation. Natural self-healing of your emotions means recognizing that a broken heart requires at least as much care and compassion as a broken leg. What follows are knowledge and strategies for dealing with a major loss.1
There are two constants in life: love and loss. Following a loss, anxiety and depression are perfectly natural. What few people realize is that a major loss inflicts an emotional wound that requires just as much care and attention to heal properly as a serious physical injury. After even a minor cut, you wash it and put on a Band-Aid. A broken back may require weeks in the hospital and months before full function is restored. A major emotional loss requires just as much care and time to heal properly. If you don’t know how to treat the emotional wounds of loss, the sad result can be slow healing and unnecessary emotional damage.
Just as the body goes through stages in healing a physical wound, the mind passes through three recognizable stages in its recovery from loss. First come shock and denial. Unable to cope with a sudden emotional blow, the mind temporarily blocks it out. We say things to ourselves such as “I can’t believe it!” “He couldn’t have done such a thing!” “This isn’t happening!” or we just feel numb. After a major loss there may be complete emotional paralysis lasting from a few moments to a few months.
When the shock begins to wear off, the second stage gradually unfolds. This is the period of fear, anger, and depression. Whenever you’re hurt by someone you love or trust, anger is an automatic and completely natural response, as is depression. A loss is a major threat to your well-being. Anxiety and crying are natural. The key to moving on from this stage is fully experiencing the pain and fear and allowing expression of the anger without any guilt. This is where the healing often gets stuck.
Once the pain is fully felt and the anger vented, the loss becomes a fact that can be accepted and understood. With enough time, it becomes less devastating. It is a painful event, but you survived. Energy and strength gradually return, often in greater measure than before.
EMOTIONAL FIRST AID
Following a major loss, the first response is anxiety and helplessness. Out of tragic disappointment and bottomless frustration, it’s very easy to fall into a cycle of self-punishment. Some people punish themselves by repeatedly going over the event in their minds, constantly telling themselves, “If only I had done something different.” But nothing can be changed. Loss leaves you feeling helpless.
TEN DO’S AND DON’TS FOR A BROKEN HEART
|
DO’S |
DON’TS |
|
Stay calm; treat yourself gently. |
Don’t panic. |
|
Recognize your injury. |
Don’t deny the hurt. |
|
Be with the pain. |
Don’t blame yourself. |
|
Take time to heal. |
Don’t dwell on the negative. |
|
Rest, nurture yourself. |
Don’t abuse alcohol or drugs. |
|
Accept comfort from friends and family. |
Don’t stay isolated. |
|
Stick to a routine. |
Don’t create more chaos. |
|
Take care in making important decisions. |
Don’t make impulsive judgments; be wary of love on the rebound. |
|
Accept understanding and support. |
Don’t be afraid to ask for help. |
|
Anticipate a positive outcome. |
Don’t lose faith. |
You can’t change the past, but the next best thing is to learn what you can change and make your pain serve your growth. The strategies for coping with loss are divided into three groups, corresponding to the three stages of healing.
1. SHOCK AND DENIAL
You can’t believe it happened. You feel numb, disoriented, helpless. All these feelings are OK too. The struggle to believe and disbelieve your loss simultaneously is natural. Give it time. The loss is real. Let yourself accept the reality that the worst has happened. Don’t try to deny it. Even small losses and disappointments, like losing a quarter in a pay phone, hurt a little. Big losses hurt a lot. The fact that you can be disappointed and hurting is proof that you’re human. It’s natural to be frightened of pain at first. Sometimes it can get so bad that it threatens to swallow you up. Don’t panic or start fighting it. Lean gently into your pain. You won’t find it bottomless.
Loss is a blow to your self-esteem. Your worry, self-condemnation, and self-deprecation are symptoms of your loss, nothing more. They have only temporary reality. Don’t give them prime-time status by paying them much attention. Better to tell yourself that you’re strong enough to go on and transform your loss into something better. Beware of the “if only’s.” Every time you punish yourself with what you might have done, you fall for the trap of trying to make believe that the past can be changed. It can’t. “If only’s” don’t count, so don’t use them.
Remember that a loss is just as much a wound as a cut or a broken bone. It hurts, and you have to give it time to heal. More than anything else, you need plenty of time. You can be confident that you will heal. The same powerful healing forces that can mend a broken bone also mend the emotional trauma of a loss. Take heart, nature is on your side.
The greater the loss, the more time you’ll take to heal. In this era of instant gratification, many people are unwilling to give themselves the time they need. Don’t make this costly mistake. Time may be a luxury, but you deserve it. Be careful not to rush your healing, or the result will be chronic strain. Real healing results in a new feeling of ease and appreciation for life. The healing process is not smooth. You’re going to have ups and downs. One day you may feel the pain is almost gone; the next day you seem to hurt as much as ever. Don’t worry about ups and downs. They’re a sign that healing is under way.
2. FEAR, ANGER, AND DEPRESSION
Cry. Don’t believe that old sexist stuff about men not crying. If you hurt and the tears are coming, let them come. Tears are cleansing and serve the healing process by letting you fully feel your pain. Crying is an important and natural form of release. It has its own beauty. You are more fragile now, there is no shame in that, so take it easy. Don’t hurry. Don’t try to force yourself to do things like going to parties or to the movies when you don’t want to. Ask a friend to come over for a quiet evening of music and talk. Avoid stressful situations that might force you to overreact. Now is not the time to take on new responsibilities. Tread slowly for a while. You deserve the special care.
Thinking of him or her? If you have lost a love through divorce or separation, it’s natural to dream about rekindling the relationship. But a forceful hand is best. Imagining that you can renew a relationship once it’s over is another form of “if only.” It’s self-punishment, like pouring salt on an open wound. The only result is more pain. Don’t indulge in self-punishment. Nothing is more painful than accepting the fact that a love relationship is over. Accept it now, face the realities, let yourself hurt. That’s the way to healing, growth, and a greater capacity for love in the future.
Release your anger. Everyone who suffers a loss or disappointment gets angry. Some may have trouble showing it, others difficulty in controlling it. But the anger is inevitable. To recover from your loss, you have to get the anger out. The biggest obstacle to healing is bottled-up anger.
Pamper yourself. Were you to suffer from a broken leg, you’d find friends and relatives bringing you fruit and candy to cheer you up. Though you’ve suffered an emotional wound that’s just as serious, you’re expected to show up for work every day as if nothing had happened. You live in a world that doesn’t acknowledge that emotional wounds hurt badly. The only way to fight back is to pamper yourself. Take a hot herbal bath, get a massage, buy yourself something you would really enjoy, get a manicure or pedicure.
Let go of your pain. Paradoxically, pain can become a friend. You may be tempted to hold on to it longer than necessary. The unconscious thinking goes something like “I’ve lost something really important to me, but at least I have my pain.” The pain itself becomes a source of stability, albeit unhappy. At some point your pain will gradually slip away. Let it go. Only then can you go on to the next step, where surviving your loss begins to pay off. You discover the new you, more powerful, more loving, and wiser than before.
Heal at your own pace. Friends or relatives may tell you, “It’s about time you got over it” or “That’s enough crying. Now you’d better get on with your life.” This advice is well intentioned, but remember that you have the right to experience your pain fully and to live through each stage of the healing process fully. Telling yourself, “It doesn’t matter” or “I’m all right now” when you don’t feel that way is a phony attempt to move on prematurely to the stage of acceptance and understanding. If you’ve suffered a major loss, it may take a year or more before you have really reached the stage of acceptance. Not that your life has stopped in the interim, but you have the right to take it a little easier during that time, to pamper yourself and mourn at your own pace.
3. ACCEPTANCE AND GROWTH
Now is the time to begin transforming your loss into personal growth. As the pain lessens, your thinking becomes sharper, your judgment grows clearer, your concentration improves, and you begin to be less self-preoccupied. Your feelings are more alive. You are stronger. There’s no reason to settle for just putting the past behind you. You can learn from it and discover new inner strengths.
Forgive. Whether your lover left you, your friends betrayed you, your boss fired you, or fate dealt you a bad break, you gain strength by forgiving as soon as you can. Remember, you don’t forgive for the other person’s benefit but for your own. Also, forgiving does not mean forgetting. To forgive originally meant “to return good treatment for ill usage.” You have been ill used. When you can return good feeling toward the person who injured you, you are finally free. Forgive yourself. OK, you made a mistake. Maybe things would be different now if you had done something else, but there is no point in punishing yourself any further. Forgiving yourself is acceptance and a step toward freedom and wisdom.
Try to begin seeing the positive in your loss. Yes, there is something positive. You’ve learned something about the world and yourself. Perhaps you were naive, or didn’t understand how complicated love relationships can become, or how people change, or how ruthless the business world can be. The point is: your loss is an extraordinary opportunity for rapid growth. Take advantage of it by examining why you lost and what you need to do to avoid making the same mistake in the future.
Accept that you’re a better person for having loved and lost than if you had never loved at all. You became involved; you took a risk and chose to love. You aren’t a coward. All of that speaks well of you. Now you are stronger for having lived through your disappointment and learned from it.
Give of yourself. The only way to begin using your new strength is to start flexing your muscles. You’re not so fragile anymore; you can take risks, share your feelings, trust yourself to love again. Start by sharing yourself in small ways. Offer to help a friend with a project; volunteer to help at a hospital or nursing home; drive an elderly person to the grocery store. When someone asks you about yourself, you don’t have to protect yourself. There’s no need for a mask. You know what the world is about, and you can handle it. The greatest joys are in sharing your real feelings. Let yourself get involved. Take hold of your new freedom.
You know much more now about yourself and about others. No longer must you react to the world; you can create the world you want to live in. No longer are you so dependent on others; you can choose when, where, how, and with whom you want to spend time. You can choose one of your dreams and take the careful steps to make it come true. No longer do you need to hold yourself back out of fear of failure or loss; you’ve been healed. Make new friends. At long last you’re ready to begin pursuing your life at full swing. Have the neighbors over for a drink. Join a health club or social group where you will meet new people. Don’t be afraid to be friendly.
THE LOSS OF SAFETY
It is through being wounded that power grows and can, in the end, become tremendous.
—FRIEDRICH NIETZSCHE
A traumatic assault can strike suddenly, but its emotional pain can last for years. No matter how healthy you are, grief from a traumatic attack can cause profound distress that’s as painful as any experience life can bring. Difficult as it is, however, grieving can’t be avoided or hurried. Natural healing takes time and patience.
After an attack, such as rape, battery, or assault, grief usually runs a long and tortuous route—anxiety, fears, sleep disorders, rage, loss of appetite, crying, preoccupation with objects and locations associated with the attack, and crushed hopes and dreams.
Survivors often feel unsafe in their bodies. Their emotions and thinking feel out of control. They also feel unsafe in relation to other people. These post-traumatic stresses can be treated in a variety of ways, such as with herbal or synthetic medicines to reduce fear and anxiety, cognitive-behavioral therapy, meditation, and vigorous exercise to help manage stress.
Cognitive-behavioral strategies consist of the recognition and naming of symptoms, daily logs to chart symptoms and adaptive responses, the identification and implementation of manageable “homework” assignments, and specific comprehensive safety plans—at home, when traveling, and at work.
The traumatized person needs a guaranteed safe refuge, either at home or in a secured shelter. The damage to safety in relationships must be addressed with progressive interpersonal strategies, such as the gradual development of a trusting relationship in psychotherapy or counseling, and social strategies that mobilize the survivor’s natural support system of family and friends. The task of reestablishing safety is especially complex when the survivor is still involved in a relationship that has been abusive in the past. The potential for violence should always be considered, even if the survivor insists he or she is no longer afraid.
Establishing a safe environment requires more than just the mobilization of caring people. It requires the assessment of continued threat and exactly what precautions are sensible or necessary. For example, housing and counseling at a shelter for battered women may be necessary while the threat of continued danger is assessed.
One may not reach the dawn save by the path of the night.
—KAHLIL GIBRAN
As recovery from a traumatic attack proceeds, the survivor needs to find ways to tell the story of the trauma, completely, in depth, and with detail. This grief work helps the traumatic memory so that it can be integrated into the survivor’s life story.
Survivors of traumatic attack should be encouraged to turn to others for support, but considerable care must be taken to ensure that they choose people they can truly trust. Family members, friends, lovers, and close friends may be of immense help, or they may interfere with recovery or be dangerous themselves. A careful evaluation must be made of each important relationship in a traumatized person’s life, assessing each as a source of potential protection, emotional support, practical help, and also as a possible source of danger.
Identify whatever feels best to you for finding solace during times of grief. For some, spending time outdoors in a natural setting is uplifting. For others, hurts are resolved best by browsing through photo albums or old letters. Express your feelings of grief. This may mean talking with loved ones, close friends, and perhaps your family physician or counselor. You might also find it beneficial to talk with those who have experienced similar losses, by joining an organized support group for victims of violent crimes.
A technique called eye movement desensitization and reprocessing (EMDR) has proven effective for post-traumatic stress disorder in seventeen controlled studies. The EMDR patient is asked to recall the traumatic event while performing rapid eye movements back and forth. This process is thought to help the brain “metabolize” the painful memories.
HEALING THE PAIN
OF CHILDHOOD
Happiness is having a large, loving, caring, close-knit family in another city.
—GEORGE BURNS
Adult anxieties can have their roots in the losses—rejection, betrayal, humiliation, neglect, and terror—of childhood. The loving, innocent heart of a child has little protection other than to suppress fear, shame, and pain in the deep recesses of the psyche. Sigmund Freud described the repetition compulsion: whatever was experienced as traumatic, deficient, or incomplete in your childhood, there is a tendency to recreate. When a child feels deeply intimidated, hurt, or rejected, this may begin a lifetime struggle with anxiety.
Whatever your age, to become a fulfilled person and be at peace, you must resolve the issues that derived from your relationships with your parents.2 Below are the warning signs that unhealed emotional wounds from childhood may be contributing to your adult anxieties:
Although there may be an innate tendency to repeat your childhood dramas, you can also work through them. What you need is an understanding of how your upbringing affected you, what negative attitudes you may have internalized, and how to change these outdated emotional habits. The Hoffman Quadrinity Process (HQP)3 is a one-week intensive residential program that guides participants through deep and rapid healing of the roots of anxiety in all four aspects of self—physical, emotional, intellectual, and spiritual. The HQP was a profound breakthrough in my own healing journey and subsequently for hundreds of my patients.
RESILIENCY—
RISING ABOVE ADVERSITY
When one door closes, another opens. But we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us.
—HELEN KELLER
Resiliency is the ability to rise above serious loss and adversity—the inner strength to master change successfully. A potentially stressful event, such as a financial setback, will have a different impact on different individuals depending on their resiliency. One person may find the stress of a minor fender-bender to be a nightmare, while someone else seriously injured in an auto accident remains emotionally stable, forgiving, and optimistic. The stress incurred depends not only on the life event but on the resiliency of the individual.
Aspects of resiliency include a sense of being in control, the ability to make your own decisions, and having good coping skills. A high rate of hypertension and heart disease has been linked to job strain, where employees feel highly pressured but have little control over how they meet job demands. The ability to cope with job strain, such as that from corporate down-sizing, business recessions, and new technologies, is affected by the strength of your business and social networks. Research has demonstrated that support from family, friends, coworkers, and even pets can act as a buffer in coping with strains at work. Intimate relationships can help shore up self-esteem that is temporarily lost and provide comfort during turbulent times in the workplace.
LOVING FRIENDS
How we approach other people each day can determine whether we experience isolation, chronic stress, suffering, and illness, or intimacy, relaxation, joy, and health.
—DEAN ORNISH, M.D.
There is a vital link between the strength of your social support system and your resilience to loss of any kind. Simply having a close friend to talk to on a regular basis may be as important as psychotherapy. Deep, caring relationships really do matter; isolation increases human anxiety. Social support is the name scientists give to the combination of ongoing involvement with others, caring relationships, and an orientation toward actively seeking friendships. Social support doesn’t depend on the number of people you know but rather on the quality of your relationships.
Take a sheet of paper and write down the names of those people with whom you have the strongest, closest bond. Include those who have been sources of warmth and approval during earlier periods of your life as well as those who actively support you now. As you list the names, you may find yourself wishing you were in closer touch with some of them. If so, list these people on a second sheet of paper. Entries may include old friends you haven’t seen in a long time or new friends you’d like to get to know better.
Now make a list of what you would like to discuss with each friend. There may be some people with or for whom you would like to do something special—meet for lunch, or send a letter or gift to let them know they’re really important to you. Is there anyone you’d like to call right now?
HELPING OTHERS HELPS YOURSELF
We make a living by what we get, but we make a life by what we give.
—SIR WINSTON CHURCHILL
Studies clearly suggest that a weekly habit of helping others may be as important to your health and longevity as regular exercise and good nutrition. In fact, it may be a key to ending the deadly cycle of fear, loneliness, and depression rampant in our society. Medical research indicates that self-centered individuals have a greater risk of anxiety, depression, and even coronary artery disease. Self-involvement breeds fear, loneliness, and despair. Altruism, charity, generosity, service, and kindness contribute not only to a meaningful life but to a more satisfying, healthier, and perhaps longer one as well. Doing good for others feels good and is good for your own well-being. Love can bolster your resistance to disease and speed the healing of anxiety.
Focusing on others gets you out of the gridlock of career anxieties, financial worries, and family stresses. Helping others tends to improve mood, deepen optimism, and nurture a genuine sense of gratitude. Helping someone less capable can enhance your appreciation of your own skills, knowledge, and strengths. Contrary to popular opinion, helping others doesn’t require a huge time commitment. All you need is a personal plan that can range from doing scheduled work with a volunteer organization to spontaneous acts of generosity and kindness throughout the week. Joining an anxiety self-help support group is a wonderful way to help yourself and also contribute to helping others (see Appendix E).
Much research has shown that helping, caring relationships can diminish anxiety and improve health. A study of 2,700 residents in Tecumseh, Michigan, demonstrated that men who did volunteer work were two-and-a-half times less likely to die from all causes of disease than their peers who were not engaged in service. A lack of social support and community service is a health risk factor as significant as smoking, elevated cholesterol, and sedentary living.